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Decadron®; Decadron® Phosphate [DSC]; Dexamethasone Intensol®; DexPak® TaperPak®; Maxidex®
Dexamethasone Sodium Phosphate
Decadron®; Dexasone®; Diodex®; Maxidex®; PMS-Dexamethasone
Systemically and locally for chronic swelling; allergic, hematologic, neoplastic, and autoimmune diseases; may be used in management of cerebral edema, septic shock, as a diagnostic agent, antiemetic
Treatment of a variety of oral diseases of allergic, inflammatory or autoimmune origin
General indicator consistent with depression; diagnosis of Cushing's syndrome
Dexamethasone has been used in patients with premature labor (26-34 weeks gestation) to stimulate fetal lung maturation. Crosses the placenta; transient leukocytosis reported. Available evidence suggests safe use during pregnancy.
Excretion in breast milk unknown
Hypersensitivity to dexamethasone or any component of the formulation; active untreated infections; ophthalmic use in viral, fungal, or tuberculosis diseases of the eye
Use with caution in patients with hypothyroidism, cirrhosis, hypertension, CHF, ulcerative colitis, or thromboembolic disorders. Corticosteroids should be used with caution in patients with diabetes, osteoporosis, peptic ulcer, glaucoma, cataracts, or tuberculosis. Use caution following acute MI (corticosteroids have been associated with myocardial rupture). Use caution in hepatic impairment. Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in the elderly in the smallest possible effective dose for the shortest duration.
May cause suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. Symptoms of adrenocortical insufficiency in suppressed patients may result from rapid discontinuation/withdrawal; deficits in HPA response may persist for months following discontinuation and require supplementation during metabolic stress. Patients receiving 20 mg/day of prednisone (or equivalent) may be most susceptible. Particular care is required when patients are transferred from systemic corticosteroids to inhaled products due to possible adrenal insufficiency or exacerbation of underlying disease, including an increase in allergic symptoms. Fatalities have occurred due to adrenal insufficiency in asthmatic patients during and after transfer from systemic corticosteroids to aerosol steroids; aerosol steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or infections. Dexamethasone does not provide adequate mineralocorticoid activity in adrenal insufficiency (may be employed as a single dose while cortisol assays are performed). Dexamethasone does not cross-react with cortisol assays.
Controlled clinical studies have shown that orally-inhaled and intranasal corticosteroids may cause a reduction in growth velocity in pediatric patients. (In studies of orally-inhaled corticosteroids, the mean reduction in growth velocity was ~1 cm per year [range 0.3-1.8 cm per year] and appears to be related to dose and duration of exposure). The growth of pediatric patients receiving inhaled corticosteroids, should be monitored routinely (eg, via stadiometry). To minimize the systemic effects of orally-inhaled and intranasal corticosteroids, each patient should be titrated to the lowest effective dose.
May suppress the immune system; patients may be more susceptible to infection. Use with caution in patients with systemic infections or ocular herpes simplex. Avoid exposure to chickenpox and measles.
Frequency not defined.
Cardiovascular: Edema, hypertension, arrhythmia, cardiomyopathy, myocardial rupture (post-MI), syncope, thromboembolism, thrombophlebitis, vasculitis
Central nervous system: Insomnia, nervousness, vertigo, seizure, psychosis, pseudotumor cerebri (usually following discontinuation), headache, mood swings, delirium, hallucinations, euphoria
Dermatologic: Hirsutism, acne, skin atrophy, bruising, hyperpigmentation, pruritus (generalized), perianal pruritus (following I.V. injection), urticaria
Endocrine & metabolic: Diabetes mellitus, adrenal suppression, hyperlipidemia, Cushing's syndrome, pituitary-adrenal axis suppression, growth suppression, glucose intolerance, gynecomastia, hypokalemia, alkalosis, amenorrhea, sodium and water retention, hyperglycemia, hypercalciuria, weight gain
Gastrointestinal: Appetite increased, indigestion, peptic ulcer, nausea, vomiting, abdominal distention, ulcerative esophagitis, pancreatitis, intestinal perforation
Genitourinary: Altered (increased or decreased) spermatogenesis
Hematologic: Transient leukocytosis
Hepatic: Transaminases increased, hepatomegaly
Neuromuscular & skeletal: Arthralgia, muscle weakness, osteoporosis, fractures, myopathy (particularly in conjunction with neuromuscular disease or neuromuscular blocking agents), tendon rupture, vertebral compression fractures, neuropathy, neuritis, parasthesia
Ocular: Cataracts, glaucoma, exophthalmos, intraocular pressure increased
Miscellaneous: Infections, anaphylactoid reaction, anaphylaxis, angioedema, avascular necrosis, secondary malignancy, Kaposi's sarcoma, intractable hiccups, impaired wound healing, abnormal fat deposition, moon face
Topical:<1%: Itching, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, skin maceration, skin atrophy, striae, miliaria, local burning, irritation. secondary infection
When consumed in high doses over prolonged periods, systemic hypercorticism and adrenal suppression may occur. In these cases, discontinuation of the corticosteroid should be done judiciously.
of CYP3A4 (minor); CYP2A6 (weak), 2B6 (weak), 2C8/9 (weak), 3A4 (weak)SubstrateInduces
Aminoglutethimide: May reduce the serum levels/effects of dexamethasone; likely via induction of microsomal isoenzymes.
Antacids: May increase the absorption of corticosteroids; separate administration by 2 hours.
Anticholinesterases: Concurrent use may lead to severe weakness in patients with myasthenia gravis.
Azole antifungals: May increase the serum levels of corticosteroids; monitor.
Bile acid sequestrants: May reduce the absorption of corticosteroids; separate administration by 2 hours.
Calcium channel blockers (nondihydropyridine): May increase the serum levels of corticosteroids; monitor.
Cyclosporine: Corticosteroids may increase the serum levels of cyclosporine. In addition, cyclosporine may increase levels of corticosteroids
Estrogens: May increase the serum levels of corticosteroids; monitor.
Fluoroquinolones: Concurrent use may increase the risk of tendon rupture, particularly in elderly patients (overall incidence rare).
Isoniazid: Serum concentrations may be decreased by corticosteroids.
Neuromuscular-blocking agents: Concurrent use with corticosteroids may increase the risk of myopathy.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Concurrent use with corticosteroids may lead to an increased incidence of gastrointestinal adverse effects; use caution.
Phenytoin: Dexamethasone may decrease serum levels/effects of phenytoin; monitor.
Salicylates: Salicylates may increase the gastrointestinal adverse effects of corticosteroids.
Thalidomide: Concurrent use with corticosteroids may increase the risk of selected adverse effects (toxic epidermal necrolysis and DVT); use caution
Vaccines, toxoids: Corticosteroids may suppress the response to vaccinations. The use of live vaccines is contraindicated in immunosuppressed patients. In patients receiving high doses of systemic corticosteroids for
Warfarin: Corticosteroids may lead to a reduction in warfarin effect; monitor.
Ethanol: Avoid ethanol (may enhance gastric mucosal irritation).
Food: Dexamethasone interferes with calcium absorption. Limit caffeine.
Herb/Nutraceutical: Avoid cat's claw, echinacea (have immunostimulant properties).
Injection solution: Store at room temperature; protect from light and freezing.
Stability of injection of parenteral admixture at room temperature (25°C): 24 hours
Stability of injection of parenteral admixture at refrigeration temperature (4°C): 2 days; protect from light and freezing
Injection should be diluted in 50-100 mL NS or D5W.
