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

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 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

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 Rheumatoid Arthritis

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 Tendonitis

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 Gouty Arthritis

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 Epicondylitis

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 Alopecia

Suggested doses:
Soft tissue infiltration: 2 to 6 mg
Ganglia: 1 to 2 mg

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Soft tissue and intralesional injections should be limited to 1 or 2 sites.

Uses: As adjunctive therapy for keloids; localized hypertrophic, infiltrated, inflammatory lesion of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis); discoid lupus erythematosus; necrobiosis lipoidica diabeticorum; alopecia areata. May be useful in cystic tumors of an aponeurosis tendon (ganglia).

Usual Adult Dose for Lichen Simplex Chronicus

Suggested doses:
Soft tissue infiltration: 2 to 6 mg
Ganglia: 1 to 2 mg

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Soft tissue and intralesional injections should be limited to 1 or 2 sites.

Uses: As adjunctive therapy for keloids; localized hypertrophic, infiltrated, inflammatory lesion of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis); discoid lupus erythematosus; necrobiosis lipoidica diabeticorum; alopecia areata. May be useful in cystic tumors of an aponeurosis tendon (ganglia).

Usual Adult Dose for Psoriasis

Suggested doses:
Soft tissue infiltration: 2 to 6 mg
Ganglia: 1 to 2 mg

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Soft tissue and intralesional injections should be limited to 1 or 2 sites.

Uses: As adjunctive therapy for keloids; localized hypertrophic, infiltrated, inflammatory lesion of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis); discoid lupus erythematosus; necrobiosis lipoidica diabeticorum; alopecia areata. May be useful in cystic tumors of an aponeurosis tendon (ganglia).

Usual Adult Dose for Granuloma Annulare

Suggested doses:
Soft tissue infiltration: 2 to 6 mg
Ganglia: 1 to 2 mg

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Soft tissue and intralesional injections should be limited to 1 or 2 sites.

Uses: As adjunctive therapy for keloids; localized hypertrophic, infiltrated, inflammatory lesion of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis); discoid lupus erythematosus; necrobiosis lipoidica diabeticorum; alopecia areata. May be useful in cystic tumors of an aponeurosis tendon (ganglia).

Usual Adult Dose for Lichen Planus

Suggested doses:
Soft tissue infiltration: 2 to 6 mg
Ganglia: 1 to 2 mg

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Soft tissue and intralesional injections should be limited to 1 or 2 sites.

Uses: As adjunctive therapy for keloids; localized hypertrophic, infiltrated, inflammatory lesion of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis); discoid lupus erythematosus; necrobiosis lipoidica diabeticorum; alopecia areata. May be useful in cystic tumors of an aponeurosis tendon (ganglia).

Usual Adult Dose for Keloids

Suggested doses:
Soft tissue infiltration: 2 to 6 mg
Ganglia: 1 to 2 mg

Comments:

• Dose will vary according to the degree of inflammation and the size and location of the affected site.
• Soft tissue and intralesional injections should be limited to 1 or 2 sites.

Uses: As adjunctive therapy for keloids; localized hypertrophic, infiltrated, inflammatory lesion of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis); discoid lupus erythematosus; necrobiosis lipoidica diabeticorum; alopecia areata. May be useful in cystic tumors of an aponeurosis tendon (ganglia).

Usual Adult Dose for Idiopathic (Immune) Thrombocytopenic Purpura

40 mg orally once a day for 4 days

• An additional 4-day course may be given if bleeding symptoms are present on day 7 or platelet count remains below 30 x10(9)/L

Comments:

• The American Society of Hematology (2011) has recommended a longer course of corticosteroids (e.g. prednisone for 21 days) over a shorter course (high-dose dexamethasone) due to longer time to loss of response, however, a recent prospective multicenter trial has shown 1 or 2 courses of high-dose dexamethasone are at least comparable to longer courses.

Use: For the treatment of immune thrombocytopenia.

Usual Pediatric Dose for Cerebral Edema

0.2 mg/kg/24 hr oral/IV/IM in divided doses

Comments:

• The smallest effective dose should be used, preferably oral.

Use: For the treatment of cerebral edema

Usual Pediatric Dose for Meningitis

Meningitis (H. influenzae type b):
Infants and Children 6 weeks or older: 0.15 mg/kg/dose IV every 6 hours for the first 2 to 4 days of antibiotic treatment

Comments:

• Dexamethasone should be started 10 to 20 minutes before or with the first dose of antibiotic; if antibiotics have already been administered, dexamethasone use has not been shown to improve patient outcomes and is not recommended.
• This is not a labeled indication.
• This drug has not been shown to reduce overall mortality, but has been shown to reduce hearing loss and neurological sequelae.

Note: For pneumococcal meningitis, data has not shown clear benefit from dexamethasone administration; risk and benefits should be considered prior to use.

Use: To reduce hearing loss and neurological sequelae associated with meningitis.

Usual Pediatric Dose for Anti-inflammatory

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

Oral:

• Initial dose: 0.02 mg to 0.3 mg/kg/day OR 0.6 to 9 mg/m2/day orally in 3 or 4 divided doses
• 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, while 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 observed closely for signs that require 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 Pediatric Dose for Immunosuppression

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

Oral:

• Initial dose: 0.02 mg to 0.3 mg/kg/day OR 0.6 to 9 mg/m2/day orally in 3 or 4 divided doses
• 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, while 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 observed closely for signs that require 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 Pediatric Dose for Nausea/Vomiting - Chemotherapy Induced

Highly Emetogenic Chemotherapy Regimens:
6 mg/m2 oral/IV every 6 hours

Moderately Emetogenic Chemotherapy Regimens:

• BSA 0.6 m2 or less: 2 mg IV/oral every 12 hours
• BSA greater than 0.6 m2: 4 mg IV/oral every 12 hours

Comments:

• The addition of dexamethasone to anti-emetic regimens improves control of vomiting, although the risk-benefit remains uncertain.
• For regimens containing aprepitant, the dose of dexamethasone should be reduced by one-half.
• This is not a labeled indication, but recommended in many anti-emetic protocols.

Use: For the prevention of nausea and vomiting associated with chemotherapy.

Usual Pediatric Dose for Asthma - Acute

0.6 mg/kg oral/IV/IM once

Comments:

• Studies have shown dexamethasone in single doses (0.3 mg/kg up to 1.7 mg/kg; maximum single dose 36 mg) or multiple doses (0.6 mg/kg once a day for 2 days) is comparable to a 5-day course of prednisone/prednisolone in the treatment of acute asthma exacerbations.

Use: For the treatment of acute asthma exacerbation.

Usual Pediatric Dose for Croup

0.6 mg/kg oral/IM/ IV once
Maximum dose: 16 mg

Comment: Further dosing and route of administration determined by clinical course

Use: For the treatment of childhood croup (laryngotracheobronchitis).

Usual Pediatric Dose for Acute Mountain Sickness

0.15 mg/kg oral/IV/IM every 6 hours

Comments:

• Dosing based on Wilderness and Environmental Medicine guidance.
• Prophylactic use of this drug for acute mountain sickness (AMS) is not recommended in pediatric patients due to the potential for toxicity; safer alternatives such as graded ascent and acetazolamide should be considered.
• Treatment does not facilitate acclimation; further ascent should be delayed until the patient is asymptomatic while off the medication.

Use: For the treatment of acute mountain sickness.

Usual Pediatric Dose for Idiopathic (Immune) Thrombocytopenic Purpura

0.6 mg/kg/day oral/IV for 4 days every 4 weeks for 6 cycles

Comments:

• High-dose dexamethasone may be considered appropriate second-line treatment in those who have significant bleeding despite IVIg, anti-D, or a short course of corticosteroids.
• Additionally, it may be considered in patients with chronic immune thrombocytopenia as an alternative to splenectomy or in patients who do not response to splenectomy.
• There is limited data on use of this drug in the pediatric population; the above dose is from a study in a small number of patients.

Use: For the treatment of immune thrombocytopenia.

Renal Dose Adjustments

No dose adjustment recommended

Liver Dose Adjustments

Use with caution

Dose Adjustments

Elderly: The more serious consequences of common side effects should be carefully considered when initiating therapy.

