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(DEX-uh-METH-uh-sone)
Aeroseb-Dex, Decadron, Decaspray, Dexameth, Dexone, Hexadrol, Maxidex
Dexamethasone Acetate
Dalalone DP, Dalalone LA, Decadron-LA, Decaject-L.A., Dexasone-L.A., Dexone LA, Solurex LA
Dexamethasone Sodium Phosphate
AK-Dex, Dalalone, Decadron Phosphate, Decaject, Dexasone, Dexone, Hexadrol Phosphate, Solurex, Baldex, Decadrol, Decadron Phosphate Injection, Dexadron Eye-Ear Solution, Dexair, Dexotic, Diodex, Methasone, PMS-Dexamethasone Sodium Phosphate, Storz-Dexa
Class: Corticosteroid

 Action Synthetic long-acting glucocorticoid that depresses formation, release and activity of endogenous mediators of inflammation including prostaglandins, kinins, histamine, liposomal enzymes and complement system. Also modifies body’s immune response.

 Indications Testing of adrenal cortical hyperfunction; management of primary or secondary adrenal cortex insufficiency, rheumatic disorders, collagen diseases, dermatologic diseases, allergic states, allergic and inflammatory ophthalmic processes, respiratory diseases, hematologic disorders, neoplastic diseases, cerebral edema associated with primary or metastatic brain tumor, craniotomy or head injury, edematous states (caused by nephrotic syndrome), GI diseases, multiple sclerosis, tuberculous meningitis, trichinosis with neurologic or myocardial involvement.

Intra-articular or soft tissue administration: Short-term adjunctive treatment for such conditions as synovitis of osteoarthritis, rheumatoid arthritis, acute gouty arthritis, posttraumatic osteoarthritis. Intralesional administration: Treatment for such conditions as keloids, psoriatic plaques, discoid lupus erythematosus, alopecia areata. Topical: Treatment of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. Oral inhalation: Treatment of corticosteroid-responsive and bronchial asthma bronchospastic states. Intranasal: Treatment of allergic or inflammatory nasal conditions, nasal polyps (excluding those originating within sinuses). Ophthalmic: Treatment of steroid-responsive inflammatory conditions of palpebral and bulbar conjunctiva, lid, cornea and anterior segment of globe. Unlabeled use(s): Treatment of acute mountain sickness, bacterial meningitis, bronchopulmonary dysplasia in preterm infants; diagnosis of depression; treatment of hirsutism and use as antiemetic.

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines; topical monotherapy in primary bacterial infections; intranasal use in untreated localized infections involving nasal mucosa; ophthalmic use in acute superficial herpes simplex keratitis, fungal diseases of ocular structures, vaccinia, varicella and ocular tuberculosis.

 Route/Dosage

All dosages shown are for adults unless indicated otherwise.

DEXAMETHASONE

Initial dose: PO 0.75 to 9 mg/day. SUPPRESSION TESTS: Cushing’s syndrome: PO 1 mg at 11 PM.

Alternate: PO 0.5 mg q 6 hr for 48 hr. To distinguish Cushing’s syndrome–caused pituitary ACTH excess from other causes: PO 2 mg q 6 hr for 48 hr. ACUTE MOUNTAIN SICKNESS: PO 4 mg q 6 hr. ANTIEMETIC: PO 16 to 20 mg. DIAGNOSIS OF DEPRESSION: PO 1 mg. HIRSUTISM: PO 0.5 to 1 mg/day.

DEXAMETHASONE ACETATE

SYSTEMIC: IM 8 to 16 mg; may repeat in 1 to 3 wk. INTERLESIONAL: IM 0.8 to 1.6 mg. INTRA-ARTICULAR AND SOFT TISSUE: IM 4 to 16 mg; may repeat at 1 to 3 wk intervals.

DEXAMETHASONE SODIUM PHOSPHATE

SYSTEMIC: IV/IM 0.5 to 9 mg/day. CEREBRAL EDEMA: IV 10 mg, then IM 4 mg q 6 hr until maximum response. BRAIN TUMORS: IV/IM 2 mg bid to tid. UNRESPONSIVE SHOCK: IV 1 to 6 mg/kg as single injection; or 40 mg followed by repeated IV injections q 2 to 6 hr. BACTERIAL MENINGITIS IV 0.15 mg/kg q 6 hr. BRONCHOPULMONARY DYSPLASIA: PRETERM INFANTS IV 0.5 mg/kg. INTRA-ARTICULAR, INTRALESIONAL OR SOFT TISSUE: LARGE JOINTS: 2 to 4 mg. SMALL JOINTS: 0.8 to 1 mg. BURSAE: 2 to 3 mg. TENDON SHEATHS: 0.4 to 1 mg. SOFT TISSUE INFILTRATION: 2 to 6 mg. GANGLIA: 1 to 2 mg. TOPICAL: Apply sparingly to affected areas bid to qid. ORAL INHALATION: ADULTS: 3 inhalations tid to qid. CHILDREN: 2 inhalations tid to qid. INTRANASAL: ADULTS: 2 sprays (168 mcg) into each nostril bid to tid. CHILDREN 6 to 12 yr: 1 or 2 sprays (84 to 168 mcg) into each nostril bid. OPHTHALMIC: SOLUTION: Instill 1 to 2 drops into conjunctival sac q 1 hr during day and q 2 hr during night. OINTMENT: Apply thin coating in lower conjunctival sac tid to qid.

 Interactions

Aminoglutethimide: May decrease dexamethasone-induced adrenal suppression. Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis. Anticoagulants, oral: May alter anticoagulant dose requirements. Barbiturates: May decrease effects of dexamethasone. Hydantoins: May increase clearance and decrease therapeutic efficacy of dexamethasone. Rifampin: May increase clearance and decrease therapeutic efficacy of dexamethasone. Salicylates: May reduce serum levels and efficacy of salicylates. Troleandomycin: May increase dexamethasone effects.

 Lab Test Interferences May cause increased urine glucose and serum cholesterol; decreased serum levels of potassium, T3 and T4; decreased uptake of thyroid 131I; false-negative nitroblue-tetrazolium test; altered brain scan results; suppression of skin test reactions.

 Adverse Reactions

CV: Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; increased intracranial pressure with papilledema (pseudotumor cerebri); vertigo; headache; neuritis; paresthesias; psychosis. DERM: Impaired wound healing; thin fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus–like lesions; subcutaneous fat atrophy; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema, perineal irritation; hyperpigmentation or hypopigmentation. Topical application: Burning; itching; irritation; erythema; dryness; folliculitis; hypertrichosis; pruritus; perioral dermatitis; allergic contact dermatitis; stinging, cracking and tightening of skin; secondary infections; skin atrophy; striae; miliaria; telangiectasia. EENT: Posterior subcapsular cataracts; increased IOP; glaucoma; exophthalmos. Oral inhalation: Dry mouth; throat irritation; hoarseness; dysphonia; coughing. Intranasal: Nasal irritation; burning; stinging; dryness; epistaxis or bloody mucus; rebound congestion; sneezing, rhinorrhea; anosmia; loss of sense of taste; throat discomfort. Ophthalmic: Glaucoma with optic nerve damage; visual acuity and field defects; posterior subcapsular cataract formation; secondary ocular infections; transient stinging or burning. GI: Pancreatitis; abdominal distension; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer with perforation and hemorrhage; bowel perforation. GU: Increased or decreased number and motility of spermatozoa. HEMA: Leukocytosis. META: Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia. RESP: Oral inhalation: Wheezing. OTHER: Musculoskeletal effects (eg, weakness, myopathy, muscle mass loss, osteoporosis, spontaneous fractures); endocrine abnormalities (eg, menstrual irregularities, cushingoid state, growth suppression in children sweating, decreased carbohydrate tolerance, hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetics, anaphylactoid or hypersensitivity reactions); aggravation or masking of infections; malaise; leukocytosis; fatigue; insomnia. Intra-articular: Osteonecrosis; tendon rupture; infection; skin atrophy; postinjection flare; hypersensitivity; facial flushing. Topical use may theoretically produce adverse reactions seen with systemic use because of absorption.

