Dexamethasone

Drug #222

Chemically Dexamethasone is 9-Fluoro-11ß, 17, 21-trihydroxy-16a-methylpregna-1, 4-diene-3, -20-dione. Dexamethasone is a corticosteroid. It reduces swelling and inflammation. Dexamethasone is used in different conditions such as skin diseases, allergic conditions, breathing problems, cancer, blood disorders, eye diseases and in arthritis. Dexamethasone is also used to treat nausea and vomitting produced by cancer chemotherapy;.

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Primary Characteristics

Dexamethasone is also known as Dexamethasone Sodium Phospate.

It is of Synthetic origin and belongs to Steroid.

It belongs to Glucocorticoid agonist pharmacological group on the basis of mechanism of action and also classified in Corticosteroid Nasal pharmacological group.

Molecular Weight: 392.5 · Solubility in Water: insoluble · Solubility in Alcohol: 1 in 42 · Non-proprietary name: Dexamethasone · pH: 8.9 · Isotonic value: 6.75.

Pharmacokinetics

Absorption: Dexamethasone has an oral bioavailability is 90%.

Distribution: Dexamethasone has a volume of distribution is 0.58 l/kg (0.8-1l/kg). plasma protein binding is 66-77%.

Elimination: it is metabolised via slow via liver, plasma half-life is 3.6 ± 0.9 hr (3.5), renal excretion is 60%.

Indications

Dexamethasone is primarily indicated in conditions like Adrenocortical insufficiency, Anorexia in palliative care, Brain tumors, Cerebral oedema, Congenital adrenal hyperplasia, Dyspnoea, Dyspnoea in palliative care, Headache due to raised intracranial pressure in palliative care, Nausea and vomiting (chemotherapy induced), Pain due to nerve compression in palliative care, Palliative surgery., Raised intracranial pressure, Respiratory distress syndrome, Shock, Suppression of inflammatory and allergic disorders.

Dexamethasone is also indicated for secondary conditions like Asthma, Blood disorders, Connective tissue diseases, GI diseases, Liver diseases, Malignancy, Ocular diseases, osteoarthiritis of superficial joints, Osteoarthritis, Renal diseases, Toxic epidermal necrolysis.

Contraindications

Dexamethasone is contraindicated in conditions like Diabetes mellitus, Hypertension, Psychosis, Osteoporosis, GI ulceration, Infections, Renal insufficiency.

Dosage

Dexamethasone's dosage details are as follows:

Dose	Single Dose	Frequency	Route	Instructions
Adult Dosage
2 – 6 mg	—	—		Soft tissue infection
0.8 – 4 mg	—	—	Intra-articular	(Depending upon the size of joint)
10.2 mg	10.2 mg	—	IV,IM	daily
0.05 – 0.1 %	—	—	Ophthalmic	As Required.To be given as drops.
5.25 mg	5.25 mg	Every 24h	PO
Paediatric Dosage (20kg)
20.8 mg	20.8 mg	Every 6h	Intra Venous	Initial dose followed by 3.3mg till 8th day then by daily reduction of 1.7mg.For 35 kg and over
20.8 mg	20.8 mg	—	IV	Initial dose . The follow up is same This dose is for children below 35 kg.
1 %	1 %	Every 6h	Opthalmic	1 to 2 drops
0.01 – 0.1 mg/kg	—	Every 24h	Oral	daily
Neonatal Dosage (3kg)
0.2 mg/kg	0.2 mg/kg	Every 8h	Intramuscular
0.2 mg/kg	0.2 mg/kg	Every 8h	Intravenous
0.2 mg/kg	0.2 mg/kg	Every 8h	oral

Drug Interactions

Unknown11 interactions

16 interactions

Minor1 interaction

Moderate1 interaction

Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Side Effects

Dexamethasone in overdosage may give rise to further complications which include Glaucoma , Peptic ulceration , Myopathy , Osteoporosis , Posterior subcapsular cataract , Growth retardation , Aseptic bone necrosis , Ocular hypertension , Subcapsular cataract , Pancreatic disturbance , Cushing like features , Oedema , Retinal detachment , Moon face , Truncal obesity, Negative calcium balance.

Dexamethasone produces potentially life-threatening effects which include Collapse , Suppression of hypothalamus-pituitary-adrenal axis. Careful monitoring is needed with proper medical management.

Dexamethasone is known to cause more or less tolerable side effects which are usually transient. These include adrenal suppression, Euphoria, Facial rounding, Fragility of skin, Glucose intolerance, Increased appetite, Insomnia, lipid metabolism, Nausea, Nervousness, Nocturia , Obesity, protein catabolism, Vomiting .

Warnings / Precautions

Dexamethasone should be used with caution in patients with active tuberculosis infection of respiratory tract or in untreated fungal, bacterial or systemic viral infections. Corticosteroids should only be used systemically with great caution in the presence of congestive heart failure (CHF), recent myocardial infraction (MI), hypertension, diabetes mellitus, epilepsy, glaucoma, hypothyroidism, liver failure, osteoprosis, peptic ulceration or renal impairment. Children may be at increase risk of some adverse effects, corticosteroid cause growth retardation and prolonged use is rarely justified. Passive immunization is recommended to non-immune patients who do come in contact with chickenpox or measles. Live vaccine should not be given to patients receiving high dose systemic corticosteroid therapy nor for atleast 3 months afterwards, killed vaccine or toxoids may be given, although the response may be attenuated. During prolong treatment with corticosteroids, patients should be examined regularly, sodium intake may need to be reduced and calcium and potassium supplement may be necessary. Patient should carry cards given full details of their corticosteroid therapy. Avoid use during pregnancy. Use nasal steroids with caution until healing has occurred. Dose adjustment required in patient with renal

Interference in Pathology

Dexamethasone may interfere in the diagnosis of Measurement of Serum Digoxin by Immunoassay. , Impairment of Glucose Tolerance , Reduced levels of Prolactin , Lowers basal TSH, FSH and LH Levels , Reuces hGH response to various stimuli , Lowering of Plasma cortisol,Potassium, and Oestrogens .

Available Brands

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Single Ingredient

Eye Drops

Inj

Inj

Oint

Tabs

Multi-Ingredient Combinations

Cream

0.04 %w/w 0.1 %w/w 0.1 gm 0.4 %w/w 3500 IU/g

Drops

E and E Drops

Ear Drops

Eye Drops

Eye Oint

Oint

Storage Conditions

Dexamethasone should be stored Inj, Cream, Gel, Ear Soln, Eye Oint, Soln or Susp. Oral Inhaler, Nasal Aerosol. Tab, Oral Elixir, Oral Soln.

Drug Classification

1.8.3 — Hormones and antihormones
2.18.1 — Corticosteroids, systemic
3.21.2.1 — Corticosteroids
4.28 — Otic drugs