What is Decadron (Dexamethasone)?

Dexamethasone (Oral)

Dexamethasone is a steroid that prevents the release of substances in the body that cause inflammation. Dexamethasone is used to treat many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders. Dexamethasone may also be used for purposes not listed in this medication guide.
Dexamethasone (Injection)

Dexamethasone is in a class of drugs called steroids. Dexamethasone prevents the release of substances in the body that cause inflammation. Dexamethasone is used to treat many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, breathing disorders, inflammatory eye conditions, blood cell disorders, leukemia, or endocrine disorders. Dexamethasone may also be used for other purposes not listed in this medication guide.
In This Section:

What is the most important information I should know about Decadron (Dexamethasone)? What should I discuss with my healthcare provider before taking Decadron (Dexamethasone)? How much does Decadron (Dexamethasone) cost? What conditions might Decadron (Dexamethasone) treat? What does Decadron (Dexamethasone) look like?

What is the most important information I should know about Decadron (Dexamethasone)?
Dexamethasone (Oral)

You should not use this medication if you are allergic to dexamethasone, or if you have a fungal infection anywhere in your body. Before taking dexamethasone, tell your doctor about all of your medical conditions, and about all other medicines you are using. There are many other diseases that can be affected by steroid use, and many other medicines that can interact with steroids. Your steroid medication needs may change if you have any unusual stress such as a serious illness, fever or infection, or if you have surgery or a medical emergency. Tell your doctor about any such situation that affects you during treatment.

Steroid medication can weaken your immune system, making it easier for you to get an infection or worsening an infection you already have or have recently had. Tell your doctor about any illness or infection you have had within the past several weeks. Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medication. Do not receive a "live" vaccine while you are taking dexamethasone. Vaccines may not work as well while you are taking a steroid. Do not stop using dexamethasone suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. Wear a medical alert tag or carry an ID card stating that you take dexamethasone. Any medical care provider who treats you should know that you are using a steroid.
Dexamethasone (Injection)

You should not use this medication if you are allergic to dexamethasone or sulfites, or if you have a fungal infection anywhere in your body. Before using dexamethasone, tell your doctor about all of your medical conditions, and about all other medicines you are using. There are many other diseases that can be affected by steroid use, and many other medicines that can interact with steroids. Your steroid medication needs may change if you have any unusual stress such as a serious illness, fever or infection, or if you have surgery or a medical emergency. Tell your doctor about any such situation that affects you during treatment. Avoid activities that place too much stress on your joints. Dexamethasone can decrease pain and swelling, and you may be tempted to increase your activity if you are feeling better. Any joint damage may go unnoticed while you are being treated with dexamethasone. Steroid medication can weaken your immune system, making it easier for you to get an infection or worsening an infection you already have or have recently had. Tell your doctor about any illness or infection you have had within the past several weeks. Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medication. Do not receive a "live" vaccine while you are being treated with dexamethasone. Vaccines may not work as well while you are using a steroid. Ask your doctor when you can safely receive a live vaccine after your dexamethasone treatment ends.

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What should I discuss with my healthcare provider before taking Decadron (Dexamethasone)?
Dexamethasone (Oral)

You should not use this medication if you are allergic to dexamethasone, or if you have a fungal infection anywhere in your body. Steroid medication can weaken your immune system, making it easier for you to get an infection. Steroids can also worsen an infection you already have, or reactivate an infection you recently had. Before taking this medication, tell your doctor about any illness or infection you have had within the past several weeks. To make sure you can safely take dexamethasone, tell your doctor if you have any of these other conditions: liver disease (such as cirrhosis) kidney disease a thyroid disorder diabetes a history of malaria tuberculosis osteoporosis a muscle disorder such as myasthenia gravis glaucoma or cataracts herpes infection of the eyes stomach ulcers, ulcerative colitis, or diverticulitis depression or mental illness congestive heart failure; or high blood pressure FDA pregnancy category C. It is not known whether dexamethasone will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Dexamethasone can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Steroids can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using this medication.
Dexamethasone (Injection)

You should not use this medication if you are allergic to dexamethasone or sulfites, or if you have a fungal infection anywhere in your body.

Steroid medication can weaken your immune system, making it easier for you to get an infection. Steroids can also worsen an infection you already have, or reactivate an infection you recently had. Before using this medication, tell your doctor about any illness or infection you have had within the past several weeks. Other medical conditions you should tell your doctor about before using dexamethasone include: asthma liver disease (such as cirrhosis) kidney disease a thyroid disorder a history of malaria osteoporosis a muscle disorder such as myasthenia gravis glaucoma or cataracts herpes simplex infection of the eyes stomach ulcers, ulcerative colitis, or diverticulitis depression or mental illness congestive heart failure high blood pressure; or if you have recently had a heart attack If you have any of these conditions, you may need a dose adjustment or special tests to safely use dexamethasone. FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Dexamethasone can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Steroids can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using this medication.

What are the possible side effects of Decadron (Dexamethasone)?

Dexamethasone (Oral)

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

problems with your vision swelling, rapid weight gain, feeling short of breath severe depression, unusual thoughts or behavior, seizure (convulsions) bloody or tarry stools, coughing up blood pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate) low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure) Less serious side effects may include:

sleep problems (insomnia), mood changes acne, dry skin, thinning skin, bruising or discoloration slow wound healing increased sweating headache, dizziness, spinning sensation nausea, stomach pain, bloating muscle weakness; or changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist) This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Dexamethasone (Injection)

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Tell your doctor at once if you have any of these serious side effects: problems with your vision swelling, rapid weight gain, feeling short of breath severe depression, unusual thoughts or behavior, seizure (convulsions) bloody or tarry stools, coughing up blood pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate) low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure) Less serious side effects may include:

sleep problems (insomnia), mood changes acne, dry skin, thinning skin, bruising or discoloration slow wound healing increased sweating headache, dizziness, spinning sensation nausea, stomach pain, bloating; or changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist) This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs affect Decadron (Dexamethasone)?

Dexamethasone (Oral)

Many drugs can interact with dexamethasone. Below is just a partial list. Tell your doctor if you are using: aspirin (taken on a daily basis or at high doses) a diuretic (water pill) a blood thinner such as warfarin (Coumadin) cyclosporine (Gengraf, Neoral, Sandimmune) insulin or diabetes medications you take by mouth ketoconazole (Nizoral) rifampin (Rifadin, Rifater, Rifamate, Rimactane); or seizure medications such as phenytoin (Dilantin) or phenobarbital (Luminal, Solfoton) This list is not complete and other drugs may interact with dexamethasone. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
Dexamethasone (Injection)

There are many other medicines that can interact with steroids. Below is only a partial list of these medicines: aspirin (taken on a daily basis or at high doses) a diuretic (water pill) a blood thinner such as warfarin (Coumadin) diet pills, or cough and cold medications indomethacin (Indocin); or seizure medications such as phenytoin (Dilantin) or phenobarbital (Luminal, Solfoton)

This list is not complete and there may be other drugs that can interact with dexamethasone. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Back to Top

What should I avoid while taking Decadron (Dexamethasone)?

Dexamethasone (Oral)

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medication. Do not receive a "live" vaccine while using dexamethasone. The vaccine may not work as well during this time, and may not fully protect you from disease. Live vaccines include measles, mumps, rubella (MMR), oral polio, rotavirus, typhoid, varicella (chickenpox), H1N1 influenza, and nasal flu vaccine. Avoid drinking alcohol while you are taking dexamethasone.
Dexamethasone (Injection)

Avoid activities that place too much stress on your joints. Dexamethasone can decrease pain and swelling, and you may be tempted to increase your activity if you are feeling better. Any joint damage may go unnoticed while you are being treated with dexamethasone. Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medication. Do not receive a "live" vaccine while you are being treated with dexamethasone. Vaccines may not work as well while you are using a steroid. Ask your doctor when you can safely receive a live vaccine after your dexamethasone treatment ends.

How should I take Decadron (Dexamethasone)?

Dexamethasone (Oral)

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results.

Your steroid medication needs may change if you have unusual stress such as a serious illness, fever or infection, or if you have surgery or a medical emergency. Tell your doctor about any such situation that affects you. This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using dexamethasone. Do not stop using dexamethasone suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. Wear a medical alert tag or carry an ID card stating that you take dexamethasone. Any medical care provider who treats you should know that you are using steroid medication. Store at room temperature away from moisture and heat.
Dexamethasone (Injection)

Dexamethasone is given as an injection into a muscle or through a needle placed into a vein. You will receive this injection in a clinic or hospital setting. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Your steroid medication needs may change if you have unusual stress such as a serious illness, fever or infection, or if you have surgery or a medical emergency. Tell your doctor about any such situation that affects you. This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using dexamethasone. Dexamethasone injection is usually given for only a few days. After your treatment ends, you may have withdrawal symptoms such as fever, weakness, and joint or muscle pain. Talk to your doctor about how to treat or avoid any withdrawal symptoms. Back to Top

What happens if I overdose on Decadron (Dexamethasone)?

Dexamethasone (Oral)

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Long-term use of high steroid doses can lead to symptoms such as thinning skin, easy bruising, changes in the shape or location of body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.
Dexamethasone (Injection)

Seek emergency medical attention if you think you have received too much of this medicine. A single large dose of dexamethasone is not expected to produce life-threatening symptoms. However, long-term use of high steroid doses can lead to symptoms such as thinning skin, easy bruising, changes in the shape or location of body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex. Back to Top

What happens if I miss a dose of Decadron (Dexamethasone)?

Dexamethasone (Oral)

Call your doctor for instructions if you miss a dose of dexamethasone.

Dexamethasone (Injection)

Since dexamethasone injection is given as needed by a healthcare professional, it is not likely that you will miss a dose.

http://www.everydayhealth.com/drugs/decadron

Treatment of Asthma - Part II by Warren P. Silberstein, M.D. 06/23/97 updated 09/10/98 updated 04/07/01 Maintenance Medications Maintenance medications include anti-inflammatory medications which relieve the inflammation that provokes bronchospasm and causes increased mucus, and long acting bronchodilators which keep the airways open for prolonged periods. Antiinflammatory medications include steroids and non-steroidal anti-inflammatory medications. The non-steroidal anti-inflammatory medications used for asthma are not related to the non-steroidal anti-inflammatory drugs (NSAIDs) used for arthritis such as ibuprofen. The steroids used to treat asthma are corticosteroids which are not anabolic steroids and have nothing to do with those illegal drugs used by some unscrupulous athletes. Maintenance medications are not to be taken for treatment of an acute asthma attack. Attacks are treated with rescue medications. In fact, if a patient is wheezing when he is due to take a dose of an inhaled maintenance medication, he should take his rescue medication first to control the wheezing so that the maintenance medication can be delivered to the entire bronchial tree.

Cromolyn (Intal) - available as a spray and nebulizer solution. Cromolyn is an anti-inflammatory medication which is relatively free of side effects. It may cause some throat irritation and, as with all inhalation medications, may provoke cough or wheezing. Initially treatment with cromolyn is generally taken 4 times daily. After 2 to 4 weeks there is usually an improvement in symptoms including a decreased need for rescue medications. After a period of good control of symptoms the dose of cromolyn can be decreased to 3 times daily and eventually to a maintenance of twice daily. The medication should not be discontinued without the advice of a physician since the absence of symptoms may be the result of taking the medication. Cromolyn and most of the other anti-inflammatory medications are not useful when taken intermittently or just when symptoms begin. Cromolyn can be used to prevent

exercise induced asthma if taken prior to sports or exercise even if it is not taken regularly. Nedocromil (Tilade) - available as a spray. This medication is very similar to cromolyn. It is a more potent anti-inflammatory than cromolyn. It is relatively side effect free. The main side effects are headache and nausea. Bad taste has also been listed as a cause for discontinuing therapy. Zafirlukast (Accolate) - available as a tablet. Accolate is one of the newest asthma medications. It is a completely different type of anti-inflammatory known as a leukotriene inhibitor. Leukotrienes are involved in the inflammatory response that provokes asthma. Adverse reactions include headaches, infections, nausea, and diarrhea. This medication is a mid-potency anti-inflammatory whose main advantage is that it can be used by patients who can't or prefer not to use sprays. It is not recommended for young children. Montelukast (Singulair) - available as a tablet and chewable tablet. Singulair is the newest leukotriene antagonist, and is similar to Accolate. Its advantages are that it is approved for children 6 years old and older, and it is taken only once daily. Its use can decrease or even avoid the use of steroids. Like Accolate, it is also useful for patients who prefer tablets over sprays or children who have not yet mastered the use of sprays. Reactions to the medication may include diarrhea, laryngitis, pharyngitis, nausea, otitis, sinusitis, and viral infection. Inhaled Steroids - available as sprays. Steroids are used for their potent antiinflammatory effect. There are many brands available, all of which are good medications. They are difficult to compare with regard to potency because 1 mg of one type of steroid is not equivalent to 1 mg of another. Current recommendations and guidelines form the U.S. Federal Government are to use high potency inhaled steroids for treating severe asthma, but until recently, there was no high potency spray available in the U.S. Higher doses can be given by increasing the number of sprays given, however, in my experience, the more sprays a patient has to take at a time, the less effectively he takes them. Some of the major brands include: o Beclomethasone (Beclovent, Vanceril, Becloforte) - Becloforte is a high potency spray which is available from Canada. Each spray delivers almost six times the amount of medicine as one spray of the other two brands. If your physician feels you would benefit from Becloforte he can order it from Clayman's Pharmacy in Quebec at 514-735-5243. They will ship it to you if you provide them with credit card information. I'm sure there are other Canadian pharmacies that would do the same, but I provide this information because I have dealt with them and have their telephone number. Given the other high potency inhaled steroids now available in the USA, that should not be necessary. o Flunisolide (Aerobid, Aerobid-M)

o o o

Triamcinolone (Azmacort) - comes with a built in spacer. Fluticasone (Flovent) - Flovent comes in three strengths including the highest potency inhaled steroid currently available in the United States. Budesonide (Pulmicort) - comes as a turbohaler which is activated by breathing in. It's delivery mechanism makes it easier for children to use. It is approved for children over 6 years. Pulmicort Respules come in two strengths for use in the nebulizer once or twice daily. It is approved for children 1 year old and up. It is the only nebulized steroid available in the USA.

All inhaled steroids have essentially the same side effects which include thrush (a yeast infection in the mouth), hoarseness, dry throat, irritated throat, and dry mouth. The risk of thrush can be minimized by using a spacer which increases the amount of medication deposited in the lungs and decreases the amount deposited in the mouth and throat. Rinsing the mouth after each use can also decrease the risk of thrush. Inhaled steroids are the most potent available anti-inflammatory drugs available for the treatment of asthma besides oral steroids. They are excellent medications for the long term management and control of moderate to severe asthma. In general they do not cause the side effects of systemic (oral, intravenous, or injected) steroids, but they are absorbed to some extent, and in high enough doses, can suppress the normal production of steroids by the body. Because of the possibility of systemic absorption of inhaled steroids, patients treated with these drugs should be observed carefully for any evidence of systemic steroid effects including suppression of growth in children. The degree to which inhaled steroids suppress gowth, if at all, is currently under study. Steroids also blunt the immune response. While there are no reports of serious problems with infection in children on the sprays, caution is advised if susceptible children on these sprays are exposed to chicken pox or measles. Because of all these cautions, inhaled steroids are generally not first line drugs. They are reserved for more severe asthma. Generally, cromolyn or nedocromil should be tried first. Inhaled steroids are much preferred over systemic steroids for management of asthma, so in situations where children end up taking oral steroids frequently for management of asthma, using the steroid spray to maintain control after discontinuing the oral steroid is an excellent idea. Steroids are serious medicine, but asthma can be a serious disease. When steroids are needed, they are excellent medicines. My daughter has been using an inhaled steroid for 12 years.

Systemic Steroids - Systemic means taken into the body rather than put directly into the lungs as with a spray or nebulizer. Children who are sick enough to be hospitalized for asthma generally get steroids intravenously. Some physicians will give an injection of Decadron, Depomedrol , or another steroid to patients in their office for acute asthma attacks. Most commonly, patients take steroids by mouth for severe exacerbations of their asthma.. There are many brands - pills such as Prednisone, Medrol, Decadron, Aristocort, and liquids like Pediapred, or Prelone. Systemic steroids have a much more potent anti-inflammatory effect on the inflamed airways than inhaled steroids, and they have a much more rapid onset of action than inhaled steroids. They also have a much greater risk of side effects. Initial side effects such as stomach irritation and mood changes are dose related. The most serious side effects are related to prolonged use. Prolonged use of steroids can cause growth retardation, osteoporosis, cataracts, a rounded face, increased body fat, fluid retention, muscle weakness, peptic ulcer, menstrual irregularities, aggravation of diabetes mellitus, impaired wound healing, and decreased immunity. In addition, systemic steroids taken for more than two weeks causes sufficient suppression of normal adrenal gland function that the steroids must be tapered rather than abruptly withdrawn. For these reasons, the use of systemic steroids is reserved for treatment of severe or persistent asthma symptoms or increasing symptoms not adequately controlled by treatment. Courses of systemic steroids should be kept as short as possible to minimize side effects, but generally a minimum of three days is required to achieve an adequate anti-inflammatory response. In spite of potential side effects, it is not desirable to stop steroids prematurely since that will most likely result in a return of symptoms necessitating reinstitution of the steroids. Therefore, patients must be monitored closely to determine the optimal duration of treatment. Steroids are potent medicines, but in short courses they are generally well tolerated. Asthma can be a serious disease. Even though the use of steroids should not be taken lightly, with appropriate monitoring, there should be no hesitation about using steroids to control asthma symptoms.

Albuterol (Proventil Repetabs, Volmax) - available as tablets. The two brands listed are long acting preparations of albuterol which can be taken by mouth to provide prolonged bronchodilation. Side effects include hyperactivity, shakiness, rapid heart rate, and are the same as the shorter acting albuterol. Salmeterol (Serevent) - available as a spray. Salmeterol is a 12 hour bronchodilator. It is meant to be taken every 12 hours to control recurrent wheezing. Long acting bronchodilators are especially useful for patients who

are awakened by wheezing. The 12 hour duration helps them to stay wheeze free through a night of sleep. Salmeterol is similar to the rescue medicine albuterol, but its duration of action is longer and its onset of action is slower. Salmeterol should not be taken to control the acute onset of wheezing. It is not a rescue medicine. If a patient is wheezing when it is time to take his Salmeterol he should first take his rescue medicine to control the wheeze. Side effects are similar to albuterol although sprays generally have fewer systemic side effects than medicines taken by mouth. Ipratropium bromide (Atrovent) - available as a spray. Useful for prevention of bronchospasm. Unlike other bronchodilators, Ipratropium bromide blocks the reflexes that cause bronchospasm. Its onset of action is not rapid enough to use as a rescue medication. It can be used in combination with the bronchodilators that cause bronchial relaxation to achieve better control. Ipratropium bromide is used more commonly for chronic bronchitis and emphysema than for asthma. The most common side effects are dry mouth and cough. Methylxanthines include aminophylline and theophyllines (Elixophylline, Slo-bid, Theo-Dur, Quibron, and many others). These drugs are stimulants similar to caffeine which act as bronchodilators. When I first became a pediatrician, prior to the development of drugs like albuterol and metaproterenol, theophyllines were the first line drugs for treating asthma. Only the intravenous aminophylline and theophylline elixir (Elixophylline) have relatively rapid onset of action. The others are long acting medications primarily useful for chronic management. Aside from being stimulants, theophyllines taste terrible and tend to upset the stomach. Their use requires monitoring of the blood level of theophylline. Most pediatricians today use these medicines only for additional control of wheezing in children already on the other medications.
Combination Medications

These include combinations of ephedrine and theophylline such as Marax and Tedral. I mention them only for historical perspective in case you hear of patients on these medications. They are generally not used anymore. Even though both theophylline and ephedrine are bronchodilators, their use in combination increases their side effects more than it increases their therapeutic benefits.

www.mindspring.com/~drwarren/asthma3.htm

Treatment of Asthma - Part I by Warren P. Silberstein, M.D. 06/16/97

The main categories of medications used to treat asthma are anti-inflammatory drugs, since asthma is an inflammatory disease of the airways, and bronchodilatorswhich help to relieve the constriction of the airways which cause the acute symptoms of asthma. In the management of asthma these medications are divided intomaintenance drugs - those medicines which are taken chronically to control and prevent asthma symptoms, and rescue drugs - those medications which are used to relieve acute symptoms.

Rescue Medications

Albuterol (Proventil, Ventolin) - available as a syrup, tablet, spray, and nebulizer solution. These medications work by stimulating receptors on the smooth muscles lining the bronchial tree causing these muscles to relax. Syrup and tablets must be absorbed into the system before they can reach the place where they work. Sprays are much more effective at relieving acute symptoms because when they are inhaled they go right to where they are needed and begin to work immediately. Because the medication is going directly to where it is needed less medication needs to enter the body to get results than with pills or syrup. The use of sprays may be limited in children because of the need to learn the skills necessary for proper inhalation of the medication. There are devices (spacers) which can aid in the delivery of sprays. The effectiveness of sprays may also be limited by an asthmatic's ability to hold the spray in his lungs if he is coughing too much and the inability of the spray to get down into the small airways during a severe asthma attack. A nebulizer delivers the medication on a

fine mist over a period of 10 to 15 minutes. This makes it more suitable for use with infants because there are no skills to learn in order for the infant to inhale the medication. The nebulizer is also more effective for treating acute attacks than the spray. Inhalations (nebulizer and spray) provide 4 to 6 hours of bronchodilation and may be repeated every 4 hours as necessary; however, patients who require frequent or prolonged treatment with rescue medications also require maintenance medications for better control and prevention of symptoms. We will talk more about spacers, nebulizers, and the proper use of these medications in the next two weeks when we talk about the Management of Asthma. The main side effects of albuterol are a result of its stimulant properties. It can cause rapid heart rate, palpitations, tremors, shakiness, nervousness, hyperactivity, irritability, and insomnia. Surprisingly, any inhaled medication including bronchodilators like albuterol can provoke wheezing by irritating the airways.

Metaproterenol (Alupent, Metaprel) - available as a syrup, tablet, spray, and nebulizer solution. The mechanism of action and side effects are the same as albuterol. Patients who experience excessive side effects from one of these medications may tolerate the other. Pirbuterol (Maxair) - available as a spray. Similar to albuterol and metaproterenol. Terbutaline (Brethaire, Brethine, Bricanyl) - available as spray, tablets, and injection. Similar to all above. The injectable form can be used to relieve bronchospasm in emergency situations. Isoetharine (Bronkosol, Bronkometer) - available as spray and nebulizer solution. The mechanism of action and side effects are similar to all of the above; however, isoetherine is more cardiac stimulant than the newer medications previously discussed. In addition, its duration of action is not as prolonged but its frequency of use is limited by its side effects. Some severe chronic asthmatics may respond better to isoetharine than the other medications. Isoproterenol (Isuprel) - available as spray, tablets, and nebulizer solution Similar to isoetharine. Isoproterenol is a potent bronchodilator which may be used intravenously with careful monitoring in extreme situations. Epinephrine bitartrate (Primatene) - available as a spray (Primatene tablets are a different formulation). The mechanism of action is similar to all the sprays above. Like isoetharine, it is more cardiac stimulant and does not have as prolonged bronchodilator effect as albuterol and similar sprays. Primatene is a popular medication because it provides rapid relief of symptoms, is available

without a prescription, and has been advertised on TV for years. I think asthmatics would be better served by having their care supervised by a physician and using the newer prescription sprays which provide more prolonged relief with fewer side effects. In addition, as we will discuss in the next two weeks when we talk about the Management of Asthma, rescue medications are sufficient treatment for asthmatics who have only occasional symptoms, but patients with severe, chronic, or recurrent symptoms require appropriate maintenance medications which are only available through a physician. Epinephrine or Adrenaline - two names for the same thing. Available as an injectable. the mechanism of action and side effects are similar to isoetharine and isoproterenol. The advantage of injectables is that they can be used to provide quick relief to asthmatics who are having such severe bronchospasm that inhalation is not effective. Epinephrine is available in an auto-injector (Epipen and Epi-pen Jr.) which can be used for self administration for acute allergic reactions and acute asthma. Such use is intended to relieve acute symptoms to allow time to seek medical care and is not a substitute for such care.

All of the rescue medications are rapidly acting bronchodilators, drugs which reduce the constriction of the smooth muscles of the bronchial tree quickly thereby opening the airways and providing almost immediate symptomatic relief of wheezing. The main differences between them are the degree of cardiac (heart) stimulation, duration of action, and the mode of administration. This list reviews the major medications in use today in the U.S.A. but is by no means a complete listing of all rescue medications. The main rescue medications in other countries may differ, but the principles are the same. For mild asthmatics who have only occasional symptoms treatment with rescue medications may be sufficient, but since these medications do not reduce the inflammation that causes the airway constriction or the increased mucus production, asthmatics who have more frequent, persistent, or severe symptoms require maintenance medications as well.
http://www.mindspring.com/~drwarren/asthma2.htm

Decadron Drug Description Decadron (dexamethasone) is a corticosteroid, is similar to a natural hormone produced by the adrenal glands and is used to treat arthritis, skin, blood, kidney, eye, thyroid, intestinal disorders, severe allergies,

and asthma. Decadron is also used to treat certain types of cancer and occasionally, cerebral edema. Decadron is available as a generic termed dexamethasone; however the brand name Decadron is no longer available in the U.S. Side effects of Decadron may include GI symptoms (nausea, vomiting), headache, acne or skin rash, increased hair growth, irregular menstrual periods, easy bruising, and anxiety, or depression. Decadron is available in strengths of 0.5 and 0.75 mg tablets. Side effects of Decadron listed above may become severe; in addition other severe effects include GI bleeding, increased susceptibility to many types of infections, and swelling. Decadron should be used during pregnancy or during breastfeeding only if the potential benefit justifies the potential risk to the fetus or infant. Infants may suffer adrenal suppression if their mothers use this drug during pregnancy. In special instances (for example, leukemia and nephrotic syndrome), Decadron has been used in pediatric patients. Such use should be done in most patients in conjunction with a pediatric specialist. Our Decadron Drug Center provides a comprehensive view of available drug information as well as related drugs, user reviews, supplements, and diseases, and conditions.

What are the precautions when taking dexamethasone (Decadron)?

Before taking dexamethasone, tell your doctor or pharmacist if you are allergic to it; or to other corticosteroids (e.g., prednisone); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: active fungal infections. Before using this medication, tell your doctor or pharmacist your medical history, especially of: other infections (e.g., tuberculosis, herpes), kidney disease, liver disease, mental/mood conditions (e.g., psychosis, anxiety, depression), low blood minerals (e.g., low potassium/calcium),... Read All Potential Precautions of Decadron
Last reviewed on RxList: 6/12/2007 This monograph has been modified to include the generic and brand name in many instances.

DECADRON CONSUMER (CONTINUED)

SIDE EFFECTS:Stomach upset, headache, dizziness, menstrual changes, trouble sleeping, increased appetite, or weight gain may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor immediately if any of these unlikely but serious side effects occur: signs of infection (e.g., fever, persistent sore throat), bone/joint pain, increased thirst/urination, fast/slow/irregular heartbeat, eye pain/pressure, heartburn, black stools, vomit that looks like coffee grounds, puffy face, swelling of the ankles/feet, stomach/abdominal pain, pain/redness/swelling of arms/legs, tiredness, mental/mood changes (e.g., depression, mood swings, agitation), unusual hair/skin growth, muscle pain/cramps, weakness, easy bruising/bleeding, slow wound healing, thinning skin, seizures.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA1088. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PRECAUTIONS:Before taking dexamethasone, tell your doctor or pharmacist if you are allergic to it; or to other corticosteroids (e.g., prednisone); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: active fungal infections. Before using this medication, tell your doctor or pharmacist your medical history, especially of: other infections (e.g., tuberculosis, herpes), kidney disease, liver disease, mental/mood conditions (e.g., psychosis, anxiety, depression), low blood minerals (e.g., low potassium/calcium), thyroid disease, stomach/intestinal problems (e.g., ulcer, ulcerative colitis, diverticulitis, unexplained diarrhea), high blood pressure, heart problems (e.g., congestive heart failure, recent heart attack), diabetes, eye diseases (e.g., cataracts, glaucoma, herpes infection of the eye), brittle bones (osteoporosis), history of blood clots. This medication may mask signs of infection or put you at greater risk of developing very serious infections. Report any injuries or signs of infection (e.g., persistent sore throat/fever/cough, pain during urination, muscle aches) that occur during treatment. If you have been taking this medication for a long time, your body may not make enough natural hormones while you are under physical stress (e.g., due to infection, surgery, injury). Your dose may need to be adjusted. If you have stopped taking this drug within the past 12 months, you may need to start taking it again if your body is under physical stress. Consult your doctor for more details. Before having surgery, tell your doctor or dentist that you are using this medication or have taken it within the last 12 months. Do not have immunizations, vaccinations, or skin tests unless specifically directed by your doctor. Live vaccines may cause serious complications (e.g., infection) if given while you are taking this medication. Avoid contact with people who have recently received oral polio vaccine or flu vaccine inhaled through the nose. Avoid contact with people who have chickenpox or measles unless you have previously had these diseases (e.g., in childhood). If you are exposed to one of these infections and you have not previously had it, seek immediate medical attention.

If you have a history of ulcers or take large doses of aspirin or other arthritis medication, limit alcoholic beverages while taking this medication to decrease the risk of stomach/intestinal bleeding. Consult your doctor or pharmacist for more details. If you have diabetes, this drug may make it harder to control your blood sugar levels. Monitor your blood sugar levels regularly and inform your doctor of the results. Your medicine, exercise plan, or diet may need to be adjusted. This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages. Caution is advised when using this drug for long periods in children. This medication may temporarily slow down a child's rate of growth, but it will probably not affect final adult height. Monitor your child's height periodically. During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Infants born to mothers who have been using this medication for an extended time and/or at high doses may have low levels of corticosteroid hormone. Tell your doctor immediately if you notice symptoms such as persistent nausea/vomiting, severe diarrhea, or weakness in your newborn. This drug may pass into breast milk and could have undesirable effects on a nursing infant. Consult your doctor before breast- feeding.

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Decadron
Generic Name: Dexamethasone Other Brand Names: Dexasone, Diodex, Hexadrol, Maxidex Other Names: Dexamethasone Sodium Phosphate, Dexamethasone Acetate Drug Type: Decadron has many uses in the treatment of cancer. It is classified as a glucocorticosteroid. (For more detail, see "How Decadron Works" section below). What Decadron Is Used For: As an anti-inflammatory medication. Decadron relieves inflammation in various parts of the body. It is used specifically to decrease swelling (edema), associated with tumors of the spine and brain, and to treat eye inflammation. To treat or prevent allergic reactions. As treatment of certain kinds of autoimmune diseases, skin conditions, asthma and other lung conditions. As treatment for a variety of cancers, such as leukemia, lymphoma, and multiple myeloma. To treat nausea and vomiting associated with some chemotherapy drugs. Used to stimulate appetite in cancer patients with severe appetite problems. Also used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids produced by the adrenal glands).

Note: If a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful. How Decadron Is Given: Decadron may be given to you in many forms. In a pill form, it is available in a variety of tablet sizes. If you are on a daily dose of Decadron (usually less than 10 mg), and you miss a dose, take the dose as soon as you remember. If you are on high doses of Decadron (20 mg or 40 mg per day for 4 days out of the month), and you miss your dose, contact your healthcare provider. You may be instructed to repeat the missed dose, and continue the medication. Take pills with food or after meals Decadron may also be given by infusion into a vein (intravenously or IV) Decadron eye drops are given to treat or prevent many eye conditions. The eye drops are most commonly given to patients with leukemia or lymphoma, to prevent inflammation of the eyes (conjunctivitis), if you are receiving high dose chemotherapy (usually Cytarabine [Ara-C]). The eye drops are given every six hours, in both eyes, and for at least 48 hours after the chemotherapy has completed. Do not stop taking these eye drops unless directed by your healthcare provider. You may be given Decadron as a lotion (topical) to treat skin disorders. The amount of Decadron you will receive depends on many factors, including your general health or other health problems, and the reason you are receiving Decadron. Your doctor will determine your dosage and schedule. Decadron Side Effects: Important things to remember about Decadron side effects: Most people do not experience all of the Decadron side effects listed. Decadron side effects are often predictable in terms of their onset and duration. Decadron side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent Decadron side effects. The following Decadron side effects are common (occurring in greater than 30%) for patients taking Decadron: Increased appetite Irritability Difficulty sleeping (insomnia) Swelling in your ankles and feet (fluid retention) Heartburn Muscle weakness Impaired wound healing Increased blood sugar levels. Persons with Diabetes may need to have blood sugar levels monitored more closely and possible adjustments to diabetes medications. The following are less common Decadron side effects (occurring in >10%) for patients receiving Decadron:

Headaches Dizziness Mood swings Cataracts and bone thinning (with long-term use) This list includes common and less common side effects for individuals taking Decadron. Decadron side effects that are very rare, occurring in less than 10% of patients, are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When To Contact Your Doctor or Health Care Provider: Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: Fever of 100.5 F (38 C), chills (possible signs of infection)

If you feel an irregular or fast heart beat, shortness of breath, or chest or jaw pain, seek emergency help and notify your healthcare provider If you become suddenly confused The following symptoms require medical attention, but are not emergency situations. Contact your health care provider within 24 hours of noticing any of the following: Extreme fatigue (unable to carry on self-care activities) Any unusual bleeding or bruising Black or tarry stools, or blood in your stools or urine Nausea (interferes with ability to eat and unrelieved with prescribed medications) Vomiting (vomiting more than 4-5 times in a 24-hour period) Dizziness or lightheadedness, feeling faint. Persistent headache Severe hot flashes or mood swings Inability to sleep (insomnia) Severe skeletal (bone) pain Difficult or painful urination; increased urination, or severe thirst Changes in vision, blurred vision, eye pain, enlarged pupils, discharge Any new rashes or changes in your skin Swelling of the feet or ankles. Sudden weight gain (greater than 3 pounds a week) Swelling, redness and/or pain in one leg or arm and not the other Always inform your health care provider if you experience any unusual symptoms. Decadron Precautions: Before starting Decadron treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this. Do not receive any kind of immunization or vaccination without your doctor's approval while taking Decadron. If you have been on Decadron pills daily, for a long period of time, serious side effects may occur if you discontinue the medication abruptly. Do not stop taking Decadron unless directed by your healthcare provider. Do not change the dose of Decadron on your own. Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). For both men and women: Do not conceive a child (get pregnant) while taking Decadron. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy. Do not breast feed while taking Decadron. Decadron Self Care Tips: If you are on Decadron for a long period of time, you may be more susceptible to infection. Wash your hands well, and report any symptoms of infection to your healthcare provider if noted. If you are given eye drops or eye ointment: You may be more sensitive to the light. Wearing sunglasses may help. It is normal to notice a little blurriness for a short time after the drops or ointment are placed in your eyes. Notify your healthcare provider with any changes in vision, blurriness, or eye pain. If you are given eye drops or eye ointment: Ask your healthcare provider if you may wear contact lenses. Contact lenses may absorb the medication for at least 15 minutes. Wash your hands well before putting eye drops, to decrease the chance of a bacterial infection in your eyes. If you are Decadron as a lotion (topical) to treat skin disorders: Do not apply to open areas of skin, or if you have open or weeping sores. Topical Decadron should not be used for a long time. Discuss this with your healthcare provider. Take Decadron with food to lessen an upset stomach. Also take Decadron early on in the day (before 12:00 noon, if possible), so you will be able to sleep better at night.

If you have diabetes, Decadron may increase your blood sugar levels. You may need more frequent monitoring. Drink 2 to 3 quarts of fluid every 24 hours, unless you were told to restrict your fluid intake, and maintain good nutrition. Avoid sun exposure. Wear SPF 15 (or higher) sun block and protective clothing. To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. In general, drinking alcoholic beverages should be avoided. You should also limit caffeine intake (colas, tea, coffee and chocolate, especially). These beverages may irritate your stomach. If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and Testing While Taking Decadron: You will be checked regularly by your health care professional while you are taking Decadron, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. How Decadron Works: Corticosteroids are naturally produced by the adrenal gland in the body. Corticosteroids influence the functioning of most of the body's systems (heart, immune, muscles and bones, endocrine and nervous system). They exert a wide array of effects including effects on the metabolism of carbohydrates, protein and fats. They help to maintain balance of fluids and electrolytes. Decadron is classified as a corticosteroid (more precisely a glucocorticosteroid), and has many uses in the treatment of cancer. One way that it works is to decrease inflammation (swelling). It does this by preventing infection- fighting white blood cells (polymorphonuclear leukocytes) from traveling to the area of swelling in your body. (This is why you are more prone to infection while taking steroids). Taking advantage of the anti-inflammatory properties of the medication, corticosteroids are used to decrease the swelling around tumors. For example, by decreasing swelling around tumors in the spine, brain, or bone, it can decrease the pressure of the tumor on nerve endings and relieve pain or other symptoms caused by the pressing tumor. Another way Decadron works is by altering the body's normal immune system responses. Corticosteroids are used to treat certain conditions that effect the immune system such as aplastic anemia (AA), Immune Thrombocytopenia Purpura (ITP), Thrombotic Thrombocytopenia Purpura (TTP), or hemolytic anemia. In addition, it is thought that corticosteroids may help in the treatment of patients with blood disorders, such as multiple myeloma. Corticosteroids may work by causing programmed cell death (apoptosis) of certain cells, which may help to fight your disease. Decadron is also used in the short-term treatment of nausea caused by chemotherapy. How it does this is not fully understood. It also has been used to stimulate appetite for patients with severe appetite problems. Corticosteroids are used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids produced by the adrenal glands).

http://www.chemocare.com/bio/decadron.asp scott Hamilton

screen shoot Dr Mirna nurasri praptini 6 agustus 2011

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dexamethasone oral, Decadron, DexPak

Pharmacy Author: Omudhome Ogbru, PharmD Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: dexamethasone oral BRAND NAME: Decadron, DexPak

DRUG CLASS AND MECHANISM: Dexamethasone is a synthetic (man-made) corticosteroid. Corticosteroids are naturally-occurring chemicals produced by the adrenal glands located above the kidneys. Corticosteroids affect the function of many cells within the body and suppress the immune system. Corticosteroids also block inflammation and are used in a wide variety of inflammatory diseases affecting many organs.

PRESCRIPTION: Yes GENERIC AVAILABLE: Yes PREPARATIONS: Tablets: 0.25, 0.5, 0.75, 1, 1.5, 2, 4, and 6 mg. Elixir: 0.5 mg /5 mL. Solution: 0.5, 1 mg/5 ml STORAGE: Dexamethasone should be stored at 68-77 F (20-25 C) and not frozen. PRESCRIBED FOR: Dexamethasone is used for reducing inflammation in many conditions. Some examples include rheumatoid arthritis, systemiclupus, acute gouty arthritis, psoriatic arthritis, ulcerative colitis, and Crohn's disease. Severe allergic conditions that fail to respond to other treatments also may respond to dexamethasone. Examples include bronchial asthma,allergic rhinitis, drug-induced dermatitis, and contact and atopic dermatitis. Chronic skin conditions treated with dexamethasone include dermatitis herpetiformis, pemphigus, severe psoriasis and severe seborrheic dermatitis. Chronic allergic and inflammatory conditions of the uvea, iris,conjunctiva and optic nerves of the eyes also are treated with dexamethasone. Dexamethasone is used in the treatment of cancers of the white blood cells (leukemias), and lymph gland cancers (lymphomas). Blood diseases involving destruction by the body's own immune system of platelets (idiopathic thrombocytopenia purpura), and red blood cells (autoimmune hemolytic anemia) also are treated with dexamethasone. Other miscellaneous conditions treated with dexamethasone include thyroiditis andsarcoidosis. Finally, dexamethasone is used as replacement therapy in patients whose adrenal glands are unable to produce sufficient amounts of corticosteroids. DOSING: Dosage requirements of corticosteroids vary greatly among individuals and the diseases being treated. In general, the lowest possible effective dose is used. The initial oral dose is 0.75 to 9 mg daily depending on the disease. The initial dose should be adjusted based on response. Corticosteroids given in multiple doses throughout the day are more effective but also are more toxic as compared with the same total daily dose given once daily, or every other day. DRUG INTERACTIONS: Corticosteroids may increase or decrease the effect of blood thinners, for example, warfarin (Coumadin). Blood clotting should be monitored and the dose of blood thinner adjusted in order to achieve the desired level of blood thinning when patients receiving blood thinners are begun on corticosteroids, including dexamethasone.

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dexamethasone oral Index Glossary dexamethasone oral on RxList

dexamethasone oral, Decadron, DexPak (cont.)

Phenobarbital, ephedrine, phenytoin (Dilantin), and rifampin (Rifadin, Rimactane) may increase the breakdown of corticosteroid reduced effects. Therefore, the dose of corticosteroid may need to be increased if treatment with any of these agents is begun. PREGNANCY: Dexamethasone has not been adequately evaluated inpregnant women.

NURSING MOTHERS: Dexamethasone has not been adequately evaluated in nursing mothers. Corticosteroids appear in breas

SIDE EFFECTS: Side effects of dexamethasone depend on the dose, the duration and the frequency of administration. Short co with few and mild side effects. Long term, high dose dexamethasone usually will produce predictable and potentially serious side dose of dexamethasone should be used for the shortest possible length of time to minimize side effects. Alternate day dosing also

Side effects of dexamethasone and other corticosteroids range from mild annoyances to serious irreversible damage. Side effects pressure, loss of potassium, headache, muscle weakness, puffiness of and hair growth on the face, thinning andeasy bruising of s worsening ofdiabetes, irregular menses, growth retardation in children, convulsions, and psychic disturbances. Psychic disturban swings, personality changes, and even psychotic behavior.

Prolonged use of dexamethasone can depress the ability of body's adrenal glands to produce corticosteroids. Abruptly stopping d symptoms of corticosteroid insufficiency, with accompanying nausea, vomiting, and even shock. Therefore, withdrawal of dexam reducing the dose. Gradually tapering dexamethasone not only minimizes the symptoms of corticosteroid insufficiency, but also under treatment.

Dexamethasone and other corticosteroids can mask signs of infection and impair the body's natural immune response that is impo corticosteroids are more susceptible to infections and can develop more serious infections than individuals not receiving corticos example, chickenpox and measles viruses can produce serious and even fatal illnesses in patients on high doses of dexamethason should be avoided in patients taking high doses of dexamethasone, since even vaccine viruses may cause disease in these patients as tuberculosis (TB) and malaria, can remain dormant in a patient for years. Dexamethasone and other corticosteroids can reactiv tuberculosis may require treatment of the TB while undergoing corticosteroid treatment.

By interfering with the patient's immune response, dexamethasone can impede the effectiveness of vaccinations. Dexamethasone test and cause falsely negative results in patients with dormant tuberculosis infection.

