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DERMATOLOGICALS › CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS › CORTICOSTEROIDS, PLAIN › Corticosteroids, moderately potent (group II)
dexamethasone
D07AB19
Forms & Strengths
- Tablet: 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg
- Oral Solution: 0.5 mg/5 mL, 1 mg/mL
- Injection: 4 mg/mL, 10 mg/mL, 20 mg/mL, 100 mg/5 mL
- Topical Cream/Ointment: 0.1%
- Ophthalmic Suspension: 0.1%
Adult Dosing
- Anti-inflammatory/Immunosuppressive: 0.75 mg to 9 mg orally daily in divided doses
- Cerebral Edema: 10 mg IV load, then 4 mg IV every 6 hours
- COVID-19: 6 mg orally or IV once daily for up to 10 days
- Bacterial Meningitis: 10 mg IV every 6 hours for 4 days, initiated prior to or with first antibiotic dose
Pediatric Dosing
- Anti-inflammatory/Immunosuppressive: 0.02 to 0.3 mg/kg/day orally or IV in divided doses every 6 to 12 hours
- Croup: 0.6 mg/kg orally or intramuscularly as a single dose (max 16 mg)
- Bacterial Meningitis: 0.15 mg/kg IV every 6 hours for 4 days, initiated prior to or with first antibiotic dose
Indications
- Endocrine disorders (primary or secondary adrenocortical insufficiency)
- Rheumatic disorders and severe inflammatory conditions
- Cerebral edema associated with primary or metastatic brain tumor, craniotomy, or head injury
- Severe allergic and anaphylactic reactions
- SARS-CoV-2 (COVID-19) infection in hospitalized patients requiring oxygen support
Mechanism of Action
- Potent synthetic glucocorticoid with negligible mineralocorticoid activity
- Crosses cell membranes and binds to cytosolic glucocorticoid receptors
- Modulates gene expression by upregulating anti-inflammatory proteins and downregulating pro-inflammatory cytokines
- Suppresses immune response by inhibiting neutrophil and monocyte accumulation at inflammation sites
Contraindications
- Systemic fungal infections
- Known hypersensitivity to dexamethasone or any component of the formulation
- Administration of live or live-attenuated vaccines while taking immunosuppressive doses
Adverse Reactions
- Hyperglycemia, weight gain, increased appetite, and fluid retention
- Insomnia, mood changes, anxiety, psychosis, and euphoria
- Peptic ulcer disease, gastrointestinal bleeding, and pancreatitis
- Immunosuppression with increased susceptibility to infections
- Long-term use causes hypothalamic-pituitary-adrenal axis suppression, osteoporosis, and myopathy
Drug Interactions
- CYP3A4 inducers (e.g., phenytoin, carbamazepine, rifampin) decrease dexamethasone concentrations and efficacy
- CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) increase dexamethasone exposure and risk of toxicity
- Nonsteroidal anti-inflammatory drugs (NSAIDs) increase risk of gastrointestinal ulceration and bleeding
- Antidiabetic agents: glucocorticoids antagonize hypoglycemic effects, requiring dose adjustments
- Warfarin: variable effects on International Normalized Ratio (INR); monitor closely
Curated Content: Needs Vetting Before Put to Clinical Use