Decadron, Dexamethasone Intensol, Maxidex, Mymethasone
DEXAMETHASONE SODIUM PHOSPHATE
Decadron Phosphate, Maxidex Ophthalmic
Classifications: hormone; adrenal corticosteroid; glucocorticoid; Therapeutic:adrenal corticosteroid
Pregnancy Category: C
Dexamethasone: 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg tablets; 0.5 mg/5 mL, 0.5 mg/0.5 mg oral solution; 0.01%, 0.04% topical aerosol; Dexamethasone sodium phosphate: 4 mg/mL, 10 mg/mL, 20 mg/mL, 24 mg/mL injection; 0.1% cream; 0.1% ophthalmic solution, suspension; 0.05% ophthalmic ointment
Long-acting synthetic adrenocorticoid with intense antiinflammatory (glucocorticoid) activity and minimal mineralocorticoid
activity. Antiinflammatory action: Prevents accumulation of inflammatory cells at sites of infection; inhibits phagocytosis, lysosomal enzyme release, and
synthesis of potent mediators of inflammation, prostaglandins, and leukotrienes; reduces capillary dilation and permeability. Immunosuppression: Not clearly understood, but may be due to prevention or suppression of delayed hypersensitivity immune reaction.
Has antiinflammatory and immunosuppression properties.
Adrenal insufficiency concomitantly with a mineralocorticoid; inflammatory conditions, allergic states, collagen diseases,
hematologic disorders, cerebral edema, and addisonian shock. Also palliative treatment of neoplastic disease, as adjunctive
short-term therapy in acute rheumatic disorders and GI diseases, and as a diagnostic test for Cushing's syndrome and for
differential diagnosis of adrenal hyperplasia and adrenal adenoma.
As an antiemetic in cancer chemotherapy; as a diagnostic test for endogenous depression; and to prevent hyaline membrane
disease in premature infants.
Systemic fungal infection, acute infections, active or resting tuberculosis, vaccinia, varicella, administration of live
virus vaccines (to patient, family members), latent or active amebiasis; Cushing's syndrome; neonates or infants <1300 g;
pregnancy (category C), lactation. Topical use: Rosacea, perioral dermatitis; venous statis ulcers. Ophthalmic use: Primary open-angle glaucoma, eye infections, superficial ocular herpes simplex, keratitis, and tuberculosis of eye.
Stromal herpes simplex, keratitis, GI ulceration, renal disease, diabetes mellitus, hypothyroidism, myasthenia gravis, CHF,
cirrhosis, psychic disorders, seizures; children; coagulopathy.
Route & Dosage
|Allergies, Inflammation, Neoplasias
Adult: PO 0.254 mg b.i.d. to q.i.d. IM 816 mg q13wk or 0.81.6 mg intralesional q13wk IV 0.750.9 mg/kg/d divided q612h
Child: PO/IV/IM 0.080.3 mg/kg/d divided q612h
Adult: IV 10 mg followed by 4 mg q6h, reduce dose after 24 d then taper over 57 d
Child: PO/IV/IM 12 mg/kg loading dose, then 11.5 mg/kg/d divided q46h x 5 d (max: 16 mg/d)
Adult: IV 16 mg/kg as a single dose or 40 mg repeated q26h if needed or 20 mg bolus then 3 mg/kg/d
Dexamethasone Suppression Test
Adult: PO 0.5 mg q6h for 48 h
Adult/Child: Ophthalmic/Topical/Inhalation/Intranasal See Appendix A.
- Give the once-daily dose in the a.m. with food or liquid of patient's choice.
- Taper dosage over a period of time before discontinuing because adrenal suppression can occur with prolonged use.
- Do not store or expose aerosol to temperature above 48.9° C (120° F); do not puncture or discard into a fire or
- Give IM injection deep into a large muscle mass (e.g., gluteus maximus). Avoid SC injection: Atrophy and sterile abscesses
- Use repository form, dexamethasone acetate, for IM or local injection only. The white suspension settles on standing; mild
shaking will resuspend drug.
PREPARE: Direct: Give undiluted. Intermittent: Dilute in D5W or NS for infusion.
ADMINISTER: Direct: Give direct IV push over 30 sec or less. Intermittent: Set rate as prescribed or according to amount of solution to infuse.
