Indications & Dose:
Suppression of inflammatory and allergic disorders
Adult: 0.5–10 mg daily
Mild croup
Child: 150 micrograms/kg for 1 dose
Severe croup (or mild croup that might cause complications)
Child: Initially 150 micrograms/kg for 1 dose, to be given before transfer to hospital, then (by mouth or byintravenous injection) 150 micrograms/kg, then (bymouth or by intravenous injection) 150 micrograms/kgafter 12 hours if required
Congenital adrenal hyperplasia (under expert supervision)
Adult: Consult specialist for advice on dosing
Corticosteroid responsive conditions
Adult: Consult specialist for advice on dosing
Overnight dexamethasone suppression test
Adult: 1 mg for 1 dose, to be given at night
Adjunctive treatment of bacterial meningitis (starting before or with first dose of antibacterial)
Adult: 8.3 mg every 6 hours for 4 days
Symptom control of anorexia (in palliative care)
Adult: 2–4 mg daily
Obstruction due to tumour (dysphagia in palliative care)
Adult: 8 mg daily
Bronchospasm or partial obstruction (dyspnoea in palliative care)
Adult: 4–8 mg daily
Nausea and vomiting (adjunct in palliative care)
Adult: 8–16 mg daily
Headaches due to raised intracranial pressure (in palliative care)
Adult: 16 mg daily for 4–5 days, then reduced to 4–6 mg daily, reduce dose if possible. To be given before 6pm to reduce the risk of insomnia
Pain due to nerve compression (in palliative care)
Adult: 8 mg daily
Cerebral oedema associated with malignancy
Adult: 0.5–10 mg daily
Cerebral oedema
Adult: Initially 8–16 mg for 1 dose, then (by intramuscular injection or by intravenous injection) 5 mg every 6 hours until adequate response achieved then taper-off gradually, use the 3.8 mg/ mL injection preparation for this dose
Cerebral oedema associated with malignancy
Adult: Initially 8.3 mg for 1 dose, then (by intramuscular injection) 3.3 mg every 6 hours as required for 2–4 days, subsequently, reduce dose gradually and stop over 5–7 days, use the 3.3 mg/ mL injection preparation for this dose
• Shock:
IV 1-6 mg/kg or 40 mg q26h (phosphate)
• Prophylaxis during premature labor (to prevent infant respiratory distress due to immature lungs):
6 mg q 12h x 4 doses
• Intralesional:
0.8-1.6 mg (acetate)
• Intra-articular and soft tissue:
4-16 mg q l-3 wk (acetate); large joints 2-4 mg (phosphate); small joints 0.8-1 mg (phosphate); bursae 23 mg (phosphate); tendon sheaths 0.41 mg (phosphate); soft tissue infiltration 2-6 mg (phosphate); ganglia 1-2 mg (phosphate)
Contraindications:
Systemic fungal infections; (ophth): acute superficialherpes simplex keratitis and other viral diseases of the cornea and conjunctiva; fungal diseases of ocular structures; ocular TB; following uncomplicated removal of a superficial corneal foreign body. Pregnancy.
Side Effects:
CNS: Depression, headache, moodchanges, seizures,vertigo
CV: CHF,hypertension, tachycardia,thromboernbolism, thrombophlebitis
EENT: Blurred vision, cataracts, dryness, epistaxis, increased intraocular pressure, localized infections of nose and pharynx with C. albicans, nasal irritation, nasal septum perforation, rebound congestion, sneezing, sore throat, stinging (nasal); cataracts, decreased acuity, glaucoma exacerbation, increased intraocular pressure, increased probability of corneal infection, optic nerve damage, poor corneal wound healing, stinging, transient burning (ophth)
GI: Abdominal distention, diarrhea, GI hemorrhage,increased appetite, nausea, pancreatitis
GU: Hypercalciuria
METAB: Cushingoid state, decreased glucose tolerance, decreased t4, growth suppression in children, HPA suppression, hyperglycemia
MS: Aseptic necrosis of femoral and humeraI heads, fractures, myopathy, osteoporosis, weakness
SKIN: Acne, bruising, ecchymosis, petechiae, poor wound healing, striae, suppression of skin test reactions, thin fragile skin
Cautions:
Precautions:
Psychosis, cerebral malaria, elderly, AIDS, latent tuberculosis or amebiasis (reactivation of disease), diabetes mellitus, glaucoma, osteoporosis, ulcerative colitis (intestinal perforation), CHF, myasthenia gravis, renal disease, esophagitis, peptic ulcer, hypertension; (ophth): infections of the eye, glaucoma.
Breast-feeding: Use with caution
Old age: Use with caution.
Interaction:
Drugs
Aminoglutethamide: Enhanced elimination of corticosteroids; marked reduction in corticosteroid response; increased clearance of dexamethasone; doubling of dose may be necessary
Antidiabetics: Increased blood glucose
Barbiturates, carbamazepine:Reduced serum concentrations of corticosteroids; increased clearance of dexamethasone
Cholestyramine, colestipol: Possible reduced absorption of corticosteroids
Cyclosporirne: Possible increased concentration of both drugs, seizures
Erythromycin, troleandomycin, clarithromycin, ketoconazole: Possible enhanced steroid effect
Estrogens, oral contraceptives:Enhanced effects of corticosteroids Isoniazid: Reduced plasma concentrations of isoniazid
IUDs: Inhibition of inflammation may decrease contraceptive effect
NSAIDs: Increased risk GI ulceration
Rifampin: Reduced therapeutic effect of corticosteroids; may reduce hepatic clearance of prednisone
Salicylates: Subtherapeutic salicylate concentrations possible
Warnings:
Adverse Effects:
Lactations:
Special Precautions:
Counselling:
Side Effects Or Adverse Reactions:
Patient And Carer Advice:
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