GENERIC NAME: Dexamethasone

BRAND NAME: Adrecort

CLASSIFICATION: Long-acting Systemic Corticosteroids

SUGGESTED DOSE (BY MANUFACTURER):

Inflammation

Adult: PO 0.75-9 mg/day, in divided doses q6-12hr; or

phosphate IM 0.5-9 mg/day divided q6-12hr

Child: PO 0.024-0.34 mg/kg/day in divided doses q6-12hr

Shock

Adult: IV (phosphate) single dose 1-6 mg/kg or

IV 40 mg q2-6hr as needed up to 72 hr

Cerebral edema

Adult: IV (phosphate) 10 mg, then 4-6 mg

IM q6hr 3 2-4 days, then taper over 1 wk

Child: PO/IM/IV loading dose 1-2 mg/kg, then 1-1.5 mg/kg/day, max 16
mg/day divided q4-6hr for 2-4 days, then taper down qwk

Adrenocortical insufficiency

Adult: PO 0.75-9 mg/day in divided doses

Child: PO 0.03-0.3 mg/kg/day divided in 2-4 doses

Suppression test

Adult: PO 1 mg at 11 pm or 0.5 mg q6hr 3 48 hr

MODE OF ACTION:

- Decreases inflammation by suppressing migration of polymorphonuclear

leukocytes, fibroblasts, reversing increased capillary permeability and
 lysosomal stabilization, suppresses normal immune response, no
mineralocorticoid effects

INDICATION:

- Inflammation, allergies, neoplasms, cerebral edema, septic shock, collagen

disorders, dexamethasone suppression test for Cushing syndrome,
adrenocortical insufficiency, TB, meningitis, acute exacerbations of MS

CONTRAINDICATION:

- Psychosis, hypersensitivity to corticosteroids, sulfites, or benzyl alcohol,

idiopathic thrombocytopenia, acute glomerulonephritis, amebiasis, fungal
infections, nonasthmatic bronchial disease, child ,2 yr, AIDS, TB, glaucoma,
ocular infection
- Precautions: Pregnancy C, breastfeeding, diabetes mellitus, osteoporosis,
seizure disorders, ulcerative colitis, CHF, myasthenia gravis, renal disease,
peptic ulcer, esophagitis, recent MI, hypertension, TB, active hepatitis,
psychosis, sulfite hypersensitivity, thromboembolic disorders, abrupt
discontinuation, coagulopathy, ulcerative colitis, seizure disorders
- Women with systemic infection including tuberculosis or sepsis.

DRUG INTERACTION:

Individual Drugs

- Alcohol, amphotericin B, cyclosporine, digoxin, indomethacin: increased side

effects
- Ambemonium, isoniazid, neostigmine, sometrem: decreased effects of each
specific product
- Bosentan, carbamazepine, cholestyramine, colestipol, ePHEDrine, ethotoin,
phenytoin, rifampin, theophylline: decreased action of dexamethasone
- cyclosporine, tacrolimus: increased effect of each drug
- Ketoconazole, NSAIDs: increased action of dexamethasone

Drug Classifications

- Antacids, barbiturates: decreased action of dexamethasone

 - Antibiotics (macrolide), contraceptives (hormonal), estrogens, salicylates:
increased action of dexamethasone
- Anticholinesterases, anticoagulants, anticonvulsants, antidiabetics,
salicylates, toxoids/vaccines: decreased effects of each specific product
- Antidiabetics: increased effect of these products
- Diuretics, NSAIDs, salicylates: increased side effects
- Quinolones: increased risk of tendinitis, tendon rupture
- Thiazide diuretics: decreased potassium levels

Drug/Lab Test

- Increased: cholesterol, Na, blood glucose, uric acid, Ca, urine glucose
- Decreased: Ca, potassium, T4, T3, thyroid 131I uptake test, urine 17-OHCS,
17-KS, PBI
- False negative: skin allergy tests

NURSING RESPONSIBILITIES:

BIBLIOGRAPHY: