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dexamethasone (injection)

Generic Name: dexamethasone (injection) (DEX a METH a sone)
Brand Name: De-Sone LA, Dexacen-4, Dexasone, Dexasone LA, Solurex, Solurex LA

What is dexamethasone?

Dexamethasone is a steroid that prevents the release of substances in the body that cause inflammation.

Dexamethasone is used to treat many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, breathing disorders, inflammatory eye conditions, blood cell disorders, leukemia, or endocrine disorders.

Dexamethasone may also be used for purposes not listed in this medication guide.

What is the most important information I should know about dexamethasone?

You should not use this medication if you have a fungal infection anywhere in your body.

What should I discuss with my healthcare provider before using dexamethasone?

You should not use this medication if you are allergic to dexamethasone or sulfites, or if you have a fungal infection anywhere in your body.

Steroid medication can weaken your immune system, making it easier for you to get an infection. Steroids can also worsen an infection you already have, or reactivate an infection you recently had. Before using this medication, tell your doctor about any illness or infection you have had within the past several weeks.

To make sure dexamethasone is safe for you, tell your doctor if you have:

  • tuberculosis;

  • cirrhosis or other liver disease;

  • kidney disease;

  • a thyroid disorder;

  • a history of malaria;

  • osteoporosis;

  • a muscle disorder such as myasthenia gravis;

  • glaucoma or cataracts;

  • herpes infection of the eyes;

  • stomach ulcers, ulcerative colitis, or diverticulitis;

  • depression or mental illness;

  • congestive heart failure;

  • high blood pressure; or

  • if you have recently had a heart attack.

FDA pregnancy category C. It is not known whether dexamethasone will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

Dexamethasone can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

Steroids can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using this medication.

How is dexamethasone injection given?

Dexamethasone is often injected into a muscle or into a vein through an IV. A healthcare provider will give you this injection. Dexamethasone injection is usually given for only a few days.

Your dosage needs may change if you have any unusual stress such as a serious illness, fever or infection, or if you have surgery or a medical emergency. Tell your doctor about any such situation that affects you.

This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using dexamethasone.

After your treatment ends, you may have withdrawal symptoms such as fever, weakness, and joint or muscle pain. You should not stop using dexamethasone suddenly.

What happens if I miss a dose?

Because you will receive dexamethasone in a clinical setting, you are not likely to miss a dose.

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid after receiving dexamethasone?

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using a steroid.

Do not receive a "live" vaccine while using dexamethasone. Steroids may increase your risk of harmful effects from a live vaccine. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

Dexamethasone side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Tell your doctor at once if you have:

  • problems with your vision;

  • swelling, rapid weight gain, feeling short of breath;

  • severe depression, unusual thoughts or behavior, seizure (convulsions);

  • bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

  • pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate);

  • low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or

  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Common side effects may include:

  • sleep problems (insomnia), mood changes;

  • acne, dry skin, thinning skin, bruising or discoloration;

  • slow wound healing;

  • increased sweating;

  • headache, dizziness, spinning sensation;

  • bloating; or

  • changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Side Effects (complete list)

Dexamethasone dosing information

Usual Adult Dose for Acute Mountain Sickness:

Prevention of AMS and HACE:
Usual 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 AMS: 4 mg orally/IV/IM every 6 hours

Treatment of 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.

Uses:
-For the prevention of AMS and HACE.
-For the treatment of AMS and HACE, and to treat concurrent HACE and HAPE when neurologic dysfunctions do not resolve rapidly with administration of supplemental oxygen.

Usual Adult Dose for 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.

Use: For the treatment of cerebral edema.

Usual Adult Dose 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.

Uses: Diagnostic testing for Cushing's syndrome.

Usual Adult Dose for Nausea/Vomiting -- Chemotherapy Induced:

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.

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

Usual Adult Dose for 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.

Use: For the treatment of unresponsive shock.

Usual Adult Dose for 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

Use: For the treatment of multiple myeloma.

Usual Adult Dose for 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.

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

Usual Adult Dose for Anti-inflammatory:

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.

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.

Usual Adult Dose for Immunosuppression:

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.

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.

Usual Adult Dose for Brain/Intracranial Tumor:

2 mg oral/IV/IM 2 to 3 times a day

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

Usual Adult Dose for Allergic Reaction:

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.

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

Usual Adult Dose for Bursitis:

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.

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.

Usual Adult Dose for 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.

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.

Usual Adult Dose for Rheumatoid Arthritis:

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.

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.

Usual Adult Dose for Tendonitis:

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.

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.

Usual Adult Dose for Gouty Arthritis:

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.

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.

Usual Adult Dose for Epicondylitis:

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.

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.

Usual Adult Dose for Alopecia:

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.

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).

Usual Adult Dose for Lichen Simplex Chronicus:

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.

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).

Usual Adult Dose for Psoriasis:

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.

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).

Usual Adult Dose for Granuloma Annulare:

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.

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).

Usual Adult Dose for Lichen Planus:

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.

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).

Usual Adult Dose for Keloids:

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.

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).

Usual Adult Dose for Idiopathic (Immune) Thrombocytopenic Purpura:

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.

Use: For the treatment of immune thrombocytopenia.

Usual Pediatric Dose for Cerebral Edema:

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

Comments:
-The smallest effective dose should be used, preferably oral.

Use: For the treatment of cerebral edema

Usual Pediatric Dose for 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.

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

Usual Pediatric Dose for Anti-inflammatory:

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.

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.

Usual Pediatric Dose for Immunosuppression:

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.

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.

Usual Pediatric Dose for Nausea/Vomiting -- Chemotherapy Induced:

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.

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

Usual Pediatric Dose for Asthma -- Acute:

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.

Use: For the treatment of acute asthma exacerbation.

Usual Pediatric Dose for Croup:

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

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

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

Usual Pediatric Dose for 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.

Use: For the treatment of acute mountain sickness.

Usual Pediatric Dose for Idiopathic (Immune) Thrombocytopenic Purpura:

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.

Use: For the treatment of immune thrombocytopenia.

What other drugs will affect dexamethasone?

Many drugs can interact with dexamethasone. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with dexamethasone. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about dexamethasone.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.03.

Date modified: November 15, 2017
Last reviewed: November 19, 2013

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