Dexamethasone


Full Generic Medicine Info
Dosage/Direction for Use

Oral
Anti-inflammatory or immunosuppressive
Adult: Initially, 0.5-9 mg daily in divided doses. Max: 1.5 mg daily. Dosage is individualised and adjusted depending on the disease being treated and patient response. Refer to detailed product guideline.
Child: Initially, 0.02-0.3 mg/kg daily in 3-4 divided doses. Dose depends on disease severity and patient response. Refer to detailed product guideline.

Oral
As a screening test for Cushing's syndrome
Adult: 2 mg at 11 pm, followed by a blood test for plasma cortisol at 8 am the following morning. Alternatively, 500 mcg 6 hourly for 48 hours, then measure plasma cortisol at 8 am on the 3rd morning (with 24-hour urine collections for determination of 17-hydroxycorticosteroid excretion).

Oral
Acute exacerbations in multiple sclerosis
Adult: Initially, 30 mg daily for 1 week followed by 4-12 mg every other day for 1 month.

Oral
As a diagnostic test in differentiating pituitary and ectopic production of ACTH in patients with ACTH-dependent Cushing's syndrome
Adult: 2 mg 6 hourly for 48 hours then measure plasma cortisol at 8 am on the morning following the last dose (with 24-hour urine collections for determination of 17-hydroxycorticosteroid excretion).

Intra-articular
Inflammatory joint diseases
Adult: 333 mcg to 5 mg depending on the degree of inflammation and the size and location of the joint. For soft tissues: 2-6 mg. All doses are repeated once every 3-5 days for bursae to once every 2-3 weeks for joints. Refer to detailed product guideline.
Child: 167-333 mcg/kg daily.

Parenteral
Anti-inflammatory or immunosuppressive
Adult: Initially, 0.4-20 mg daily given via IV/IM inj depending on the condition being treated, may be maintained or adjusted until satisfactory response is achieved.
Child: 167-333 mcg/kg daily.

Intravenous
Shock
Adult: 1.67-5 mg/kg slowly over several minutes, may be repeated within 2-6 hours until condition is stable and usually for up to 72 hours. Alternatively, initial dose may be followed by continuous infusion of 2.5 mg/kg per 24 hours.
Child: 167-333 mcg/kg daily.

Parenteral
Cerebral oedema caused by malignancy
Adult: Initially, 8.3 mg via IV followed by 3.3 mg via IM 6 hourly until symptoms subside, dose may be reduced after 2-4 days and gradually stopped over 5-7 days. Recurrent or inoperable neoplasms: Maintenance: 1.7 mg given via IV/IM inj bid or tid.
Child: 167-333 mcg/kg daily.

Ophthalmic
Inflammatory eye disorders
Adult: As 0.1% solution: Instill 1 drop 4-6 times daily. Severe conditions: Instill 1 drop hourly, then reduced to 1 drop 4 hourly as the inflammation subsides.

Otic/Aural
Otic inflammation
Adult: As 0.1% solution: Instill 3-4 drops into the cleaned aural canal bid or tid, reduced dose gradually if favourable response is obtained. Alternatively, pack the aural canal with a gauze wick saturated with the solution for 12-24 hours, may be repeated as necessary.

Intravitreal
Uveitis
Adult: As intravitreal implant containing 700 mcg injected into the affected eye. Retreat after approx 6 months in cases of loss or decrease in vision and/or increase in retinal thickness.
Child:

Intravitreal
Macular oedema secondary to retinal vein occlusion
Adult: As intravitreal implant containing 700 mcg injected into the affected eye. Retreat after approx 6 months in cases of loss or decrease in vision and/or increase in retinal thickness.
Child:

