dexamethasone

(dex a meth' a sone)

dexamethasone
Oral, topical dermatologic aerosol and gel, ophthalmic suspension:
Aeroseb-Dex, Decadron, Dexameth, Dexasone (CAN), Dexone, Hexadrol,
Maxidex Ophthalmic

dexamethasone acetate
IM, intra-articular, or soft-tissue injection:
Cortastat LA, Dalalone L.A., Decaject LA, Dexasone-L.A., Dexone LA,
Solurex LA

dexamethasone sodium phosphate

IV, IM, intra-articular, intralesional injection; respiratory inhalant; intranasal steroid;
ophthalmic solution and ointment; topical dermatologic cream:
Cortastat, Dalalone, Decadron Phosphate, Decadron Phosphate
Ophthalmic, Decadron Phosphate Turbinaire, Decaject, Dexasone, Dexone,
Hexadrol Phosphate, Solurex

Pregnancy Category C

Drug classes
Corticosteroid
Glucocorticoid
Hormone

Therapeutic actions
Enters target cells and binds to specific receptors, initiating many complex reactions that
are responsible for its antiinflammatory and immunosuppressive effects.

Indications
• Hypercalcemia associated with cancer
• Short-term management of various inflammatory and allergic disorders, such as
rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus),
status asthmaticus, and autoimmune disorders
• Hematologic disorders: Thrombocytopenic purpura, erythroblastopenia
• Trichinosis with neurologic or myocardial involvement
• Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some
leukemias and lymphomas
• Cerebral edema associated with brain tumor, craniotomy, or head injury
• Testing adrenocortical hyperfunction
• Unlabeled uses: Antiemetic for cisplatin-induced vomiting, diagnosis of
depression
 • Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques
• Respiratory inhalant: Control of bronchial asthma requiring corticosteroids in
conjunction with other therapy
• Intranasal: Relief of symptoms of seasonal or perennial rhinitis that responds
poorly to other treatments
• Dermatologic preparations: Relief of inflammatory and pruritic manifestations of
dermatoses that are steroid-responsive
• Ophthalmic preparations: Inflammation of the lid, conjunctiva, cornea, and globe

Contraindications and cautions

• Contraindicated with infections, especially tuberculosis, fungal infections,
amebiasis, vaccinia and varicella, and antibiotic-resistant infections, allergy to any
component of the preparation used.
• Use cautiously with renal or hepatic disease; hypothyroidism, ulcerative colitis
with impending perforation; diverticulitis; active or latent peptic ulcer;
inflammatory bowel disease; CHF, hypertension, thromboembolic disorders;
osteoporosis; seizure disorders; diabetes mellitus; lactation.

Available forms
Tablets—0.25, 0.5, 0.75, 1, 1.5, 2, 4, 6 mg; elixir—0.5 mg/5 mL; oral solution—0.5 mg/5
mL; injection—8 mg/mL, 16 mg/mL, 4 mg/mL, 10 mg/mL, 20 mg/mL, 24 mg/mL;
aerosol—84 mcg/actuation; ophthalmic solution—0.1%; ophthalmic suspension—0.1%;
ophthalmic ointment—0.05%; topical ointment—0.05%; topical cream—0.05%, 0.1%;
topical aerosol—0.01%, 0.04%

