In general, glucocorticoid dosage depends on the severity of the condition and the response of the patient. Under certain circumstances, for stress and changed clinical picture, extra dosage adjustments maybe necessary. If no favorable response is noted within a couple of days, continuation of glucocorticoid therapy is undesirable. For Systemic Therapy, daily dosages of 0.05-0.2 mg/kg body weight are usually sufficient. As soon as the symptoms diminish, dosage should be reduced under continuous observation of the clinical picture to the lowest possible level or tapered off completely. This should be done by giving in the early morning, daily or preferably every other day, 1 dose of an oral glucocorticoid with a shorter biological half-life than dexamethasone, e.g. prednisone. For acute life-endangering situations (e.g. anaphylaxis, acute severe asthma), substantial higher dosages maybe needed. Cerebral Edema (adults): Initial dose 10-20 mg IV followed by 6 mg IV or IM every 6 hrs., until a satisfactory result has been obtained. In brain surgery, these dosages may be necessary until several days after the operation. Thereafter, the dosage has to be tapered off gradually. Increase of intracranial pressure associated with brain tumors can be counteracted by continuous treatment.
For Local Therapy, the following dosages can be recommended: Intra-articularly: 2-4 mg in large and 0.8-1 mg in small joints; Intrabursally: 2-4 mg; in tendon sheaths: 0.4-1 mg. The frequency of these injections may vary from every 3-5 days to every 2-3 weeks. For Rectal Drip in cases of Ulcerative Colitis: 5 mg diluted in 120 mL saline. Dexamethasone injection can be administered by IV, SC, IM and local injection as well as rectal drip. With IV administration, high plasma levels can be obtained rapidly. IV injection of massive doses should be given slowly, over a period of several minutes. Intra-articular injections should be given under strictly aseptic conditions as glucocorticoids decrease resistance to infection. It has been shown not to lose its potency for at least 24 hrs (at a room temperature and in daylight conditions) when diluted with any of the following infusion fluids: Sodium chloride 0.9%, anhydrous glucose 5%, invert sugar 10%, sorbitol 5%, Ringer's solution, Hatmann's solution (Ringer-lactate), Rheomacrodex, Isodex Haemaccel. Using these infusions fluids, Dexamethasone injection can also be injected directly into the infusion line without causing precipitation of the ingredients. Direct injection into the infusion line is also possible with following infusion fluids but the 24hr stability has not been established: Mannitol 10%. Or as prescribed by the physician.