Definition

Dexamethasone is a synthetic glucocorticoid. Its naturally occuring counterparts arehydrocortisone and cortisone.
Although the drug is used in a variety of ways, in general, it reduces inflammation and depresses the immune
system. Dexamethasone may also be called by its brand name, Decadron.

Purpose
Dexamethasone is used in the treatment of many disorders. For example, it may be used:

as replacement therapy in the treatment of Addison's disease

in the management of various inflammatory disorders, such as rheumatoid arthritis

to coat drug-eluting stents, which are devices used in treating coronary artery disease to reduce the chance
that previously clogged arteries will become blocked again

in managing such allergic disorders as asthma

as induction therapy prior to stem cell transplantation

Patients with ulcerative colitis may benefit from dexamethasone therapy, as might those with exacerbations
of multiple sclerosis. Such blood disorders as thrombocytopenic purpura orerythroblastopenia, may also be managed
with dexamethasone.
Dexamethasone is often prescribed to patients with cancer. In some cases, the drug is part of the drug treatment for
the disease, and in other cases it is used to manage side effects caused by the treatment or the cancer itself. For
example, dexamethasone may be given to treat nauseaand vomiting associated with chemotherapy.
Dexamethasone may be used to decrease abnormally high levels of potassium that develop in association with
cancer. In some cases, it may be used as palliation in leukemia or lymphoma. Because of
its antiinflammatory properties, dexamethasone may help reduce swelling in the brain caused by a brain tumor. It
may also help prevent hypersensitivity reactions associated with drugs like paclitaxel. Dexamethasone is also
commonly used to treat nausea associated withchemotherapy. It is particularly useful with the drug cisplatin, which
frequently causes nausea and vomiting.
In non-Hodgkin's lymphoma (NHL), dexamethasone is part of a drug regimen known as DHAP. Here, dexamethasone
is given with chemotherapy drugs called cisplatin and cytarabine. Also in treating NHL, dexamethasone may be used
in a regimen caled "m-BACOD," which also includes the administration
of methotrexate, leucovorin, bleomycin, doxorubicin, cyclophosphamide, andvincristine. Dexamethasone may also be
helpful in patients with multiple myeloma. In the EDAPregimen, dexamethasone is given with etoposide, cytosine
arabinoside (cytarabine), and cisplatin; in VAD, it is given with vincristine and doxorubicin.

Description
Patients should not stop taking dexamethasone without first consulting their physician. When dexamethasone
treatment stops, it must be gradually reduced over time before it can be completely discontinued. Sudden withdrawal
of glucocorticoids may result in adrenal insufficiency.

When possible, the drug should be taken before nine A.M. to imitate the time that the body'scorticosteroid levels are
typically at their highest. A child taking dexamethasone will be carefully monitored to ensure the drug is not affecting
his or her growth. Patients taking large doses of dexamethasone should try to take the drug with meals. Antacids may
be recommended between meals to reduce gastrointestinal effects and to prevent peptic ulcer.

Recommended Dosage
Dexamethasone is available in oral, intravenous (IV), topical, ophthalmic, or inhaled form. In cancer patients, the oral
and IV routes are used most frequently. The pill is available in several color-coded dosages [0.25 milligrams (mg),
0.5mg, 0.75mg, 1.5mg, 4mg, and 6mg]. Dexamethasone should be given very slowly by the IV route.
Dosages to treat disease are highly individualized, but generally start at 0.75 to 9.0 mg per day. The lowest
therapeutic dose should be given, though amounts given may need to be increased during times of stress. Dosages
of medications may be changed based on factors specific to the individual. The following dosages are general
guidelines for dexamethasone when it is used in conjunction with chemotherapy agents:

DHAP. Forty milligrams of dexamethasone is given in pill or IV form per day for the first four days of
treatment, followed by cisplatin and cytarabine.

M-BACOD. Six milligrams per meter square (mg/m2) of dexamethasone is given as a pill on the first five
days of treatment.

EDAP. Forty milligrams of dexamethasone is given in pill form on the first four days of treatment. It is given
again on days 9-12, and 17-20.

When used to prevent or manage nausea or vomiting associated with chemotherapy, dexamethasone is given in the
following dosages: 420 mg IV every 46 hours. Alternatively, a one-time dose of 1020 mg may be given IV. When
pills are preferred, 48 mg of dexamethasone may be given four times, every four hours. When used to prevent
hypersensitivity reactions in paclitaxel treatment, 20mg should be given orally twelve and six hours before treatment
begins.

