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Dexamethasone

Brand Name: Decadron, Dexamethasone Intensol, Dexasone, Solurex, Baycadron

Generic Name: dexamethasone

Drug Class: Corticosteroids; Anti-Inflammatory Agents

What Is Dexamethasone and How Does It Work?

Dexamethasone is used to treat conditions such as arthritis, blood/hormone/immune system disorders, allergic reactions, certain skin and eye conditions, breathing problems, certain bowel disorders, and certain cancers. It is also used as a test for an adrenal gland disorder (Cushing's syndrome).

Dexamethasone is a corticosteroid hormone (glucocorticoid). It decreases your body's natural defensive response and reduces symptoms such as swelling and allergic-type reactions.

Dexamethasone may also be used to prevent nausea and vomiting caused by cancer chemotherapy.

Dexamethasone is available under the following different brand names: Decadron, Dexamethasone Intensol, Dexasone, Solurex, and Baycadron.

Dosages of Dexamethasone:

Dosage Forms & Strengths

Tablet as potassium

  • 0.5 mg
  • 0.75 mg
  • 1 mg
  • 1.5 mg
  • 2 mg
  • 4 mg
  • 6 mg

Injectable suspension

  • 4 mg/mL
  • 10 mg/mL

Elixir/oral solution

  • 0.5 mg/5mL

Oral concentrate

  • 1 mg/1mL

Powder packet for oral solution

  • 50 mg

Dosage Considerations – Should be Given as Follows:

Inflammation

  • Adult: 0.75-9 mg/day intravenous/intramuscular/oral (IV/IM/PO) divided every 6-12 hours
  • Intra-articular, intra-lesional, or soft tissue: 0.2-6 mg/day
  • Pediatric: 0.08-0.3 mg/kg/day intravenous/intramuscular/oral (IV/IM/PO) divided every 6 hours or every 12 hours

Multiple Sclerosis (Acute Exacerbation)

  • 30 mg/day orally for 1 week; follow by 4-12 mg/day for 1 month

Cerebral Edema

  • 1-6 mg/kg intravenously (IV) once or 40 mg IV every 2-6 hours as needed
  • Alternative: 20 mg IV, then 3 mg/kg/day by continuous IV infusion
  • High-dose treatment not to be continued beyond 48-72 hours

Allergic Conditions

  • For control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, and serum sickness
  • Day 1: 4-8 mg intramuscularly (IM)
  • Days 2-3: 3 mg/day orally divided every 12 hours
  • Day 4: 1.5 mg/day orally divided every 12 hours
  • Days 5-6: 0.75 mg/day orally in single daily dose
  • Day 7: No treatment

Dexamethasone Suppression Test

  • Low-dose test
    • Screening for Cushing syndrome
    • Overnight test: 1 mg orally between 11:00 PM and midnight; cortisol level tested between 8:00 and 9:00 AM on following morning
    • Standard 2-day test: 0.5 mg orally every 6 hours (9:00 AM, 3:00 PM, 9:00 PM, 3:00 AM) for 2 days; cortisol level tested 6 hours after final dose (9:00 AM)

High-dose test

  • Confirmed Cushing syndrome in which further workup is needed to identify whether hormone excess is the result of Cushing syndrome or other causes
  • Standard 2-day test: After determination of baseline serum cortisol or 24-hr urinary free cortisol, 2 mg orally every 6 hours for 2 days; urine for free cortisol is collected during test, and serum cortisol is checked 6 hours after final dose
  • Overnight test: After determination of baseline serum cortisol, 8 mg (typically) orally between 11:00 pm and midnight; cortisol level tested between 8:00 and 9:00 AM on following morning
  • Intravenous (IV) test: After determination of baseline serum cortisol, 1 mg/hour by continuous IV infusion for 5-7 hours

Pediatric

Airway Edema

  • 0.5-2 mg/kg/day oral/intravenous/intramuscular (PO/IV/IM) divided every 6 hours, starting 24 hours before extubation and continued for 4-6 doses afterward

Croup, Pediatric

  • 0.6 mg/kg oral/intravenous/intramuscular (PO/IV/IM) once; not to exceed 16 mg

Meningitis

  • Children over 6 weeks: 0.6 mg/kg/day intravenously (IV) divided every 6 hours for first 2-4 days of antibiotic therapy, starting 10-20 minutes before or simultaneously with first antibiotic dose

Cerebral Edema Associated With Brain Tumor

  • 1-2 mg/kg oral/intravenous/intramuscular (PO/IV/IM) once; maintenance: 1-1.5 mg/kg/day IV/IM divided every 4-6 hours; not to exceed 16 mg/day

Spinal Cord Compression

Adrenal Cortical Hyperfunction Test

  • After determination of baseline cortisol level, 1 mg orally at bedtime
  • Plasma cortisol level then determined at 8:00 AM on following morning; level will be decreased in normal individuals but at baseline level in Cushing syndrome

What Are Side Effects Associated with Using Dexamethasone?

Side effects associated with use of Dexamethasone, include the following:

Postmarketing side effects of dexamethasone reported include:

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Dexamethasone?

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Severe interactions of dexamethasone include:

  • apixaban
  • artemether/lumefantrine
  • cariprazine
  • cobimetinib
  • dienogest/estradiol valerate
  • elbasvir/grazoprevir
  • elvitegravir/cobicistat/emtricitabine/tenofovir DF
  • lumacaftor/ivacaftor
  • lumefantrine
  • lurasidone
  • mifepristone
  • naloxegol
  • ombitasvir/paritaprevir/ritonavir
  • ombitasvir/paritaprevir/ritonavir and dasabuvir
  • panobinostat
  • praziquantel
  • regorafenib
  • rilpivirine
  • roflumilast
  • vandetanib

Dexamethasone has serious interactions with at least 118 different drugs.

