Dexamethasone

Dexamethasone is a corticosteroid, is similar to a natural human adrenal hormone cortisol produced by your adrenal glands. Dexamethasone often is used to replace the adrenal hormone cortisol when your body does not make enough of it. Dexamethasone has potent antiinflammatory and immunosuppressive properties and are widely used in medicine. Dexamethasone relieves inflammation (swelling, heat, redness, and pain) and is used to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders (e.g., colitis); severe allergies; and asthma. Dexamethasone is also used to treat certain types of cancer.

Dexamethasone is used with other drugs to treat the following types of cancer:

• Leukemia.
• Lymphoma.
• Mycosis fungoides (a type of cutaneous T-cell lymphoma).

Dexamethasone is also used alone or with other drugs to prevent or treat the following conditions related to cancer:

• Anemia.
• Cerebral edema (fluid build-up in the brain) associated with brain tumors.
• Drug hypersensitivity (allergic reactions).
• Hypercalcemia (high blood levels of calcium).
• Thrombocytopenia (low platelet levels).

Dexamethasone is also used alone or with other drugs to treat many other diseases and conditions. Dexamethasone continues to be studied in the treatment of many types of cancer and other conditions.

Dexamethasone is available only with your doctor’s prescription.

Dexamethasone comes as a tablet and a solution to take by mouth. Your doctor will prescribe a dosing schedule that is best for you. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take dexamethasone exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Do not stop taking dexamethasone without talking to your doctor. Stopping the drug abruptly can cause loss of appetite, upset stomach, vomiting, drowsiness, confusion, headache, fever, joint and muscle pain, peeling skin, and weight loss. If you take large doses for a long time, your doctor probably will decrease your dose gradually to allow your body to adjust before stopping the drug completely. Watch for these side effects if you are gradually decreasing your dose and after you stop taking the tablets or oral liquid, even if you switch to an inhalation corticosteroid medication. If these problems occur, call your doctor immediately. You may need to increase your dose of tablets or liquid temporarily or start taking them again.

Dexamethasone mechanism of action

Dexamethasone is a potent glucocorticoid with very little, if any, mineralocorticoid activity ¹. Dexamethasone’s effect on the body is seen in a variety of ways. It has been shown to work is by suppressing migration of neutrophils and decreasing lymphocyte colony proliferation. It has been shown that capillary membrane becomes less permeable as well. Lysosomal membranes have increased stability. There are higher concentrations of vitamin A compounds in the serum, and prostaglandin and some cytokines (interleukin-1, interleukin-12, interleukin-18, tumor necrosis factor, interferon gamma, and granulocyte-macrophage colony stimulating factor) are inhibited. Increased levels of surfactant and improved pulmonary circulation have also been shown with dexamethasone use. Dexamethasone is metabolized by the liver and excreted in the urine mainly. Dexamethasone has a half-life of approximately 3 hours.

Dexamethasone special precautions

Before taking dexamethasone:

• tell your doctor and pharmacist if you are allergic to dexamethasone, aspirin, tartrazine (a yellow dye in some processed foods and drugs), or any other drugs.
• tell your doctor and pharmacist what prescription and nonprescription medications you are taking especially anticoagulants (‘blood thinners’) such as warfarin (Coumadin), arthritis medications, aspirin, cyclosporine (Neoral, Sandimmune), digoxin (Lanoxin), diuretics (‘water pills’), ephedrine, estrogen (Premarin), ketoconazole (Nizoral), oral contraceptives, phenobarbital, phenytoin (Dilantin), rifampin (Rifadin), theophylline (Theo-Dur), and vitamins.
  if you have a fungal infection (other than on your skin), do not take dexamethasone without talking to your doctor.
  tell your doctor if you have or have ever had liver, kidney, intestinal, or heart disease; diabetes; an underactive thyroid gland; high blood pressure; mental illness; myasthenia gravis; osteoporosis; herpes eye infection; seizures; tuberculosis (TB); or ulcers.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking dexamethasone, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking dexamethasone.
• if you have a history of ulcers or take large doses of aspirin or other arthritis medication, limit your consumption of alcoholic beverages while taking this drug. Dexamethasone makes your stomach and intestines more susceptible to the irritating effects of alcohol, aspirin, and certain arthritis medications: this effect increases your risk of ulcers.

Special dietary instructions

Your doctor may instruct you to follow a low-sodium, low-salt, potassium-rich, or high-protein diet. Follow these directions.

Dexamethasone may cause an upset stomach. Take dexamethasone with food or milk.

Pregnancy

Pregnancy Category C: Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Dexamethasone interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking dexamethasone, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using dexamethasone with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Artemether
• Desmopressin
• Praziquantel
• Rilpivirine
• Rotavirus Vaccine, Live

Using dexamethasone with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Aceclofenac
• Acemetacin
• Aldesleukin
• Alfentanil
• Amtolmetin Guacil
• Balofloxacin
• Bemiparin
• Benzhydrocodone
• Besifloxacin
• Boceprevir
• Bromfenac
• Bufexamac
• Buprenorphine
• Bupropion
• Celecoxib
• Ceritinib
• Choline Salicylate
• Ciprofloxacin
• Clarithromycin
• Clonixin
• Cobicistat
• Codeine
• Conivaptan
• Daclatasvir
• Darunavir
• Desogestrel
• Dexibuprofen
• Dexketoprofen
• Diclofenac
• Dienogest
• Diflunisal
• Dihydrocodeine
• Dipyrone
• Doxorubicin
• Doxorubicin Hydrochloride Liposome
• Dronedarone
• Drospirenone
• Droxicam
• Efavirenz
• Elvitegravir
• Enoxacin
• Enzalutamide
• Estradiol
• Ethinyl Estradiol
• Ethynodiol
• Etodolac
• Etofenamate
• Etonogestrel
• Etoricoxib
• Etravirine
• Felbinac
• Fenoprofen
• Fentanyl
• Fepradinol
• Feprazone
• Fleroxacin
• Floctafenine
• Flufenamic Acid
• Flumequine
• Flurbiprofen
• Fosamprenavir
• Gatifloxacin
• Gemifloxacin
• Gestodene
• Hemin
• Hydrocodone
• Ibuprofen
• Indomethacin
• Ixabepilone
• Ketoprofen
• Ketorolac
• Lapatinib
• Levofloxacin
• Levonorgestrel
• Lomefloxacin
• Lornoxicam
• Loxoprofen
• Lumiracoxib
• Macimorelin
• Meclofenamate
• Mefenamic Acid
• Meloxicam
• Meperidine
• Mestranol
• Methadone
• Morniflumate
• Moxifloxacin
• Nabumetone
• Nadifloxacin
• Nadroparin
• Naproxen
• Nepafenac
• Nevirapine
• Nifedipine
• Niflumic Acid
• Nilotinib
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Nimodipine
• Norethindrone
• Norfloxacin
• Norgestimate
• Norgestrel
• Ofloxacin
• Oxaprozin
• Oxycodone
• Oxyphenbutazone
• Parecoxib
• Pazufloxacin
• Pefloxacin
• Pentazocine
• Phenylbutazone
• Piketoprofen
• Piperaquine
• Piroxicam
• Pranoprofen
• Proglumetacin
• Propyphenazone
• Proquazone
• Prulifloxacin
• Ritonavir
• Rofecoxib
• Rufloxacin
• Salicylic Acid
• Salsalate
• Saquinavir
• Sargramostim
• Sodium Salicylate
• Sparfloxacin
• Sufentanil
• Sulindac
• Sunitinib
• Tacrolimus
• Telaprevir
• Tenoxicam
• Thalidomide
• Tiaprofenic Acid
• Ticagrelor
• Tolfenamic Acid
• Tolmetin
• Tosufloxacin
• Tramadol
• Ulipristal
• Valdecoxib
• Velpatasvir
• Vincristine Sulfate Liposome
• Vortioxetine
• Voxilaprevir

Using dexamethasone with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Alcuronium
• Aminoglutethimide
• Aprepitant
• Aspirin
• Atracurium
• Auranofin
• Caspofungin
• Fluindione
• Fosaprepitant
• Fosnetupitant
• Fosphenytoin
• Gallamine
• Hexafluorenium
• Licorice
• Metocurine
• Netupitant
• Ospemifene
• Pancuronium
• Phenobarbital
• Phenytoin
• Rifampin
• Rifapentine
• Saiboku-To
• Vecuronium
• Warfarin

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of dexamethasone. Make sure you tell your doctor if you have any other medical problems, especially:

• Cataracts or
• Congestive heart failure or
• Cushing’s syndrome (adrenal gland problem) or
• Diabetes or
• Eye infection or
• Fluid retention or
• Glaucoma or
• Hyperglycemia (high blood sugar) or
• Hypertension (high blood pressure) or
• Infection (eg, bacterial, virus, fungus) or
• Mood changes, including depression or
• Myasthenia gravis (severe muscle weakness) or
• Osteoporosis (weak bones) or
• Peptic ulcer, active or history of or
• Personality changes or
• Stomach or intestinal problems (eg, diverticulitis, ulcerative colitis) or
• Tuberculosis, inactive—Use with caution. May make these conditions worse.
• Fungal infections or
• Herpes simplex eye infection—Should not be used in patients with these conditions.

Dexamethasone vs Prednisone

Prednisone and dexamethasone are both a synthetic, anti-inflammatory glucocorticoid that derives from cortisone. Like dexamethasone, prednisone reduces inflammation. Prednisone also damps down your immune system, which can help in autoimmune illnesses like rheumatoid arthritis, where your immune system mistakenly attacks its own tissues. Prednisone is biologically inert and converted to prednisolone in the liver ². Prednisone is an FDA-approved as an anti-inflammatory or immunosuppressive agent used to treat a wide range of health problems including immunosuppressive/endocrine, rheumatic, collagen, dermatologic, allergic states, ophthalmic, respiratory, blood disorders, skin diseases, infections, certain cancers, edematous, gastrointestinal (GI), acute exacerbations of multiple sclerosis, and as an anti-inflammatory and an antineoplastic agent and to prevent organ rejection after a transplant. Prednisone is a corticosteroid (cortisone-like medicine or steroid). Prednisone works on the immune system to help relieve swelling, redness, itching, and allergic reactions. Prednisone is available only with a doctor’s prescription ³.