Intravitreal
Diabetic macular oedema
Adult: As intravitreal implant containing 700 mcg injected into the affected eye. Retreat after approx 6 months in cases of loss or decrease in vision and/or increase in retinal thickness.
Child:
Administration
Should be taken with food.
Contraindications
Systemic fungal infections; systemic infection unless being treated with specific anti-infectives. Perforation of drum membrane (otic). Administration of live virus vaccine.
Special Precautions
Patients with hypertension, acute MI, heart failure, diabetes mellitus, gastrointestinal diseases (e.g. diverticulitis intestinal anastomoses, active or latent peptic ulcer ulcerative colitis); ocular diseases (e.g. cataracts, glaucoma, history of ocular herpes simplex); osteoporosis, history of seizure disorder, thyroid disease. Renal and hepatic impairment. Elderly. Children. Pregnancy and lactation. Avoid abrupt withdrawal or rapid dose reduction. Ophth: This drug may cause blurring of vision, if affected, do not drive or operate machinery. Remove contact lenses prior to ophthalmic administration and reinsert after 15 minutes. Monitoring Parameters Monitor growth for children and intraocular pressure.
Adverse Reactions
Significant: Adrenal suppression (e.g. hypercortisolism, suppression of hypothalamic-pituitary-adrenal [HPA] axis); Kaposi sarcoma; myopathy; perineal irritation, psychiatric disturbance, immunosuppression (e.g. secondary infections, activation of latent infections, mask acute infection); increased intra-ocular pressure, open-angle glaucoma and cataracts. Rarely, anaphylactoid reactions. Endocrine disorders Growth retardation in children. Eye disorders: Bacterial keratitis, eye irritation and pruritus, burning sensation, ocular discomfort. General disorders and administration site conditions: Impaired wound healing. Investigations: Weight gain. Metabolism and nutrition disorders: Cushing's syndrome, obesity. Musculoskeletal and connective tissue disorders: Osteoporosis. Nervous system disorders: Headache, muscle atrophy. Psychiatric disorders: Euphoria, depression, suicidal tendencies. Skin and subcutaneous tissue disorders: Skin fragility.
Overdosage
Symptoms: Anaphylatic and hypersensitivity reactions. Management: Supportive treatment. May administer adrenaline, aminophylline; provide positive pressure ventilation.
Drug Interactions
Decreased plasma concentration with CYP3A4 inducers (e.g. barbiturates, carbamazepine, ephedrine, phenytoin, rifabutin, rifampicin). Increased plasma concentration with CYP3A4 inhibitors (e.g. erythromycin, ketoconazole, ritonavir). May increase renal clearance of salicylates. May enhances hypokalaemic effects of diuretics (acetazolamide, loop, thiazide), amphotericin B injection, corticosteroids, carbenoxolone, and K-depleting agents. May enhance anticoagulant effect of warfarin.
Potentially Fatal: May diminish therapeutic effect of live virus vaccines.
Lab Interference
False negative results with nitroblue tetrazolium test for bacterial infection.
Action
Dexamethasone is a highly potent and long-acting glucocorticoid which acts as an anti-inflammatory agent by suppressing neutrophil migration, decreasing production of inflammatory mediators, reversing increased capillary permeability, and suppressing immune response. It lacks mineralocorticoid properties and has minimal Na-retaining properties which makes it suitable for treating conditions where water retention is a disadvantage.
Absorption: Readily absorbed from the gastrointestinal tract. Time to peak plasma concentration: 1-2 hours (oral); approx 30-120 minutes (IM); 5-10 minutes (IV).
Distribution: Crosses placenta and enters breast milk. Plasma protein binding: Approx 77%, mainly to albumins.
Metabolism: Metabolised in the liver by CYP3A4 enzyme.
Excretion: Via urine (up to 65%). Elimination half-life: 4±0.9 hours (oral); approx 1-5 hours (IV).
Storage
Intra-articular: Store below 25°C. Intravenous: Store below 25°C. Intravitreal: Store below 25°C. Ophthalmic: Store below 25°C. Oral: Store below 25°C. Otic/Aural: Store below 25°C. Parenteral: Store below 25°C.
ATC Classification
C05AA09 - dexamethasone ; Belongs to the class of products containing corticosteroids for topical use. Used in the treatment of hemorrhoids and anal fissures.
H02AB02 - dexamethasone ; Belongs to the class of glucocorticoids. Used in systemic corticosteroid preparations.
D10AA03 - dexamethasone ; Belongs to the class of topical corticosteroids used in the treatment of acne.
S01BA01 - dexamethasone ; Belongs to the class of corticosteroids. Used in the treatment of inflammation of the eye.
S02BA06 - dexamethasone ; Belongs to the class of corticosteroids used in the treatment of inflammation of the ear.
A01AC02 - dexamethasone ; Belongs to the class of local corticosteroid preparations. Used in the treatment of diseases of the mouth.
D07XB05 - dexamethasone ; Belongs to the class of moderately potent (group II) corticosteroids in other combinations. Used in the treatment of dermatological diseases.
S03BA01 - dexamethasone ; Belongs to the class of corticosteroids used in ophthalmologic and otologic preparations.
D07AB19 - dexamethasone ; Belongs to the class of moderately potent (group II) corticosteroids. Used in the treatment of dermatological diseases.
S01CB01 - dexamethasone ; Belongs to the class of corticosteroids/antiinfectives/mydriatics combinations. Used in the treatment of eye diseases.
R01AD03 - dexamethasone ; Belongs to the class of topical corticosteroids used for prophylaxis and treatment of allergic rhinitis.
Disclaimer: This information is independently developed by CIMS based on dexamethasone from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 CIMS. All rights reserved. Powered by CIMSAsia.com
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