Anti-inflammatory agent, systemic corticosteroid

⚠️ PCP and ACP: requires BCEHS-specific education 

• Adjunctive treatment for croup and bronchospasm secondary to asthma or chronic obstructive pulmonary disease

• Systemic fungal infections
• Hypersensitivity to dexamethasone or other corticosteroids

• Onset: minutes to hours; dependant on indication and route of administration
• Peak: 8 hours (IM); 1-2 hours (PO)
• Duration: short (IV)

• Cardiovascular: Bradycardia, cardiac arrhythmia, cardiac failure, cardiomegaly, circulatory shock, edema, embolism (fat), hypertension, hypertrophic cardiomyopathy (premature infants), myocardial rupture (post-MI), syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis
• Central nervous system: Depression, emotional lability, euphoria, headache, increased intracranial pressure, insomnia, malaise, myasthenia, neuritis, neuropathy, paresthesia, personality changes, pseudotumor cerebri (usually following discontinuation), psychiatric disorder, seizure, vertigo
• Dermatologic: Acne vulgaris, allergic dermatitis, alopecia, atrophic striae, diaphoresis, ecchymoses, erythema, facial erythema, fragile skin, hyperpigmentation, hypertrichosis, hypopigmentation, perianal skin irritation (itching, burning, tingling; following IV injection), petechiae, skin atrophy, skin rash, subcutaneous atrophy, suppression of skin test reaction, urticaria, xeroderma
• Endocrine & metabolic: Adrenal suppression, carbohydrate intolerance, Cushing syndrome, decreased glucose tolerance, decreased serum potassium, diabetes mellitus, fluid retention, glycosuria, growth suppression (children), hirsutism, HPA-axis suppression, hyperglycemia, hypokalemic alkalosis, menstrual disease, moon face, negative nitrogen balance, protein catabolism, redistribution of body fat, sodium retention, weight gain
• Gastrointestinal: Abdominal distention, gastrointestinal hemorrhage, gastrointestinal perforation, hiccups, increased appetite, nausea, pancreatitis, peptic ulcer, pruritus ani (following IV injection), ulcerative esophagitis
• Genitourinary: Defective (increased or decreased) spermatogenesis
• Hematologic & oncologic: Kaposi sarcoma, petechial, tumor lysis syndrome
• Hepatic: Hepatomegaly, increased serum transaminases
• Hypersensitivity: Anaphylactoid reaction, anaphylaxis, angioedema, hypersensitivity
• Infection: Infection, sterile abscess
• Local: Postinjection flare (intra-articular use)
• Neuromuscular & skeletal: Amyotrophy, aseptic necrosis of bones (femoral and humoral heads), bone fractures, Charcot-like arthropathy, myasthenia, myopathy (particularly in conjunction with neuromuscular disease or neuromuscular-blocking agents), osteoporosis, rupture of tendon, steroid myopathy, vertebral compression fracture
• Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure, subcapsular posterior cataract
• Respiratory: Pulmonary edema
• Miscellaneous: Wound healing impairment

Source: Dexamethasone. In: Lexicomp Online, UpToDate, Waltham, MA. (Accessed November 20, 2020.) 

• May cause hypercortisolism, particularly in younger children or when used for long periods of time at higher doses.  
• Dexamethasone should not generally be used for adrenal insufficiency as it does not provide any mineralocorticoid activity.  
• Use with caution in patients with heart failure or hypertension: dexamethasone has been associated with fluid retention and electrolyte disturbance.  
• Corticosteroids have been associated with myocardial rupture when used in acute myocardial infarction. 
• Dexamethasone crosses the placenta.  Some studies have found an association between corticosteroid use in the first trimester with oral clefts and decreased birth weights. 

• Corticosteroids may enhance the adverse or toxic effects of nonsteroidal anti-inflammatory agents and salicylates (including gastrointestinal ulceration and bleeding).  They may also reduce the serum concentration of salicylates. 
• May decrease the serum concentration of phenytoin.
• May enhance the anticoagulant properties of warfarin.