Precautions
Dexamethasone should be used cautiously in patients with kidney or liver problems,hypothyroidism, high blood
pressure, or a history of heart attack. Patients with diabetes mellitus should monitor blood sugar levels carefully,
as hyperglycemia may result. If changes occur, patients should notify their doctors immediately. Sudden cessation of
dexamethasone therapy is dangerous for patients on therapy for longer than two weeks. The drug should be
gradually withdrawn under a physician's guidance.

Side Effects
Adverse effects vary widely, and depend on the dosage and route of the drug. Certain drugs may result in decreased
blood levels, and therefore render dexamethasone less effective. Patients taking the following drugs should be
carefully monitored for decreased levels of dexamethasone:phenytoin, phenobarbitol, ephedrine, and rifampin.
Conversely, some drugs, such as troleandomycin, may increase blood levels of dexamethasone.
Because of its immunosuppressive properties, dexamethasone may decrease the signs and symptoms of infection.
Depending on the amount of drug being administered, patients may consider taking measure to prevent infection by
avoiding crowded areas and washing their hands frequently. Patients should inform their doctor if they notice

a fever, sore throat, or cuts or abrasions that don't heal. Laboratory tests may also be affectedfalse negative results
may occur in the nitroblu-tetrazolium test for bacterial infections.
Glucocorticoids, such as hydrocortisone, tend to make the body retain salt. Although dexamethasone's salt-retaining
properties are not as severe as hydrocortisone's, salt retentionmay result in fluid and electrolyte imbalances. Patients
at risk may experience high blood pressure or even congestive heart failure. Weight gain or swelling may indicate salt
and fluid retention.
Other adverse effects may include headache, dizziness, insomnia, increased appetite, mood
swings, menstrual changes, muscle weakness, acne and/or sweating. Depression may be worsened with
dexamethasone use. Some men experience changes in the motility and number of their sperm with steroid treatment.
Patients should talk to their doctors about any unusual symptoms they experience. In cancer patients, increased
appetite may actually be beneficial.
Dexamethasone crosses the placenta and is excreted in breast milk. If a pregnant woman is taking large doses of the
drug, her newborn should be monitored for evidence of hypoadrenalism. Optimally, breast-feeding should be avoided.
There is some concern that dexamethasone, in large quantities, suppresses growth or disrupts the baby's normal
corticosteroid production.

Interactions
Patients should discuss all their medications, prescription and non-prescription, with their doctor. If dexamethasone is
administered in amounts that suppress the immune system, live vaccines, such as small pox, should not be
administered. Dexamethasone may alter the effect of anticoagulant drugs. Frequent laboratory tests should be
performed to monitor blood levels. If dexamethasone is given with diuretics, potassium levels may be abnormally low,
and should be frequently monotired. Doctors may recommend that patients on long-term therapy follow a potassiumrich diet.

Resources
Books
Wilson, Billie A., Margaret T. Shannon, and Carolyn L. Stang. Nurses Drug Guide 2000. Stamford, CT: Appleton &
Lange, 2000.

Periodicals
Hesketh, P. J. "New Treatment Options for Chemotherapy-Induced Nausea and Vomiting."Supportive Care in
Cancer 12 (August 2004): 550554.
Kumar, S., M. Q. Lacy, A. Dispenzieri, et al. "Single-Agent Dexamethasone for Pre-Stem Cell Transplant Induction
Therapy for Multiple Myeloma." Bone Marrow Transplantation 34 (September 2004): 485490.
Liu, X., I. de Scheerder, and W. Desmet. "Dexamethasone-Eluting Stent: An Anti-Inflammatory Approach to Inhibit
Coronary Restenosis." Expert Review of Cardiovascular Therapy 2 (September 2004): 653660.

Organizations

American Society of Health-System Pharmacists (ASHP). 7272 Wisconsin Avenue, Bethesda, MD 20814. (301) 6573000. .
United States Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857-0001. (888) INFOFDA. .
Tamara Brown, R.N.; Rebecca J. Frey, PhD
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Drug Info:
Dexamethasone
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Brand names: AK-DexCortastatCortastat L.A.CortidexCortidex L.A.Dalalone D.PDalalone

L.ADalaloneDeca 4Deca L.A. 8DecadronDecadron-LADexacort PH TurbinaireDexacort
RespihalerDexone L.A.DexPak TaperPakMaxidexOcu-DexPrimethasonePrimethasone L ARobadex
LASolurex

Chemical formula: