DEXAMETHASONE

Therapeutic Category Corticosteroid Pharmacologic class: Glucocorticoid Use\ Indications Cerebral edema, Tuberculous meningitis Palliative management of recurrent or inoperable brain tumors Inflammatory conditions, neoplasias Acute, self-limited allergic disorders, acute exacerbations of chronic allergic disorders Shock Dexamethasone suppression test for Cushing syndrome Adrenocortical insufficiency Acute exacerbation of multiplesclerosis Pharmacological Effects Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes; suppresses immune response; stimulates bone marrow; and influences protein, fat, and carbohydrate metabolism. Adverse Reaction CNS: euphoria, insomnia, psychotic behavior, vertigo, headache, paresthesia, seizures, depression. CV: heart failure, hypertension, edema, arrhythmias, thrombophlebitis, thromboembolism. EENT: cataracts, glaucoma. GI: peptic ulceration, GI irritation, increased appetite, pancreatitis, nausea, vomiting. GU: menstrual irregularities, increased urine glucose and calcium levels. Metabolic: hypokalemia, hyperglycemia, carbohydrate intolerance, hypercholesterolemia, hypocalcemia, sodium retention. Musculoskeletal: growth suppression in children, osteoporosis, tendon rupture, myopathy. Skin: hirsutism, delayed wound healing, acne, various skin eruptions, atrophy at I.M. injection site. After abrupt withdrawal: rebound inflammation, fatigue, weakness, arthralgia, fever, dizziness, lethargy, fainting, orthostatic hypotension, dyspnea, anorexia, hypoglycemia. After prolonged use, sudden withdrawal may be fatal. Precautions/Warnings/Contraindication Contraindicated in patients hypersensitive to drug or its ingredients, Contraindicated in patients with systemic fungal infections, Contraindicated in patients receiving immunosuppressive doses together with live virus vaccines. I.M. administration is contraindicated in patients with idiopathic thrombocytopenic purpura. Use with caution in patient with recent MI. Use cautiously in patients with GI ulcer, renal disease, hypertension, osteoporosis, diabetes mellitus, hypothyroidism, cirrhosis, Thromboembolic disorders, seizures, myasthenia gravis, heart failure, tuberculosis, active hepatitis, ocular herpes simplex, emotional instability, or psychotic tendencies May increase cholesterol and glucose levels. May decrease calcium, potassium, T3, and T4 levels.

Pregnancy category: C Breast-feeding: Use cautiously Interactions: Aminoglutethimide: May cause loss of dexamethasone-induced adrenal suppression. Use together cautiously. Antidiabetics, including insulin: May decrease response. May need dosage adjustment. Aspirin, indomethacin, other NSAIDs: May increase risk of GI distress and bleeding. Use together cautiously. Barbiturates, carbamazepine, phenytoin, rifampin: May decrease corticosteroid effect. Increase corticosteroid dosage. Cardiac glycosides: May increase risk of arrhythmia resulting from hypokalemia. May need dosage adjustment. Cyclosporine: May increase toxicity. Monitor patient closely. Ephedrine: May cause decreased half-life and increased clearance of dexamethasone. Oral anticoagulants: May alter dosage requirements. Monitor PT and INR closely. Potassium-depleting drugs such as thiazide diuretics: May enhance potassium-wasting effects of dexamethasone. Salicylates: May decrease salicylate level. Monitor patient for lack of salicylate effectiveness. Skin-test antigens: May decrease response. Postpone skin testing until therapy is completed. Toxoids, vaccines: May decrease antibody response and may increase risk of neurologic complications. Avoid using together. Dosing Adult: 0.75 to 9 mg/day P.O. or 0.5 to 9 mg/day phosphate I.M/I.V Children: 0.02 to 0.3 mg/kg P.O. daily, in three or four divided doses. Brand Available: Parenteral: Dexamethasone 4mg/ml Decadron 4mg/ml Dexamex 4mg/ml Tablets: Dexamethasone 0.5/4mg Decadron 0.5/4mg Dexamex 0.5/4mg