Dexamethasone Dosage

Usual Adult Dose for Acute Mountain Sickness

Oral, IV and IM (injections as sodium phosphate):
0.75 to 9 mg per day in divided doses every 6 to 12 hours
IM (as acetate):
8 to 16 mg, may repeat in 1 to 3 weeks
Intralesional (as acetate):
0.8 to 1.6 mg
Intraarticular and soft tissue as acetate):
4 to 16 mg, may repeat in 1 to 3 weeks
Intraarticular, intralesional, or soft tissue (as sodium phosphate):
0.4 to 6 mg per day

Usual Adult Dose for Asthma - Acute

Oral, IV and IM (injections as sodium phosphate):
0.75 to 9 mg per day in divided doses every 6 to 12 hours
IM (as acetate):
8 to 16 mg, may repeat in 1 to 3 weeks
Intralesional (as acetate):
0.8 to 1.6 mg
Intraarticular and soft tissue as acetate):
4 to 16 mg, may repeat in 1 to 3 weeks
Intraarticular, intralesional, or soft tissue (as sodium phosphate):
0.4 to 6 mg per day

Usual Adult Dose for Croup

Oral, IV and IM (injections as sodium phosphate):
0.75 to 9 mg per day in divided doses every 6 to 12 hours
IM (as acetate):
8 to 16 mg, may repeat in 1 to 3 weeks
Intralesional (as acetate):
0.8 to 1.6 mg
Intraarticular and soft tissue as acetate):
4 to 16 mg, may repeat in 1 to 3 weeks
Intraarticular, intralesional, or soft tissue (as sodium phosphate):
0.4 to 6 mg per day

Usual Adult Dose for Anti-inflammatory

Oral, IV and IM (injections as sodium phosphate):
0.75 to 9 mg per day in divided doses every 6 to 12 hours
IM (as acetate):
8 to 16 mg, may repeat in 1 to 3 weeks
Intralesional (as acetate):
0.8 to 1.6 mg
Intraarticular and soft tissue as acetate):
4 to 16 mg, may repeat in 1 to 3 weeks
Intraarticular, intralesional, or soft tissue (as sodium phosphate):
0.4 to 6 mg per day

Usual Adult Dose for Cerebral Edema

Initial 10 mg IV once, followed by 4 mg IM every 6 hours until symptoms of cerebral edema subside. Dosage may be reduced after 2 to 4 days, and discontinued slowly over a period of 5 to 7 days.

Usual Adult Dose for Cushing's Syndrome

Suppression test or diagnosis for Cushing's syndrome:
1 mg orally at 11 p.m. Blood plasma cortisol measurement at 8 a.m. the next morning.
or
0.5 mg by mouth every 6 hours for 48 hours (with 24 hour urine collection for 17 hydroxycorticosteroid excretion).

Differentiation of Cushing's syndrome due to ACTH excess from Cushing's due to other causes: Oral: Dexamethasone 2 mg every 6 hours for 48 hours (with 24 hour urine collection for 17 hydroxycorticosteroid excretion).

Usual Adult Dose for Nausea/Vomiting - Chemotherapy Induced

Prophylaxis:
10 mg to 20 mg orally or IV, 15 to 30 minutes before treatment on each treatment day
For continuous infusion of chemotherapy:
10 mg orally or IV every 12 hours on each treatment day.
For mildly emetogenic therapy: 4 mg oral, IV or IM every 4 to 6 hours.
Delayed nausea and vomiting:
8 mg orally every 12 hours for 2 days; then 4 mg every 12 hours for 2 days.
or
20 mg orally 1 hour before chemotherapy; then 10 mg orally 12 hours after chemotherapy; then 8 mg orally every 12 hours for 4 doses; then 4 mg orally every 12 hours for 4 doses.

Usual Adult Dose for Shock

Addisonian crisis/shock:
4 to 10 mg IV as single dose, repeat if necessary.

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

Usual Adult Dose for Multiple Myeloma

Multiple myeloma: Oral, IV: 40 mg/day, days 1 to 4, 9 to 12, and 17 to 20, repeated every 4 weeks (alone or as part of a regimen).

Usual Adult Dose for Multiple Sclerosis

Multiple sclerosis (acute exacerbation): Oral: 30 mg/day for 1 week, followed by 4 to 12 mg/day for 1 month.

Usual Adult Dose for Adrenal Insufficiency

Physiological replacement: Oral, IM, IV (should be given as sodium phosphate): 0.03 to 0.15 mg/kg/day or 0.6 to 0.75 mg/m2/day in divided doses every 6 to 12 hours.

Usual Pediatric Dose for Cerebral Edema

Initial loading dose: 1 to 2 mg/kg once orally, IV or IM.
Maintenance: 1 to 1.5 mg /kg/day, give in divided doses every 4 to 6 hours for 5 days then taper for 5 days, then discontinue. Maximum dose: 16 mg/day.

Usual Pediatric Dose for Meningitis - Meningococcal

(Not approved by FDA):

Meningitis (H. influenzae type b): Infants and Children 6 weeks or older: IV: 0.15 mg/kg/dose every 6 hours for the first 2 to 4 days of antibiotic treatment; start dexamethasone 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 outcome and is not recommended. Note: For pneumococcal meningitis, data has not shown clear benefit from dexamethasone administration; risk and benefits should be considered prior to use.

Usual Pediatric Dose for Meningitis - Haemophilus influenzae

(Not approved by FDA):

Meningitis (H. influenzae type b): Infants and Children 6 weeks or older: IV: 0.15 mg/kg/dose every 6 hours for the first 2 to 4 days of antibiotic treatment; start dexamethasone 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 outcome and is not recommended. Note: For pneumococcal meningitis, data has not shown clear benefit from dexamethasone administration; risk and benefits should be considered prior to use.

Usual Pediatric Dose for Meningitis - Pneumococcal

(Not approved by FDA):

Meningitis (H. influenzae type b): Infants and Children 6 weeks or older: IV: 0.15 mg/kg/dose every 6 hours for the first 2 to 4 days of antibiotic treatment; start dexamethasone 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 outcome and is not recommended. Note: For pneumococcal meningitis, data has not shown clear benefit from dexamethasone administration; risk and benefits should be considered prior to use.

Usual Pediatric Dose for Meningitis - Listeriosis

(Not approved by FDA):

Meningitis (H. influenzae type b): Infants and Children 6 weeks or older: IV: 0.15 mg/kg/dose every 6 hours for the first 2 to 4 days of antibiotic treatment; start dexamethasone 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 outcome and is not recommended. Note: For pneumococcal meningitis, data has not shown clear benefit from dexamethasone administration; risk and benefits should be considered prior to use.

Usual Pediatric Dose for Anti-inflammatory

0.08 to 0.3 mg/kg/day or 2.5 to 5 mg/m2/day in divided doses every 6 to 12 hours.

Usual Pediatric Dose for Nausea/Vomiting - Chemotherapy Induced

(Not approved by FDA):

Prior to chemotherapy:
10 mg/meter squared IV for first dose (maximum 20 mg) then 5 mg/meter squared/dose every 6 hours as needed.

Usual Pediatric Dose for Asthma - Acute

Asthma exacerbation: Oral, IM, IV: 0.6 mg/kg once (maximum dose: 16 mg)

Usual Pediatric Dose for Croup

(Not approved by FDA):

Croup (laryngotracheobronchitis): Oral, IM, IV: 0.6 mg/kg once (maximum: 20 mg). A single dose of 0.15 mg/kg has also been shown effective.

Usual Pediatric Dose for Adrenal Insufficiency

Physiological replacement: Oral, IM, IV (should be given as sodium phosphate): 0.03 to 0.15 mg/kg/day or 0.6 to 0.75 mg/m2/day in divided doses every 6 to 12 hours.

Usual Pediatric Dose for Acute Mountain Sickness

(Not approved by FDA):
Acute mountain sickness (AMS)/high altitude cerebral edema (HACE); treatment: Oral, IM, IV: 0.15 mg/kg/dose every 6 hours; consider using for high altitude pulmonary edema because of associated HACE with this condition.

Usual Pediatric Dose for Bronchopulmonary Dysplasia

(Not approved by FDA):
Bronchopulmonary dysplasia, facilitation of ventilator wean: postnatal age =7 days: Oral, IV: Initial: 0.15 mg/kg/day given in divided doses every 12 hours for 3 days, then tapered every 3 days over 7 days; total dexamethasone dose: 0.89 mg/kg given over 10 days; others have used 0.2 mg/kg/day given once daily and tapered every 3 days over 7 days (total dexamethasone dose: 1 mg/kg) ( or tapered over 14 days (total dexamethasone dose: 1.9 mg/kg). Note: High doses (0.5 mg/kg/day) do not confer additional benefit over lower doses, are associated with higher incidence of adverse effects (including adverse neurodevelopmental outcomes), and are not recommended for use. However, a meta-analysis reported total cumulative doses greater than 4 mg/kg reduced the relative risk for the combined outcome, mortality, or bronchopulmonary dysplasia; further studies are needed.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dialysis

Supplemental dose is not necessary.