Stable in D5W, NS
Y-site administration: Compatible: Acyclovir, allopurinol, amifostine, amikacin, amphotericin B cholesteryl sulfate complex, amsacrine, aztreonam, cefepime, cefpirome, cisatracurium, cisplatin, cladribine, cyclophosphamide, cytarabine, docetaxel, doxorubicin, doxorubicin liposome, etoposide phosphate, famotidine, filgrastim, fluconazole, fludarabine, foscarnet, gatifloxacin, gemcitabine, granisetron, heparin, heparin with hydrocortisone sodium succinate, levofloxacin, linezolid, lorazepam, melphalan, meperidine, meropenem, morphine, ondansetron, paclitaxel, piperacillin/tazobactam, potassium chloride, propofol, remifentanil, sargramostim, sodium bicarbonate, sufentanil, tacrolimus, teniposide, theophylline, thiotepa, vinorelbine, vitamin B complex with C, zidovudine. Incompatible: Ciprofloxacin, idarubicin, midazolam, topotecan. Variable (consult detailed reference): Methotrexate
Compatibility in syringe: Compatible: Granisetron, metoclopramide, ranitidine, sufentanil. Incompatible: Doxapram, glycopyrrolate. Variable (consult detailed reference): Diphenhydramine, hydromorphone, ondansetron
Compatibility when admixed: Compatible: Aminophylline, bleomycin, cimetidine, floxacillin, furosemide, granisetron, lidocaine, meropenem, mitomycin, nafcillin, netilmicin, ondansetron, prochlorperazine edisylate, ranitidine, verapamil. Incompatible: Daunorubicin, diphenhydramine with lorazepam and metoclopramide, metaraminol, vancomycin. Variable (consult detailed reference): Amikacin
Decreases inflammation by suppression of neutrophil migration, decreased production of inflammatory mediators, and reversal of increased capillary permeability; suppresses normal immune response. Dexamethasone's mechanism of antiemetic activity is unknown.
Onset of action: Acetate: Prompt
Duration of metabolic effect: 72 hours; acetate is a long-acting repository preparation
Half-life elimination: Normal renal function: 1.8-3.5 hours; Biological half-life: 36-54 hours
Time to peak, serum: Oral: 1-2 hours; I.M.: ~8 hours
Excretion: Urine and feces
Antiemetic (prior to chemotherapy): I.V. (should be given as sodium phosphate): 5-20 mg given 15-30 minutes before treatment
Anti-inflammatory immunosuppressant: Oral, I.M., I.V. (injections should be given as sodium phosphate): 0.08-0.3 mg/kg/day or 2.5-10 mg/m2/day in divided doses every 6-12 hours
Extubation or airway edema: Oral, I.M., I.V. (injections should be given as sodium phosphate): 0.5-2 mg/kg/day in divided doses every 6 hours beginning 24 hours prior to extubation and continuing for 4-6 doses afterwards
Cerebral edema: I.V. (should be given as sodium phosphate): Loading dose: 1-2 mg/kg/dose as a single dose; maintenance: 1-1.5 mg/kg/day (maximum: 16 mg/day) in divided doses every 4-6 hours for 5 days then taper for 5 days, then discontinue
Bacterial meningitis in infants and children >2 months: I.V. (should be given as sodium phosphate): 0.6 mg/kg/day in 4 divided doses every 6 hours for the first 4 days of antibiotic treatment; start dexamethasone at the time of the first dose of antibiotic
Physiologic replacement: Oral, I.M., I.V.: 0.03-0.15 mg/kg/day or 0.6-0.75 mg/m2/day in divided doses every 6-12 hours
Prophylaxis: Oral, I.V.: 10-20 mg 15-30 minutes before treatment on each treatment day
Continuous infusion regimen: Oral or I.V.: 10 mg every 12 hours on each treatment day
Mildly emetogenic therapy: Oral, I.M., I.V.: 4 mg every 4-6 hours
Delayed nausea/vomiting: Oral: 4-10 mg 1-2 times/day for 2-4 days or
8 mg every 12 hours for 2 days; then
4 mg every 12 hours for 2 days or
20 mg 1 hour before chemotherapy; then
10 mg 12 hours after chemotherapy; then
8 mg every 12 hours for 4 doses; then
4 mg every 12 hours for 4 doses
Oral, I.M., I.V. (injections should be given as sodium phosphate): 0.75-9 mg/day in divided doses every 6-12 hours
Intra-articular, intralesional, or soft tissue (as sodium phosphate): 0.4-6 mg/day
Ointment: Apply thin coating into conjunctival sac 3-4 times/day; gradually taper dose to discontinue
Suspension: Instill 2 drops into conjunctival sac every hour during the day and every other hour during the night; gradually reduce dose to every 3-4 hours, then to 3-4 times/day
Topical: Apply 1-4 times/day. Therapy should be discontinued when control is achieved; if no improvement is seen, reassessment of diagnosis may be necessary.
