Dosing & Uses
Dosage Forms & Strengths
0.75-9 mg/day IV/IM/PO divided q6-12hr
Intra-articular, intralesional, or soft tissue: 0.2-6 mg/day
Multiple Sclerosis (Acute Exacerbation)
30 mg/day PO for 1 week; follow by 4-12 mg/day for 1 mo
10 mg IV, then 4 mg IM q6hr until clinical improvement is observed; may be reduced after 2-4 days and gradually discontinued over 5-7 days
1-6 mg/kg IV once or 40 mg IV q2-6hr PRN
Alternative: 20 mg IV, then 3 mg/kg/day by continuous IV infusion
High-dose treatment not to be continued beyond 48-72 hours
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 IM
Days 2-3: 3 mg/day PO divided q12hr
Day 4: 1.5 mg/day PO divided q12hr
Days 5-6: 0.75 mg/day PO in single daily dose
Day 7: No treatment
Dexamethasone Suppression Test
- Screening for Cushing syndrome
- Overnight test: 1 mg PO between 11:00 PM and midnight; cortisol level tested between 8:00 and 9:00 AM on following morning
- Standard 2-day test: 0.5 mg PO q6hr (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)
- 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 PO q6hr for 2 days; urine for free cortisol is collected during test, and serum cortisol is checked 6 hours after final dose
- Overnight test: After determination of baseline serum cortisol, 8 mg (typically) PO between 11:00 pm and midnight; cortisol level tested between 8:00 and 9:00 AM on following morning
- IV test: After determination of baseline serum cortisol, 1 mg/hr by continuous IV infusion for 5-7 hours
Chemotherapy-Induced Nausea & Vomiting (Off-label)
8-12 mg PO/IV alone or in combination with other antiemetics before chemotherapy, then 8 mg PO/IV q24hr for 1-3 days after chemotherapy (days 2-4)
Altitude Sickness (Off-label)
- 2 mg PO q6hr or 4 mg PO q12hr beginning on day of ascent; may be discontinued after 2- to 3-day stay at same elevation or initiation of descent
- Acute mountain sickness (AMS): 4 mg PO/IV/IM q6hr
- High-altitude cerebral edema (HACE): 8 mg once followed by 4 mg PO/IV/IM q6hr until symptoms resolve
Spinal Cord Compression (Off-label)
10-100 mg IV, then 4-24 mg IV q6hr during radiation therapy, then tapered
Dosage Forms & Strengths
Cerebral Edema Associated With Brain Tumor
Adrenal Cortical Hyperfunction Test
After determination of baseline cortisol level, 1 mg PO at bedtime
Plasma cortisol level then determined at 8:00 AM on following morning; level will be decreased in normal individuals but at baseline level in Cushing syndrome
Respiratory Distress Syndrome in Premature Infants (Off-label)
4 mg IM q8hr administered to mother for 2 days before delivery
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
Change in spermatogenesis
Delayed wound healing
Increased intracranial pressure
Pituitary adrenal axis suppression
Pseudotumor cerebri (on withdrawal)
Spermatogenesis altered (increased or decreased)
•Fluid and electrolyte disturbances: Tumor lysis syndrome
Systemic fungal infection
Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids
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 apparent association between 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 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 patient is receiving steroids already, may increase dosage
Metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients; changes in thyroid status of patient may necessitate adjustment in dosage
Corticosteroids may exacerbate systemic fungal infections; not for use in 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 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
Use of oral corticosteroids not recommended in treatment of optic neuritis and may lead to increase in risk of new episodes; corticosteroids should not be used in active ocular herpes simplex
Use lowest possible dose to control condition under treatment; risk/benefit decision must be made in each individual 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
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 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 suggestion (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 therapy has been associated with development of Karposi 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
Patient may requre higher doses when subject to stress
Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (eg, for Addison’s disease)
- 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 use of fluoroscopy
- Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use
Pregnancy & Lactation
Pregnancy category: C
Lactation: Drug excreted in breast milk; not recommended
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Potent glucocorticoid with minimal to no mineralocorticoid activity
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes (PMNs) and reducing capillary permeability; stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentration, and inhibits prostaglandin and proinflammatory cytokines; suppresses lymphocyte proliferation through direct cytolysis, inhibits mitosis, breaks down granulocyte aggregates, and improves pulmonary microcirculation
Onset: Between a few minutes and several hours; dependent on indication and route of administration
Peak serum time: 8hr (IM); 1-2 hr (PO)
Vd: 2 L/kg
Metabolized in liver
Half-life: 1.8-3.5 hr (normal renal function)
Excretion: Urine (mainly), feces (minimally)
Solution: D5W, NS
Additive: Aminophylline, bleomycin, cimetidine, floxacillin, furosemide, granisetron, lidocaine, meropenem, mitomycin, nafcillin, netilmicin, ondansetron, prochlorperazine, ranitidine, verapamil
Syringe: Caffeine, granisetron, metoclopramide, ondansetron, ranitidine, sufentanil
Y-site (partial list): Acyclovir, allopurinol, cisplatin, cladribine, cyclophosphamide, cytarabine, docetaxel, etoposide phosphate, famotidine, fentanyl, fluconazole, gemcitabine, heparin with hydrocortisone, linezolid, lorazepam, meperidine, morphine, potassium chloride, propofol, sodium bicarbonate, zidovudine
Additive: Amikacin(?), daunorubicin, diphenhydramine with lorazepam and metoclopramide, metaraminol, vancomycin
Syringe: Diphenhydramine(?), doxapram, glycopyrrolate, hydromorphone(?)
Y-site: Ciprofloxacin, fenoldopam, idarubicin, methotrexate(?), midazolam, topotecan
Standard diluent: 4 mg/50 mL D5W or 10 mg/50 mL D5W
Minimum volume: 50 mL D5W
Dexamethasone 4 mg/mL injection is clear and colorless
Dexamethasone sodium phosphate: Administered by IV push, continuous or intermittent IV infusion, or IM
Acetate injection: Administered only IM
Protect from light
Protect from freezing
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.