Adult Dosing

Corticosteroid-responsive conditions

• 0.5-9 mg/day IM/IV div q6-12 hrs
• Note: Frequency varies by condition; taper dose gradually after long-term use

Adrenal insufficiency

• 0.03-0.15 mg/kg/day IM/IV divided q6-12 hrs

Cerebral edema, acute

• Start: 10 mg IV x 1; then 4 mg IM/IV q6 hrs until symptoms subside
• Gradually taper dose over 5-7 days; switch to PO when possible

Shock, unresponsive

• Start: 40 mg IV x 1; repeat q2-6 hrs PRN
• Alt: 20 mg IV x 1, then 3 mg/kg/day IV or 1-6 mg/kg IV q2-6 hrs PRN

Airway edema or extubation

• 0.5–2 mg/kg/day IM/IV divided q6 hrs
• Start 24 hrs prior to extubation and continue for 24 hr post-extubation

Acute allergic disorders

• Start 4-8 mg IM on first day; switch to oral therapy on second day (refer monograph for oral dexamethasone)
• 1.5 mg PO bid on days 2 & 3
• 0.75 mg PO bid on day 4
• 0.75 PO qd on days 5 & 6

Nausea/Vomiting; cancer chemotherapy induced (Not FDA approved)

• 8-10 mg IV x 1; followed by 4 mg IM/IV q6 hrs

Pediatric Dosing

Corticosteroid-responsive conditions

• 0.08-0.3 mg/kg/day IM/IV div q6-12 hrs
• Note: Frequency varies by condition; taper dose gradually after long-term use

Adrenal insufficiency

• 0.03 -0.3 mg/kg/day IM/IV divided q6-12 hrs
• Start 24 hrs prior to extubation and continue for 24 hr post-extubation

Cerebral edema, acute

• Start 1-2 mg/kg IV followed by 1–1.5 mg/kg/day divided q4–6 hrs for 5 days. [Max: 16 mg/day]
• Taper over 1-6 wks; switch to PO when possible

Airway edema or extubation (Non FDA Approved)

• 0.5–2 mg/kg/day IM/IV divided q6 hrs

Nausea/Vomiting; cancer chemotherapy induced (Not FDA approved)

• Start 10 mg/m² IV x 1; followed by 5 mg/m² IV q6 hrs. [Max: 20 mg/dose]

Croup [Non-FDA Approved]

• 0.15-0.6 mg/kg IM/IV once. No advantage to higher dose than 0.15 mg/kg, and no advantage to injectable over oral administration. In severe croup, many providers will proceed with higher dose of 0.6 mg/kg [Max=12 mg] IV

[Outline]

• Adult Dosing
• Pediatric Dosing

• Chronic diseases including inflammatory, allergic, hematologic, endocrine, neoplastic, dermatologic and autoimmune disorders
• Cerebral edema
• Diagnostic agent in adrenal disorders

• Hypersensitivity to the product and its constituents
• Systemic fungal infections

• N/A

Renal Dose Adjustment

• Renal impairment: No dose adjustments

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustment not defined

• IM\IV therapy should be reserved for patients who are not able to take the drugs orally or for use in an emergency situation
• Anaphylactoid and hypersensitivity reactions have been reported for dexamethasone sodium phosphate injection, use with caution in susceptible people
• Corticosteroids can cause elevation of blood pressure, sodium and water retention, and increased excretion of potassium. Dietary salt restriction and potassium supplementation may be needed
• Corticosteroids may mask signs of infection. May decrease host-defense mechanisms to prevent dissemination of infection
• Reversible hypothalamic-pituitary adrenal (HPA) axis suppression may occur
• Drug-induced secondary adrenocortical insufficiency may result from rapid withdrawal; taper gradually to discontinue
• Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids
• Use with caution in active or latent peptic ulcers, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis, due to increased risk of perforation
• Monitor weight, blood pressure, and electrolytes frequently
• Monitor chest X ray, BMD if prolonged treatment; ophthalmological exams if treatment > 6 wks
• Consider upper GI X-ray if history of peptic ulcer disease or significant dyspepsia

Cautions: Use cautiously in

• Hepatic impairment
• Seizure disorder
• Diabetes Mellitus
• Fluid and electrolyte imbalance
• Cardiovascular disease
• Hypertension
• Tuberculosis

Pregnancy Category:C

Breastfeeding: Safety Unknown. Alternate drug might be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 26 October 2009).

• METABOLIC: Sodium retention, fluid retention, hypokalemia, alkalosis
• CV: Hypertension, edema, CHF
• EENT: cataracts, increased intraocular pressure
• GI: Peptic ulceration, anorexia, nausea, increased appetite, vomiting, pancreatitis
• DERM: Fragile skin, acne, petechiae, erythema, decreased wound healing, ecchymoses
• CNS: Convulsions, depression, increased ICP, euphoria, headache, vertigo, hallucinations, insomnia, personality changes, psychoses, restlessness
• ENDO: Adrenal suppression, hyperglycemia, growth suppression in children, development of cushingoid state, weight gain, hirsuitism, amenorrhea
• HEMA: Thromboembolism, thrombophlebitis
• MUSC: Muscle wasting, muscle weakness, steroid myopathy, osteoporosis, aseptic necrosis of joints, pathologic fractures of long bones, tendon rupture
• MISC: Allergic reactions, cushingoid appearance (moon face, buffalo hump), malaise, increased susceptibility to infection

• Glucocorticoid; Precise mechanism of anti-inflammatory action unknown; suppresses inflammation and the normal immune response; has glucocorticoid and mineralocorticoid effects
• 4 mg Dexamethasone equivalent to approx. 100 mg hydrocortisone
• Primarily metabolized by the liver
• Renally excreted
• Half-life: 3- 4.5 hrs (plasma), 36-54 hrs (tissue)

US Trade Name(s)

• Only generic available

US Availability

dexamethasone sodium phosphate (generic)

• INJ: 4 mg/mL (1, 5, 30 mL vials)
• INJ: 10 mg/mL (1 mL vials)

Canadian Trade Name(s)

• Only generic available

Canadian Availability

dexamethasone sodium phosphate (generic)

• INJ: 4 mg/mL
• INJ: 10 mg/mL

UK Trade Name(s)

• Only generic available

UK Availability

dexamethasone sodium phosphate (generic)

• INJ: 4 mg/mL (1 mL amps)
• INJ: 8 mg/2 mL (2 mL vials)
• INJ: 24 mg/mL (5 mL vials)

Australian Trade Name(s)

• Only generic available

Australian Availability

dexamethasone (generic)

• INJ: 4 mg/mL
• INJ: 8 mg/2 mL

[Outline]

Endocrine/Metabolic

Steroids; Adrenal Cortical

Corticosteroids

Allergy & Immunology

Steroids; Adrenal Cortical

Corticosteroids

Pricing data from www.DrugStore.com in U.S.A.

• Dexamethasone Sodium Phosphate 4 MG/ML SOLN [Box] (APP PHARMACEUTICAL)
  25 ml = $37.99
  75 ml = $95.97

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.