Chemotherapy: Oral, I.V.: 40 mg every day for 4 days, repeated every 4 weeks (VAD regimen)
Cerebral edema: I.V. 10 mg stat, 4 mg I.M./I.V. (should be given as sodium phosphate) every 6 hours until response is maximized, then switch to oral regimen, then taper off if appropriate; dosage may be reduced after 24 days and gradually discontinued over 5-7 days
Dexamethasone suppression test (depression indicator) (unlabeled use): Oral: 1 mg at 11 PM, draw blood at 8 AM the following day for plasma cortisol determination
Cushing's syndrome, diagnostic: Oral: 1 mg at 11 PM, draw blood at 8 AM; greater accuracy for Cushing's syndrome may be achieved by the following:
Dexamethasone 0.5 mg by mouth every 6 hours for 48 hours (with 24-hour urine collection for 17-hydroxycorticosteroid excretion)
Differentiation of Cushing's syndrome due to ACTH excess from Cushing's due to other causes: Oral: Dexamethasone 2 mg every 6 hours for 48 hours (with 24-hour urine collection for 17-hydroxycorticosteroid excretion)
Multiple sclerosis (acute exacerbation): 30 mg/day for 1 week, followed by 4-12 mg/day for 1 month
Physiological replacement: Oral, I.M., I.V. (should be given as sodium phosphate): 0.03-0.15 mg/kg/day or 0.6-0.75 mg/m2/day in divided doses every 6-12 hours
Treatment of shock:
Addisonian crisis/shock (ie, adrenal insufficiency/responsive to steroid therapy): I.V. (given as sodium phosphate): 4-10 mg as a single dose, which may be repeated if necessary
Unresponsive shock (ie, unresponsive to steroid therapy): I.V. (given as sodium phosphate): 1-6 mg/kg as a single I.V. dose or up to 40 mg initially followed by repeat doses every 2-6 hours while shock persists
Hemodialysis: Supplemental dose is not necessary
Peritoneal dialysis: Supplemental dose is not necessary
Oral: Administer with meals to decrease GI upset.
I.M.: Acetate injection is not for I.V. use.
I.V.: Administer as a 5-10 minute bolus; rapid injection is associated with a high incidence of perianal discomfort.
Topical: For external use. Do not use on open wounds. Apply sparingly to occlusive dressings. Should not be used in the presence of open or weeping lesions.
Hemoglobin, occult blood loss, serum potassium, and glucose
Dexamethasone suppression test, overnight: 8 AM cortisol <6 mcg/100 mL (dexamethasone 1 mg); plasma cortisol determination should be made on the day after giving dose
May be taken with meals to decrease GI upset. May need diet with increased potassium, pyridoxine, vitamin C, vitamin D, folate, calcium, and phosphorus.
Inform prescriber of all prescriptions, OTC medications, or herbal products you are taking, and any allergies you have. Do not take any new medication during therapy unless approved by prescriber. Take exactly as directed, do not increase dose or discontinue abruptly without consulting prescriber.
Oral: Take with or after meals. Avoid alcohol and limit intake of caffeine or stimulants. Prescriber may recommend increased dietary vitamins, minerals, or iron. If you have diabetes, monitor glucose levels closely (antidiabetic medication may need to be adjusted). Inform prescriber if you are experiencing greater-than-normal levels of stress (medication may need adjustment). You may be more susceptible to infection (avoid crowds and persons with contagious or infective conditions and do not have any vaccinations unless approved by prescriber). Some forms of this medication may cause GI upset (small, frequent meals and frequent mouth care may help). Report promptly excessive nervousness or sleep disturbances; signs of infection (eg, sore throat, unhealed injuries); excessive growth of body hair or loss of skin color; vision changes; excessive or sudden weight gain (>3 lb/week); swelling of face or extremities; respiratory difficulty; muscle weakness; tarry stool, persistent abdominal pain; worsening of condition or failure to improve. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.
