Dexamethasone

General
  • Type: Corticosteroid
  • Dosage Forms: PO; IM; IV, ophthalmic
  • Common Trade Names: Decadron

Adult Dosing

Anaphylaxis
  • 10mg IV or PO

COVID
  • 6mg Qday
    • Dexamethasone improves 28d mortality compared to placebo in patients requiring IMV (NNT = 8.5) and those patients requiring oxygen therapy (NNT = 29).
    • There was no benefit to patients not requiring oxygenation support and potentially harm

Pediatric Dosing

Anaphylaxis
  • 0.6mg/kg

Asthma Exacerbation
  • 0.6mg/kg once PO

Post-operative Airway Edema
  • 0.5 mg/kg PO q6hrs x1-2 days

Special Populations
  • Pregnancy Rating: C
  • Lactation: Single doses are considered compatible however corticosteroids are present in breast milk and further discussion should be had with mother due to potential serious adverse reactions in breastfed infant.
  • Renal Dosing
    • Adult
      • Not defined
    • Pediatric
      • Not defined
  • Hepatic Dosing
    • Adult
      • Not defined
    • Pediatric
      • Not defined

Contraindications
  • Allergy to class/drug

Adverse Reactions

Serious
  • There is some evidence to suggest small increases in the risk of sepsis, venous thromboembolism, and fractures in short courses of steroid use [1]

Pharmacology
  • Half-life:
    • Adults: Oral 4 ± 0.9 hours, IV 1 - 5 hours
  • Metabolism: Hepatic
  • Excretion: Urine ~10%
  • Mechanism of Action: surpasses neutrophil migration, decreases production of inflammatory mediators, reverses increased capillary permeability, suppresses normal immune response

See Also

References
  1. Waljee, A. K., Rogers, M. A. M., Lin, P., Singal, A. G., Stein, J. D., Marks, R. M., … Nallamothu, B. K. (2017). Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. Bmj. doi: 10.1136/bmj.j1415


Dexamethasone (systemic): Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.

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