Prednisone is available only on prescription as tablets and as a liquid to drink. It can also be given by injection but this is usually only done in hospital.

What is dexamethasone used for?

Dexamethasone has a wide variety of uses in the medical field. Dexamethasone provides relief for inflamed areas of the body. It is used to treat a number of different conditions, such as inflammation (swelling), severe allergies, adrenal problems, arthritis, asthma, blood or bone marrow problems, kidney problems, skin conditions, and flare-ups of multiple sclerosis. Dexamethasone is a corticosteroid (cortisone-like medicine or steroid). It works on the immune system to help relieve swelling, redness, itching, and allergic reactions. As a treatment, dexamethasone has been useful in the treatment of acute exacerbations of multiple sclerosis, allergies, cerebral edema, inflammation, and shock ⁴. Patients with conditions such as asthma, atopic and contact dermatitis, and drug hypersensitivity reactions have benefited from the use of dexamethasone ⁵.

In endocrinology, dexamethasone has been found useful as a test for Cushing syndrome ⁶. This test begins with a low dose test. There are 2 versions of this test: the standard two-day test and the overnight test. With the standard test, 0.5 mg oral dose of dexamethasone is given every 6 hours for 2 days. Six hours after the final dose is given serum cortisol levels are measured. The overnight test begins with a 1 mg oral dose of dexamethasone at 11:00 pm with a second 1 mg oral dose at midnight. The following morning, serum cortisol levels are tested between 8:00 am and 9:00 am. The test is read as a positive screening test for Cushing syndrome if the final cortisol reading is high, signaling that the more specific confirmative high dose dexamethasone suppression test should be ordered. The high dose dexamethasone suppression test has three forms: the standard 2-day test, the overnight test, and the intravenous (IV) test. With all 3 versions of the test, baseline serum cortisol levels need to be determined before commencing with the test. Baseline serum can be measured with a 24-hour urinary free cortisol test ⁷. The standard 2-day test uses 2 mg of oral dexamethasone given every 6 hours for 2 days. During the 2-day exam, urine is collected and tested for free cortisol and 6 hours after the final dose of dexamethasone; blood is drawn to measure the serum cortisol level. The overnight test begins with an 8 mg oral dose of dexamethasone at 11:00 pm. The following morning between 8:00 am, and 9:00 am, serum cortisol is measured. The IV test is the shortest of the test. One milligram of dexamethasone is given via continuous intravenous infusion per hour for 7 hours. Serum cortisol is measured at the end of 7 hours.

Off-label indications are as follows. Dexamethasone is used in the treatment of chemotherapy-induced nausea and vomiting. It is used in the prevention and treatment of altitude sickness. It has also been used in the treatment of spinal cord compression due to metastases in oncological cases ⁸.

Dexamethasone contraindications

Dexamethasone use is contraindicated if patients have systemic fungal infections, hypersensitivity to dexamethasone, or cerebral malaria. It is also contraindicated to administer live or live-attenuated vaccines during the use of dexamethasone as the immune system is being suppressed and will less like form a strong enough immune response placing the patient at risk. It is still okay to administer killed or inactivated vaccines although it should be noted that immune response may be attenuated and it is unpredictable if immunity with developing as a result ⁹.

In patients with cirrhosis, diverticulitis, myasthenia gravis, renal insufficiency, or ulcerative diseases such as peptic ulcer disease or ulcerative colitis, it is important to use caution when prescribing dexamethasone. It is also recommended to use dexamethasone with caution during pregnancy as there is an increased risk of oral cleft formations. It has been shown that large doses can increase blood pressure. In patients with recent myocardial infarction, it is advised to proceed with caution as an increase in free wall rupture of the left ventricle has been reported with use of dexamethasone. Suppression of the hypothalamus pituitary adrenal axis (HPA axis) occurs with use, and therefore rapid withdrawal of dexamethasone is not recommended. It is important to gradually increase and/or decrease any corticosteroid due to its effect on the hypothalamus pituitary adrenal axis.

Latent diseases such as fungal (Candida, Cryptococcus, Pneumocystis), parasitic (Toxoplasmosis, Amebiasis, Strongyloides), and bacterial (Mycobacterium, Nocardia) infections may become active due to suppression of the immune system ¹⁰.

Steroid use may inhibit bone formation and may lead to the formation of osteoporosis. Caution should be taken when prescribing dexamethasone to populations at higher risk for osteoporosis.

Dexamethasone dosage

Dexamethasone is available in various formulations. As a tablet, it is available in strengths ranging from 0.5 mg to 6 mg. Other forms of administration are as an injectable suspension or as an oral solution ¹¹.

