Dexamethasone
DECADRON
Pronunciation: dex-a-METH-a-soen
“Dex, a metal Decahedron”
cushingoid moon face → corticosteroid
What it isLong-acting glucocorticoid with negligible mineralocorticoid effect; cerebral edema, croup, antiemesis and COVID-19.
Why this oneIts potency and long half-life allow single or once-daily dosing, and the lack of sodium retention suits raised intracranial pressure.
What limits itProfound axis suppression from the long duration. Hyperglycemia is prominent; CYP3A4 substrate and inducer.
FDA-approved for
- inflammation (~1958)
Off-label
- antiemesis
- cerebral edema
- croup
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Corticosteroid-responsive disorders | Adults | 0.75–9 mg/day | lowest effective maintenance dose | varies by disease |
| Corticosteroid-responsive disorders | Pediatric | 0.02–0.3 mg/kg/day divided TID–QID | individualized | |
| Acute exacerbation of multiple sclerosis | Adults | 30 mg/day x 1 week | then 4–12 mg every other day x 1 month |
Renal Undefined
Hepatic Undefined
Instructions
- For oral administration; individualize dose to disease and response
- After favorable response, decrease in small decrements to lowest effective maintenance dose
- If stopping after long-term therapy, withdraw gradually rather than abruptly
- May need to increase dose transiently during stress/illness
Available strengths
- tab 0.25, 0.5, 0.75, 1, 1.5, 2, 4, 6, 20 mg
- drops 0.1 %
- inj 4, 10 mg
- sol 0.5 mg/5 mL
- sol 1 mg/mL
- susp 0.1 %
- insert 0.4 mg
- ointment 0.075 g/100 g
- + 1 other marketed form not shown
Contraindications
- Systemic fungal infections
Cautions
- Immunosuppression/decreased resistance to infection
- Adrenal suppression; taper to withdraw
- Fluid retention, hypertension, hypokalemia
- Hyperglycemia/latent diabetes
- Peptic ulcer, GI perforation/bleeding
- Osteoporosis, growth suppression in children
- Neuropsychiatric effects (mood changes, psychosis)
Adverse reactions
- Fluid retention/edema
- Hyperglycemia
- Increased appetite/weight gain, cushingoid state
- Osteoporosis, muscle weakness
- Mood/behavioral changes, insomnia
- Impaired wound healing, thin fragile skin
Pregnancy Undefined
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 0.25 mg | tab | per unit | not offered | |
| 0.5 mg | tab | per unit | $0.07/ea | offered |
| 0.75 mg | tab | per unit | $0.09/ea | offered |
| 1 mg | tab | per unit | $0.16/ea | offered |
| 1.5 mg | tab | per unit | $0.17/ea | offered |
| 2 mg | tab | per unit | $0.25/ea | offered |
| 4 mg | tab | per unit | $0.19/ea | offered |
| 6 mg | tab | per unit | $0.38/ea | offered |
| 20 mg | tab | per unit | not offered | |
| 0.1 % | drops | per unit | not offered | |
| 4 mg | inj | per unit | $0.67/mL | not offered |
| 10 mg | inj | per unit | $1.16/mL | not offered |
Available combined with: ciprofloxacin / dexamethasone
Generic entry1982
NO BOXED WARNINGS
Principal riskAdrenal suppression; the longest-acting corticosteroid
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHyperglycemia, infection, osteoporosis and potentially severe mood, sleep or psychotic effects.
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