Composition
Inj 2.5 mg/4 mg/8 mg: Perml: Dexamethasone sodium phosphate 2.5 mg/4 mg/8 mg.Tab 0.5 mg/1 mg/1.5 mg: Dexamethasone 0.5 mg/1 mg/1.5 mg. Elixir:Per 5 ml: Dexamethasone 0.5 mg.
Indications & Dosage
Congenital adrenal hyperplasia: BY IM OR SLOW IV INJ OR IV INF OR ORAL: Adult: Consult specialist for advice on dosing. Adjunctive treatment of bacterial meningitis (starting before or with first dose of antibacterial): BY IV INJ: Adult: 8.3 mg every 6 hours for 4 days. Symptom control of anorexia (in palliative care): Adult: 2-4 mg daily. Obstruction due to tumour (dysphagia in palliative care): Adult: 8 mg daily. Bronchospasm or partial obstruction (dyspnoea in palliative care): Adult: 4-8 mg daily. Nausea and vomiting (adjunct in palliative care): ORAL: Adult: 8-16 mg daily. Headaches due to raised intracranial pressure (in palliative care): Adult: 16 mg daily for 4-5 days, then reduced to4-6 mg daily, reduce dose if possible. To be given before 6pm to reduce the risk of insomnia. Pain due to nerve compression (in palliative care): Adult: 8 mg daily. Cerebral oedema associated with malignancy: ORAL: Adult: 0.5-10 mg daily. BY IV INJ: Adult: Initially 8.3 mg for 1 dose, then (by IM injection) 3.3 mg every 6 hours as required for 2-4 days, subsequently, reduce dosegradually and stop over 5-7 days, use the 3.3 mg/ml injection preparation for this dose. Cerebral oedema: BY IV INJ: Adult:Initially 8-16 mg for 1 dose, then (by IM injection or by IV injection) 5 mg every 6 hours until adequate response achieved then taper-off gradually, dosage may be reduced after 2-4 days & gradually discontinued over 5-7 days, use the 3.8 mg/ml injection preparation for this dose. Prophylaxis of Antiemetic: BY IV INJ OR ORAL: Adult: 10-20mg 15-30 min before treatment on each treatment day. Continuous IV INF regimen: 10mg every 12 hrs on each treatment day. Mildly emetogenic therapy: BY IM OR IV INJ OR ORAL: Adult: 4mg every 4-6 hrs. Delayed nausea vomiting: Oral: 4-10mg 1-2 times/day for 2-4 days or 8mg every 12 hrs for 2 days; then 4mg every 12 hrs for 2 days or 20mg 1 hr before chemotherapy; then 10mg 12 hrs after chemotherapy; then 8mg every 12 hrs for 4 doses; then 4mg every 12 hrs for 4 doses. Inflammatory & allergic disorders: ORAL: Children 1 month to18 yrs: 10-100 mcg/kg daily in 1-2 divided doses, adjusted according to response; up to 300 mcg/kg daily may be required in emergency situations. BYIM OR IV INJ OR INF: Children 1 month-12 yr: 83-333 mcg/kg daily in 1-2 divided doses, max 20mg daily; 12-18 yr: initially 0.4-20mg daily. BYIM OR IV INJ OR ORAL: Adult: 0.75-10 mg/day in divided doses every 6-12 hrs. Intra-articular, intra-lesional, or soft tissue (as sodium phosphate): 0.4-6 mg/day. Multiple myeloma: BY IV INJ OR ORAL: Adult: 40 mg/day, days 1 to 4, 9 to 12, & 17 to 20, repeated every 4 weeks (alone or as part of a regimen). Extubation or airway oedema: BYIM OR IV INJ OR ORAL: Adult: 0.5-2 mg/kg/day in divided doses every 6 hrs beginning 24 hrs prior to extubation & continuing for 4-6 doses afterwards. Cushings syndrome, diagnostic: ORAL: Adult: 0.5mg every 6 hrs for 48 hrs (with 24-hr urine collection for 17-hydroxycorticosteroid excretion). Differentiation of Cushings syndrome due to ACTH excess from Cushings due to other causes: Dexamethasone 2mg every 6 hrs for 48 hrs (with 24-hr urine collection for 17-hydroxycorticosterold excretion). Multiple sclerosis (acute exacerbation): Adult: 30 mg/day for 1 week followed by 4-12 mg/day for 1 month. Physiological replacement: BY IM OR IV INJ OR ORAL: Adult: 0.03-0.15 mg/kg/day or 0.6-0.75 mg/square meter/ day in divided doses every 6-12 hrs. BY IV INJ ORORAL: Children 1 month-18 yr: 250-500 mcg/square meter every 12 hr, adjusted according to response. Treatment of shock, Addisonian crisis or shock: BY IV inj: Adult: 4-10mg as a single dose, which may be repeated if necessary. Treatment of shockunresponsive to steroid