• In the treatment of inflammation, it is advised to begin with low doses of 0.75 mg/day, which may be titrated to 9 mg/day, with dosing divided into 2 to 4 doses throughout the day. This applies to intravenous, intramuscular, and oral administrations. Less may be used when directly administered to the lesion or tissue with dosing ranging from 0.2 to 6 mg per day ¹².
• For the treatment of acute multiple sclerosis exacerbations, 30 mg oral daily doses taken for seven days is recommended followed by 1 month of 4 to 12 mg oral daily doses.
• As cerebral edema may be a life-threatening condition, aggressive treatment is necessary. It is recommended that 10 mg of intravenous dexamethasone be administered followed by 4 mg of intramuscular administration given every 6 hours. In this instance, it is necessary to titrate down over 7 days to discontinue dexamethasone therapy ¹³.
• In the treatment of circulatory shock, it is advised to administer 1 to 6 mg/kg of intravenous dexamethasone as a one-time bolus. This regiment may be substituted for 40 mg given intravenously every 2 to 6 hours as needed. Treatment with high dose dexamethasone is not recommended beyond 2 to 3 days.
• Allergic reactions have been shown to improve with a 6-day regiment beginning with 4 to 8 mg intramuscular injection on the first day. This is followed by oral doses on days 2 to 6 beginning with 1.5 mg every 12 hours for days 2 and 3, 0.75 mg every 12 hours for the third day, and finally 0.75 mg daily for days 5 and 6. The patient should appropriately be titrated down by day 7 with no dosing necessary on day 7.

Adult dose for Acute Mountain Sickness

Uses:

• For the prevention of Acute Mountain Sickness and High-Altitude Cerebral Edema (HACE).
• For the treatment of Acute Mountain Sickness and High-Altitude Cerebral Edema (HACE), and to treat concurrent High-Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE) when neurologic dysfunctions do not resolve rapidly with administration of supplemental oxygen.

Prevention of Acute Mountain Sickness and High-Altitude Cerebral Edema (HACE):

• Dose: 2 mg orally every 6 hours OR 4 mg orally every 12 hours
• Very High Risk Situations (e.g. military, search and rescue at altitudes greater than 3500 m): 4 mg orally every 6 hours
• Duration of Therapy: Should not exceed 10 days to prevent glucocorticoid toxicity or adrenal suppression

Treatment of Acute Mountain Sickness: 4 mg orally/IV/IM every 6 hours

Treatment of High-Altitude Cerebral Edema (HACE): 8 mg orally/IV/IM once; followed by 4 mg orally/IV/IM every 6 hours

Comments:

• Dosing based on Wilderness and Environmental Medicine guidance.
• This drug has shown benefit for the prevention of acute mountain sickness (AMS) and high altitude cerebral edema (HACE), however, the evidence for prevention of high altitude pulmonary edema (HAPE) is lacking; this drug should be used in conjunction with non-pharmacologic measures and only in situations when the risk profile is favorable.
• Treatment does not facilitate acclimation; further ascent should be delayed until the patient is asymptomatic while off the medication.

Adult dose for Cerebral Edema

Use: For the treatment of cerebral edema.

• Initial dose: 10 mg IV once, followed by 4 mg IM every 6 hours until maximal response is noted
• After 2 to 4 days, dose should be reduced and then gradually discontinued over a period of 5 to 7 days

Comments:

• After symptoms subside, may switch to oral therapy (1 to 3 mg orally 3 times a day) and then taper gradually over 5 to 7 days.
• In patients undergoing brain surgery, may continue treatment for several days postoperatively.
• In nonoperative cases, continuous therapy may be needed to remain symptom-free.

Adult dose for Testing for Cushing’s syndrome

Uses: Diagnostic testing for Cushing’s syndrome.

Dexamethasone Suppression Tests:

• Short suppression test: 1 mg orally at 11 PM; draw plasma cortisol at 8 AM the following morning
• Long suppression test: 0.5 mg orally every 6 hours for 48 hours; 24-hour urine collections are made before, during, and at the end of the test for determination of 17-hydroxycorticosteroids
• Test to distinguish Cushing’s syndrome: 2 mg orally every 6 hours for 48 hours; 24-hour urine collections are made before, during, and at the end of the test for determination of 17-hydroxycorticosteroids

Comment: The long suppression test provides greater accuracy in diagnosing Cushing’s syndrome.

Adult dose for Nausea/Vomiting – Chemotherapy Induced

Use: For prophylaxis and treatment of chemotherapy induced nausea and vomiting.

