← Search & browse all drugs
RESPIRATORY SYSTEM › NASAL PREPARATIONS › DECONGESTANTS AND OTHER NASAL PREPARATIONS FOR TOPICAL USE › Corticosteroids
dexamethasone
R01AD03
Forms & Strengths
- Oral 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 Solution: 4 mg/mL, 10 mg/mL
- Nasal Spray: 0.05%
Adult Dosing
- Anti-inflammatory/Immunosuppressive: 0.75 mg to 9 mg daily orally in divided doses every 6 to 12 hours
- Cerebral Edema: Loading dose 10 mg IV, then 4 mg IV every 6 hours until maximum response
- COVID-19: 6 mg orally or IV once daily for up to 10 days
- Allergic Rhinitis: 1 to 2 sprays per nostril twice daily (Nasal formulation)
Pediatric Dosing
- Airway Edema (Extubation): 0.5 mg/kg/day to 2 mg/kg/day IV divided every 6 hours starting 24 hours prior to extubation
- Bacterial Meningitis: 0.15 mg/kg IV every 6 hours for 4 days, initiated prior to or with first antibiotic dose
- Cerebral Edema: Loading dose 1 to 2 mg/kg IV, then 1 to 1.5 mg/kg/day IV divided every 4 to 6 hours
Indications
- Endocrine disorders (primary or secondary adrenocortical insufficiency)
- Rheumatic disorders and collagen diseases
- Allergic and inflammatory conditions
- Cerebral edema associated with brain tumor, craniotomy, or head injury
- COVID-19 requiring supplemental oxygen
- Allergic rhinitis (nasal formulation)
Mechanism of Action
- Potent synthetic glucocorticoid with virtually no mineralocorticoid activity
- Crosses cell membranes and binds to specific cytosolic glucocorticoid receptors
- Modulates gene transcription, inhibiting leukocyte infiltration, decreasing cytokine production, and suppressing immune response
Contraindications
- Systemic fungal infections
- Hypersensitivity to dexamethasone or any component of the formulation
- Administration of live or live-attenuated vaccines while receiving immunosuppressive doses
Adverse Reactions
- Fluid retention, hypertension, and electrolyte imbalance
- Hyperglycemia, increased appetite, and weight gain
- Insomnia, mood swings, psychosis, and anxiety
- Peptic ulcer disease, gastrointestinal bleeding, and dyspepsia
- Immunosuppression and increased susceptibility to infections
- Osteoporosis, muscle weakness, and adrenal suppression with prolonged use
Drug Interactions
- Strong CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin) decrease dexamethasone efficacy
- CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) increase dexamethasone plasma concentrations
- Nonsteroidal anti-inflammatory drugs (NSAIDs) increase risk of gastrointestinal ulceration and bleeding
- Antidiabetic agents: corticosteroids may diminish glycemic control, requiring dose adjustment
- Coumarin anticoagulants: variable effects on INR; monitor coagulation parameters closely
Curated Content: Needs Vetting Before Put to Clinical Use