dexamethasone (Rx)

Brand and Other Names:Decadron, Dexamethasone Intensol, more...Dexasone, Solurex, Baycadron
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 0.5mg
  • 0.75mg
  • 1mg
  • 1.5mg
  • 2mg
  • 4mg
  • 6mg

injectable suspension

  • 4mg/mL
  • 10mg/mL

elixir/oral solution

  • 0.5mg/5mL

oral concentrate

  • 1mg/1mL
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Inflammation

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

Cerebral Edema

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

Shock

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

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 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

Low-dose 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)

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 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)

Prophylaxis

  • 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

Treatment

  • 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

Multiple Myeloma (Orphan)

Orphan designation for treatment of multiple myeloma (MM)

Sponsor

  • Celgene Corporation; 86 Morris Avenue Summit, New Jersey 07901

Dosage Forms & Strengths

tablet

  • 0.5mg
  • 0.75mg
  • 1mg
  • 1.5mg
  • 2mg
  • 4mg
  • 6mg

injectable suspension

  • 4mg/mL
  • 10mg/mL

elixir/oral solution

  • 0.5mg/5mL

oral concentrate

  • 1mg/1mL
more...

Airway Edema

0.5-2 mg/kg/day PO/IV/IM divided q6hr, starting 24 hours before extubation and continued for 4-6 doses afterward  

Croup

0.6 mg/kg PO/IV/IM once; not to exceed 16 mg 

Inflammation

0.08-0.3 mg/kg/day IV/PO/IM divided q6hr or q12hr  

Meningitis

>6 weeks: 0.6 mg/kg/day IV divided q6hr for first 2-4 days of antibiotic therapy, starting 10-20 minutes before or simultaneously with first antibiotic dose  

Cerebral Edema Associated With Brain Tumor

1-2 mg/kg IV/IM once; maintenance: 1-1.5 mg/kg/day IV/IM divided q4-6hr; not to exceed 16 mg/day  

Spinal Cord Compression

2 mg/kg/day IV divided q6hr 

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)

Prophylaxis

4 mg IM q8hr administered to mother for 2 days before delivery

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Interactions

Interaction Checker

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            Adverse Effects

            Frequency Not Defined

            Allergic reactions: Anaphylactoid reaction, anaphylaxis, angioedema

            Cardiovascular: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction, edema, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis

            Dermatologic: Acne, allergic dermatitis, dry scaly skin, ecchymoses and petechiae, erythema, impaired wound healing, increased sweating, rash, striae, suppression of reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria

            Endocrine: Decreased carbohydrate and glucose tolerance, development of cushingoid state, hyperglycemia, glycosuria, hirsutism, hypertrichosis, increased requirements for insulin or oral hypoglycemic agents in diabetes, manifestations of latent diabetes mellitus, menstrual irregularities, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in pediatric patients

            Fluid and electrolyte disturbances: Congestive heart failure in susceptible patients, fluid retention, hypokalemic alkalosis, potassium loss, sodium retention, tumor lysis syndrome

            Gastrointestinal: Abdominal distention, elevation in serum liver enzyme levels (usually reversible upon discontinuation), hepatomegaly, increased appetite, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with inflammatory bowel disease), ulcerative esophagitis

            Metabolic: Negative nitrogen balance due to protein catabolism Musculoskeletal: Aseptic necrosis of femoral and humeral heads, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures

            Neurological/Psychiatric: Convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychic disorders, vertigo

            Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts, vision blurred

            Other: Abnormal fat deposits, decreased resistance to infection, hiccups, increased or decreased motility and number of spermatozoa, malaise, moon face, weight gain

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            Warnings

            Contraindications

            Systemic fungal infection

            Documented hypersensitivity

            Cerebral malaria

            Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids

            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 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

            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 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 with possible damage to optic nerves, and may enhance establishment of secondary ocular infections due to bacteria, fungi, or viruses; consider referral to ophthalmologist for patients who develop ocular symptoms or use corticosteroid-containing products for more than 6 weeks

            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)

            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 use of fluoroscopy
            • Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use
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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Drug excreted in breast milk; not recommended

            Pregnancy Categories

            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.

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            Pharmacology

            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

            Absorption

            Onset: Between a few minutes and several hours; dependent on indication and route of administration

            Peak serum time: 8hr (IM); 1-2 hr (PO)

            Distribution

            Vd: 2 L/kg

            Metabolism

            Metabolized in liver

            Elimination

            Half-life: 1.8-3.5 hr (normal renal function)

            Excretion: Urine (mainly), feces (minimally)

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            Administration

            IV Compatibilities

            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

            IV Incompatibilities

            Additive: Amikacin(?), daunorubicin, diphenhydramine with lorazepam and metoclopramide, metaraminol, vancomycin

            Syringe: Diphenhydramine(?), doxapram, glycopyrrolate, hydromorphone(?)

            Y-site: Ciprofloxacin, fenoldopam, idarubicin, methotrexate(?), midazolam, topotecan

            IV Preparation

            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

            IV/IM Administration

            Dexamethasone sodium phosphate: Administered by IV push, continuous or intermittent IV infusion, or IM

            Acetate injection: Administered only IM

            Storage

            Protect from light

            Protect from freezing

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            Images

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            Formulary

            FormularyPatient Discounts

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            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.

            Tier Description
            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.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.