Dexamethasone has moderate interactions with at least 298 different drugs.

Dexamethasone has mild interactions with at least 136 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

What Are Warnings and Precautions for Dexamethasone?

Warnings

  • This medication contains dexamethasone. Do not take Decadron, Dexamethasone Intensol, Dexasone, Solurex, or Baycadron if you are allergic to dexamethasone or any ingredients contained in this drug
  • Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

Effects of Drug Abuse

  • Agent is potent diuretic that, if given in excessive amounts, may lead to profound diuresis with water and electrolyte depletion

Short-Term Effects

  • See "What Are Side Effects Associated with Using Dexamethasone?"

Long-Term Effects

  • Corticosteroids can produce reversible hypothalamic-pituitary adrenal (HPA) axis suppression with potential for glucocorticosteroid insufficiency after withdrawal of treatment; adrenocortical insufficiency may result from too rapid withdrawal; may be minimized by gradual reduction of dosage; relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, reinstitute hormone therapy; if patient is receiving steroids already, may increase dosage
  • Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts; if steroid therapy is continued for more than 6 weeks, monitor intraocular pressure
  • Prolonged therapy has been associated with development of Kaposi's sarcoma
  • See "What Are Side Effects Associated with Using Dexamethasone?"

Cautions

  • Use with caution in cirrhosis, diverticulitis, myasthenia gravis, peptic ulcer disease, ulcerative colitis, renal insufficiency, pregnancy
  • Average and large doses of corticosteroids can cause elevation of blood pressure, sodium and water retention, and increased excretion of potassium; these effects are less likely to occur with synthetic derivatives except when used in large doses; dietary salt restriction and potassium supplementation may be necessary; all corticosteroids increase calcium excretion
  • Literature reports suggest apparent association between use of corticosteroids and left ventricular free wall rupture after recent myocardial infarction; therapy with corticosteroids should be used with great caution in these patients
  • Corticosteroids can produce reversible hypothalamic-pituitary adrenal (HPA) axis suppression with potential for glucocorticosteroid insufficiency after withdrawal of treatment; adrenocortical insufficiency may result from too rapid withdrawal; may be minimized by gradual reduction of dosage; relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, reinstitute hormone therapy; if patient is receiving steroids already, may increase dosage
  • Metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients; changes in thyroid status of patient may necessitate adjustment in dosage
  • Corticosteroids may exacerbate systemic fungal infections; not for use in presence of such infections unless needed to control life-threatening drug reactions; concomitant use of amphotericin B and hydrocortisone followed by cardiac enlargement and congestive heart failure reported
  • Latent disease may be activated or there may be an exacerbation of intercurrent infections due to pathogens, including those caused by Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, toxoplasma; rule out latent amebiasis or active amebiasis before initiating corticosteroid therapy in any patient who has spent time in the tropics or any patient with unexplained diarrhea
  • Corticosteroids should be used with great care in patients with known or suspected Strongyloides (threadworm) infestation; corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia; not for use in cerebral malaria
  • Close observation necessary if corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity; reactivation of the disease may occur; during prolonged corticosteroid therapy, these patients should receive chemoprophylaxis
  • Use of oral corticosteroids not recommended in treatment of optic neuritis and may lead to increase in risk of new episodes; corticosteroids should not be used in active ocular herpes simplex
  • Use lowest possible dose to control condition under treatment; risk/benefit decision must be made in each individual case as to dose and duration of treatment and as to whether daily or intermittent therapy should be used
  • May lead to inhibition of bone growth in pediatric patients and development of osteoporosis at any age; special consideration should be given to patients at increased risk of osteoporosis (e.g., postmenopausal women) before initiating corticosteroid therapy
  • Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations; existing emotional instability or psychotic tendencies may also be aggravated by corticosteroids
  • Minimal mineralocorticoid activity
  • Thromboembolic disorders
  • Myopathy has been reported
  • Delayed wound healing
  • Withdraw therapy with gradual tapering dose
  • May have systemic and local effects; examine joint fluid, as necessary to exclude a septic process; avoid injection into infected site; frequent intra-articular injections may result in damage to joint tissue
  • If exposed to chickenpox, prophylaxis with varicella zoster immune globulin (VZIG) may be indicated; if exposed to measles, prophylaxis with immune globulin (IG) may be indicated; if chickenpox develops, treatment with antiviral agents should be considered
  • Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored)
  • Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy
  • Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts; if steroid therapy is continued for more than 6 weeks, monitor intraocular pressure
  • Prolonged therapy has been associated with development of Kaposi's sarcoma
  • May affect velocity growth in children; monitor routinely
  • Killed or inactivated vaccines may be administered; however, the response to such vaccines cannot be predicted
  • Patient may require higher doses when subject to stress
  • Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (e.g., for Addison's disease)
  • Epidural injection:
    • Serious neurologic events, some resulting in death, have been reported with epidural injection
    • Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke
    • These serious neurologic events have been reported with and without use of fluoroscopy
    • Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use

Pregnancy and Lactation

  • Use dexamethasone with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available, or neither animal nor human studies were done
  • Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy
  • Dexamethasone is excreted in breast milk; it is not recommended for use while breastfeeding