Dexamethasone impairs calcium absorption and new bone formation. Patients on prolonged treatment with dexamethasone and o an increased risk of bone fractures. Supplemental calcium and vitamin D are encouraged to slow this process of bone thinning. It patients treated with steroids that the loss of bone may be prevented by treatment with biphosphonate drugs, for example, alendro

In rare individuals, destruction of large joints can occur while undergoing treatment with dexamethasone or other corticosteroids involved joints, and can require joint replacements. The reason behind such destruction is not clear. Reference: FDA Prescribing Information

Last Editorial Review: 3/12/2009

http://www.medicinenet.com/dexamethasone_oral/article.htm

dexamethasone - oral, Decadron, Hexadrol GENERIC NAME: DEXAMETHASONE - ORAL (dex-uh-METH-uh-sown) BRAND NAME(S): Decadron, Hexadrol
Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes |Missed Dose | Storage USES: Dexamethasone is used to treat conditions such as arthritis, blood/hormone/immune system disorders, allergic reactions, certain skin and eye conditions, breathing problems, certain bowel disorders, and certain cancers. It is also used as a test for an adrenal gland disorder (Cushing's syndrome).This medication is a corticosteroid hormone (glucocorticoid). It decreases your body's natural defensive response and reduces symptoms such as swelling and allergic-type reactions.OTHER This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.This drug may also be used to prevent nausea and vomiting caused by cancer chemotherapy. HOW TO USE: Take this medication by mouth as directed by your doctor. Take with food or milk to prevent stomach upset. Take this medication by mouth with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise. If you are using the liquid form of the medication, use a medication-measuring device to carefully measure the prescribed dose. Do not use a household spoon.If you take this medication once daily, take it in the morning before 9 AM. If you are taking this medication every other day or on another schedule besides a daily one, it may help to mark your calendar with a reminder.The dosage and length of treatment are based on your medical condition and response to therapy. Your doctor may attempt to reduce your dose slowly from time to time to minimize side effects.Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. It is important to continue taking this

medication even if you feel well. Follow the dosing schedule carefully, and take this medication exactly as prescribed.Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.Inform your doctor if your condition does not improve or worsens. SIDE EFFECTS: Stomach upset, headache, dizziness, menstrual changes, trouble sleeping, increased appetite, or weight gain may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor immediately if any of these unlikely but serious side effects occur: signs of infection (e.g., fever, persistent sore throat), bone/joint pain, increased thirst/urination, fast/slow/irregular heartbeat, eye pain/pressure, heartburn, black stools, vomit that looks like coffee grounds, puffy face, swelling of the ankles/feet, stomach/abdominal pain, pain/redness/swelling of arms/legs, tiredness, mental/mood changes (e.g.,depression, mood swings, agitation), unusual hair/skin growth, muscle pain/cramps, weakness, easy bruising/bleeding, slow wound healing, thinning skin, seizures.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PRECAUTIONS: Before taking dexamethasone, tell your doctor or pharmacist if you are allergic to it; or to other corticosteroids (e.g.,prednisone); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: active fungal infections.Before using this medication, tell your doctor or pharmacist your medical history, especially of: other infections (e.g., tuberculosis, herpes), kidney disease,liver disease, mental/mood conditions (e.g., psychosis, anxiety, depression), low blood minerals (e.g., low potassium/calcium), thyroid disease, stomach/intestinal problems (e.g., ulcer, ulcerative colitis, diverticulitis, unexplained diarrhea), high blood pressure, heart problems (e.g.,congestive heart failure, recent heart attack), diabetes, eye diseases (e.g.,cataracts, glaucoma, herpes infection of the eye), brittle bones (osteoporosis), history of blood clots.This medication may mask signs of infection or put you at greater risk of developing very serious infections. Report any injuries or signs of infection (e.g., persistent sore throat/fever/cough, pain during urination, muscle aches) that occur during treatment.If you have been taking this medication for a long time, your body may not make enough natural hormones while you are under physical stress(e.g., due to infection, surgery, injury). Your dose may need to be adjusted. If you have stopped taking this drug within the past 12 months, you may need to start taking it again if your body is under physical stress. Consult your doctor for more details.Before having surgery, tell your doctor or dentist that you are using this medication or have taken it within the last 12 months.Do not have immunizations, vaccinations, or skin tests unless

specifically directed by your doctor. Live vaccines may cause serious complications (e.g., infection) if given while you are taking this medication. Avoid contact with people who have recently received oral polio vaccine orflu vaccine inhaled through the nose.Avoid contact with people who havechickenpox or measles unless you have previously had these diseases (e.g., in childhood). If you are exposed to one of these infections and you have not previously had it, seek immediate medical attention.If you have a history of ulcers or take large doses of aspirin or other arthritis medication, limit alcoholic beverages while taking this medication to decrease the risk of stomach/intestinal bleeding. Consult your doctor or pharmacist for more details.If you have diabetes, this drug may make it harder to control your blood sugar levels. Monitor your blood sugar levels regularly and inform your doctor of the results. Your medicine, exercise plan, or diet may need to be adjusted.This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.Caution is advised when using this drug for long periods in children. This medication may temporarily slow down a child's rate of growth, but it will probably not affect final adult height. Monitor your child's height periodically.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Infants born to mothers who have been using this medication for an extended time and/or at high doses may have low levels of corticosteroid hormone. Tell your doctor immediately if you notice symptoms such as persistent nausea/vomiting, severe diarrhea, or weakness in your newborn.This drug may pass into breast milk and could have undesirable effects on a nursing infant. Consult your doctor before breast- feeding. DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.This drug should not be used with the following medication because a very serious interaction may occur: natalizumab.If you are currently using the medication listed above, tell your doctor or pharmacist before starting dexamethsone.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: aminoglutethimide, aprepitant, birth control pills, "blood thinners" (e.g.,warfarin), bupropion, certain cancer drugs (dasatinib, lapatinib, sunitinib,aldesleukin), caspofungin, cholestyramine, cyclosporine, diabetes medications (e.g., glyburide), digoxin, drugs affecting liver enzymes that remove dexamethasone from your body (such as azole antifungals includingketoconazole, barbiturates including phenobarbital, macrolide antibiotics including erythromycin, rifamycins including rifampin, certain anti-seizuremedications including phenytoin, carbamazepine), drugs that may cause potassium loss (e.g., amphotericin B, "water pills"/diuretics such ashydrochlorothiazide), ephedrine, estrogen hormone replacement, HIV protease inhibitors (e.g., indinavir), isoniazid, mifepristone, quinolone antibiotics (e.g., levofloxacin), salicylates (e.g., salsalate), temsirolimus,thalidomide.Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (NSAIDs such as aspirin, ibuprofen, or naproxen) that may increase the risk of stomach bleeding. Low-dose aspirin should be continued if prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention (usually at dosages of 81-325 milligrams per day). Consult your doctor or pharmacist for more details.This medication may interfere with certain laboratory tests (including skin tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know

you use this drug.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medicationsOVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents should call the US National Poison Hotline at 1-800222-1222. Canada residents should call a provincial poison control center. NOTES: Do not share this medication with others.If this medication is used for an extended time, laboratory and/or medical tests (e.g., blood sugar/mineral levels, blood pressure, eye exams) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.Talk with your doctor about making changes to your lifestyle that may decrease the side effects of this medication (e.g., weight-bearing exercise, dietary changes including controlling salt intake and getting more potassium/calcium). MISSED DOSE: If you are taking this medication daily and on a regular schedule, and you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.If you are taking this medication every other day or are slowly reducing your dose, and you miss a dose, then contact your doctor or pharmacist immediately to establish a new dosing schedule. STORAGE: Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-800-854-1166 (USA) or 1-800-668-1507 (Canada).
Last Editorial Review: 5/24/2011

http://www.medicinenet.com/dexamethasone-oral/article.htm

dexamethasone oral Index

Featured: dexamethasone oral, Decadron, DexPak Main Article Dexamethasone oral (Decadron, DexPak) is a drug prescribed to reduce inflammation in many conditions, rheumatoid arthritis, systemic lupus, acute gouty arthritis, psoriatic arthritis, ulcerative colitis, Crohn's disease. It is also prescribed to treat severe allergic conditions bronchial asthma, allergic rhinitis, drug-induced dermatitis, contact and atopic dermatitis. Dexamethasone is also used to treat chronic skin conditions as well as for the treatment of cancers of the white blood cells, lymph gland cancers, and blood diseases. It is also prescribed to treat conditions such as thyroiditis and sarcoidosis. Side effects, drug interactions, warnings and precautions, and efficacy during pregnancy information should be reviewed prior to taking this medication.

http://www.medicinenet.com/script/main/forum.asp?articlekey=44932

Use of dexamethasone and prednisone in acute asthma exacerbations in pediatric patients

1. 2. 1. Allan E. Shefrin, MD FRCPC and Ran D. Goldman, MD Correspondence: Dr Ran D. Goldman, BC Childrens Hospital, Department of Pediatrics, Room K4-226, Ambulatory Care Building, 4480 Oak St, Vancouver, BC V6H 3V4; telephone 604 875-2345, extension 5217; fax 604 875-2414; e-mail rgoldman@cw.bc.ca

QUESTION Children frequently present to my rural emergency department with asthma exacerbations. Should I prescribe systemic corticosteroids? If so, which systemic corticosteroid should I prescribe? ANSWER A short course of steroids is indicated in the treatment of asthma exacerbations. Both prednisone (1 to 2 mg/kg daily for 5 days) and dexamethasone (0.3 to 0.6 mg/kg daily for 1 to 5 days) are effective in reducing hospital admissions and unscheduled return to care, with minimal side effects.

http://www.cfp.ca/content/55/7/704.abstract

J Pediatr. 2001 Jul;139(1):20-6.

Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma.
Qureshi F, Zaritsky A, Poirier MP.
Source Department of Pediatrics and the Division of Pediatric Emergency Medicine, Children's Hospital of The Kings Daughters and Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.

Abstract
OBJECTIVE: The objective was to determine whether 2 days of oral dexamethasone (DEX) is more effective than 5 days of oral prednisone/prednisolone (PRED) in improving symptoms and preventing relapse in children with acute asthma. STUDY DESIGN: This was a prospective randomized trial of children (2 to 18 years old) who presented to the emergency department with acute asthma. PRED 2 mg/kg, maximum 60 mg (odd days) or DEX 0.6 mg/kg, maximum 16 mg (even days) was used. At discharge children in the PRED group were prescribed 4 daily doses (1 mg/kg/d, maximum 60 mg); children in the DEX group received a prepackaged dose (0.6 mg/kg, maximum 16 mg) to take the next day. The primary outcome was relapse within 10 days. RESULTS: When DEX was compared with PRED, relapse rates (7.4% of 272 vs 6.9% of 261), hospitalization rates from the emergency department (11% vs 12%) or after relapse (20% vs 17%), and symptom persistence at 10 days (22% vs

21%) were similar. In the PRED group more children were excluded for vomiting in the emergency department (3% vs 0.3%; P =.008), more parents were noncompliant (4% vs. 0.4%; P =.004), and more children missed > or =2 days of school (19.5% vs. 13.2%; P =.05). CONCLUSION: In children with acute asthma, 2 doses of dexamethasone provide similar efficacy with improved compliance and fewer side effects than 5 doses of prednisone.

http://www.ncbi.nlm.nih.gov/pubmed/11445789

From Medscape Medical News

Single-Dose IM Dexamethasone Alone Effective for Acute Asthma

Alicia Ault Nov. 3, 2003 (New Orleans) Children with prior episodes of asthma who present to emergency rooms can be treated effectively with a single dose of intramuscular (IM) dexamethasone, potentially replacing a five-day course of oral steroids, researchers reported here Friday at the annual meeting of the American Academy of Pediatrics. Stephen L. Gordon, MD, from the Children's Hospital of New YorkPresbyterian, presented data from a prospective randomized study comparing a single dose of IM dexamethasone (0.6 mg/kg up to a maximum of 15 mg) to five days of oral prednisolone (2 mg/kg/day). Ages of the children in the study ranged from 18 months to 6 years, and they had at least two documented previous episodes of moderate to severe asthma. A total of 1,713 children were evaluated, but 1,158 were excluded for scoring too low on the Asthma Score scale, which assigns points for respiratory rate, wheezing, and rate of retractions. To be eligible for study, children were required to score between 3 and 7 out of a total 9 points. After further exclusions and withdrawals, 88 patients were assigned to dexamethasone and 93 to prednisolone. The primary endpoint was the Asthma Score at four-day follow-up. Mean initial score was 4.51 in the dexamethasone-treated patients and 4.27 in the prednisolone-treated patients. For both groups, both mean four-day score and mean decline in score were similar, with most patients dropping to a score of 1 or less. About 27% of the dexamethasone group and 21% of the prednisolone group had a score above 1 at four days, but only 2.9% of the dexamethasone group and 4.2% of the prednisolone group were admitted to the hospital at that time. Two weeks after the initial dosing, 5.9% of the dexamethasone group and 4.1% of the prednisolone group were admitted.

Study limitations include the fact that it was a sample of convenience, and there was a lack of blinding in the treating physician, commented Dr. Gordon. But, given the results, "single-dose IM dexamethasone appears to be as effective as a five-day course of oral prednisolone in the treatment of moderate to severe asthma exacerbations," he told session attendees. Session moderator Richard John Scarfone, MD, FAAP, from the Children's Hospital of Philadelphia, Pennsylvania, told Medscape that Dr. Gordon's study had the potential to change practice. "The data suggests that dexamethasone might be equally as effective as prednisolone," he said, adding that compliance should be better with the injection. "I think it still needs a little more study," Rodney Boychuk, MD, FAAP, from the Kapiolani Medical Center for Women and Children in Honolulu, Hawaii, told Medscape, adding that he would not yet suggest a change in practice at his facility. Currently, children are given IM dexamethasone plus a five-day course of steroids at Kapiolani, he said, adding that he'd like that combination to be a third group in any future study. The findings have led to changes in the emergency department at Children's Hospital in New York, Dr. Gordon told Medscape. Some children can't tolerate prednisolone or may be nauseated and unable to hold down a pill or liquid, he said. But because there were no good data on the steroid's injection effectiveness, physicians were concerned about dosing only with dexamethasone, which tends to be short-acting. "Most of us now are convinced by this," he said, adding that the injection also is "an advantage in terms of compliance," because physicians cannot be sure whether parents are fully dosing children with oral prednisolone. Dr. Gordon said he was confident that both oral and injectable steroids are effective for acute exacerbations, despite a paper in the Nov. 1 issue of The Lancet suggesting that a five-day course of oral steroids is no more effective than placebo in reducing symptoms andhospital admissions. Taking a quick glance at the Lancet paper, Dr. Gordon said that the researchers seemed to have studied a slightly different population, one that did not have prior confirmed asthmatic episodes. AAP 2003 National Conference and Exhibition: Abstract 204. Presented Oct. 31, 2003. Reviewed by Gary D. Vogin, MD Alicia Ault is a freelance writer for Medscape.

http://www.medscape.com/viewarticle/463877

Dexamethasone Oral
pronounced as(dex a meth' a sone) What side effects can this medication cause?What storage conditions are needed for this medicine?In case of emergency/overdoseWhat other information should I know?Brand names Why is this medication prescribed?How should this medicine be used?What special precautions should I follow?What special dietary instructions should I follow?What should I do if I forget a dose?

Why is this medication prescribed?

Dexamethasone, a corticosteroid, is similar to a natural hormone produced by your adrenal glands. It often is used to replace this chemical when your body does not make enough of it. It relieves inflammation (swelling, heat, redness, and pain) and is used to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders (e.g., colitis); severe allergies; and asthma. Dexamethasone is also used to treat certain types of cancer. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Dexamethasone comes as a tablet and a solution to take by mouth. Your doctor will prescribe a dosing schedule that is best for you. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take dexamethasone exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking dexamethasone without talking to your doctor. Stopping the drug abruptly can cause loss of appetite, upset stomach, vomiting, drowsiness, confusion, headache, fever, joint and muscle pain, peeling skin, and weight loss. If you take large doses for a long time, your doctor probably will decrease your dose gradually to allow your body to adjust before stopping the drug completely. Watch for these side effects if you are gradually decreasing your dose and after you stop taking the tablets or oral liquid, even if you switch to an inhalation corticosteroid medication. If these problems occur, call your doctor immediately. You may need to increase your dose of tablets or liquid temporarily or start taking them again.

What special precautions should I follow?