Dosages
ADULTS
Systemic administration
Individualize dosage based on severity of condition and response. Give daily dose before
9 AM to minimize adrenal suppression. If long-term therapy is needed, alternate-day
therapy with a short-acting steroid should be considered. After long-term therapy,
withdraw drug slowly to avoid adrenal insufficiency. For maintenance therapy, reduce
initial dose in small increments at intervals until the lowest clinically satisfactory dose is
reached.
Oral (dexamethasone, oral)
0.75–9 mg/day.
• Suppression tests for Cushing's syndrome: 1 mg at 11 PM; assay plasma cortisol
at 8 PM the next day. For greater accuracy, give 0.5 mg q 6 hr for 48 hr, and
collect 24-hr urine to determine 17-OH-corticosteroid excretion.
• Suppression test to distinguish Cushing's syndrome due to ACTH excess from that
resulting from other causes: 2 mg q 6 hr for 48 hr. Collect 24-hr urine to
determine 17-OH-corticosteroid excretion.
IM (dexamethasone acetate)
8–16 mg; may repeat in 1–3 wk. Dexamethasone phosphate: 0.5–0.9 mg/day; usual dose
range is one-third to one-half the oral dose.
IV (dexamethasone sodium phosphate)
0.5–9 mg/day.
• Cerebral edema: 10 mg IV and then 4 mg IM q 6 hr; change to oral therapy, 1–
3 mg tid, as soon as possible and taper over 5–7 days.
PEDIATRIC PATIENTS
IV
Individualize dosage based on severity of condition and response, rather than by strict
adherence to formulas that correct adult doses for age or body weight. Carefully observe
growth and development in infants and children on long-term therapy.
• Unresponsive shock: 1–6 mg/kg as a single IV injection (as much as 40 mg
initially followed by repeated injections q 2–6 hr has been reported).
Intralesional (dexamethasone acetate)
ADULTS AND PEDIATRIC PATIENTS
4–16 mg intra-articular, soft tissue; 0.8–1.6 mg intralesional.
(dexamethasone sodium phosphate)
0.4–6 mg (depending on joint or soft-tissue injection site).
Respiratory inhalant (dexamethasone sodium phosphate)
84 mcg released with each actuation.
ADULTS
3 inhalations tid–qid, not to exceed 12 inhalations/day.
PEDIATRIC PATIENTS
2 inhalations tid–qid, not to exceed 8 inhalations/day.
Intranasal (dexamethasone sodium phosphate)
Each spray delivers 84 mcg dexamethasone.
ADULTS
2 sprays (168 mcg) into each nostril bid–tid, not to exceed 12 sprays (1,008 mcg)/day.
PEDIATRIC PATIENTS
1 or 2 sprays (84–168 mcg) into each nostril bid, depending on age, not to exceed 8
sprays (672 mcg). Arrange to reduce dose and discontinue therapy as soon as possible.
Topical dermatologic preparations
Apply sparingly to affected area bid–qid.
Ophthalmic solutions, suspensions
Instill 1 or 2 drops into the conjunctival sac q 1 hr during the day and q 2 hr during the
night; after a favorable response, reduce dose to 1 drop q 4 hr and then 1 drop tid–qid.
Ophthalmic ointment
Apply a thin coating in the lower conjunctival sac tid–qid; reduce dosage to bid and then
qid after improvement.

Pharmacokinetics
Route Onset Peak Duration
Oral Slow 1–2 hr 2–3 days
IM Rapid 30–60 min 2–3 days
IV Rapid 30–60 min 2–3 days

Metabolism: Hepatic; T1/2: 110–210 min

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

IV facts
Preparation: No preparation required.
Infusion: Administer by slow, direct IV injection over 1 min.
Incompatibilities: Do not combine with daunorubicin, doxorubicin, metaraminol,
vancomycin.

Adverse effects
Adverse effects depend on dose, route, and duration of therapy. The first list is primarily
associated with absorption; the list following is related to specific routes of
administration.
Systemic administration
• CNS: Seizures, vertigo, headaches, pseudotumor cerebri, euphoria, insomnia,
mood swings, depression, psychosis, intracerebral hemorrhage, reversible cerebral
atrophy in infants, cataracts, increased IOP, glaucoma
• CV: Hypertension, CHF, necrotizing angiitis
• Endocrine: Growth retardation, decreased carbohydrate tolerance, diabetes
mellitus, cushingoid state, secondary adrenocortical and pituitary
unresponsiveness
• GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention
• GU: Amenorrhea, irregular menses
• Hematologic: Fluid and electrolyte disturbances, negative nitrogen balance,
increased blood sugar, glycosuria, increased serum cholesterol, decreased serum
T3 and T4 levels
• Hypersensitivity: Anaphylactoid or hypersensitivity reactions
• Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass,
osteoporosis, spontaneous fractures
• Other: Impaired wound healing; petechiae; ecchymoses; increased sweating;
thin and fragile skin; acne; immunosuppression and masking of signs of infection;
activation of latent infections, including TB, fungal, and viral eye infections;
pneumonia; abscess; septic infection; GI and GU infections
Intra-articular
• Musculoskeletal: Osteonecrosis, tendon rupture, infection
Intralesional therapy
• CNS: Blindness (when used on face and head—rare)
Respiratory inhalant
• Endocrine: Suppression of HPA function due to systemic absorption
• Respiratory: Oral, laryngeal, pharyngeal irritation
• Other: Fungal infections
Intranasal
• CNS: Headache
• Dermatologic: Urticaria
• Endocrine: Suppression of HPA function due to systemic absorption
• GI: Nausea
• Respiratory: Nasal irritation, fungal infections, epistaxis, rebound congestion,
perforation of the nasal septum, anosmia
Topical dermatologic ointments, creams, sprays
 • Endocrine: Suppression of HPA function due to systemic absorption, growth
retardation in children (children may be at special risk for systemic absorption
because of their large skin surface area to body weight ratio)
• Local: Local burning, irritation, acneiform lesions, striae, skin atrophy
Ophthalmic preparations
• Endocrine: Suppression of HPA function due to systemic absorption; more
common with long-term use
• Local: Infections, especially fungal; glaucoma, cataracts with long-term use