 Precautions

Pregnancy: Pregnancy category undetermined (systemic use); Category C (topical uses). Lactation: Excreted in breast milk. Children: May be more susceptible to adverse reactions from topical use than are adults. Observe growth and development of infants and children on prolonged therapy. Elderly: May require lower doses. Adrenal suppression: Prolonged therapy may lead to hypothalamic-pituitary-adrenal suppression. Fluid and electrolyte balance: Can cause elevated blood pressure, salt and water retention and increased potassium and calcium excretion. Dietary salt restriction and potassium supplementation may be needed. Hepatitis: May be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Infections: May mask signs of infection. May decrease host-defense mechanisms to prevent dissemination of infection. Ocular effects: Use systemically with caution in ocular herpes simplex because of possible corneal perforation. Ophthalmic use: Prolonged use may result in glaucoma or other complications. Peptic ulcer: May contribute to peptic ulceration, especially in large doses. Renal impairment: Use cautiously; monitor renal function. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during and after stressful situations. Sulfites: Some products may contain sodium bisulfite, which may cause allergic-type reactions in some individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency. Discontinue gradually.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • For IM injection, inject dexamethasone acetate deep into gluteal muscle. Avoid injection into deltoid, and rotate injection sites. Do not use SC route.
  • Refer to package insert for directions on how to store particular form of dexamethasone.
  • If ordered PO, administer in morning to coincide with body’s normal secretion of cortisol.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Obtain baseline weight and vital signs.
  • Assess involved system before and periodically during therapy.
  • When used in child, periodically assess child’s growth.
  • Monitor intake and output.
  • Assess patient regularly for signs of infection (delayed wound healing, WBC count) because steroids can mask other common signs of infection such as fever, swelling and redness.
  • Notify physician if signs of fluid overload develop (peripheral edema, weight gain, rales/crackles, dyspnea).
  • If emotional changes occur, such as depression, take safety measures such as suicide precautions.
  • If side effects develop with long-term therapy, expect to change to alternate-day therapy. Check medication record and document well.
OVERDOSAGE: SIGNS & SYMPTOMS
  Acute overdose: Fever, myalgia, arthralgia, malaise, anorexia, nausea, skin desquamation, orthostatic hypotension, dizziness, fainting, dyspnea, hypoglycemia. Chronic: Cushingoid changes: Moonface, central obesity, striae, hirsutism, acne, ecchymoses, hypertension, osteoporosis, myopathy, sexual dysfunction, diabetes, hyperlipidemia, peptic ulcer, infection, electrolyte and fluid imbalance

 Patient/Family Education

  • Caution patient that stopping drug abruptly is dangerous and may cause adrenal insufficiency.
  • Explain rationale for tapering off medication when that time comes.
  • Teach patient or family procedures for correctly administering specific form of drug (ophthalmic, inhalation, topical, etc.).
  • Caution patient against receiving immunizations while drug is being taken.
  • Advise patient on long-term therapy to carry medication identification card or to wear bracelet. In case of emergency, this information is important for treatment.
  • Instruct patient to avoid people with infections, particularly respiratory.
  • If form patient is receiving is intranasal, instruct him/her to clear nasal passages of secretions before administering drug.
  • If topical, advise patient not to use occlusive dressings such as plastic wrap more than 12 hrs a day. Occlusion may lead to sweat retention and bacterial and fungal infections. Remember that tight-fitting plastic diapers on infants may also be occlusive.
  • Teach patient to take oral forms with meals or snacks if GI irritation occurs.
  • Review guidelines for missed doses of particular product with patient.
  • Teach patient on long-term therapy how to keep a weight record.
  • Instruct patient to inform other physicians that he/she is taking a steroid.
  • Review signs of infection and remind patient that fever, swelling and redness may be masked in infection.
  • Review possible side effects of dexamethasone with patient and instruct him/her to report these to physician.

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