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Before taking dexamethasone, tell your doctor and pharmacist if you are allergic to dexamethasone, aspirin, tartrazine (a yellow dye in some processed foods and drugs), or any other drugs.

tell your doctor and pharmacist what prescription and nonprescription medications you are taking especially anticoagulants ('blood thinners') such as warfarin (Coumadin), arthritis medications, aspirin, cyclosporine (Neoral, Sandimmune), digoxin (Lanoxin), diuretics ('water pills'), ephedrine, estrogen (Premarin), ketoconazole (Nizoral), oral contraceptives, phenobarbital, phenytoin (Dilantin), rifampin (Rifadin), theophylline (Theo-Dur), and vitamins. if you have a fungal infection (other than on your skin), do not take dexamethasone without talking to your doctor. tell your doctor if you have or have ever had liver, kidney, intestinal, or heart disease; diabetes; an underactive thyroid gland; high blood pressure; mental illness; myasthenia gravis; osteoporosis; herpes eye infection; seizures; tuberculosis (TB); or ulcers. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking dexamethasone, call your doctor. if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking dexamethasone. if you have a history of ulcers or take large doses of aspirin or other arthritis medication, limit your consumption of alcoholic beverages while taking this drug. Dexamethasone makes your stomach and intestines more susceptible to the irritating effects of alcohol, aspirin, and certain arthritis medications: this effect increases your risk of ulcers.

What special dietary instructions should I follow?

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Your doctor may instruct you to follow a low-sodium, low-salt, potassium-rich, or high-protein diet. Follow these directions. Dexamethasone may cause an upset stomach. Take dexamethasone with food or milk.

What should I do if I forget a dose?

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When you start to take dexamethasone, ask your doctor what to do if you forget a dose. Write down these instructions so that you can refer to them later. If you take dexamethasone once a day, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

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Dexamethasone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: upset stomach stomach irritation

vomiting headache dizziness insomnia restlessness depression anxiety acne increased hair growth easy bruising irregular or absent menstrual periods

If you experience any of the following symptoms, call your doctor immediately: skin rash swollen face, lower legs, or ankles vision problems cold or infection that lasts a long time muscle weakness black or tarry stool

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

What storage conditions are needed for this medicine?

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Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose
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In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other information should I know?

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Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to dexamethasone. Checkups are especially important for children because dexamethasone can slow bone growth. If your condition worsens, call your doctor. Your dose may need to be adjusted. Carry an identification card that indicates that you may need to take supplementary doses (write down the full dose you took before gradually decreasing it) of dexamethasone during periods of stress (injuries, infections, and severe asthma attacks). Ask your pharmacist or doctor how to obtain this card. List your name, medical problems, drugs and dosages, and doctor's name and telephone number on the card. This drug makes you more susceptible to illnesses. If you are exposed to chicken pox, measles, or tuberculosis (TB) while taking dexamethasone, call your doctor. Do not have a vaccination, other immunization, or any skin test while you are taking dexamethasone unless your doctor tells you that you may. Report any injuries or signs of infection (fever, sore throat, pain during urination, and muscle aches) that occur during treatment. Your doctor may instruct you to weigh yourself every day. Report any unusual weight gain. If your sputum (the matter you cough up during an asthma attack) thickens or changes color from clear white to yellow, green, or gray, call your doctor; these changes may be signs of an infection. If you have diabetes, dexamethasone may increase your blood sugar level. If you monitor your blood sugar (glucose) at home, test your blood or urine more frequently than usual. Call your doctor if your blood sugar is high or if sugar is present in your urine; your dose of diabetes medication and your diet may need to be changed. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand names
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Decadron

Dexamethasone Intensol Dexpak Taperpak

Last Reviewed - 09/01/2008

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682792.html

Decadron
Pronunciation: dex-a-METH-a-sone Generic Name: Dexamethasone Brand Name: Generic only. No brands available. Treating certain conditions associated with decreased adrenal gland function. It is also used to treat severe inflammation due to certain conditions, including severe asthma, severe allergies, rheumatoid arthritis, ulcerative colitis, certain blood disorders, lupus, multiple sclerosis, and certain eye and skin conditions. It may also be used for other conditions as determined by your doctor. Decadron is a corticosteroid. It works by decreasing or preventing tissues from responding to inflammation. It also modifies the body's response to certain immune stimulation.

Do NOT use Decadron if:

you are allergic to any ingredient in Decadron you have a systemic fungal infection you are taking mifepristone Contact your doctor or health care provider right away if any of these apply to you.

Before using Decadron:

Some medical conditions may interact with Decadron. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines, foods, or other substances if you are scheduled for a vaccination with a live virus vaccine (eg, smallpox) if you have an underactive thyroid, liver or kidney problems, diabetes, or ulcerative colitis if you have heart problems, esophagitis, gastritis, stomach obstruction or perforation, or an ulcer if you have a history of mental problems (eg, depression), glaucoma, cataracts, or other eye problems if you have a herpes infection in your eye or any other type of infection (bacterial, fungal, or viral); have or recently had tuberculosis (TB) or tested positive for TB, measles, or chickenpox Some MEDICINES MAY INTERACT with Decadron. Tell your health care provider if you are taking any other medicines, especially any of the following:

Barbiturates (eg, phenobarbital), carbamazepine, hydantoins (eg, phenytoin), or rifampin because they may decrease Decadron's effectiveness Clarithromycin, azole antifungals (eg, ketoconazole), steroidal contraceptives (eg, desogestrel), or troleandomycin because because weakness, confusion, muscle aches, joint pain, or low blood sugar, may occur Methotrexate or ritodrine because the risk of their side effects may be increased by Decadron Hydantoins (eg, phenytoin),mifepristone, or live vaccines because their effectiveness may be decreased by Decadron Anticoagulants (eg, warfarin) or aspirin because their actions and side effects may be increased or decreased by Decadron This may not be a complete list of all interactions that may occur. Ask your health care provider if Decadron may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
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How to use Decadron:

Use Decadron as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Take Decadron by mouth with food.

If you miss a dose of Decadron, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. Ask your health care provider any questions you may have about how to use Decadron.

Important safety information:

Decadron may lower the ability of your body to fight infection. Avoid contact with people who have colds or infections. Tell your doctor if you notice signs of infection like fever, sore throat, rash, or chills. Tell your doctor or dentist that you take Decadron before you receive any medical or dental care, emergency care, or surgery. Decadron may cause an elevation in blood pressure, salt and water retention, and increased potassium loss. You may need to restrict the use of salt and take a calcium supplement. Decadron can cause calcium loss and promote the development of osteoporosis. Take adequate calcium and vitamin D supplements. Diabetes patients -- Decadron may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine. Caution is advised when using Decadron in CHILDREN; they may be more sensitive to its effects. Corticosteroids may affect growth rate in CHILDREN and teenagers in some cases. They may need regular growth checks while they take Decadron. PREGNANCY and BREAST-FEEDING: It is not known if Decadron can cause harm to the fetus. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Decadron while you are pregnant. Decadron is found in breast milk. Do not breast-feed while taking Decadron.

Possible side effects of Decadron:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome: Difficulty sleeping; feeling of a whirling motion; increased appetite; increased sweating; indigestion; mood changes; nervousness. Seek medical attention right away if any of these SEVERE side effects occur: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); appetite loss; black, tarry stools; changes in menstrual periods; convulsions; depression; diarrhea; dizziness; exaggerated sense of well-being; fever; general body discomfort; headache; increased pressure in the eye; joint or muscle pain; mood swings; muscle weakness; personality changes; prolonged sore throat, cold, or fever; puffing of the face; severe nausea or vomiting; swelling of feet or legs; unusual weight gain; vomiting material that looks like coffee grounds; weakness; weight loss.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA. See also: Decadron side effects (in more detail)
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If OVERDOSE is suspected:
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Proper storage of Decadron: Store Decadron at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Decadron out of the reach of children and away from pets.

General information:

If you have any questions about Decadron, please talk with your doctor, pharmacist, or other health care provider. Decadron is to be used only by the patient for whom it is prescribed. Do not share it with other people. If your symptoms do not improve or if they become worse, check with your doctor. Check with your pharmacist about how to dispose of unused medicine. This information is a summary only. It does not contain all information about Decadron. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider. Issue Date: September 7, 2011 Database Edition 11.3.1.003

Copyright 2011 Wolters Kluwer Health, Inc.

Decadron Side Effects

Generic Name: dexamethasone,dexamethasone sodium phosphate Please note - some side effects for Decadron may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA athttp://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).
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Side Effects of Decadron - for the Consumer

Decadron
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Decadron: Difficulty sleeping; feeling of a whirling motion; increased appetite; increased sweating; indigestion; mood changes; nervousness. Seek medical attention right away if any of these SEVERE side effects occur when using Decadron: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); appetite loss; black, tarry stools; changes in menstrual periods; convulsions; depression; diarrhea; dizziness; exaggerated sense of well-being; fever; general body discomfort; headache; increased pressure in the eye; joint or muscle pain; mood swings; muscle weakness; personality changes; prolonged sore throat, cold, or fever; puffing of the face; severe nausea or vomiting; swelling of feet or legs; unusual weight gain; vomiting material that looks like coffee grounds; weakness; weight loss. This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

Decadron Dose Pack Tablets (Dose Pack)

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Decadron Dose Pack Tablets (Dose Pack): Difficulty sleeping; feeling of a whirling motion; increased appetite; increased sweating; indigestion; mood changes; nervousness. Seek medical attention right away if any of these SEVERE side effects occur when using Decadron Dose Pack Tablets (Dose Pack): Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); appetite loss; black, tarry stools; changes in menstrual periods; convulsions; depression; diarrhea; dizziness; exaggerated sense of well-being; fever; general body discomfort; headache; increased pressure in the eye; joint or muscle pain; mood swings; muscle weakness; personality changes; prolonged sore throat, cold, or fever; puffing of the face; severe nausea or vomiting; swelling of feet or legs; unusual weight gain; vomiting material that looks like coffee grounds; weakness; weight loss. This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.
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Decadron Side Effects - for the Professional

Decadron
The following adverse reactions have been reported with Decadron or other corticosteroids: Allergic reactions: Anaphylactoid reaction, anaphylaxis, angioedema. Cardiovascular: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction, edema, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis. Dermatologic: Acne, allergic dermatitis, dry scaly skin, ecchymoses and petechiae, erythema, impaired wound healing, increased sweating, rash, striae, suppression of reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria. Endocrine: Decreased carbohydrate and glucose tolerance, development of cushingoid state, hyperglycemia, glycosuria, hirsutism, hypertrichosis, increased requirements for insulin or oral hypoglycemic agents in diabetes, manifestations of latent diabetes mellitus, menstrual irregularities,

secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in pediatric patients. Fluid and electrolyte disturbances: Congestive heart failure in susceptible patients, fluid retention, hypokalemic alkalosis, potassium loss, sodium retention. Gastrointestinal: Abdominal distention, elevation in serum liver enzyme levels (usually reversible upon discontinuation), hepatomegaly, increased appetite, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with inflammatory bowel disease), ulcerative esophagitis. Metabolic: Negative nitrogen balance due to protein catabolism. Musculoskeletal: Aseptic necrosis of femoral and humeral heads, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures. Neurological/Psychiatric: Convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychic disorders, vertigo. Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts. Other: Abnormal fat deposits, decreased resistance to infection, hiccups, increased or decreased motility and number of spermatozoa, malaise, moon face, weight gain.
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Side Effects by Body System - for Healthcare Professionals

Cardiovascular
Cardiovascular side effects have included bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, myocardial

rupture following recent myocardial infarction, edema, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis and vasculitis.

Musculoskeletal
Musculoskeletal side effects have included muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humoral heads, pathologic fracture of long bones, and tendon rupture.

Gastrointestinal
Gastrointestinal side effects have included peptic ulcer with potential perforation and hemorrhage, perforation of small and large bowel, pancreatitis, abdominal distention, nausea, increased appetite, and ulcerative esophagitis.

Endocrine
Endocrine side effects have included development of cushingoid state, suppression of growth in children, and secondary adrenocortical and pituitary unresponsiveness.

Nervous system
Nervous system side effects have included convulsions, increased intracranial pressure with papilledema, vertigo, myalgia, arthralgia, malaise, headache, hiccups, and psychic disturbances.

Metabolic
Metabolic side effects have included negative nitrogen balance due to protein catabolism, decreased carbohydrate and glucose tolerance, weight gain, hirsutism, hypokalemic alkalosis, and increased requirements for insulin or oral hypoglycemic agents in diabetics.

Ocular
Ocular side effects have included posterior subcapsular cataracts, increased intraocular pressure, glaucoma, and exophthalmos.

Dermatologic
Dermatologic side effects have included impaired wound healing, thin fragile skin, petechiae and ecchymoses, dry scaly skin, erythema, acne, thinning scalp hair, urticaria, increased sweating, rash, striae, allergic dermatitis, urticaria, angioneurotic edema, and suppression of skin test reactions.

Psychiatric
Psychiatric side effects have included euphoria, insomnia, mood swings, personality changes, severe depression, and psychotic manifestations.

Hematologic
Hematologic side effects have included rare reports of thromboembolism.

Genitourinary
Genitourinary effects have included increase/decrease in motility and number of spermatozoa in men and menstrual irregularities in women.

Hepatic
Hepatic side effects have included reports of reversible hepatomegaly. Three case reports of children treated with high dose dexamethasone describe the earliest diagnosis of hepatomegaly as early as 8 days from the start of therapy.

Hypersensitivity
Hypersensitivity side effects have included anaphylactoid reactions, anaphylaxis and angioedema.

Renal
Renal side effects have included fluid retention, sodium retention, and potassium loss,

A total of 723 drugs (2985 brand and generic names) are known to interact with Decadron (dexamethasone).

36 major drug interactions 613 moderate drug interactions 74 minor drug interactions
Show all medications in the database that may interact with Decadron (dexamethasone).

Common medications checked in combination with Decadron (dexamethasone)

aspirin Ativan (lorazepam) Compazine (prochlorperazine) Dilaudid (hydromorphone) gabapentin hydrochlorothiazide Keppra (levetiracetam) Lasix (furosemide)

Neurontin (gabapentin) Norvasc (amlodipine) omeprazole ondansetron Phenergan (promethazine) Protonix (pantoprazole) Reglan (metoclopramide) Tylenol (acetaminophen)

metformin morphine

Zocor (simvastatin) Zofran (ondansetron)

There are 2 alcohol/food/lifestyle interactions with Decadron (dexamethasone) which include: High Blood Pressure (Hypertension)
Moderate Potential Hazard, Moderate plausibility corticosteroids - fluid retention Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone. The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities. However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods. Therapy with corticosteroids should be administered cautiously in patients with preexisting fluid retention, hypertension, congestive heart failure, and/or renal dysfunction. Dietary sodium restriction and potassium supplementation may be advisable.

High Cholesterol (Hyperlipoproteinemia, Hypertriglyceridemia, Sitosterolemia)

Moderate Potential Hazard, Moderate plausibility corticosteroids - hyperlipidemia Corticosteroids may elevate serum triglyceride and LDL cholesterol levels if used for longer than brief periods. Patients with preexisting hyperlipidemia may require closer monitoring during prolonged corticosteroid therapy, and adjustments made accordingly in their lipid-lowering regimen.

