Dexamethasone

Know the basics

What is dexamethasone used for?

Dexamethasone is used to treat conditions such as arthritis, blood/hormone/immune system disorders, allergic reactions, certain skin and eye conditions, breathing problems, certain bowel disorders, and certain cancers. It is also used as a test for an adrenal gland disorder (Cushing’s syndrome).

Dexamethasone is a corticosteroid hormone (glucocorticoid). It decreases your body’s natural defensive response and reduces symptoms such as swelling and allergic-type reactions.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

Dexamethasone may also be used to prevent nausea and vomiting caused by cancer chemotherapy.

How should I take dexamethasone?

Take dexamethasone by mouth as directed by your doctor. Take with food or milk to prevent stomach upset. Take dexamethasone by mouth with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise. If you are using the liquid form of the medication, use a medication-measuring device to carefully measure the prescribed dose. Do not use a household spoon.

If you take dexamethasone once daily, take it in the morning before 9 AM. If you are taking this medication every other day or on another schedule besides a daily one, it may help to mark your calendar with a reminder.

The dosage and length of treatment are based on your medical condition and response to therapy. Your doctor may attempt to reduce your dose slowly from time to time to minimize side effects.

Use dexamethasone regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. It is important to continue taking dexamethasone even if you feel well. Follow the dosing schedule carefully, and take dexamethasone exactly as prescribed.

Do not stop taking dexamethasone without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.

Inform your doctor if your condition does not improve or worsens.

How do I store dexamethasone?

Dexamethasone is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store dexamethasone in the bathroom or the freezer. There may be different brands of dexamethasone that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush dexamethasone down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Know the precautions & warnings

What should I know before using dexamethasone?

Before taking dexamethasone,

• Tell your doctor and pharmacist if you are allergic to dexamethasone, aspirin, tartrazine (a yellow dye in some processed foods and drugs), or any other drugs.
• Tell your doctor and pharmacist what prescription and nonprescription medications you are taking especially anticoagulants (‘blood thinners’) such as warfarin (coumadin), arthritis medications, aspirin, cyclosporine (neoral, sandimmune), digoxin (lanoxin), diuretics (‘water pills’), ephedrine, estrogen (premarin), ketoconazole (nizoral), oral contraceptives, phenobarbital, phenytoin (dilantin), rifampin (rifadin), theophylline (theo-dur), and vitamins.
• If you have a fungal infection (other than on your skin), do not take dexamethasone without talking to your doctor.
• Tell your doctor if you have or have ever had liver, kidney, intestinal, or heart disease; diabetes; an underactive thyroid gland; high blood pressure; mental illness; myasthenia gravis; osteoporosis; herpes eye infection; seizures; tuberculosis (tb); or ulcers.
• Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking dexamethasone, call your doctor.
• If you are having surgery, including dental surgery, tell the doctor or dentist that you are taking dexamethasone.
• If you have a history of ulcers or take large doses of aspirin or other arthritis medication, limit your consumption of alcoholic beverages while taking this drug. Dexamethasone makes your stomach and intestines more susceptible to the irritating effects of alcohol, aspirin, and certain arthritis medications: this effect increases your risk of ulcers.

Is it safe to take dexamethasone during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this medication during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking this medication. This medication is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

• A=No risk,
• B=No risk in some studies,
• C=There may be some risk,
• D=Positive evidence of risk,
• X=Contraindicated,
• N=Unknown

Know the side effects

What are the side effects of dexamethasone?

Some side effects may include but are not limited to: vision changes, swelling, and rapid weight gain.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

• Problems with your vision;
• Swelling, rapid weight gain, feeling short of breath;
• Severe depression, unusual thoughts or behavior, seizure (convulsions);
• Bloody or tarry stools, coughing up blood;
• Pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate);
• Low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling);
• Dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Less serious side effects may include:

• Sleep problems (insomnia), mood changes;
• Acne, dry skin, thinning skin, bruising or discoloration;
• Slow wound healing;
• Increased sweating;
• Headache, dizziness, spinning sensation;
• Nausea, stomach pain, bloating;
• Muscle weakness;
• Changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Know the interactions

What drugs may interact with dexamethasone?

Dexamethasone may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Artemether, Daclatasvir, Praziquantel, Rilpivirine, Rotavirus Vaccine, Live.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Aldesleukin, Aripiprazole, Axitinib, Boceprevir, Bosutinib, Bupropion, Carbamazepine, Ceritinib, Clarithromycin, Clozapine, Cobicistat, Crizotinib, Dabrafenib, Darunavir, Dasatinib, Doxorubicin, Doxorubicin Hydrochloride , Liposome, Efavirenz, Eliglustat, Elvitegravir, Enzalutamide, Eslicarbazepine Acetate, Etravirine, Fosamprenavir, Hydrocodone, Idelalisib, Imatinib, Itraconazole, Ivabradine, Ixabepilone, Lapatinib, Mitotane, Nevirapine, Nifedipine, Nilotinib, Nimodipine, Piperaquine, Pixantrone, Primidone, Ritonavir, Rivaroxaban, Romidepsin, Siltuximab, Sunitinib, Telaprevir, Temsirolimus, Thalidomide, Ticagrelor, Topotecan, Vincristine Sulfate, Vincristine Sulfate Liposome, Vortioxetine.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Alatrofloxacin, Alcuronium, Aminoglutethimide, Aprepitant, Aspirin, Atracurium, Balofloxacin, Caspofungin, Cinoxacin, Ciprofloxacin, Clinafloxacin, Enoxacin, Fleroxacin, Fluindione, Flumequine, Fosaprepitant, Fosphenytoin, Gallamine, Gemifloxacin, Grepafloxacin, Hexafluorenium, Levofloxacin, Licorice, Lomefloxacin, Metocurine, Moxifloxacin, Netupitant, Norfloxacin, Ofloxacin, Ospemifene, Pancuronium, Pefloxacin, Phenobarbital, Phenytoin, Prulifloxacin, Rifampin, Rifapentine, Rosoxacin, Rufloxacin, Saiboku-To, Sparfloxacin, Temafloxacin, Tosufloxacin, Trovafloxacin Mesylate, Vecuronium, Warfarin.

Does food or alcohol interact with dexamethasone?

Dexamethasone may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with dexamethasone?

Dexamethasone may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have, especially:

• Cataracts;
• Congestive heart failure;
• Cushing’s syndrome (adrenal gland problem);
• Diabetes;
• Eye infection;
• Fluid retention;
• Glaucoma;
• Hyperglycemia (high blood sugar);
• Hypertension (high blood pressure);
• Infection (eg, bacterial, virus, fungus);
• Mood changes, including depression;
• Myasthenia gravis (severe muscle weakness);
• Osteoporosis (weak bones);
• Peptic ulcer, active or history of;
• Personality changes;
• Stomach or intestinal problems (eg, diverticulitis, ulcerative colitis);
• Tuberculosis, inactive—Use with caution. May make these conditions worse.
• Fungal infections;
• Herpes simplex eye infection—Should not be used in patients with these conditions.

Understand the Dosage

The information provided is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist before using this medication.

What is the dose of Dexamethasone for an adult?

Usual Adult Dose for Acute Mountain Sickness

Oral, intravenous or intramuscular (injections as sodium phosphate):

0.75 to 9 mg per day in divided doses every 6 to 12 hours

intramuscular (as acetate):

8 to 16 mg, may repeat in 1 to 3 weeks

Intralesional (as acetate):

0.8 to 1.6 mg

Intraarticular and soft tissue as acetate):

4 to 16 mg, may repeat in 1 to 3 weeks

Intraarticular, intralesional, or soft tissue (as sodium phosphate):

0.4 to 6 mg per day

Usual Adult Dose for Asthma – Acute

Oral, intravenous or intramuscular (injections as sodium phosphate):

0.75 to 9 mg per day in divided doses every 6 to 12 hours

intramuscular (as acetate):

8 to 16 mg, may repeat in 1 to 3 weeks

Intralesional (as acetate):

0.8 to 1.6 mg

Intraarticular and soft tissue as acetate):

4 to 16 mg, may repeat in 1 to 3 weeks

Intraarticular, intralesional, or soft tissue (as sodium phosphate):

0.4 to 6 mg per day

Usual Adult Dose for Croup

Oral, intravenous or intramuscular (injections as sodium phosphate):

0.75 to 9 mg per day in divided doses every 6 to 12 hours

intramuscular (as acetate):

8 to 16 mg, may repeat in 1 to 3 weeks

Intralesional (as acetate):

0.8 to 1.6 mg

Intraarticular and soft tissue as acetate):