Highly emetogenic chemotherapy regimens:

• 12 to 20 mg oral/IV prior to chemotherapy followed by 8 mg oral/IV once or twice a day for 2 to 4 days

Moderately emetogenic chemotherapy regimens:

• 8 mg oral/IV prior to chemotherapy followed by 4 to 8 mg oral/IV on days 2 and 3

Low emetogenic chemotherapy regimens:

• 4 to 8 mg oral/IV prior to chemotherapy

Comments:

• This drug may be used alone but is most often used in combination with other agents, e.g. neurokinin 1 (NK1) antagonists and 5-hydroxytryptamine-3 (5-HT3) antagonists.
• When used in combination regimens, it is the combination of agents that defines the dose and duration of use for this drug; this is not a labeled indication.
• When receiving combination chemotherapy, the agent with the most emetic potential should determine the regimen of anti-emetic therapy that should be used.

Adult dose for Shock

Use: For the treatment of unresponsive shock.

Unresponsive shock:

• 1 to 6 mg/kg IV as a single dose or up to 40 mg initially followed by repeat IV doses every 2 to 6 hours while shock persists

Published protocols:

• 20 mg IV as a single dose followed by IV infusion of 3 mg/kg/24 hours
• 1 to 6 mg/kg IV as a single dose
• 40 mg IV as a single dose followed by repeat IV doses every 4 to 6 hours while shock persists

Comments:

• High-dose therapy should only be continued until patient’s condition has stabilized and usually no longer than 48 to 72 hours.

Adult dose for Multiple Myeloma

Use: For the treatment of multiple myeloma.

40 mg oral/IV on days 1, 8, 15, 22, and repeated every 4 weeks

Comments:

• This drug is a part of most major treatment regimens in multiple myeloma; treatment regimens should be consulted.
• In regimens containing bortezomib, the day 1 dexamethasone dose may be split to provide 20 mg on the day of and 20 mg on the day after bortezomib.
• Doses may need to be adjusted for performance status or other toxicities

Adult dose for Multiple Sclerosis

Use: For the treatment of acute exacerbations of multiple sclerosis.

Acute exacerbation: 30 mg orally once a day for 1 week followed by 4 to 8 mg orally every other day for 1 month

Comments:

• Short-term high-dose corticosteroids are an accepted standard of care for treating relapses of multiple sclerosis; chronic daily corticosteroids are not recommended.
• IV methylprednisolone, oral prednisone and prednisolone are the corticosteroids most studied and cited in clinical guidelines; while this drug has been used, efficacy studies and comparative data are lacking.

Adult dose for Anti-inflammatory

Uses: For use as a potent anti-inflammatory agent in managing disorders, diseases, and conditions affecting many organ systems including endocrine, dermatologic, ophthalmic, nervous. gastrointestinal, respiratory, musculoskeletal, and hematologic.

Dosing should be individualized on the basis of disease and patient response

Oral:

• Initial dose: 0.75 mg to 9 mg orally per day

Parenteral:

• Initial dose: 0.5 mg to 9 mg IV or IM per day in divided doses every 12 hours

Maintenance dose: After a favorable initial response, dose should be decreased in small amounts to the lowest dose that maintains an adequate clinical response; if a positive response is not achieved after a reasonable period of time, alternative therapy should be sought.

Comments:

• Lower doses, including doses lower than recommended doses, may suffice in less severe disease; doses in excess of recommended doses may be required in severe disease; in life-threatening situations, doses exceeding multiples of the oral dose may be justified.
• When oral therapy is not feasible IV or IM therapy in doses ranging from one-third to one-half the oral dose may be given every 12 hours.
• Patients should be closely monitored for signs requiring dose adjustments; if therapy is to be stopped after more than a few days, it should be gradually withdrawn.

Adult dose for Immunosuppression

Uses: For use as a potent anti-inflammatory agent in managing disorders, diseases, and conditions affecting many organ systems including endocrine, dermatologic, ophthalmic, nervous. gastrointestinal, respiratory, musculoskeletal, and hematologic.

Dosing should be individualized on the basis of disease and patient response

Oral:

• Initial dose: 0.75 mg to 9 mg orally per day

Parenteral:

• Initial dose: 0.5 mg to 9 mg IV or IM per day in divided doses every 12 hours

Maintenance dose: After a favorable initial response, dose should be decreased in small amounts to the lowest dose that maintains an adequate clinical response; if a positive response is not achieved after a reasonable period of time, alternative therapy should be sought.

Comments:

• Lower doses, including doses lower than recommended doses, may suffice in less severe disease; doses in excess of recommended doses may be required in severe disease; in life-threatening situations, doses exceeding multiples of the oral dose may be justified.
• When oral therapy is not feasible IV or IM therapy in doses ranging from one-third to one-half the oral dose may be given every 12 hours.
• Patients should be closely monitored for signs requiring dose adjustments; if therapy is to be stopped after more than a few days, it should be gradually withdrawn.

Adult dose for Brain/Intracranial Tumor

Use: For palliative management of recurrent or inoperable brain tumors.

• 2 mg oral/IV/IM 2 to 3 times a day

Adult dose for Allergic Reaction

Use: For the treatment of acute, self-limited allergic disorder or exacerbation of chronic allergic disorder.

