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dexamethasone

Pronunciation

Generic Name: dexamethasone (oral) (dex a METH a sone)
Brand Name: Baycadron, Dexamethasone Intensol, DexPak 10 Day Taperpak, DexPak 13 DayTaperpak, DexPak 6 DayTaperpak

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, or breathing 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 medicine if you have a fungal infection anywhere in your body.

Tell your doctor about all your medical conditions, and all the medicines you are using. There are many other diseases that can be affected by steroid use, and many other medicines that can interact with steroids.

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

You should not use dexamethasone if you are allergic to it, 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 taking 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:

  • liver disease (such as cirrhosis);

  • kidney disease;

  • a thyroid disorder;

  • a history of malaria;

  • tuberculosis;

  • osteoporosis;

  • a muscle disorder such as myasthenia gravis;

  • glaucoma or cataracts;

  • herpes infection of the eyes;

  • stomach ulcers, ulcerative colitis, diverticulitis, inflammatory bowel disease;

  • depression or mental illness;

  • congestive heart failure; or

  • high blood pressure.

Also tell your doctor if you have diabetes. Steroid medicines may increase the glucose (sugar) levels in your blood or urine. You may also need to adjust the dose of your diabetes medications.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Dexamethasone can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Steroids can affect growth in children. Tell your doctor if your child is not growing at a normal rate while using this medicine.

How should I take dexamethasone?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Your dose needs may change if you have 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.

Do not stop using dexamethasone suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.

Wear a medical alert tag or carry an ID card stating that you take dexamethasone. Any medical care provider who treats you should know that you are using steroid medication.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of dexamethasone.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

An overdose of dexamethasone is not expected to produce life threatening symptoms. However, long term use of high steroid doses can lead to symptoms such as thinning skin, easy bruising, changes in the shape or location of body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while taking 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 steroid medication.

Do not receive a "live" vaccine while using dexamethasone. The vaccine may not work as well during this time, and may not fully protect you from disease. Live vaccines include measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

Avoid drinking alcohol while you are taking dexamethasone.

Dexamethasone side effects

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

Call your doctor at once if you have:

  • muscle tightness, weakness, or limp feeling;

  • problems with your vision;

  • shortness of breath (even with mild exertion), swelling, rapid weight gain;

  • severe depression, unusual thoughts or behavior;

  • a seizure (convulsions);

  • bloody or tarry stools, coughing up blood;

  • lower back pain, blood in your urine, little or no urination;

  • confusion, numbness or tingly feeling around your mouth;

  • fast or slow heart rate, weak pulse;

  • a pancreas disorder--severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate;

  • low potassium--leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling; or

  • dangerously high blood pressure--severe headache, blurred vision, pounding in your neck or ears, nosebleed, anxiety.

Common side effects may include:

  • fluid retention (swelling in your hands or ankles);

  • sleep problems (insomnia), mood changes;

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

  • slow wound healing;

  • increased sweating, increased hair growth;

  • headache, dizziness, spinning sensation;

  • nausea, stomach pain, bloating;

  • muscle weakness; 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.

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. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using, especially:

  • aspirin (taken on a daily basis or at high doses);

  • cyclosporine;

  • digoxin;

  • an antibiotic such as erythromycin or rifampin;

  • antifungal medicine such as ketoconazole;

  • birth control pills or hormone replacement therapy;

  • a blood thinner such as warfarin (Coumadin, Jantoven);

  • a diuretic (water pill);

  • glaucoma medication;

  • insulin or diabetes medications you take by mouth;

  • medicine to treat dementia or Parkinson's disease;

  • an NSAID (nonsteroidal anti-inflammatory drug) such as ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, meloxicam, and others; or

  • seizure medications such as carbamazepine, phenytoin, or phenobarbital.

This list is not complete and many other drugs can interact with dexamethasone. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

See also: Side effects (in more detail)

Where can I get more information?

  • Your 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: 6.02.

Date modified: August 01, 2017
Last reviewed: December 19, 2016

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