4 to 16 mg, may repeat in 1 to 3 weeks

Intraarticular, intralesional, or soft tissue (as sodium phosphate):

0.4 to 6 mg per day

Usual Adult Dose for Anti-inflammatory

Oral, intravenous or intramuscular (injections as sodium phosphate):

0.75 to 9 mg per day in divided doses every 6 to 12 hours

intramuscular (as acetate):

8 to 16 mg, may repeat in 1 to 3 weeks

Intralesional (as acetate):

0.8 to 1.6 mg

Intraarticular and soft tissue as acetate):

4 to 16 mg, may repeat in 1 to 3 weeks

Intraarticular, intralesional, or soft tissue (as sodium phosphate):

0.4 to 6 mg per day

Usual Adult Dose for Cerebral Edema

Initial 10 mg intravenous once, followed by 4 mg intramuscular every 6 hours until symptoms of cerebral edema subside. Dosage may be reduced after 2 to 4 days, and discontinued slowly over a period of 5 to 7 days.

Usual Adult Dose for Cushing’s Syndrome

Suppression test or diagnosis for Cushing’s syndrome:

1 mg orally at 11 p.m. Blood plasma cortisol measurement at 8 a.m. the next morning.

or

0.5 mg by mouth every 6 hours for 48 hours (with 24 hour urine collection for 17 hydroxycorticosteroid excretion).

Differentiation of Cushing’s syndrome due to ACTH excess from Cushing’s due to other causes: Oral: Dexamethasone 2 mg every 6 hours for 48 hours (with 24 hour urine collection for 17 hydroxycorticosteroid excretion).

Usual Adult Dose for Nausea/Vomiting – Chemotherapy Induced

Prophylaxis:

10 mg to 20 mg orally or intravenous, 15 to 30 minutes before treatment on each treatment day

For continuous infusion of chemotherapy:

10 mg orally or intravenous every 12 hours on each treatment day.

For mildly emetogenic therapy: 4 mg oral, intravenous or intramuscular every 4 to 6 hours.

Delayed nausea and vomiting:

8 mg orally every 12 hours for 2 days; then 4 mg every 12 hours for 2 days.

or

20 mg orally 1 hour before chemotherapy; then 10 mg orally 12 hours after chemotherapy; then 8 mg orally every 12 hours for 4 doses; then 4 mg orally every 12 hours for 4 doses.

Usual Adult Dose for Shock

Addisonian crisis/shock:

4 to 10 mg intravenous as single dose, repeat if necessary.

Unresponsive shock:

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

Usual Adult Dose for Multiple Myeloma

Multiple myeloma: Oral, intravenous: 40 mg/day, days 1 to 4, 9 to 12, and 17 to 20, repeated every 4 weeks (alone or as part of a regimen).

Usual Adult Dose for Multiple Sclerosis

Multiple sclerosis (acute exacerbation): Oral: 30 mg/day for 1 week, followed by 4 to 12 mg/day for 1 month.

Usual Adult Dose for Adrenal Insufficiency

Physiological replacement: Oral, intravenous or intramuscular (should be given as sodium phosphate): 0.03 to 0.15 mg/kg/day or 0.6 to 0.75 mg/m2/day in divided doses every 6 to 12 hours.

What is the dose of Dexamethasone for a child?

Usual Pediatric Dose for Cerebral Edema

Initial loading dose: 1 to 2 mg/kg once orally, intravenous or intramuscular.

Maintenance: 1 to 1.5 mg /kg/day, give in divided doses every 4 to 6 hours for 5 days then taper for 5 days, then discontinue. Maximum dose: 16 mg/day.

Usual Pediatric Dose for Meningitis – Meningococcal

(Not approved by FDA):

Meningitis (H. influenzae type b): Infants and Children 6 weeks or older: intravenous 0.15 mg/kg/dose every 6 hours for the first 2 to 4 days of antibiotic treatment; start dexamethasone 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 outcome and is not recommended. Note: For pneumococcal meningitis, data has not shown clear benefit from dexamethasone administration; risk and benefits should be considered prior to use.

Usual Pediatric Dose for Meningitis – Haemophilus influenzae

(Not approved by FDA):

Meningitis (H. influenzae type b): Infants and Children 6 weeks or older: intravenous 0.15 mg/kg/dose every 6 hours for the first 2 to 4 days of antibiotic treatment; start dexamethasone 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 outcome and is not recommended. Note: For pneumococcal meningitis, data has not shown clear benefit from dexamethasone administration; risk and benefits should be considered prior to use.