• First day: 4 to 8 mg IM once
• Second and third day: 1.5 mg orally twice per day
• Fourth day: 0.75 mg orally twice per day
• Fifth and sixth day: 0.75 mg orally once a day
• Seventh day: No treatment
• Eighth day: Reassessment

Comments: This dosing schedule is designed to ensure adequate therapy during an acute episode while minimizing the risk of overdose in chronic cases.

Adult dose for Bursitis

Use: As adjunctive therapy for an acute episode or exacerbation of synovitis of osteoarthritis, rheumatoid arthritis, acute and subacute bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, and posttraumatic osteoarthritis.

Suggested doses:

• Large joints: 2 to 4 mg
• Small joints: 0.8 to 1 mg
• Bursae: 2 to 4 mg
• Tendon Sheaths: 0.4 to 1 mg

Injections may be repeated from once every 3 to 5 days to once every 2 to 3 weeks

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Intrasynovial and soft tissue injections should be limited to 1 or 2 sites; frequent intra-articular injections may cause damage to joint tissue.

Adult dose for Osteoarthritis

Use: As adjunctive therapy for an acute episode or exacerbation of synovitis of osteoarthritis, rheumatoid arthritis, acute and subacute bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, and posttraumatic osteoarthritis.

Suggested doses:

• Large joints: 2 to 4 mg
• Small joints: 0.8 to 1 mg
• Bursae: 2 to 4 mg
• Tendon Sheaths: 0.4 to 1 mg

Injections may be repeated from once every 3 to 5 days to once every 2 to 3 weeks

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Intrasynovial and soft tissue injections should be limited to 1 or 2 sites; frequent intra-articular injections may cause damage to joint tissue.

Adult dose for Rheumatoid Arthritis

Use: As adjunctive therapy for an acute episode or exacerbation of synovitis of osteoarthritis, rheumatoid arthritis, acute and subacute bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, and posttraumatic osteoarthritis.

Suggested doses:

• Large joints: 2 to 4 mg
• Small joints: 0.8 to 1 mg
• Bursae: 2 to 4 mg
• Tendon Sheaths: 0.4 to 1 mg

Injections may be repeated from once every 3 to 5 days to once every 2 to 3 weeks

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Intrasynovial and soft tissue injections should be limited to 1 or 2 sites; frequent intra-articular injections may cause damage to joint tissue.

Adult dose for Tendonitis

Use: As adjunctive therapy for an acute episode or exacerbation of synovitis of osteoarthritis, rheumatoid arthritis, acute and subacute bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, and posttraumatic osteoarthritis.

Suggested doses:

• Large joints: 2 to 4 mg
• Small joints: 0.8 to 1 mg
• Bursae: 2 to 4 mg
• Tendon Sheaths: 0.4 to 1 mg

Injections may be repeated from once every 3 to 5 days to once every 2 to 3 weeks

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Intrasynovial and soft tissue injections should be limited to 1 or 2 sites; frequent intra-articular injections may cause damage to joint tissue.

Adult dose for Gouty Arthritis

Use: As adjunctive therapy for an acute episode or exacerbation of synovitis of osteoarthritis, rheumatoid arthritis, acute and subacute bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, and posttraumatic osteoarthritis.

Suggested doses:

• Large joints: 2 to 4 mg
• Small joints: 0.8 to 1 mg
• Bursae: 2 to 4 mg
• Tendon Sheaths: 0.4 to 1 mg

Injections may be repeated from once every 3 to 5 days to once every 2 to 3 weeks

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Intrasynovial and soft tissue injections should be limited to 1 or 2 sites; frequent intra-articular injections may cause damage to joint tissue.

Adult dose for Epicondylitis

Use: As adjunctive therapy for an acute episode or exacerbation of synovitis of osteoarthritis, rheumatoid arthritis, acute and subacute bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, and posttraumatic osteoarthritis.

Suggested doses:

• Large joints: 2 to 4 mg
• Small joints: 0.8 to 1 mg
• Bursae: 2 to 4 mg
• Tendon Sheaths: 0.4 to 1 mg

Injections may be repeated from once every 3 to 5 days to once every 2 to 3 weeks

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Intrasynovial and soft tissue injections should be limited to 1 or 2 sites; frequent intra-articular injections may cause damage to joint tissue.

Adult dose for Alopecia

Uses: As adjunctive therapy for keloids; localized hypertrophic, infiltrated, inflammatory lesion of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis); discoid lupus erythematosus; necrobiosis lipoidica diabeticorum; alopecia areata. May be useful in cystic tumors of an aponeurosis tendon (ganglia).

Suggested doses:

• Soft tissue infiltration: 2 to 6 mg
• Ganglia: 1 to 2 mg

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Soft tissue and intralesional injections should be limited to 1 or 2 sites.

Adult dose for Lichen Simplex Chronicus

Uses: As adjunctive therapy for keloids; localized hypertrophic, infiltrated, inflammatory lesion of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis); discoid lupus erythematosus; necrobiosis lipoidica diabeticorum; alopecia areata. May be useful in cystic tumors of an aponeurosis tendon (ganglia).

Suggested doses:

• Soft tissue infiltration: 2 to 6 mg
• Ganglia: 1 to 2 mg

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Soft tissue and intralesional injections should be limited to 1 or 2 sites.

Adult dose for Psoriasis

Uses: As adjunctive therapy for keloids; localized hypertrophic, infiltrated, inflammatory lesion of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis); discoid lupus erythematosus; necrobiosis lipoidica diabeticorum; alopecia areata. May be useful in cystic tumors of an aponeurosis tendon (ganglia).

Suggested doses:

• Soft tissue infiltration: 2 to 6 mg
• Ganglia: 1 to 2 mg

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Soft tissue and intralesional injections should be limited to 1 or 2 sites.

Adult dose for Granuloma Annulare

Uses: As adjunctive therapy for keloids; localized hypertrophic, infiltrated, inflammatory lesion of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis); discoid lupus erythematosus; necrobiosis lipoidica diabeticorum; alopecia areata. May be useful in cystic tumors of an aponeurosis tendon (ganglia).

Suggested doses:

• Soft tissue infiltration: 2 to 6 mg
• Ganglia: 1 to 2 mg

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Soft tissue and intralesional injections should be limited to 1 or 2 sites.

Adult dose for Lichen Planus

Uses: As adjunctive therapy for keloids; localized hypertrophic, infiltrated, inflammatory lesion of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis); discoid lupus erythematosus; necrobiosis lipoidica diabeticorum; alopecia areata. May be useful in cystic tumors of an aponeurosis tendon (ganglia).

Suggested doses:

• Soft tissue infiltration: 2 to 6 mg
• Ganglia: 1 to 2 mg

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Soft tissue and intralesional injections should be limited to 1 or 2 sites.

Adult dose for Keloids

Uses: As adjunctive therapy for keloids; localized hypertrophic, infiltrated, inflammatory lesion of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis); discoid lupus erythematosus; necrobiosis lipoidica diabeticorum; alopecia areata. May be useful in cystic tumors of an aponeurosis tendon (ganglia).

Suggested doses:

• Soft tissue infiltration: 2 to 6 mg
• Ganglia: 1 to 2 mg

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Soft tissue and intralesional injections should be limited to 1 or 2 sites.

Adult dose for Idiopathic (Immune) Thrombocytopenic Purpura

Use: For the treatment of immune thrombocytopenia.

• 40 mg orally once a day for 4 days
• An additional 4-day course may be given if bleeding symptoms are present on day 7 or platelet count remains below 30 x10(9)/L

Comments:

• The American Society of Hematology (2011) has recommended a longer course of corticosteroids (e.g. prednisone for 21 days) over a shorter course (high-dose dexamethasone) due to longer time to loss of response, however, a recent prospective multicenter trial has shown 1 or 2 courses of high-dose dexamethasone are at least comparable to longer courses.

Pediatric dose for Cerebral Edema

Use: For the treatment of cerebral edema

• 0.2 mg/kg/24 hr oral/IV/IM in divided doses

Comments:

• The smallest effective dose should be used, preferably oral.

Pediatric dose for Meningitis

Use: To reduce hearing loss and neurological sequelae associated with meningitis.

Meningitis (H. influenzae type b):

• Infants and Children 6 weeks or older: 0.15 mg/kg/dose IV every 6 hours for the first 2 to 4 days of antibiotic treatment

Comments:

• Dexamethasone should be started 10 to 20 minutes before or with the first dose of antibiotic; if antibiotics have already been administered, dexamethasone use has not been shown to improve patient outcomes and is not recommended.
• This is not a labeled indication.
• This drug has not been shown to reduce overall mortality, but has been shown to reduce hearing loss and neurological sequelae.

Note: For pneumococcal meningitis, data has not shown clear benefit from dexamethasone administration; risk and benefits should be considered prior to use.

Pediatric dose for Anti-inflammatory

Uses: For use as a potent anti-inflammatory agent in managing disorders, diseases, and conditions affecting many organ systems including endocrine, dermatologic, ophthalmic, nervous. gastrointestinal, respiratory, musculoskeletal, and hematologic.

Dosing should be individualized on the basis of disease and patient response

Oral:

• Initial dose: 0.02 mg to 0.3 mg/kg/day OR 0.6 to 9 mg/m2/day orally in 3 or 4 divided doses
• Maintenance dose: After a favorable initial response, dose should be decreased in small amounts to the lowest dose that maintains an adequate clinical response; if a positive response is not achieved after a reasonable period of time, alternative therapy should be sought.

Comments:

• Lower doses, including doses lower than recommended doses may suffice in less severe disease, while doses in excess of recommended doses may be required in severe disease; in life-threatening situations, doses exceeding multiples of the oral dose may be justified.
• When oral therapy is not feasible IV or IM therapy in doses ranging from one-third to one-half the oral dose may be given every 12 hours.
• Patients should be observed closely for signs that require dose adjustments; if therapy is to be stopped after more than a few days, it should be gradually withdrawn.