therapy: BY IV INJ: Adult: 1-6 mg/kg as a single dose or up to 40mg initially followed by repeat doses every 2-6 hrs while shock persists. Life-threatening cerebral oedema: BY IV INJ: Children 1 month to 18 yrs: Under 35 kg body-weight, initially 16.7 mg, then 3.3mg every 3 hr for 3 days, then 3.3mg every 6 hr for 1 day, then 1.7mg every 6 hr for 4 days, then decrease by 0.8mg daily; Over 35 kg body-weight, initially.20.8 mg, then 3.3mg every 2 hr for 3 days, then 3.3mg every 4 hr for 1 day, then 3.3mg every 6 hr for 4 days, then decrease by 1.7mg daily. Bacterial meningitis: BY IV INJ: Children 3 month-18 yr: 150 mcg/ kg (max 10 mg) every 6 hr for 4 days starting before or with first dose of antibacterial. Croup: ORAL: Children 1 month to 18 yr: Single dose of dexamethasone 150 mcg/kg. Severe croup (or mid croup that might cause complications), single dose of dexa-methasone 150 mcg/kg can be administered by mouth before transfer to hospital. In hospital, dexamethasone 150 mcg/kg (by mouth or by injection): the dose may be repeated after 12 hr if necessary. Note: Dexamethasone 1 mg equivalent to dexamethasone phosphate 1.2mg equivalent to dexamethasone sodium phosphate I.3mg.
Administration
Administer IV as a 5-10 mins bolus; do not administer rapid IV inj. Inject undiluted IV dose directly into IV tubing of infusing compatible solution over 30 sec or less, as prescribed. Shake IM solution before injecting deep into large muscle mass.Injection should be diluted in 50-100 mlNS or D5W.
Compatibility
Stable in D5W or NS. Y-site administration:See drug to drug IV Compatibility chart
Stability
Store at 25C with excursions permitted between 15-30C. The product is sensitive to heat. Do not autoclave. Protect from freezing and light. Store container in carton until contents have been used because infusion solutions generally do not contain preservatives; mixtures should be used within 24 hours.
Contraindications
Systemic fungal infections unless specific anti-infective therapy is used, head injury, stroke.
Precautions
Active infections not controlled by antibiotics, latent or active amoebiasis, history of TB, septicaemia, symptoms may be masked, avoid or take extreme cautions in chickenpox, measles, psychiatric disorders, renal impairment, hepatic failure, cirrhosis, active peptic ulcer, myasthenia gravis, previous steroid myopathy, osteoporosis, epilepsy, hypothyroidism, diabetes, adrenal suppression, hypertension, recent myocardial infarction, congestive heart failure, thromboembolic disorders, glaucoma, corneal perforation. Withdrawal gradually, withdrawal symptoms may include fever, myalgia, arthralgia, rhinitis, itchy skin nodules and weight loss.
Interactions
Live vaccines or other vaccines, anticoagulants, hypoglycaemia agents, antihypertensives, diuretics, erythromycin, rifamycin, amphotericin, azole antifungals, ritonavir, cyclosporin, cardiac glycosides, Oestrogens including oral contraceptives. Somatropin, Carbamazepine. phenytoin, primidone, barbiturates. Muscle relaxants, NSAIDs, salicylates, sympathomimetics, mifepristone, methotrexate, theophylline, aprepitant.
Pregnancy
Caution advised
Lactation
Caution advised
Side Effects
Increased susceptibility and severity to infection, endocrine irregularities including menstrual problems, Cushingoid state, adrenal suppression, growth suppression in children, fluid/electrolyte disturbance, hypertension, negative protein, nitrogen and calcium balance, myopathy, tendon rupture, osteoporosis, osteonecrosis and fractures, impaired wound healing, sweating, hirsutism, striae, telangiectasia, acne, GIdisturbance, peptic ulceration, acute pancreatitis, candidiasis, psychiatric effects, neurological effects, insomnia, diabetes, impaired glucose tolerance, weight gain, increased appetite, ocular disturbances including cataracts, raised intraocular pressure, optic nerve damage, corneal changes, glaucoma, thromboembolism, leukocytosis.