There are 23 disease interactions with Decadron (dexamethasone):

(+) Tuberculin Test Hyperadrenocorticalism Electrolyte Imbalance Hyperlipidemia Gi Perforation Hypothyroidism Infections Liver Disease Mi Myasthenia Gravis Ocular Herpes Simplex Myopathy Pud Ocular Toxicities Scleroderma Osteoporosis Strongyloidiasis Prematurity Depression/Psychoses Thromboembolism Diabetes Vaccination Fluid Retention Corticosteroids (Includes Decadron) (+) Tuberculin Test

Severe Potential Hazard, High plausibility Applies to: History - Tuberculosis, Tuberculosis -- Latent In patients with latent tuberculosis or tuberculin reactivity, the use of pharmacologic dosages of corticosteroids may cause a reactivation of the disease. Close monitoring for signs and symptoms of tuberculosis is recommended if corticosteroid therapy is administered to patients with a history of tuberculosis or tuberculin reactivity. During prolonged corticosteroid therapy, tuberculosis chemoprophylaxis may be considered.

Corticosteroids (Includes Decadron) Electrolyte Imbalance

Severe Potential Hazard, Moderate plausibility Applies to: Hypernatremia, Hypocalcemia, Hypokalemia, Seizures Corticosteroids can cause hypernatremia, hypokalemia, and fluid retention. These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone. The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities. However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods. All corticosteroids also increase excretion of calcium and can cause hypocalcemia. Therapy with corticosteroids should be administered cautiously in patients with preexisting electrolyte disturbances. Caution is also advised when treating patients with seizure disorders, since electrolyte disturbances may trigger seizure activity.

Corticosteroids (Includes Decadron) Gi Perforation

Severe Potential Hazard, Moderate plausibility Applies to: Intestinal Anastomoses, Diverticulitis, Ulcerative Colitis Corticosteroids may cause gastrointestinal perforation and hemorrhage, usually when given in high dosages or for prolonged periods. They may also mask symptoms of complications such as peritonitis or intraabdominal sepsis. Therapy with corticosteroids should be administered cautiously in patients with diverticulitis, nonspecific ulcerative colitis (if there is a probability of impending perforation, abscess, or other pyogenic infection), or recent intestinal anastomoses.

Corticosteroids (Includes Decadron) Infections

Severe Potential Hazard, High plausibility Applies to: Infection - Bacterial/Fungal/Protozoal/Viral The immunosuppressant and anti-inflammatory effects of corticosteroids, particularly in higher dosages, may decrease host resistance to infectious agents, decrease the ability to localize infections, and mask the symptoms of infection. Secondary infections may be more likely to develop. In general, corticosteroids should not be used in patients with active infections, especially systemic fungal infections, unless they are medically necessary and effective antimicrobial therapy or other appropriate treatment has been instituted. However, for corticosteroid-dependent patients who develop a severe or life-threatening infection, continuation of corticosteroid therapy with at least

physiologic replacement dosages should be considered, since these patients may have secondary adrenocortical insufficiency. Removal of external steroid during periods of stress may be detrimental to these patients.

Corticosteroids (Includes Decadron) Mi

Severe Potential Hazard, Moderate plausibility Applies to: Myocardial Infarction, Post MI Syndrome The use of corticosteroids may be associated with left ventricular free-wall rupture in patients who have had a recent myocardial infarction. Pharmacologic dosages of corticosteroids should be administered with great caution in such patients.

Corticosteroids (Includes Decadron) Ocular Herpes Simplex

Severe Potential Hazard, Moderate plausibility Applies to: Ocular Herpes Simplex Pharmacologic dosages of corticosteroids should be used cautiously in patients with ocular herpes simplex because of the risk of corneal perforation.

Corticosteroids (Includes Decadron) Pud

Severe Potential Hazard, High plausibility Applies to: History - Peptic Ulcer, Peptic Ulcer Corticosteroids may cause peptic ulcer disease and gastrointestinal (GI) hemorrhage, usually when given in high dosages or for prolonged periods. However, even conventional dosages may aggravate symptoms in patients with a history of peptic ulcers. Delayed healing of ulcers has also been reported. Therapy with corticosteroids should be administered cautiously in patients with active or latent peptic ulcers or other risk factors for GI bleeding. Some clinicians recommend the use of prophylactic antacids or H2-antagonists between meals when large doses of corticosteroids are necessary.

Corticosteroids (Includes Decadron) Scleroderma

Severe Potential Hazard, Moderate plausibility Applies to: Systemic Sclerosis In patients with scleroderma, corticosteroids may precipitate renal crisis with malignant hypertension, possibly via steroid-induced increases in renin substrate and angiotensin II levels and decreases in vasodilator prostaglandin production. Renal failure may ensue. Therapy with corticosteroids should be administered cautiously in patients with scleroderma. In addition, they should be limited to shortterm use.

Corticosteroids (Includes Decadron) Strongyloidiasis

Severe Potential Hazard, High plausibility

Applies to: Strongyloidiasis Unlike most helminths, Strongyloides stercoralis has the ability to replicate in the human host. In patients with strongyloidiasis, the use of pharmacologic or immunosuppressive dosages of corticosteroids may result in Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia. Therapy with corticosteroids should be administered with extreme caution, if at all, in these patients.

Corticosteroids (Includes Decadron) Depression/Psychoses

Moderate Potential Hazard, Moderate plausibility Applies to: Psychosis, Depression Corticosteroids may aggravate the symptoms of psychosis and emotional instability. Patients with these conditions should be monitored for increased or worsened symptoms during corticosteroid therapy.

Corticosteroids (Includes Decadron) Diabetes

Moderate Potential Hazard, High plausibility Applies to: Diabetes Mellitus, Abnormal Glucose Tolerance Corticosteroids can raise blood glucose level by antagonizing the action and suppressing the secretion of insulin, which results in inhibition of peripheral glucose uptake and increased gluconeogenesis. Therapy with corticosteroids should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during corticosteroid therapy, and their antidiabetic regimen adjusted accordingly.

Corticosteroids (Includes Decadron) Fluid Retention

Moderate Potential Hazard, Moderate plausibility Applies to: Congestive Heart Failure, Fluid Retention, Hypertension, Renal Dysfunction Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone. The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities. However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods. Therapy with corticosteroids should be administered cautiously in patients with preexisting fluid retention, hypertension, congestive heart failure, and/or renal dysfunction. Dietary sodium restriction and potassium supplementation may be advisable.

Corticosteroids (Includes Decadron) Hyperadrenocorticalism

Moderate Potential Hazard, High plausibility

Applies to: Hyperadrenocorticism, Hyperaldosteronism, Adrenal Tumor Corticosteroids mimic the effects of endogenous cortisol and aldosterone. The use of these agents may aggravate conditions of hyperadrenocorticalism in a dose-dependent manner.

Corticosteroids (Includes Decadron) Hyperlipidemia

Moderate Potential Hazard, Moderate plausibility Applies to: Hyperlipidemia Corticosteroids may elevate serum triglyceride and LDL cholesterol levels if used for longer than brief periods. Patients with preexisting hyperlipidemia may require closer monitoring during prolonged corticosteroid therapy, and adjustments made accordingly in their lipid-lowering regimen.

Corticosteroids (Includes Decadron) Hypothyroidism

Moderate Potential Hazard, Moderate plausibility Applies to: Hypothyroidism Corticosteroids may have enhanced effects in hypothyroidism due to decreased metabolism of these agents. Patients with hypothyroidism should be monitored more closely for excessive cortisol effects. Dosage adjustments may be required secondary to changes in their thyroid condition.

Corticosteroids (Includes Decadron) Liver Disease

Moderate Potential Hazard, High plausibility Applies to: Liver Disease Corticosteroids are primarily metabolized by the liver and may have enhanced effects in patients with liver disease, especially cirrhosis. Dosage adjustments may be necessary in these patients.

Corticosteroids (Includes Decadron) Myasthenia Gravis

Moderate Potential Hazard, High plausibility Applies to: Myasthenia Gravis Although corticosteroids are commonly used in the treatment of myasthenia gravis to increase muscle strength, these agents should nevertheless be administered with caution in such setting. Patients should be treated in an intensive care unit and receive respiratory support, since muscle strength may markedly decrease initially, particularly with high dosages. Preferably, therapy should begin with relatively low dosages (15 to 25 mg/day of prednisone or equivalent) and increased stepwise as tolerated (approximately 5 mg/day of prednisone or equivalent at 2- to 3-day intervals until marked clinical improvement or a dosage of 50 mg/day is reached). Improvement may be delayed and gradual. Thus, it is important not to discontinue therapy prematurely.

Corticosteroids (Includes Decadron) Myopathy

Moderate Potential Hazard, High plausibility

Applies to: Myoneural Disorder, Myopathy Toxic myopathy has been observed with the chronic use or the administration of large doses of corticosteroids, often in patients with disorders of neuromuscular transmission such as myasthenia gravis or in patients receiving neuromuscular blocking agents. Fluorinated corticosteroids such as betamethasone, dexamethasone, and triamcinolone appear to cause more severe muscle atrophy and weakness than the nonfluorinated agents. Moreover, multiple-daily doses are more toxic than once-daily or, preferably, alternate-day morning doses. Steroid myopathy is generalized and sometimes accompanied by respiratory weakness and dyspnea. In some cases, it has resulted in quadraparesis. Elevations of creatine kinase may also occur, albeit infrequently. After withdrawal of corticosteroid therapy, recovery may be slow and incomplete. Therapy with corticosteroids should be administered cautiously in patients with preexisting myopathy or myoneural disorders, since these conditions may confound the diagnosis of steroid-induced myopathy. The presence of a normal serum CK level, minimal or no changes of myopathy on EMG, and type 2 muscle fiber atrophy on biopsy are helpful in suggesting steroid-induced weakness. If steroid myopathy is suspected, a dosage reduction or discontinuation of the steroid should be considered.

Corticosteroids (Includes Decadron) Ocular Toxicities

Moderate Potential Hazard, Moderate plausibility Applies to: Glaucoma/Intraocular Hypertension, Cataracts Prolonged use of corticosteroids may cause posterior subcapsular cataracts and elevated intraocular pressure, the latter of which may lead to glaucoma and/or damage to the optic nerves. Long-term therapy with corticosteroids should be administered cautiously in patients with a history of cataracts, glaucoma, or increased intraocular pressure.

Corticosteroids (Includes Decadron) Osteoporosis

Moderate Potential Hazard, High plausibility Applies to: Osteoporosis Corticosteroids reduce osteoblastic function and inhibit the absorption of intestinal calcium, which can result in bone resorption and bone loss during prolonged therapy. In addition, bone matrix may be affected by the protein-catabolic effects of corticosteroids, especially when given in high dosages or for prolonged periods, leading to aseptic necrosis and fractures. Long-term or high-dose corticosteroid therapy should be administered cautiously and only if necessary in patients with or at risk for osteoporosis. Adverse skeletal effects may be minimized by alternate-day or intermittent administration. Any patient receiving prolonged therapy with the equivalent of 7.5 mg prednisone/day or more are at risk for glucocorticoid-induced osteoporosis and should be managed according to The American College of Rheumatology (ACR) guidelines.

Corticosteroids (Includes Decadron) Prematurity

Moderate Potential Hazard, Moderate plausibility Applies to: Prematurity/Underweight in Infancy

The use of certain parenteral formulations of dexamethasone, hydrocortisone, methylprednisolone, prednisolone and triamcinolone is considered by the drug manufacturers to be contraindicated in neonates, particularly premature infants and infants of low birth weight. Some formulations of these drugs contain benzyl alcohol which, when used in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions, has been associated with fatalities and severe respiratory and metabolic complications in low-birth-weight premature infants. However, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns. Continuous infusions of high dosages of medications containing benzyl alcohol may, however, cause toxicity and should be avoided if possible.

Corticosteroids (Includes Decadron) Thromboembolism

Moderate Potential Hazard, Low plausibility Applies to: Thrombotic/Thromboembolic Disorder, History - Thrombotic/Thromboembolic Disorder Corticosteroids may increase blood coagulability and have rarely been associated with the development of intravascular thrombosis, thromboembolism, and thrombophlebitis. Therapy with corticosteroids should be administered cautiously in patients with thrombotic or thromboembolic disorders.

Corticosteroids (Includes Decadron) Vaccination

Moderate Potential Hazard, High plausibility Applies to: Vaccination The administration of live or live, attenuated vaccines is contraindicated in patients receiving large or immunosuppressive doses of corticosteroids. Inactivated viral or bacterial vaccines should be used with caution, since their administration may pose a risk of neurological complications in these patients. Additionally, a diminished or inadequate serum antibody response may be anticipated. Immunization may be undertaken in patients receiving corticosteroids as replacement therapy, such as for Addison's disease.

http://www.drugs.com/cdi/decadron.html

Dexamethasone is a steroid that prevents the release of substances in the body that cause inflammation. Dexamethasone is used to treat many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders. Dexamethasone may also be used for purposes not listed in this medication guide.

What is the most important information I should know about dexamethasone?

You should not use this medication if you are allergic to dexamethasone, or if you have a fungal infection anywhere in your body. Before taking dexamethasone, tell your doctor about all of your medical conditions, and about all other medicines you are using. There are many other diseases that can be affected by steroid use, and many other medicines that can interact with steroids. Your steroid medication needs may change if you have any unusual stress such as a serious illness, fever or infection, or if you have surgery or a medical emergency. Tell your doctor about any such situation that affects you during treatment. Steroid medication can weaken your immune system, making it easier for you to get an infection or worsening an infection you already have or have recently had. Tell your doctor about any illness or infection you have had within the past several weeks. Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medication. Do not receive a "live" vaccine while you are taking dexamethasone. Vaccines may not work as well while you are taking a steroid. Do not stop using dexamethasone suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. Wear a medical alert tag or carry an ID card stating that you take dexamethasone. Any medical care provider who treats you should know that you are using a steroid.

What should I discuss with my healthcare provider before taking dexamethasone?

You should not use this medication if you are allergic to dexamethasone, or if you have a fungal infection anywhere in your body. Steroid medication can weaken your immune system, making it easier for you to get an infection. Steroids can also worsen an infection you already have, or reactivate an infection you recently had. Before taking this medication, tell your doctor about any illness or infection you have had within the past several weeks. To make sure you can safely take dexamethasone, tell your doctor if you have any of these other conditions:

liver disease (such as cirrhosis); kidney disease; a thyroid disorder; diabetes; a history of malaria; tuberculosis; osteoporosis; a muscle disorder such as myasthenia gravis; glaucoma or cataracts; herpes infection of the eyes; stomach ulcers, ulcerative colitis, or diverticulitis; depression or mental illness; congestive heart failure; or high blood pressure FDA pregnancy category C. It is not known whether dexamethasone will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Dexamethasone can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Steroids can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using this medication.
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How should I take dexamethasone?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Your steroid medication needs may change if you have unusual stress such as a serious illness, fever or infection, or if you have surgery or a medical emergency. Tell your doctor about any such situation that affects you. This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using dexamethasone. Do not stop using dexamethasone suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. Wear a medical alert tag or carry an ID card stating that you take dexamethasone. Any medical care provider who treats you should know that you are using steroid medication. Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of dexamethasone.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Long-term use of high steroid doses can lead to symptoms such as thinning skin, easy bruising, changes in the shape or location of body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while taking dexamethasone?

