Dexamethasone

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.

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

• Abnormal heart rhythm (arrhythmia)
• Acne
• Adrenal suppression
• Anal itching
• Cardiac arrest
• Cataracts
• Change in spermatogenesis
• Delayed wound healing
• Depression
• Diabetes mellitus
• Emotional instability
• Enlarged liver
• Euphoria
• Excess fluid in the lungs (pulmonary edema)
• Exophthalmos
• GI perforation
• Glaucoma
• Glucose intolerance
• Glucosuria
• Hives
• Hypokalemic alkalosis
• Increased intracranial pressure
• Increased transaminases
• Insomnia
• Kaposi's sarcoma
• Menstrual irregularity
• Moon face
• Muscle disease
• Nerve pain
• Osteoporosis
• Peptic ulcer
• Pituitary adrenal axis suppression
• Pseudotumor cerebri (on withdrawal)
• Psychosis
• Rash
• Redness
• Seizure
• Slow heart rate
• Small red or purple spots on the skin
• Sperm production altered (increased or decreased)
• Spinning sensation (vertigo)
• Ulcerative esophagitis
• Weight gain

Postmarketing side effects of dexamethasone reported include:

• Fluid and electrolyte disturbances: Tumor lysis syndrome

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms such as fast, irregular, or pounding heartbeats; fluttering in your chest; shortness of breath; sudden dizziness, lightheartedness, or passing out.

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

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 a 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 the 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 the test, and serum cortisol is checked 6 hours after the 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 the 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 the first 2-4 days of antibiotic therapy, starting 10-20 minutes before or simultaneously with the 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 was then determined at 8:00 AM on the following morning; the level will be decreased in normal individuals but at a baseline level in Cushing syndrome

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.

• Dexamethasone has severe interactions with at least 20 different drugs.
• 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 about 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.

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

• Systemic fungal infection
• Documented hypersensitivity
• Cerebral malaria
• Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids

Effects of Drug Abuse

• An agent is a potent diuretic that, if given in excessive amounts, may lead to a 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 the 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 the patient is receiving steroids already, may increase the 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 the 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 an apparent association between the 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 the 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 the patient is receiving steroids already, may increase the dosage
• Metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients; changes in the thyroid status of the patient may necessitate an adjustment in dosage
• Corticosteroids may exacerbate systemic fungal infections; they are not for use in the 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 is 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
• The use of oral corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes; corticosteroids should not be used in active ocular herpes simplex
• Use the lowest possible dose to control the condition under treatment; risk/benefit decision must be made in each 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 the 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 suggestions (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 treatment has been associated with the 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
• Patients 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 the use of fluoroscopy
  • The 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 the benefits outweigh the risks. Animal studies show risk and human studies are not available, or neither animal nor human studies were done
• Some suggestions (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