Pediatric dose for Immunosuppression

Uses: For use as a potent anti-inflammatory agent in managing disorders, diseases, and conditions affecting many organ systems including endocrine, dermatologic, ophthalmic, nervous. gastrointestinal, respiratory, musculoskeletal, and hematologic.

Dosing should be individualized on the basis of disease and patient response

Oral:

• Initial dose: 0.02 mg to 0.3 mg/kg/day OR 0.6 to 9 mg/m2/day orally in 3 or 4 divided doses
• Maintenance dose: After a favorable initial response, dose should be decreased in small amounts to the lowest dose that maintains an adequate clinical response; if a positive response is not achieved after a reasonable period of time, alternative therapy should be sought.

Comments:

• Lower doses, including doses lower than recommended doses may suffice in less severe disease, while doses in excess of recommended doses may be required in severe disease; in life-threatening situations, doses exceeding multiples of the oral dose may be justified.
• When oral therapy is not feasible IV or IM therapy in doses ranging from one-third to one-half the oral dose may be given every 12 hours.
• Patients should be observed closely for signs that require dose adjustments; if therapy is to be stopped after more than a few days, it should be gradually withdrawn.

Pediatric dose for Nausea/Vomiting – Chemotherapy Induced

Use: For the prevention of nausea and vomiting associated with chemotherapy.

Highly Emetogenic Chemotherapy Regimens:

• 6 mg/m2 oral/IV every 6 hours

Moderately Emetogenic Chemotherapy Regimens:

• BSA 0.6 m² or less: 2 mg IV/oral every 12 hours
• BSA greater than 0.6 m²: 4 mg IV/oral every 12 hours

Comments:

• The addition of dexamethasone to anti-emetic regimens improves control of vomiting, although the risk-benefit remains uncertain.
• For regimens containing aprepitant, the dose of dexamethasone should be reduced by one-half.
• This is not a labeled indication, but recommended in many anti-emetic protocols.

Pediatric dose for Asthma – Acute

Use: For the treatment of acute asthma exacerbation.

• 0.6 mg/kg oral/IV/IM once

Comments:

• Studies have shown dexamethasone in single doses (0.3 mg/kg up to 1.7 mg/kg; maximum single dose 36 mg) or multiple doses (0.6 mg/kg once a day for 2 days) is comparable to a 5-day course of prednisone/prednisolone in the treatment of acute asthma exacerbations.

Pediatric dose for Croup

Use: For the treatment of childhood croup (laryngotracheobronchitis).

• 0.6 mg/kg oral/IM/ IV once
• Maximum dose: 16 mg

Comment: Further dosing and route of administration determined by clinical course

Pediatric dose for Acute Mountain Sickness

Use: For the treatment of acute mountain sickness.

• 0.15 mg/kg oral/IV/IM every 6 hours

Comments:

• Dosing based on Wilderness and Environmental Medicine guidance.
• Prophylactic use of this drug for acute mountain sickness (AMS) is not recommended in pediatric patients due to the potential for toxicity; safer alternatives such as graded ascent and acetazolamide should be considered.
• Treatment does not facilitate acclimation; further ascent should be delayed until the patient is asymptomatic while off the medication.

Pediatric dose for Idiopathic (Immune) Thrombocytopenic Purpura

Use: For the treatment of immune thrombocytopenia.

• 0.6 mg/kg/day oral/IV for 4 days every 4 weeks for 6 cycles

Comments:

• High-dose dexamethasone may be considered appropriate second-line treatment in those who have significant bleeding despite IVIg, anti-D, or a short course of corticosteroids.
• Additionally, it may be considered in patients with chronic immune thrombocytopenia as an alternative to splenectomy or in patients who do not response to splenectomy.
• There is limited data on use of this drug in the pediatric population; the above dose is from a study in a small number of patients.

Renal Dose Adjustments

• No dose adjustment recommended

Liver Dose Adjustments

• Use with caution

What should I do if I forget a dose?

When you start to take dexamethasone, ask your doctor what to do if you forget a dose. Write down these instructions so that you can refer to them later.

If you take dexamethasone once a day, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Dexamethasone side effects

Most frequent dexamethasone side effect reported by patients is the presence of insomnia after use. Some other frequent adverse effects reported by patients include acne, indigestion, weight gain, increased appetite, anorexia, nausea, vomiting, acne, agitation, and depression. There have been reports of adrenal suppression, arrhythmias, spermatogenic changes, glaucoma, hypokalemia, pulmonary edema, pseudotumor cerebri, and increased intracranial pressure ¹⁴.

Dexamethasone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• upset stomach
• stomach irritation
• vomiting
• headache
• dizziness
• insomnia
• restlessness
• depression
• anxiety
• acne
• increased hair growth
• easy bruising
• irregular or absent menstrual periods

If you experience any of the following symptoms, call your doctor immediately:

• skin rash
• swollen face, lower legs, or ankles
• vision problems
• cold or infection that lasts a long time
• muscle weakness
• black or tarry stool

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