Dexamethasone Dosage

Drug Detail:Dexamethasone (systemic) (monograph) (Medically reviewed)

Drug Class:

Usual Adult Dose for Acute Mountain Sickness

Prevention of AMS and HACE:
Usual dose: 2 mg orally every 6 hours OR 4 mg orally every 12 hours

Very High Risk Situations (e.g. military, search and rescue at altitudes greater than 3500 m): 4 mg orally every 6 hours

Duration of Therapy: Should not exceed 10 days to prevent glucocorticoid toxicity or adrenal suppression

Treatment of AMS: 4 mg orally/IV/IM every 6 hours

Treatment of HACE: 8 mg orally/IV/IM once; followed by 4 mg orally/IV/IM every 6 hours

Comments:

Dosing based on Wilderness and Environmental Medicine guidance.
This drug has shown benefit for the prevention of acute mountain sickness (AMS) and high altitude cerebral edema (HACE), however, the evidence for prevention of high altitude pulmonary edema (HAPE) is lacking; this drug should be used in conjunction with non-pharmacologic measures and only in situations when the risk profile is favorable.
Treatment does not facilitate acclimation; further ascent should be delayed until the patient is asymptomatic while off the medication.

Uses:

For the prevention of AMS and HACE.
For the treatment of AMS and HACE, and to treat concurrent HACE and HAPE when neurologic dysfunctions do not resolve rapidly with administration of supplemental oxygen.

Usual Adult Dose for Cerebral Edema

Initial dose: 10 mg IV once, followed by 4 mg IM every 6 hours until maximal response is noted

After 2 to 4 days, dose should be reduced and then gradually discontinued over a period of 5 to 7 days

Comments:

After symptoms subside, may switch to oral therapy (1 to 3 mg orally 3 times a day) and then taper gradually over 5 to 7 days.
In patients undergoing brain surgery, may continue treatment for several days postoperatively.
In nonoperative cases, continuous therapy may be needed to remain symptom-free.

Use: For the treatment of cerebral edema.

Usual Adult Dose for Cushing's Syndrome

Dexamethasone Suppression Tests:

Short suppression test: 1 mg orally at 11 PM; draw plasma cortisol at 8 AM the following morning

Long suppression test: 0.5 mg orally every 6 hours for 48 hours; 24-hour urine collections are made before, during, and at the end of the test for determination of 17-hydroxycorticosteroids

Test to distinguish Cushing's syndrome: 2 mg orally every 6 hours for 48 hours; 24-hour urine collections are made before, during, and at the end of the test for determination of 17-hydroxycorticosteroids

Comment: The long suppression test provides greater accuracy in diagnosing Cushing's syndrome.

Uses: Diagnostic testing for Cushing's syndrome.

Usual Adult Dose for Nausea/Vomiting - Chemotherapy Induced

Highly emetogenic chemotherapy regimens:
12 to 20 mg oral/IV prior to chemotherapy followed by 8 mg oral/IV once or twice a day for 2 to 4 days

Moderately emetogenic chemotherapy regimens:
8 mg oral/IV prior to chemotherapy followed by 4 to 8 mg oral/IV on days 2 and 3

Low emetogenic chemotherapy regimens:
4 to 8 mg oral/IV prior to chemotherapy

Comments:

This drug may be used alone but is most often used in combination with other agents, e.g. neurokinin 1 (NK1) antagonists and 5-hydroxytryptamine-3 (5-HT3) antagonists.
When used in combination regimens, it is the combination of agents that defines the dose and duration of use for this drug; this is not a labeled indication.
When receiving combination chemotherapy, the agent with the most emetic potential should determine the regimen of anti-emetic therapy that should be used.

Use: For prophylaxis and treatment of chemotherapy induced nausea and vomiting.

Usual Adult Dose for Shock

Unresponsive shock:
1 to 6 mg/kg IV as a single dose or up to 40 mg initially followed by repeat IV doses every 2 to 6 hours while shock persists

Published protocols:
20 mg IV as a single dose followed by IV infusion of 3 mg/kg/24 hours
1 to 6 mg/kg IV as a single dose
40 mg IV as a single dose followed by repeat IV doses every 4 to 6 hours while shock persists

Comments:

High-dose therapy should only be continued until patient's condition has stabilized and usually no longer than 48 to 72 hours.

Use: For the treatment of unresponsive shock.

Usual Adult Dose for Multiple Myeloma

40 mg oral/IV on days 1, 8, 15, 22, and repeated every 4 weeks

Comments:

This drug is a part of most major treatment regimens in multiple myeloma; treatment regimens should be consulted.
In regimens containing bortezomib, the day 1 dexamethasone dose may be split to provide 20 mg on the day of and 20 mg on the day after bortezomib.
Doses may need to be adjusted for performance status or other toxicities

Use: For the treatment of multiple myeloma.