Interactions
Drug-drug
• Increased therapeutic and toxic effects of dexamethasone with troleandomycin
• Decreased effects of anticholinesterases with corticotropin; profound muscular
depression is possible
• Decreased steroid blood levels with phenytoin, phenobarbital, rifampin
• Decreased serum levels of salicylates with dexamethasone
Drug-lab test
• False-negative nitroblue-tetrazolium test for bacterial infection
• Suppression of skin test reactions

Nursing considerations
Assessment
• History for systemic administration: Active infections; renal or hepatic disease;
hypothyroidism, ulcerative colitis; diverticulitis; active or latent peptic ulcer;
inflammatory bowel disease; CHF, hypertension, thromboembolic disorders;
osteoporosis; seizure disorders; diabetes mellitus; lactation
For ophthalmic preparations: acute superficial herpes simplex keratitis, fungal
infections of ocular structures; vaccinia, varicella, and other viral diseases of the
cornea and conjunctiva; ocular tuberculosis
• Physical for systemic administration: Baseline body weight, temperature;
reflexes, and grip strength, affect, and orientation; P, BP, peripheral perfusion,
prominence of superficial veins; R and adventitious sounds; serum electrolytes,
blood glucose
For topical dermatologic preparations: affected area for infections, skin injury

Interventions
• For systemic administration, do not give drug to nursing mothers; drug is secreted
in breast milk.
• Give daily doses before 9 AM to mimic normal peak corticosteroid blood levels.
• Increase dosage when patient is subject to stress.
• Taper doses when discontinuing high-dose or long-term therapy.
• Do not give live virus vaccines with immunosuppressive doses of corticosteroids.
• For respiratory inhalant, intranasal preparation, do not use respiratory inhalant
during an acute asthmatic attack or to manage status asthmaticus.
 • Do not use intranasal product with untreated local nasal infections, epistaxis,
nasal trauma, septal ulcers, or recent nasal surgery.
• Taper systemic steroids carefully during transfer to inhalational steroids; adrenal
insufficiency deaths have occurred.
• For topical dermatologic preparations, use caution when occlusive dressings, tight
diapers cover affected area; these can increase systemic absorption.
• Avoid prolonged use near the eyes, in genital and rectal areas, and in skin creases.

Teaching points
Systemic administration
• Do not stop taking the oral drug without consulting health care provider.
• Avoid exposure to infection.
• Report unusual weight gain, swelling of the extremities, muscle weakness, black
or tarry stools, fever, prolonged sore throat, colds or other infections, worsening
of this disorder.
Intra-articular administration
• Do not overuse joint after therapy, even if pain is gone.
Respiratory inhalant, intranasal preparation
• Do not use more often than prescribed.
• Do not stop using this drug without consulting health care provider.
• Use the inhalational bronchodilator drug before using the oral inhalant product
when using both.
• Administer decongestant nose drops first if nasal passages are blocked.
Topical
• Apply the drug sparingly.
• Avoid contact with eyes.
• Report any irritation or infection at the site of application.
Ophthalmic
• Administer as follows: Lie down or tilt head backward and look at ceiling. Warm
tube of ointment in hand for several minutes. Apply one-fourth to one-half inch of
ointment, or drop suspension inside lower eyelid while looking up. After applying
ointment, close eyelids and roll eyeball in all directions. After instilling eye drops,
release lower lid, but do not blink for at least 30 sec; apply gentle pressure to the
inside corner of the eye for 1 min. Do not close eyes tightly, and try not to blink
more often than usual; do not touch ointment tube or dropper to eye, fingers, or
any surface.
• Wait at least 10 min before using any other eye preparations.
• Eyes will become more sensitive to light (use sunglasses).
• Report worsening of the condition, pain, itching, swelling of the eye, failure of the
condition to improve after 1 wk.

Adverse effects in Italic are most common; those in Bold are life-threatening.