Doses should be titrated based on patient response and severity of the condition; patients should be continuously monitored for signs that may require a dosage adjustment:

• Increased doses may be needed during periods of stress (e.g., surgery, infection, trauma) or, exacerbations of condition
• Dose reductions should occur once an adequate response is obtained
• If a beneficial response is not achieved within a couple of days, treatment should be discontinued and an alternative therapy considered.

Gradual discontinuation of therapy is warranted if therapy is to be stopped after more than a few days.

Approximate Equivalents (IV or oral formulations):
Dexamethasone is approximately equivalent to betamethasone
Dexamethasone is approximately 4 to 6 times more potent than methylprednisolone and triamcinolone
Dexamethasone is approximately 6 to 8 times more potent than prednisone and prednisolone
Dexamethasone is approximately 25 to 30 times more potent than hydrocortisone
Dexamethasone is approximately 35 times more potent than cortisone

Precautions

Consult WARNINGS section for additional precautions.

Dialysis

Supplemental dose is not necessary

Other Comments

Administration advice:
Oral:

• Take with or after food to minimize stomach upset; if prescribed once a day it should be taken in the morning

Concentrated oral solution (Intensol[R]):

• Use provided calibrated dropper to measure doses
• Mix dose well with liquid or semi-solid food (e.g. water, juices, applesauce, pudding)
• Consume entire contents immediately after mixing

Parenteral:
Dexamethasone sodium phosphate 4 mg/mL: For IV, IM, intra-articular, intralesional, and soft tissue injection
Dexamethasone sodium phosphate 10 mg/mL: For IV and IM administration only

Storage requirements:

• Avoid freezing
• Protect from light
• Do not autoclave (steroids are sensitive to heat)

Concentrated oral solution (Intensol[R]): Discard bottle 90 days after opening; do not use if solution contains a precipitate

Reconstitution/preparation techniques:

• Maybe used with or without dilution; IV solutions should be used within 24 hours

IV compatibility: Compatible with normal saline and dextrose solutions

General:

• Current treatment guidelines maybe consulted for specific dose ranges.
• Corticosteroids confer palliative, symptomatic treatment by virtue of their anti-inflammatory effects; they are not curative.
• Long-term treatment with this high potency, long half-life steroid is associated with severe hypothalamic-pituitary adrenal (HPA) suppression and therefore use is generally limited to short-term, severe, acute situations.
• This drug is not recommended for the treatment of primary adrenal insufficiency because it frequently causes Cushingoid side effects, is difficult to titrate, and has minimal mineralocorticoid activity.
• The long duration of action of this drug makes it unsuitable for alternate-day-therapy.

Monitoring:

• Monitor growth velocity and development in pediatric patients
• Monitor intraocular pressure if therapy is continued for more than 6 weeks; regular eye exams should be encouraged
• Routine laboratory studies (including 2-hour postprandial blood glucose and serum potassium), blood pressure, weight, bone mineral density, and chest x-rays should be performed at regular intervals for patients on long-term corticosteroid therapy
• Monitor for hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing's syndrome, and hyperglycemia with chronic steroid users

Patient advice:

• Patients should understand that this drug is a corticosteroid and that it is important not to stop therapy abruptly.
• Patients should understand that during times of stress, such as surgery or infection, additional supplementation doses may be necessary; they should discuss with their healthcare professional whether they need to carry a medical identification card identifying their corticosteroid use.
• Patients on immunosuppressant doses of corticosteroids should understand that a greater risk of infection exists; they should avoid exposure to chickenpox or measles and if exposed, they should consult their healthcare professional promptly.
• Patients should check with their healthcare provider before receiving any vaccinations.
• Patients should be advised of common adverse reactions including changes in glucose tolerance, high blood pressure, behavioral/mood changes, increased appetite, and weight gain.
• Patients should understand this drug is not curative; when injected into joints, they should not over use joints despite symptomatic improvement.

Frequently asked questions

• Can I use expired neomycin and polymyxin b sulfates, dexamethasone ophthalmic?