Usual Adult Dose for Multiple Sclerosis

Acute exacerbation: 30 mg orally once a day for 1 week followed by 4 to 8 mg orally every other day for 1 month

Comments:

Short-term high-dose corticosteroids are an accepted standard of care for treating relapses of multiple sclerosis; chronic daily corticosteroids are not recommended.
IV methylprednisolone, oral prednisone and prednisolone are the corticosteroids most studied and cited in clinical guidelines; while this drug has been used, efficacy studies and comparative data are lacking.

Use: For the treatment of acute exacerbations of multiple sclerosis.

Usual Adult Dose for Anti-inflammatory

Dosing should be individualized on the basis of disease and patient response

Oral:

Initial dose: 0.75 mg to 9 mg orally per day

Parenteral:

Initial dose: 0.5 mg to 9 mg IV or IM per day in divided doses every 12 hours

Maintenance dose: After a favorable initial response, dose should be decreased in small amounts to the lowest dose that maintains an adequate clinical response; if a positive response is not achieved after a reasonable period of time, alternative therapy should be sought.

Comments:

Lower doses, including doses lower than recommended doses, may suffice in less severe disease; doses in excess of recommended doses may be required in severe disease; in life-threatening situations, doses exceeding multiples of the oral dose may be justified.
When oral therapy is not feasible IV or IM therapy in doses ranging from one-third to one-half the oral dose may be given every 12 hours.
Patients should be closely monitored for signs requiring dose adjustments; if therapy is to be stopped after more than a few days, it should be gradually withdrawn.

Uses: For use as a potent anti-inflammatory agent in managing disorders, diseases, and conditions affecting many organ systems including endocrine, dermatologic, ophthalmic, nervous. gastrointestinal, respiratory, musculoskeletal, and hematologic.

Usual Adult Dose for Immunosuppression

Dosing should be individualized on the basis of disease and patient response

Oral:

Initial dose: 0.75 mg to 9 mg orally per day

Parenteral:

Initial dose: 0.5 mg to 9 mg IV or IM per day in divided doses every 12 hours

Lower doses, including doses lower than recommended doses, may suffice in less severe disease; doses in excess of recommended doses may be required in severe disease; in life-threatening situations, doses exceeding multiples of the oral dose may be justified.
When oral therapy is not feasible IV or IM therapy in doses ranging from one-third to one-half the oral dose may be given every 12 hours.
Patients should be closely monitored for signs requiring dose adjustments; if therapy is to be stopped after more than a few days, it should be gradually withdrawn.

Usual Adult Dose for Brain/Intracranial Tumor

2 mg oral/IV/IM 2 to 3 times a day

Use: For palliative management of recurrent or inoperable brain tumors.

Usual Adult Dose for Allergic Reaction

First day: 4 to 8 mg IM once
Second and third day: 1.5 mg orally twice per day
Fourth day: 0.75 mg orally twice per day
Fifth and sixth day: 0.75 mg orally once a day
Seventh day: No treatment
Eighth day: Reassessment

Comments: This dosing schedule is designed to ensure adequate therapy during an acute episode while minimizing the risk of overdose in chronic cases.

Use: For the treatment of acute, self-limited allergic disorder or exacerbation of chronic allergic disorder.

Usual Adult Dose for Bursitis

Suggested doses:
Large joints: 2 to 4 mg
Small joints: 0.8 to 1 mg
Bursae: 2 to 4 mg
Tendon Sheaths: 0.4 to 1 mg

Injections may be repeated from once every 3 to 5 days to once every 2 to 3 weeks

Comments:

Dose will vary according to the degree of inflammation and the size and location of the affected site.
Intrasynovial and soft tissue injections should be limited to 1 or 2 sites; frequent intra-articular injections may cause damage to joint tissue.

Use: As adjunctive therapy for an acute episode or exacerbation of synovitis of osteoarthritis, rheumatoid arthritis, acute and subacute bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, and posttraumatic osteoarthritis.

Usual Adult Dose for Osteoarthritis

Dose will vary according to the degree of inflammation and the size and location of the affected site.
Intrasynovial and soft tissue injections should be limited to 1 or 2 sites; frequent intra-articular injections may cause damage to joint tissue.

Usual Adult Dose for Rheumatoid Arthritis

Dose will vary according to the degree of inflammation and the size and location of the affected site.
Intrasynovial and soft tissue injections should be limited to 1 or 2 sites; frequent intra-articular injections may cause damage to joint tissue.

Usual Adult Dose for Tendonitis

Dose will vary according to the degree of inflammation and the size and location of the affected site.
Intrasynovial and soft tissue injections should be limited to 1 or 2 sites; frequent intra-articular injections may cause damage to joint tissue.

Usual Adult Dose for Gouty Arthritis

Dose will vary according to the degree of inflammation and the size and location of the affected site.
Intrasynovial and soft tissue injections should be limited to 1 or 2 sites; frequent intra-articular injections may cause damage to joint tissue.