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Dexamethasone

Dexamethasone

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dexamethasone
(dex ameth' a sone)
dexamethasone
Oral, topical dermatologic aerosol and gel, ophthalmic suspension:
Aeroseb-Dex, Decadron, Dexameth, Dexasone (CAN), Dexone, Hexadrol,
Maxidex Ophthalmic
dexamethasone acetate
IM, intra-articular, or soft-tissue injection:
Cortastat LA, Dalalone L.A., Decaject LA, Dexasone-L.A., Dexone LA,
Solurex LA
dexamethasone sodium phosphate
IV, IM, intra-articular, intralesional injection; respiratory inhalant; intranasal steroid;
ophthalmic solution and ointment; topical dermatologic cream:

Cortastat, Dalalone, Decadron Phosphate, Decadron Phosphate
Ophthalmic, Decadron Phosphate Turbinaire, Decaject, Dexasone, Dexone,
Hexadrol Phosphate, Solurex

Pregnancy Category C
Drug classes

Corticosteroid
Glucocorticoid
Hormone

Therapeutic actions
Enters target cells and binds to specific receptors, initiating many complex reactions that
are responsible for its antiinflammatory and immunosuppressive effects.
Indications
\u2022
Hypercalcemia associated with cancer
\u2022

Short-term management of various inflammatory and allergic disorders, such as
rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus),
status asthmaticus, and autoimmune disorders

\u2022
Hematologic disorders: Thrombocytopenic purpura, erythroblastopenia
\u2022
Trichinosis with neurologic or myocardial involvement
\u2022
Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some
leukemias and lymphomas
\u2022
Cerebral edema associated with brain tumor, craniotomy, or head injury
\u2022
Testing adrenocortical hyperfunction
\u2022
Unlabeled uses: Antiemetic for cisplatin-induced vomiting, diagnosis of
depression
\u2022
Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques
\u2022
Respiratory inhalant: Control of bronchial asthma requiring corticosteroids in
conjunction with other therapy
\u2022
Intranasal: Relief of symptoms of seasonal or perennial rhinitis that responds
poorly to other treatments
\u2022
Dermatologic preparations: Relief of inflammatory and pruritic manifestations of
dermatoses that are steroid-responsive
\u2022
Ophthalmic preparations: Inflammation of the lid, conjunctiva, cornea, and globe
Contraindications and cautions
\u2022

Contraindicated with infections, especially tuberculosis, fungal infections,
amebiasis, vaccinia and varicella, and antibiotic-resistant infections, allergy to any
component of the preparation used.

\u2022

Use cautiously with renal or hepatic disease; hypothyroidism, ulcerative colitis
with impending perforation; diverticulitis; active or latent peptic ulcer;
inflammatory bowel disease; CHF, hypertension, thromboembolic disorders;
osteoporosis; seizure disorders; diabetes mellitus; lactation.

Available forms

Tablets\u20140.25, 0.5, 0.75, 1, 1.5, 2, 4, 6 mg; elixir\u20140.5 mg/5 mL; oral solution\u20140.5 mg/5
mL; injection\u20148 mg/mL, 16 mg/mL, 4 mg/mL, 10 mg/mL, 20 mg/mL, 24 mg/mL;
aerosol\u201484 mcg/actuation; ophthalmic solution\u20140.1%; ophthalmic suspension\u20140.1%;
ophthalmic ointment\u20140.05%; topical ointment\u20140.05%; topical cream\u20140.05%, 0.1%;
topical aerosol\u20140.01%, 0.04%

Dosages
ADULTS
Systemic administration

Individualize dosage based on severity of condition and response. Give daily dose before
9 AM to minimize adrenal suppression. If long-term therapy is needed, alternate-day
therapy with a short-acting steroid should be considered. After long-term therapy,
withdraw drug slowly to avoid adrenal insufficiency. For maintenance therapy, reduce
initial dose in small increments at intervals until the lowest clinically satisfactory dose is
reached.

Oral (dexamethasone, oral)
0.75\u20139 mg/day.
\u2022
Suppression tests for Cushing's syndrome: 1 mg at 11 PM; assay plasma cortisol
at 8 PM the next day. For greater accuracy, give 0.5 mg q 6 hr for 48 hr, and
collect 24-hr urine to determine 17-OH-corticosteroid excretion.
\u2022
Suppression test to distinguish Cushing's syndrome due to ACTH excess from that
resulting from other causes: 2 mg q 6 hr for 48 hr. Collect 24-hr urine to
determine 17-OH-corticosteroid excretion.
IM (dexamethasone acetate)
8\u201316 mg; may repeat in 1\u20133 wk. Dexamethasone phosphate: 0.5\u20130.9 mg/day; usual dose
range is one-third to one-half the oral dose.
IV (dexamethasone sodium phosphate)
0.5\u20139 mg/day.
\u2022
Cerebral edema: 10 mg IV and then 4 mg IM q 6 hr; change to oral therapy, 1\u2013
3 mg tid, as soon as possible and taper over 5\u20137 days.
PEDIATRIC PATIENTS
IV

Individualize dosage based on severity of condition and response, rather than by strict
adherence to formulas that correct adult doses for age or body weight. Carefully observe
growth and development in infants and children on long-term therapy.

\u2022
Unresponsive shock: 1\u20136 mg/kg as a single IV injection (as much as 40 mg
initially followed by repeated injections q 2\u20136 hr has been reported).
Intralesional (dexamethasone acetate)
ADULTS AND PEDIATRIC PATIENTS
4\u201316 mg intra-articular, soft tissue; 0.8\u20131.6 mg intralesional.
(dexamethasone sodium phosphate)
0.4\u20136 mg (depending on joint or soft-tissue injection site).
Respiratory inhalant (dexamethasone sodium phosphate)
84 mcg released with each actuation.
ADULTS
3 inhalations tid\u2013qid, not to exceed 12 inhalations/day.
PEDIATRIC PATIENTS
2 inhalations tid\u2013qid, not to exceed 8 inhalations/day.
Intranasal (dexamethasone sodium phosphate)
Each spray delivers 84 mcg dexamethasone.
ADULTS
2 sprays (168 mcg) into each nostril bid\u2013tid, not to exceed 12 sprays (1,008 mcg)/day.
PEDIATRIC PATIENTS
1 or 2 sprays (84\u2013168 mcg) into each nostril bid, depending on age, not to exceed 8
sprays (672 mcg). Arrange to reduce dose and discontinue therapy as soon as possible.
Topical dermatologic preparations
Apply sparingly to affected area bid\u2013qid.
Ophthalmic solutions, suspensions
Instill 1 or 2 drops into the conjunctival sac q 1 hr during the day and q 2 hr during the
night; after a favorable response, reduce dose to 1 drop q 4 hr and then 1 drop tid\u2013qid.
Ophthalmic ointment
Apply a thin coating in the lower conjunctival sac tid\u2013qid; reduce dosage to bid and then
qid after improvement.
Pharmacokinetics
Route
Onset
Peak
Duration
Oral
Slow
1\u20132 hr
2\u20133 days
IM
Rapid
30\u201360 min
2\u20133 days
IV
Rapid
30\u201360 min
2\u20133 days

Metabolism: Hepatic; T1/2: 110\u2013210 min
Distribution: Crosses placenta; enters breast milk
Excretion:Urin e

IV facts

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