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Dexamethasone

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Dexamethasone, Decadron

  • See Also
  1. Systemic Corticosteroid
  2. Topical Corticosteroid
  3. Inhaled Corticosteroid
  4. Intranasal Steroid
  5. Intra-articular Corticosteroid
  6. Corticosteroid Associated Osteoporosis
  7. Stress Dose Steroid
  8. Steroid-Induced Hyperglycemia
  9. Dexamethasone Suppression Test
  • Indications
  1. See Dexamethasone Suppression Test
  2. FDA approved indications
    1. Antiinflammatory or Immunosuppression
    2. Multiple Sclerosis acute exacerbation
    3. Cerebral edema
  3. Non-FDA Approved (Off-Label) indications
    1. Preterm Labor Management for Fetal Lung Maturity (off label use)
    2. Immune Thrombocytopenic Purpura
    3. Bacterial Meningitis (before first dose of Antibiotics for for HaemophilusInfluenzae or pneumococcal Meningitis)
    4. Antiemetic in Chemotherapy
    5. Acute Asthma exascerbation
    6. Bronchopulmonary Dysplasia
    7. Dexamethasone Suppression Test (Cushing"s Syndrome)
  • Mechanism
  1. See Systemic Corticosteroid
  2. See Pharmacokinetics below for relative potency
  • Medications
  1. Dexamethasone (Decadron)
    1. Tablets: 0.5 mg, 0.75 mg, 1.0 mg, 1.5 mg, 2 mg, 4 mg, 6 mg
    2. Solution or Elixir: 0.5 mg/5 ml
  2. Non-Systemic formulations
    1. See Intra-articular Corticosteroid
  • Dosing
  1. Adult
    1. Antiinflammatory or Immunosuppression
      1. Dexamethasone 0.5 to 10 mg/day PO/IM/IV divided every 6-12 hours
    2. Multiple Sclerosis acute exacerbation
      1. Dexamethasone 30 mg/day for 1 week, then 4 to 12 mg every other day for 4 weeks
    3. Preterm Labor Management for Fetal Lung Maturity (off label use)
      1. Dexamethasone 6 mg IM every 12 hours for 4 doses
    4. Cerebral edema
      1. Load: 10 to 20 mg IV load
      2. Maintenance: 4 mg IV or IM every 6 hours (or 1 to 3 mg orally three times daily)
    5. Bacterial Meningitis (before first dose of Antibiotics for HaemophilusInfluenzae or pneumococcal Meningitis)
      1. Start Dexamethasone 15 minutes before first Antibiotic dose
      2. Dexamethasone 10 mg IV q6 hours for 4 days
    6. Antiemetic in Chemotherapy
      1. Treatment: 10 to 20 mg IV every 4 to 6 hours
      2. Prophylaxis: 8 mg IV or 12 mg orally before Chemotherapy, then 8 mg orally daily for 2 to 4 days
  2. Child
    1. General
      1. Dexamethasone 0.02 to 0.3 mg/kg/day divided every 6 to 8 hours
    2. Asthma Exacerbation (off-label)
      1. Dexamethasone 0.3 to 0.6 mg/kg/day up to 10-15 mg for 1-2 days
    3. Croup (off-label)
      1. Dexamethasone 0.15 to 0.6 mg/kg once up to 10 mg
      2. See Dexamethasone in Croup
    4. Bacterial Meningitis (before first dose of Antibiotics for pneumococcal Meningitis)
      1. Start Dexamethasone 15 minutes before first Antibiotic dose
      2. Dexamethasone 0.4 mg/kg every 12 hours IV for 2 days (or 0.15 mg/kg every 6 hours IV for 4 days)
    5. Bronchopulmonary Dysplasia in Premature Infants (off-label)
      1. Dexamethasone 0.5 mg/kg orally or IV divided every 12 hours for 3 days (followed by taper)
  • Pharmacokinetics
  1. Dexamethasone has high oral Bioavailability (80%) with onset of action within 1-2 hours
  2. Long Half-Life (36 to 54 hours)
  3. High potency
  4. High anti-inflammatory potency
  5. No Mineralocorticoid Activity
  • Adverse Effects
  1. See Systemic Corticosteroid
  • Safety
  1. See Systemic Corticosteroid
  2. Pregnancy category C
  3. Avoid in Lactation
  • Resources
  1. Dexamethasone Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=bf8acfdb-8dc8-4a69-90b0-33c680c421d6
  2. Dexamethasone Injection Solution (DailMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ddc82c42-2e6e-42a6-a30a-e41978e2f4da
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. Swadron and Hope in Herbert (2018) EM:Rap 18(9):16-8
  3. Dvorin (2020) Am Fam Physician 101(2): 89-94 [PubMed]
  4. Lane (1998) Endocrinol Metab Clin North Am 27:465-83 [PubMed]