Ophthalmic: For use in eyes only. Wash hands before using. Lie down or tilt your head back and look upward. Put drops of suspension or apply thin ribbon of ointment inside lower eyelid. Close eye and roll eyeball in all directions. Do not blink for 1/2 minute. Apply gentle pressure to inner corner of eye for 30 seconds. Do not use any other eye preparation for at least 10 minutes. Do not let tip of applicator touch eye; do not contaminate tip of applicator (may cause eye infection, eye damage, or vision loss). Do not share medication with anyone else. Wear sunglasses when in sunlight; you may be more sensitive to bright light. Inform prescriber if condition worsens, fails to improve, or if you experience eye pain, disturbances of vision, or other adverse eye response.
Topical: For external use only. Do not use for eyes, mucous membranes, or open wounds. Use exactly as directed and for no longer than the period prescribed. Before using, wash and dry area gently. Apply in thin layer (may rub in lightly). Apply light dressing (if necessary) to area being treated. Do not use occlusive dressing unless so advised by prescriber. Avoid exposing treated area to sunlight (severe sunburn may occur). Inform prescriber if condition worsens (swelling, redness, irritation, pain, open sores) or fails to improve.
Effects of inhaled/intranasal steroids on growth have been observed in the absence of laboratory evidence of HPA axis suppression, suggesting that growth velocity is a more sensitive indicator of systemic corticosteroid exposure in pediatric patients than some commonly used tests of HPA axis function. The long-term effects of this reduction in growth velocity associated with orally-inhaled and intranasal corticosteroids, including the impact on final adult height, are unknown. The potential for "catch up" growth following discontinuation of treatment with inhaled corticosteroids has not been adequately studied.
Withdrawal/tapering of therapy: Corticosteroid tapering following short-term use is limited primarily by the need to control the underlying disease state; tapering may be accomplished over a period of days. Following longer-term use, tapering over weeks to months may be necessary to avoid signs and symptoms of adrenal insufficiency and to allow recovery of the HPA axis. Testing of HPA axis responsiveness may be of value in selected patients. Subtle deficits in HPA response may persist for months after discontinuation of therapy, and may require supplemental dosing during periods of acute illness or surgical stress.
Dexamethasone is a long-acting corticosteroid with minimal sodium-retaining potential. Corticosteroids and muscle relaxants appear to trigger some types of ICU myopathy; avoid or administer at the lowest dose possible.
Patients will often have steroid-induced adverse effects on glucose tolerance and lipid profiles. In discontinuing steroid therapy in patients on long-term steroid supplementation, it is important that the steroid therapy be discontinued gradually. Abrupt withdrawal may result in adrenal insufficiency with hypotension and hyperkalemia. Patients on long-term steroid supplementation will require higher corticosteroid doses when subject to stress (ie, trauma, surgery, severe infection).
Oral and intravenous steroid therapy in patients with heart failure should be administered cautiously with special attention given to signs and symptoms of fluid retention.
Oral and intravenous steroid therapy in patients with heart failure should be administered cautiously with special attention given to signs and symptoms of fluid retention.
No significant effects or complications reported
No information available to require special precautions
Insomnia and nervousness are common; may cause euphoria, confusion, or hallucinations
Barbiturates and carbamazepine may decrease dexamethasone effects
Very low (<10%); may cause nausea/indigestion if taken orally on an empty stomach
[DSC] = Discontinued product
Elixir, as base: 0.5 mg/5 mL (240 mL) [contains alcohol 5%; raspberry flavor]
Injection, solution, as sodium phosphate: 4 mg/mL (1 mL, 5 mL, 10 mL, 25 mL, 30 mL); 10 mg/mL (1 mL, 10 mL)
Decadron® Phosphate: 4 mg/mL (5 mL, 25 mL); 24 mg/mL (5 mL) [contains sodium bisulfite] [DSC]
Ointment, ophthalmic, as sodium phosphate: 0.05% (3.5 g)
Solution, ophthalmic, as sodium phosphate: 0.1% (5 mL)
Solution, oral: 0.5 mg/5 mL (500 mL) [cherry flavor]
Solution, oral concentrate (Dexamethasone Intensol®): 1 mg/mL (30 mL) [contains alcohol 30%]
Suspension, ophthalmic (Maxidex®): 0.1% (5 mL, 15 mL)
Tablet: 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg [some 0.5 mg tablets may contain tartrazine]
Decadron®: 0.5 mg, 0.75 mg, 4 mg
DexPak® TaperPak®: 1.5 mg [51 tablets on taper dose card]
American Academy of Pediatrics Committee on Infectious Diseases, "Dexamethasone Therapy for Bacterial Meningitis in Infants and Children,"Pediatrics, 1990, 86(1):130-3.