Usual Pediatric Dose for Meningitis – Pneumococcal

(Not approved by FDA):

Meningitis (H. influenzae type b): Infants and Children 6 weeks or older: intravenous  0.15 mg/kg/dose every 6 hours for the first 2 to 4 days of antibiotic treatment; start dexamethasone 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 outcome and is not recommended. Note: For pneumococcal meningitis, data has not shown clear benefit from dexamethasone administration; risk and benefits should be considered prior to use.

Usual Pediatric Dose for Meningitis – Listeriosis

(Not approved by FDA):

Meningitis (H. influenzae type b): Infants and Children 6 weeks or older: intravenous 0.15 mg/kg/dose every 6 hours for the first 2 to 4 days of antibiotic treatment; start dexamethasone 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 outcome and is not recommended. Note: For pneumococcal meningitis, data has not shown clear benefit from dexamethasone administration; risk and benefits should be considered prior to use.

Usual Pediatric Dose for Anti-inflammatory

0.08 to 0.3 mg/kg/day or 2.5 to 5 mg/m2/day in divided doses every 6 to 12 hours.

Usual Pediatric Dose for Nausea/Vomiting – Chemotherapy Induced

(Not approved by FDA):

Prior to chemotherapy:

10 mg/meter squared intravenous or intramuscular for first dose (maximum 20 mg) then 5 mg/meter squared/dose every 6 hours as needed.

Usual Pediatric Dose for Asthma – Acute

Asthma exacerbation: Oral, intravenous: 0.6 mg/kg once (maximum dose: 16 mg)

Usual Pediatric Dose for Croup

(Not approved by FDA):

Croup (laryngotracheobronchitis): Oral, intravenous or intramuscular : 0.6 mg/kg once (maximum: 20 mg). A single dose of 0.15 mg/kg has also been shown effective.

Usual Pediatric Dose for Adrenal Insufficiency

Physiological replacement: Oral, intravenous or intramuscular (should be given as sodium phosphate): 0.03 to 0.15 mg/kg/day or 0.6 to 0.75 mg/m2/day in divided doses every 6 to 12 hours.

Usual Pediatric Dose for Acute Mountain Sickness

(Not approved by FDA):

Acute mountain sickness (AMS)/high altitude cerebral edema (HACE); treatment: Oral, intravenous or intramuscular : 0.15 mg/kg/dose every 6 hours; consider using for high altitude pulmonary edema because of associated HACE with this condition.

Usual Pediatric Dose for Bronchopulmonary Dysplasia

(Not approved by FDA):

Bronchopulmonary dysplasia, facilitation of ventilator wean: postnatal age =7 days: Oral, intravenous: Initial: 0.15 mg/kg/day given in divided doses every 12 hours for 3 days, then tapered every 3 days over 7 days; total dexamethasone dose: 0.89 mg/kg given over 10 days; others have used 0.2 mg/kg/day given once daily and tapered every 3 days over 7 days (total dexamethasone dose: 1 mg/kg) ( or tapered over 14 days (total dexamethasone dose: 1.9 mg/kg). Note: High doses (0.5 mg/kg/day) do not confer additional benefit over lower doses, are associated with higher incidence of adverse effects (including adverse neurodevelopmental outcomes), and are not recommended for use. However, a meta-analysis reported total cumulative doses greater than 4 mg/kg reduced the relative risk for the combined outcome, mortality, or bronchopulmonary dysplasia; further studies are needed.

How is dexamethasone available?

Dexamethasone is available in the following dosage forms and strengths:

Concentrate, Oral:

Dexamethasone Intensol: 1 mg/mL (30 mL)

Elixir, Oral:

Baycadron: 0.5 mg/5 mL (237 mL)

Generic: 0.5 mg/5 mL (237 mL)

Solution, Oral:

Generic: 0.5 mg/5 mL (240 mL, 500 mL)

Solution, Injection, as sodium phosphate:

Generic: 4 mg/mL ( 1mL, 5 mL, 30 mL); 10 mg/mL (1 mL, 10 mL)

Solution, Injection, as sodium phosphate

Generic: 10 mg/mL (1 mL)

Tablet, Oral:

Dexpak 10 Day: 1.5 mg

DexPak 13 Day: 1.5 mg

DexPak 6 Day: 1.5 mg

Generic: 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of dexamethasone, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.