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medication. Do not receive a "live" vaccine while using dexamethasone. The vaccine may not work as well during this time, and may not fully protect you from disease. Live vaccines include measles, mumps,

rubella (MMR), oral polio, rotavirus, typhoid, varicella (chickenpox), H1N1 influenza, and nasal flu vaccine. Avoid drinking alcohol while you are taking dexamethasone.

Dexamethasone side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

problems with your vision; swelling, rapid weight gain, feeling short of breath; severe depression, unusual thoughts or behavior, seizure (convulsions); bloody or tarry stools, coughing up blood; pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate); low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure). Less serious side effects may include:

sleep problems (insomnia), mood changes; acne, dry skin, thinning skin, bruising or discoloration; slow wound healing; increased sweating; headache, dizziness, spinning sensation; nausea, stomach pain, bloating; muscle weakness; or changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist). This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. See also: Dexamethasone Intensol side effects (in more detail)
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What other drugs will affect dexamethasone?

Many drugs can interact with dexamethasone. Below is just a partial list. Tell your doctor if you are using:

aspirin (taken on a daily basis or at high doses); a diuretic (water pill); a blood thinner such as warfarin (Coumadin); cyclosporine (Gengraf, Neoral, Sandimmune); insulin or diabetes medications you take by mouth; ketoconazole (Nizoral); rifampin (Rifadin, Rifater, Rifamate, Rimactane); or seizure medications such as phenytoin (Dilantin) or phenobarbital (Luminal, Solfoton). This list is not complete and other drugs may interact with dexamethasone. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Dexamethasone Intensol
Generic Name: dexamethasone (oral) (dex a METH a sone) Brand Names: Baycadron, Dexamethasone Intensol, DexPak 10 Day Taperpak, DexPak 13 DayTaperpak, DexPak 6 DayTaperpak, Dexpak Jr. Taperpak, Zema Pak 10-Day, Zema Pak 13-Day, Zema Pak 6-Day

Dexamethasone Intensol Side Effects

Generic Name: dexamethasone,dexamethasone sodium phosphate Please note - some side effects for Dexamethasone Intensol may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).
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Side Effects by Body System - for Healthcare Professionals

Cardiovascular
Cardiovascular side effects have included bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, myocardial rupture following recent myocardial infarction, edema, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis and vasculitis.

Musculoskeletal
Musculoskeletal side effects have included muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humoral heads, pathologic fracture of long bones, and tendon rupture.

Gastrointestinal
Gastrointestinal side effects have included peptic ulcer with potential perforation and hemorrhage, perforation of small and large bowel, pancreatitis, abdominal distention, nausea, increased appetite, and ulcerative esophagitis.

Endocrine
Endocrine side effects have included development of cushingoid state, suppression of growth in children, and secondary adrenocortical and pituitary unresponsiveness.

Nervous system
Nervous system side effects have included convulsions, increased intracranial pressure with papilledema, vertigo, myalgia, arthralgia, malaise, headache, hiccups, and psychic disturbances.

Metabolic
Metabolic side effects have included negative nitrogen balance due to protein catabolism, decreased carbohydrate and glucose tolerance, weight gain, hirsutism, hypokalemic alkalosis, and increased requirements for insulin or oral hypoglycemic agents in diabetics.

Ocular
Ocular side effects have included posterior subcapsular cataracts, increased intraocular pressure, glaucoma, and exophthalmos.

Dermatologic

Dermatologic side effects have included impaired wound healing, thin fragile skin, petechiae and ecchymoses, dry scaly skin, erythema, acne, thinning scalp hair, urticaria, increased sweating, rash, striae, allergic dermatitis, urticaria, angioneurotic edema, and suppression of skin test reactions.

Psychiatric
Psychiatric side effects have included euphoria, insomnia, mood swings, personality changes, severe depression, and psychotic manifestations.

Hematologic
Hematologic side effects have included rare reports of thromboembolism.

Genitourinary
Genitourinary effects have included increase/decrease in motility and number of spermatozoa in men and menstrual irregularities in women.

Hepatic
Hepatic side effects have included reports of reversible hepatomegaly. Three case reports of children treated with high dose dexamethasone describe the earliest diagnosis of hepatomegaly as early as 8 days from the start of therapy.

Hypersensitivity
Hypersensitivity side effects have included anaphylactoid reactions, anaphylaxis and angioedema.

Renal
Renal side effects have included fluid retention, sodium retention, and potassium loss,
Top

http://www.drugs.com/mtm/dexamethasone-intensol.html

NEW YORK (Reuters Health) - Adult patients with asthma exacerbations do as well with 2 days of oral dexamethasone as with 5 days of oral prednisone, according to a report in the Annals of Emergency Medicine online February 18. The authors point out that dexamethasone has the same bioavailability as prednisone but a longer half-life of up to 72 hours, so it may allow for a shorter duration of treatment.

To test this, Dr. Joel Kravitz, at the Community Medical Center of the St. Barnabas Health System in Toms River, New Jersey, and colleagues randomized 200 emergency room patients with acute asthma exacerbation to receive either 50 mg/d oral prednisone for 5 days or 16 mg/d oral dexamethasone for 2 days. Significantly more subjects returned to normal activity within 3 days with dexamethasone (90%) compared with prednisone (80%; p=0.049), the investigators found. Rates of relapse in the two groups were not significantly different at 11% among patients receiving dexamethasone versus 13% for those given prednisone, according to the report. Its not clear that the differences seen in the study translate to a clinical benefit of dexamethasone over prednisone, Dr. Kravitz and colleagues note. Still, they conclude, Our study suggests that a 2-day course of oral dexamethasone is at minimum as effective as a 5-day course of oral prednisone in the treatment of mild to moderate asthma exacerbations in patients who are discharged from the ED and may return patients to a normal level of activity more rapidly. Reference: Two Days of Dexamethasone Versus 5 Days of Prednisone in the Treatment of Acute Asthma: A Randomized Controlled Trial Ann Emerg Med 2011.

http://www.thedoctorschannel.com/video/4119.html

Dexamethasone Sodium Phosphate (Dexamethasone 2mg/5ml oral solution sugar free)

Overview About Side effects

Information specific to: Dexamethasone 2mg/5ml oral solution sugar free when used in Asthma.
Dexamethasone sodium phosphate (Dexa-meth-ah-zone soh-dee-um fossfate) is a medicine which is used in emergency treatment of asthma, asthma, preventing or treating bronchospasm in asthma, bronchitis or chronic obstructive pulmonary disease, treatment of reversible airways obstruction and asthma with seasonal allergic rhinitis.

The information in this Medicine Guide for Dexamethasone sodium phosphate varies according to the condition being treated and the particular preparation used.

Your medicine
Dexamethasone sodium phosphate is a corticosteroid. Dexamethasone sodium phosphate works by preventing or reducing inflammation. It is used to treat a number of conditions that are characterised by excessive inflammation. People who take corticosteroids for a long period of time are prone to infections as their immune system can become weak. These infections may be much more severe than they usually would be and the symptoms that would usually be used to identify such infections can be hidden. For this reason people who take Dexamethasone sodium phosphate must be careful to avoid exposure to infections such as chickenpox, shingles and measles whenever possible. If you have been exposed to chickenpox or measles, you must get immediate medical advice. Other information about Dexamethasone sodium phosphate: if you have been given a steroid warning card, make sure you carry it with you at all times while you are taking corticosteroids. These cards are normally given to you by your prescriber or by your pharmacist. If you are currently taking corticosteroids, or have taken them in the last year, you must tell everyone involved in prescribing you medicines and giving you medical treatment. This includes your doctor, dentist, nurse and pharmacist. You must make sure that they all know about your corticosteroid treatment. your prescriber will try to find the lowest dose of your medicine which can control your condition Do not share your medicine with other people. It may not be suitable for them and may harm them. The pharmacy label on your medicine tells you how much medicine you should have. It also tells you how often you should have your medicine. This is the dose that you and your prescriber have agreed you should have. You should not change the dose of your medicine unless you are told to do so by your prescriber.

If you feel that the medicine is making you unwell or you do not think it is working, then talk to your prescriber.

Whether this medicine is suitable for you

Dexamethasone sodium phosphate is not suitable for everyone and some people should never use it. Other people should only use it with special care. It is important that the person prescribing this medicine knows your full medical history. Your prescriber may only prescribe this medicine with special care or may not prescribe it at all if you: are allergic or sensitive to or have had a reaction to any of the ingredients in the medicine are allergic to corticosteroids are elderly are pregnant with fluid retention or pre-eclampsia have a gastrointestinalulcer have an eye infection have an infection have asthma have cerebral malaria have diabetes or a family history of diabetes have diverticulitis have epilepsy have glaucoma or a family history of glaucoma have had a myopathy caused by steroids have had amoebiasis or strongyloidiasis have had an allergy to any medicine in the past have had psychoses caused by steroids have had recent surgery of the abdomen have heart problems

have high blood pressure have hypothyroidism have inflammatory bowel disease have kidney problems have liver problems have migraines have myasthenia gravis have never been exposed to chicken pox have or have had or have a family history of depression have or have had or have a family history of mania have or have had personal or family history of affective disorders such as depression or bipolar disorder have or have had tuberculosis have osteoporosis have psychiatric problems have recently had a heart attack have recently had or are having a vaccination soon have recently travelled to the tropics and have diarrhoea with an unknown cause have ulcerative colitis have worms Furthermore the prescriber may only prescribe this medicine with special care or may not prescribe it at all for a child. As part of the process of assessing suitability to take this medicine a prescriber may also arrange tests: to check that this medicine is not having any undesired effects Over time it is possible that Dexamethasone sodium phosphate can become unsuitable for some people, or they may become unsuitable for it. If at any time it appears that Dexamethasone sodium phosphate has become unsuitable, it is important that the prescriber is contacted immediately.

Alcohol
Alcohol can interact with certain medicines. In the case of Dexamethasone sodium phosphate: there are no known interactions between alcohol and Dexamethasone sodium phosphate

Diet
Medicines can interact with certain foods. In some cases, this may be harmful and your prescriber may advise you to avoid certain foods. In the case of Dexamethasone sodium phosphate: while you are having Dexamethasone sodium phosphate your prescriber may advise you to limit the amount of salt in your diet while you are having Dexamethasone sodium phosphate your prescriber may advise you to take extra potassium to supplement your diet If you are unsure if your diet is suitable for Dexamethasone sodium phosphate, speak to your prescriber, nutritionist or pharmacist for further advice.

Driving and operating machinery

When taking any medicine you should be aware that it might interfere with your ability to drive or operate machinery safely. In the case of Dexamethasone sodium phosphate: this medicine could affect your ability to drive or operate machinery You should see how this medicine affects you before you judge whether you are safe to drive or operate machinery. If you are in any doubt about whether you should drive or operate machinery, talk to your prescriber.

Family planning and pregnancy

Most medicines, in some way, can affect the development of a baby in the womb. The effect on the baby differs between medicines and also depends on the stage of pregnancy that you have reached when you take the medicine.

In the case of Dexamethasone sodium phosphate: you should only have this medicine during pregnancy if your doctor thinks that you need it if you have this medicine during your pregnancy, your baby may need to have some monitoring after birth You need to discuss your specific circumstances with your doctor to weigh up the overall risks and benefits of taking this medicine. You and your doctor can make a decision about whether you are going to take this medicine during pregnancy. If the decision is that you should not have Dexamethasone sodium phosphate, then you should discuss whether there is an alternative medicine that you could take during pregnancy.

Breast-feeding
Certain medicines can pass into breast milk and may reach your baby through breast-feeding. In the case of Dexamethasone sodium phosphate: breast-feeding is not recommended while having this medicine Before you have your baby you should discuss breast-feeding with your doctor or midwife. They will help you decide what is best for you and your baby based on the benefits and risks associated with this medicine. If you wish to breast-feed you should discuss with your prescriber whether there are any other medicines you could take which would also allow you to breast-feed. You should not stop this medicine without taking advice from your doctor.

Taking other medicines

If you are taking more than one medicine they may interact with each other. At times your prescriber may decide to use medicines that interact, in other cases this may not be appropriate. The decision to use medicines that interact depends on your specific circumstances. Your prescriber may decide to use medicines that interact, if it is believed that the benefits of taking the medicines together outweigh the risks. In such cases, it may be necessary to alter your dose or monitor

you more closely. Tell your prescriber the names of all the medicines that you are taking so that they can consider all possible interactions. This includes all the medicines which have been prescribed by your GP, hospital doctor, dentist, nurse, health visitor, midwife or pharmacist. You must also tell your prescriber about medicines which you have bought over the counter without prescriptions. The following medicines may interact with Dexamethasone sodium phosphate: acetazolamide aminoglutethimide amphotericin B injection aspirin carbamazepine carbenoxolone charcoal ciclosporin colestyramine ephedrine erythromycin indometacin insulin isoniazid ketoconazole metformin phenytoin praziquantel rifabutin rifampicin ritonavir

sultopride tetracosactide thalidomide The following types of medicine may interact with Dexamethasone sodium phosphate: antacids anticholinesterases antihypertensives barbiturates clotting factors cytochrome P450 enzyme inducers cytochrome P450 enzyme inhibitors diuretics gastrointestinalpreparations that are applied topically glucocorticosteroids hypoglycaemics live vaccines loop diuretics macrolides medicines that are metabolised by the cytochrome P450 system mineralocorticoids non-steroidal anti-inflammatories oestrogens oral anticoagulants oral contraceptives potassium depleting medicines salicylates sulphonylureas thiazide diuretics

If you are taking Dexamethasone sodium phosphate and one of the above medicines or types of medicines, make sure your prescriber knows about it.

Complementary preparations and vitamins

Medicines can interact with complementary preparations and vitamins. In general, there is not much information available about interactions between medicines and complementary preparations or vitamins. If you are planning to take or are already taking any complementary preparations and vitamins you should ask your prescriber whether there are any known interactions with Dexamethasone sodium phosphate. Your prescriber can advise whether it is appropriate for you to take combinations that are known to interact. They can also discuss with you the possible effect that the complementary preparations and vitamins may have on your condition. If you experience any unusual effects while taking this medicine in combination with complementary preparations and vitamins, you should tell your prescriber.
http://www.nhs.uk/Conditions/Eczema(atopic)/Pages/MedicineOverview.aspx?condition=Asthma&medicine=Dexamethasone%20sodium%20p hosphate

Dexamethasone

Systematic (IUPAC) name

(8S,9R,10S,11S,13S,14S,16R,17R)-9- Fluoro-11,17-dihydroxy-17-(2-hydroxyacetyl)-10,13,16- trimethyl6,7,8,9,10,11,12,13,14,15,16,17- dodecahydro-3H-cyclopenta[a]phenanthren-3-one

Clinical data

AHFS/Drugs.com monograph

MedlinePlus

a682792

Pregnancy cat.