Bahal N and Nahata MC, "The Role of Corticosteroids in Infants and Children With Bacterial Meningitis,"DICP, 1991, 25(5):542-5.
Brophy TR, McCafferty J, Tyrer JH, et al, "Bioavailability of Oral Dexamethasone During High Dose Steroid Therapy in Neurological Patients,"Eur J Clin Pharmacol, 1983, 24(1):103-8.
Couser RJ, Ferrara TB, Falde B, et al, "Effectiveness of Dexamethasone in Preventing Extubation Failure in Preterm Infants at Increased Risk for Airway Edema,"J Pediatr, 1992, 121(4):591-6.
de los Reyes RA, Ausman JI, and Diaz FG, "Agents for Cerebral Edema,"Clin Neurosurg, 1981, 28:98-107.
"Dexamethasone, Granisetron, or Both for the Prevention of Nausea and Vomiting During Chemotherapy for Cancer. The Italian Group for Antiemetic Research,"N Engl J Med, 1995, 332(1):1-5.
Duggan DE, Matalia N, Ditzler, CA, et al, "Bioavailability of Oral Dexamethasone,"Clin Pharmacol Ther, 1975, 18(2):205-9.
Durand M, Sardesai S, and McEvoy C, "Effects of Early Dexamethasone Therapy on Pulmonary Mechanics and Chronic Lung Disease in Very Low Birth Weight Infants: A Randomized, Controlled Trial,"Pediatrics, 1995, 95(4):584-90.
Kris MG, Baltzer L, Pisters KM, et al, "Enhancing the Effectiveness of the Specific Serotonin Antagonists. Combination Antiemetic Therapy With Dexamethasone,"Cancer, 1993, 72(11 Suppl):3436-42.
Latreille J, Stewart D, Laberge F, et al, "Dexamethasone Improves the Efficacy of Granisetron in the First 24 h Following High-Dose Cisplatin Chemotherapy,"Support Care Cancer, 1995, 3(5):307-12.
McDonnell M and Evans N, "Upper and Lower Gastrointestinal Complications With Dexamethasone Despite H2 Antagonists,"J Paediatr Child Health, 1995, 31(2):152-4.
Ng PC, "The Effectiveness and Side Effects of Dexamethasone in Preterm Infants With Bronchopulmonary Dysplasia,"Arch Dis Child, 1993, 68(3 Spec No):330-6.
Peterson C, Hursti TJ, Borjeson S, et al, "Single High-Dose Dexamethasone Improves the Effect of Ondansetron on Acute Chemotherapy-Induced Nausea and Vomiting But Impairs the Control of Delayed Symptoms,"Support Care Cancer, 1996, 4(6):440-6.
Randin D, Vollenweider P, Tappy L, et al, "Suppression of Alcohol-Induced Hypertension by Dexamethasone,"N Engl J Med, 1995, 332(26):1733-7.
Ruvinsky ED, Douvas SG, Roberts WE, et al, "Maternal Administration of Dexamethasone in Severe Pregnancy-Induced Hypertension,"Am J Obstet Gynecol , 1984, 149(7):722-6.
Wald ER, Kaplan SL, and Mason, EO Jr, "Dexamethasone Therapy for Children With Bacterial Meningitis,"Pediatrics, 1995, 95(1):21-8.
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