INCOMPATIBILITIES Solution/additive: Daunorubicin, diphenhydramine, doxorubicin, doxapram, glycopyrrolate, metaraminol, phenobarbital, vancomycin. Y-site: Ciprofloxacin, fenoldopam, idarubicin, midazolam, topotecan.
- Store at 15°30° C (59°86° F) unless otherwise directed.
Adverse Effects (≥1%)Aerosol Therapy: Nasal irritation,
dryness, epistaxis, rebound congestion, bronchial asthma
, anosmia, perforation of nasal septum. Systemic AbsorptionCNS:
, convulsions, increased ICP, vertigo, headache, psychic disturbances. CV:
CHF, hypertension, edema. Endocrine:
Menstrual irregularities, hyperglycemia;
cushingoid state; growth suppression in children; hirsutism. Special Senses: Posterior subcapsular cataract,
increased IOP, glaucoma
, exophthalmos. GI:
Peptic ulcer with possible perforation, abdominal distension, nausea, increased appetite, heartburn, dyspepsia, pancreatitis,
bowel perforation, oral candidiasis. Musculoskeletal:
Muscle weakness, loss of muscle mass, vertebral compression fracture,
pathologic fracture of long bones, tendon rupture. Skin: Acne
, impaired wound healing,
petechiae, ecchymoses, diaphoresis, allergic dermatitis, hypo- or hyperpigmentation, SC and cutaneous atrophy, burning
and tingling in perineal area (following IV injection).
Diagnostic Test Interference
Dexamethasone suppression test for endogenous depression: false-positive results may be caused by alcohol, glutethimide, meprobamate; false-negative results may be caused by high doses of benzodiazepines (e.g., chlordiazepoxide and cyproheptadine), long-term glucocorticoid treatment, indomethacin, ephedrine, estrogens or hepatic enzyme-inducing agents (phenytoin) may also cause false-positive results in test for Cushing's syndrome.
, phenytoin, rifampin
increase steroid metabolismdosage of dexamethasone may need to be increased; amphotericin B, diuretics
compound potassium loss; ambenonium, neostigmine, pyridostigmine
may cause severe muscle weakness in patients with myasthenia gravis; may inhibit antibody response to vaccines
Readily from GI tract. Onset:
12 h PO; 8 h IM. Duration:
2.75 d PO; 6 d IM; 13 wk intralesional, intraarticular. Distribution:
Crosses placenta; distributed into breast milk. Elimination:
Hypothalamus-pituitary axis suppression: 3654 h. Half-Life:
Assessment & Drug Effects
- Monitor and report S&S of Cushing's syndrome (see Appendix F) or other systemic adverse effects.
- Monitor neonates born to a mother who has been receiving a corticosteroid during pregnancy for symptoms of hypoadrenocorticism.
- Monitor for S&S of a hypersensitivity reaction (see Appendix F). The acetate and sodium phosphate formulations may contain
bisulfites, parabens, or both; these inactive ingredients are allergenic to some individuals.
Patient & Family Education
- Take drug exactly as prescribed.
- Report lack of response to medication or malaise, orthostatic hypotension, muscular weakness and pain, nausea, vomiting,
anorexia, hypoglycemic reactions (see Appendix F), or mental depression to physician. These symptoms may signal hypoadrenocorticism.
- Report changes in appearance and easy bruising to physician. These symptoms may signal hyperadrenocorticism.
- Note: Hiccups that occur for several hours following each dose may be a complication of high-dose oral dexamethasone.
- Keep appointments for checkups; make sure electrolytes and BP are evaluated during therapy at regular intervals.
- Add potassium-rich foods to diet; report signs of hypokalemia (see Appendix F). Concomitant potassium-depleting diuretic
can enhance dexamethasone-induced potassium loss.
- Note: Dexamethasone dose regimen may need to be altered during stress (e.g., surgery, infections, emotional stress, illness, acute
bronchial attacks, trauma). Consult physician if change in living or working environment is anticipated.
- Discontinue drug gradually under the guidance of the physician.
- Note: It is important to prevent exposure to infection, trauma, and sudden changes in environmental factors, as much as possible,
because drug is an immunosuppressor.