C(US)

Legal status

Prescription only

Routes

Oral, IV, IM, SC and IO

Pharmacokinetic data

Bioavailability

80-90%

Protein binding

70%

Metabolism

hepatic

Half-life

36-54 hours

Excretion

renal

Identifiers

CAS number

50-02-2

ATC code

A01AC02 C05AA09,D07AB19, H02AB02,R01AD03, S01BA01,S02BA06, S03BA01

PubChem

CID 5743

DrugBank

DB01234

ChemSpider

5541

UNII

7S5I7G3JQL

KEGG

D00292

ChEBI

CHEBI:41879

ChEMBL

CHEMBL384467

Chemical data

Formula

C22H29FO5

Mol. mass

392.461 g/mol

SMILES

eMolecules & PubChem

Dexamethasone is a synthetic adrenocortical steroid used to treat inflammatory and autoimmune conditions. It acts as an anti-inflammatory and immunosuppressant. It is more potent than hydrocortisone. Dexamethasone is used to treat conditions such as skin conditions, ulcerative colitis, psoriasis, arthritis, allergic disorders and breathing related problems. Dexamethasone is given to cancer patients undergoing chemotherapy, to prevent certain sideeffects. Dexamethasone is also used in the treatment of high altitude cerebral edema.

The initial dexamethasone dosage varies from 0.75 to 9 mg a day depending on the disease. In pediatric patients, the range of initial doses is 0.02 to 0.3 mg/kg/day in three or four divided doses. If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually. Increased appetite Convulsions, depression, emotional instability, euphoria, headache. Glaucoma, increased intraocular pressure. Decreased resistance to infection. Fluid retention, potassium loss, sodium retention. Osteoporosis under long term treatment.

Elevated liver enzymes. Acne, Allergic dermatitis, Erythema, impaired wound-healing, increased sweating, rash.

http://www.dexamethasone.net/

Dexamethasone tablets
How does it work?
Dexamethasone is a type of medicine known as a corticosteroid. Corticosteroid medicines are derivatives of the corticosteroid hormones cortisol and aldosterone that are produced naturally by the adrenal glands. They are often simply called steroids, but it should be noted that they are very different from another group of steroids, called anabolic steroids, which have gained notoriety because of their abuse by some athletes and body builders. Corticosteroids have many important functions on every organ system. If the body's natural level of steroid hormones is too low because the adrenal glands are not producing enough hormones, this must be treated with replacement therapy to allow the body to function normally. Dexamethasone is used specifically to treat a disorder of the adrenal glands called congenital adrenal hyperplasia. People with this condition lack an enzyme needed by the adrenal glands to produce cortisol and aldosterone, and without these hormones the adrenal glands produce too much of the male sex hormones (androgens). This causes early (or inappropriate) appearance of male characteristics. Taking dexamethasone daily helps return the hormone levels to normal. Corticosteroid hormones are also involved in controlling inflammatory responses in the body. Dexamethasone has an anti-inflammatory effect and is used to decrease inflammation in various different diseases and conditions. Dexamethasone decreases inflammation by acting within cells to prevent the release of certain chemicals that are important in the immune system. These chemicals are normally involved in producing immune and allergic responses. By decreasing the release of these chemicals in a particular area, inflammation is reduced. This can help control a wide number of disease states characterised by excessive inflammation. These include severe allergic reactions, inflammation of the lungs in asthma and inflammation of the joints in arthritis. Dexamethasone also decreases the numbers of white blood cells circulating in the blood. This, along with the decrease in inflammatory chemicals, can prevent the rejection of organ transplants, as it prevents the body from attacking foreign tissue. It is useful for the treatment of certain types of leukaemia, where there is an abnormally large production of certain white blood cells, and for treating certain diseases that are caused by the immune system attacking tissues in the body (autoimmune diseases).

What is it used for?

Returning hormone levels to normal in a disorder of the adrenal glands called congenital adrenal hyperplasia. Testing to determine the underlying cause of Cushing's syndrome(dexamethasone suppression test). Reducing swelling in the brain or raised pressure inside the skull associated with brain tumours. Preventing nausea and vomiting associated with chemotherapy for cancer. Dexamethasone can also be used to treat a wide variety of diseases and conditions that require either reduction of inflammation or suppression of the immune system. These include those listed below. Severe allergic reactions, eg anaphylaxis. Rheumatoid arthritis, juvenile chronic arthritis, polymyalgia rheumatica. Inflammatory muscle disorders, eg polymyositis. Flare-ups of multiple sclerosis.

Inflammatory bowel disease such as Crohn's disease and ulcerative colitis. Inflammation of the liver (hepatitis). Inflammatory disorders of the kidney, such as nephrotic syndrome. Inflammatory disorders of the lungs, eg asthma, COPD, aspiration pneumonitis, allergic lung disease such as farmer's and pigeon breeder's lung, Lffler's syndrome, cryptogenic fibrosing alveolitis. Sarcoidosis. Inflammatory disease called systemic lupus erythematosus, which can affect many organs throughout the body and is caused by the immune system attacking connective tissue in the body. Inflammatory skin disorders, including pemphigus vulgaris, bullous pemphigoid and erythema multiforme (StevensJohnson syndrome). Inflammatory eye disorders, eg uveitis, optic neuritis, chorioretinitis, iridocyclitis, temporal arteritis. Rare condition involving inflammation in the walls of arteries (polyarteritis nodosa). Anaemia caused by the immune system attacking red blood cells (autoimmune haemolytic anaemia). Cancer of the bone marrow (multiple myeloma). Leukaemia. Cancer of the lymph nodes (lymphoma). Idiopathic thrombocytopenia purpura. Breast cancer that has spread to other parts of the body. Helping to prevent the immune system attacking a transplanted organ, eg heart, liver, kidney etc.

Warning!
Corticosteroids should preferably be taken in the morning to mimic the natural production of corticosteroids by the adrenal glands. However, you should follow the instructions given by your doctor, as this is not appropriate for all uses of dexamethasone. Corticosteroids should be taken after food to minimise irritation to the stomach. You must not stop taking this medicine suddenly if you have been taking it for more than three weeks. This is because long-term use of corticosteroids can suppress the natural production of corticosteroids by the adrenal glands, which means that the body becomes temporarily reliant on the medicine. When it is time to stop treatment the dose should be tapered down gradually, to allow the adrenal glands to start producing adequate amounts of natural steroids again. Follow the instructions given by your doctor or pharmacist. Your doctor may also want you to stop treatment gradually if you have been taking high doses (more than 6mg dexamethasone daily) even if only for three weeks or less; if you have been treated with corticosteroid tablets or injections in the last year; if you had problems with your adrenal glands before treatment was started; or if you have been repeatedly taking doses in the evening. You will be given a steroid card with this medicine that you should carry with you at all times. Show it to anyone who treats you (eg doctor, nurse, pharmacist, dentist, anaesthetist). The card contains details of your prescriber, type of steroid, dose taken and the duration of treatment. It's purpose is to act as a reminder that your medicine should not be stopped suddenly, and to provide information of your treatment to other people treating you. This is important because the effects that corticosteroids have on the body may affect other medical treatment you may be given. If you have an accident the card contains information that could save your life. You should also show your steroid card to anyone who treats you for three months after you stop treatment with steroids. During times of physical stress, for example illnesses, trauma or surgery, your adrenal glands would normally produce more steroid hormones to cope. However, during long-term treatment with this medicine the action of your adrenal glands will be suppressed, so this increase in hormones won't happen naturally. As a result your steroid dose will normally need to be increased temporarily during these kind of events. Discuss this with your doctor. Corticosteroids decrease the body's natural immune and inflammatory responses. They may increase your susceptibility to infections and can also mask the symptoms of infections, making you think they are less serious than they are. For this reason, it is important to consult your doctor if you get any signs of infection during treatment. If you have never had chickenpox you could be at risk of severe chickenpox while having treatment with this medicine and should avoid close personal contact with people who have chickenpox or shingles (herpes zoster). You should also avoid contact with people who have measles. If you are exposed to people with these diseases either during treatment, or in the three months after stopping treatment, you should consult your doctor urgently, as you will need an injection of immunoglobulin to help you stop getting the diseases. This is very important as these diseases can be life-threatening in people treated with long-term corticosteroids.

Corticosteroid treatment, especially with high doses, can alter mood and behaviour early in treatment. People may experience confusion, irritability, nightmares, difficulty sleeping, mood changes and depression, and suffer from delusions and suicidal thoughts. In a few cases these effects have also occured when corticosteroid treatment is being withdrawn. For this reason, it is important to let your doctor know if you notice any change in your mood or behaviour during treatment or when stopping treatment, particularly if you begin to feel depressed, or have any disturbing thoughts or feelings. Most of these problems go away if the dose is lowered or the medicine is stopped. However if problems do happen they might need treatment. Children and adolescents having long-term treatment with this medicine should have their growth regularly monitored.

Use with caution in

Children and adolescents. Elderly people. Decreased kidney function. Liver failure or cirrhosis. Inflammation of the bowel and back passage (ulcerative colitis). Painful inflammation of small sacs or pouches in the wall of the gut (diverticulitis). People who have recently had a surgical procedure called intestinal anastomosis, which involves the joining together of ends of the intestine after a section has been removed. Peptic ulcer. People with a history of blood clots in the blood vessels (thromboembolism). Heart failure. People who have recently had a heart attack. High blood pressure (hypertension). Diabetes, or a family history of diabetes. Underactive thyroid gland (hypothyroidism). Epilepsy. Migraine. Glaucoma, or a family history of glaucoma. Current severe psychiatric illness, or a personal or family history of psychiatric illness, including depression, manic depression or schizophrenia. History of psychiatric illness caused by the use of a corticosteroid. Osteoporosis. Women who have passed the menopause. Abnormal muscle weakness (myasthenia gravis). People who have previously experienced muscle disorders (myopathy) caused by steroids. People with a history of tuberculosis (TB). Herpes simplex, eg cold sores or genital herpes. Herpes simplex virus infection of the eye. Fungal infections of the eye. People with parasitic infections, eg amoebiasis. Malaria affecting the brain (cerebral malaria). History of allergies.

Not to be used in
People with widespread infection, unless this is being treated with specific anti-infectives. Corticosteroids should not be used for the management of head injury or strokebecause they are unlikely to be of benefit and may even be harmful. This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine. This medicine should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the developing baby. When administered for long periods or repeatedly during pregnancy, corticosteroids may increase the risk of slowed growth in the developing baby. They may also cause the baby to make less of its own steroid hormones after birth, although this usually resolves on its own and rarely causes any problems. Seek further medical advice from your doctor. If you think you could have fallen pregnant while you are taking this medicine you should consult your doctor for advice. It is important that you do not suddenly stop taking the medicine unless your doctor tells you to - see the warnings above. This medicine passes into breast milk. It should be used with caution in mothers who are breastfeeding and only if the benefits to the mother outweigh any risks to the nursing infant. Lower doses taken by the mother are unlikely to significantly affect the baby, but if the mother is taking high doses for long periods of time, the medicine could cause the baby's adrenal glands to make less of their own steroid hormones. Seek medical advice from your doctor.

Label warnings

Take this medication with or after food. Follow the printed instructions you have been given with this medication.

Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect. Raised blood sugar level. Increased appetite and weight gain. Increased susceptibility to infections and increased severity of infections (see warnings above). Effects on the gut, such as indigestion or abdominal bloating, nausea, ulceration in the stomach or intestine, inflammation of the pancreas (pancreatitis). Ulceration or thrush infection in the throat. Muscle weakness or wasting. Thinning of the bones (osteoporosis) and increased risk of breaking a bone. Effects on the skin, such as skin thinning, impaired healing, acne, bruising, stretch marks, increased sweating, change in pigmentation, increased hair growth (hirsutism). Psychiatric reactions, such as mood changes (including irritability, depression and suicidal thoughts), psychotic reactions (including mania, delusions and hallucinations), anxiety, confusion, memory loss, sleep disturbances (see warning above). Cushing's syndrome, characterised by a moon face. Menstrual disturbances. Decrease in the production of natural steroids by the adrenal glands (adrenal suppression - see warning above). Effects on the eyes, such as raised pressure inside the eye (glaucoma), cataracts. Slowed growth in children and adolescents. Hiccups. Blood clots in the blood vessels (thromboembolism). The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that thecombination is safe. Dexamethasone may increase blood sugar levels and so may oppose the blood sugar lowering effects of antidiabetic medicines. People with diabetes may need an increase in their dose of insulin or antidiabetic tablets. Dexamethasone may enhance the anti-blood-clotting effect of anticoagulant medicines such as warfarin. People taking anticoagulant medicines in combination with dexamethasone should have their blood clotting time (INR) regularly monitored, particularly after starting or stopping treatment with dexamethasone and after any dose changes. If dexamethasone is used in combination with non-steroidal anti-inflammatory drugs (NSAIDs) eg ibuprofen, there may be an increased risk of side effects on the gut, such as stomach ulceration and bleeding. Dexamethasone may decrease the blood levels of the following medicines: caspofungin indinavir isoniazid saquinavir. Dexamethasone may also decrease the blood levels of salicylates such as aspirin. When dexamethasone is stopped, this may result in excessive levels of the salicylate, unless the dose is readjusted. You should not take antacids for indigestion or heartburn wthin two hours of taking this medicine, because they can decrease the absorption of dexamethasone from the gut and may therefore make it less effective. The following medicines may increase the removal of dexamethasone from the body, thus reducing its effects. You may need a larger dose of dexamethasone if you are also taking any of these medicines: barbituates, eg amobarbital, phenobarbital carbamazepine ephedrine phenytoin primidone rifabutin rifampicin. The effect of corticosteroids may be reduced in the three to four days following use of mifepristone. The following medicines may reduce the removal of dexamethasone from the body and so may increase its effects or side effects: aprepitant ciclosporin (dexamethasone may also increase the blood level and risk of side effects of ciclosporin) itraconazole ketoconazole macrolide-type antibiotics, eg erythromycin protease inhibitors, eg ritonavir. There may be an increased chance of side effects on the liver or blood cells if dexamethasone is used in combination with high-dose methotrexate. Dexamethasone may decrease the body's immune response. This means that vaccines may be less effective if given during treatment, because the body does not produce sufficient antibodies. Live vaccines may cause serious infections. Live vaccines include: measles, mumps, rubella, MMR, BCG, chickenpox, oral polio, oral typhoid and yellow fever. These should not be given to people whose immune system is underactive due to treatment with this medicine. Corticosteroids can cause fluid and salt retention and so may oppose the effects of antihypertensive medicines used to treat high blood pressure and diuretics, eg furosemide. However, dexamethasone is much less likely than other corticosteroids to have this effect. Corticosteroids can also lower the amount of potassium in the blood, though this is much less likely with dexamethasone than with other corticosteroids. However, there may be an increased chance of the level of potassium in the blood falling too low (hypokalaemia) if dexamethasone is used in combination with the following medicines: acetazolamide

amphotericin beta agonists, eg salbutamol, salmeterol, terbutaline carbenoxolone potassium-losing diuretics, eg furosemide, bendroflumethiazide theophylline.

http://www.netdoctor.co.uk/medicines/100000740.html