DEXAMETHASONE
(dex-a-meth'a-sone)
Aeroseb-Dex, Decaderm, Decadron, Decaspray, Deronil , Dexameth, Dexamethasone Intensol, Dexasone, Dexone, Hexadrol, Maxidex, Mymethasone, Oradexon 
DEXAMETHASONE ACETATE
Dalalone D. P., Dalalone-LA, Decadron-LA, Decaject-LA, Dexacen LA-8, Dexasone-LA, Dexo-LA, Dexon LA, Dexone LA, Solurex-LA
DEXAMETHASONE SODIUM PHOSPHATE
AK-Dex, Alba Dex, Dalalone, Decadrol, Decadron Phosphate, Decaject, Dex-4, Dexacen-4, Dexasone, Dexon, Dexone, Hexadrol Phosphate, Maxidex Ophthalmic, Savacort-D, Solurex
Classifications: hormones and synthetic substitutes, adrenal corticosteroid; glucocorticoid; steroid
Prototype: Prednisone
Pregnancy Category: C

Availability

Dexamethasone 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg tablets; 0.5 mg/5 mL, 0.5 mg/0.5 mg oral solution; 0.01%, 0.04% topical aerosol; Dexamethasone Acetate 8 mg/mL, 16 mg/mL injection suspension; Dexamethasone Sodium Phosphate 4 mg/mL, 10 mg/mL, 20 mg/mL, 24 mg/mL injection; 0.1% cream; 0.1% ophthalmic solution, suspension; 0.05% ophthalmic ointment

Actions

Long-acting synthetic adrenocorticoid with intense antiinflammatory (glucocorticoid) activity and minimal mineralocorticoid activity. Antiinflammatory action: Prevents accumulation of inflammatory cells at sites of infection; inhibits phagocytosis, lysosomal enzyme release, and synthesis of selected chemical mediators of inflammation; reduces capillary dilation and permeability. Immunosuppression: Not clearly understood, but may be due to prevention or suppression of delayed hypersensitivity immune reaction.

Therapeutic Effects

Drug has antiinflammatory and immunosuppression properties.

Uses

Adrenal insufficiency concomitantly with a mineralocorticoid; inflammatory conditions, allergic states, collagen diseases, hematologic disorders, cerebral edema, and addisonian shock. Also palliative treatment of neoplastic disease, as adjunctive short-term therapy in acute rheumatic disorders and GI diseases, and as a diagnostic test for Cushing's syndrome and for differential diagnosis of adrenal hyperplasia and adrenal adenoma.

Unlabeled Uses

As an antiemetic in cancer chemotherapy; as a diagnostic test for endogenous depression; and to prevent hyaline membrane disease in premature infants.

Contraindications

Systemic fungal infection, acute infections, active or resting tuberculosis, vaccinia, varicella, administration of live virus vaccines (to patient, family members), latent or active amebiasis. Ophthalmic use: Primary open-angle glaucoma, eye infections, superficial ocular herpes simplex, keratitis and tuberculosis of eye. Safe use during pregnancy (category C), lactation, or in children is not established.

Cautious Use

Stromal herpes simplex, keratitis, GI ulceration, renal disease, diabetes mellitus, hypothyroidism, myasthenia gravis, CHF, cirrhosis, psychic disorders, seizures.

Route & Dosage

Allergies, Inflammation, Neoplasias
Adult: PO 0.25–4 mg b.i.d. to q.i.d. IM 8–16 mg q1–3 wk or 0.8–1.6 mg intralesional q1–3 wk
Child: PO/IV/IM 0.08–0.3 mg/kg/d divided q6–12h

Cerebral Edema
Adult: IV 10 mg followed by 4 mg q4h, reduce dose after 2–4 d then taper over 5–7 d
Child: PO/IV/IM 1–2 mg/kg loading dose, then 1–1.5 mg/kg/d divided q4–6h (max: 16 mg/d)

Shock
Adult: IV 1–6 mg/kg as a single dose or 40 mg repeated q2–6h if needed

Dexamethasone Suppression Test
Adult: PO 0.5 mg q6h for 48 h

Inflammation
Adult/Child: Ophthalmic/Topical/Inhalation/Intranasal See Appendix A.

Administration

Oral
Intramuscular
Intravenous

PREPARE: Direct: Give undiluted.  Intermittent: Dilute in D5W or NS for infusion.  

ADMINISTER: Direct: Give direct IV push over 30 sec or less.  Intermittent: Set rate as prescribed or according to amount of solution to infuse.  

INCOMPATIBILITIES Solution/additive: Daunorubicin, doxorubicin, doxapram, glycopyrrolate, metaraminol, vancomycin.

Adverse Effects (1%)

Aerosol therapy: Nasal irritation, dryness, epistaxis, rebound congestion, bronchial asthma, anosomia, perforation of nasal septum. Systemic Absorption—CNS: Euphoria, insomnia, convulsions, increased ICP, vertigo, headache, psychic disturbances. CV: CHF, hypertension, edema. Endocrine: Menstrual irregularities, hyperglycemia; cushingoid state; growth suppression in children; hirsutism. Special Senses: Posterior subcapsular cataract, increased IOP, glaucoma, exophthalmos. GI: Peptic ulcer with possible perforation, abdominal distension, nausea, increased appetite, heartburn, dyspepsia, pancreatitis, bowel perforation, oral candidiasis. Musculoskeletal: Muscle weakness, loss of muscle mass, vertebral compression fracture, pathologic fracture of long bones, tendon rupture. Skin: Acne, impaired wound healing, petechiae, ecchymoses, diaphoresis, allergic dermatitis, hypo- or hyperpigmentation, SC and cutaneous atrophy, burning and tingling in perineal area (following IV injection).

Diagnostic Test Interference

Dexamethasone suppression test for endogenous depression: false-positive results may be caused by alcohol, glutethimide, meprobamate; false-negative results may be caused by high doses of benzodiazepines (e.g., chlordiazepoxide and cyproheptadine), long-term glucocorticoid treatment, indomethacin, ephedrine, estrogens or hepatic enzyme-inducing agents (phenytoin) may also cause false-positive results in test for Cushing's syndrome.

Interactions

Drug: barbiturates, phenytoin, rifampin increase steroid metabolism—dosage of dexamethasone may need to be increased; amphotericin B, diuretics compound potassium loss; ambenonium, neostigmine, pyridostigmine may cause severe muscle weakness in patients with myasthenia gravis; may inhibit antibody response to vaccines, toxoids.

Pharmacokinetics

Absorption: Readily absorbed from GI tract. Onset: Rapid onset. Peak: 1–2 h PO; 8 h IM. Duration: 2.75 d PO; 6 d IM; 1–3 wk intralesional, intraarticular. Distribution: Crosses placenta; distributed into breast milk. Elimination: Hypothalamus-pituitary axis suppression: 36–54 h. Half-Life: 3–4.5 h.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug