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Dexamethasone

Classification

Corticosteroid

Indications

⚠️ PCP and ACP: requires BCEHS-specific education

Management of croup in pediatrics over the age of 6 months
Adjunctive treatment for exacerbation of asthma or chronic obstructive pulmonary in patients with a known diagnosis of these conditions
- Diagnosis can be established by
  - Patient identification of condition
  - Availability of an action plan
  - Regular inhaler use
- Adjunctive treatment should be considered when there is a lack of improvement in symptoms despite use of ipratropium and salbutamo

Contraindications

Hypersensitivity to dexamethasone or other corticosteroids
Active systemic fungal infection

Adult dosages

⚠️ PCP and ACP: requires BCEHS-specific education

All indications: 8 mg IV/PO. PO preferred.
- ☎️ CliniCall consultation required prior to administration for care planning.

Pediatric Considerations And Dosing

⚠️ PCP and ACP: requires BCEHS-specific education:

Follow Page for Age weight-based dosing

All indications: 0.6 mg/kg IV/PO, to a maximum of 16 mg. PO preferred. May combine with juice to improve palatability.
- If actual weight obtained, round dose to the nearest 0.5mg
- ☎️ CliniCall consultation required prior to administration for care planning.

Preparation and Administration

Injectable formulation of dexamethasone can be mixed with juice to improve palatability for oral administration. Administer immediately after mixing with juice.

How Supplied

Vial of 20 mg in 5 mL (4 mg/mL)

Mechanism Of Action

Suppresses neutrophil migration, decreasing production of inflammatory mediators, and reversing increased capillary permeability.

Pharmacokinetics

Onset Based on Clinical Effect:
IV: up to 2 hours
Oral: 2-6 hours

Peak:
6-12 hours

Duration of Action:
36-72 hours

Adverse Effects

This list includes the side effects most likely to impact the patient with short term use of systemic corticosteroids and does not consider side effects associated with long term use.

Cardiac: Worsening heart failure and edema (including pulmonary), hypertension
Central Nervous System: Emotional lability, personality or mood changes, insomnia, dizziness, headache
Derm: Injection site reaction
GI: Nausea, stomach upset, increased appetite, reflux
Endo: Increased blood sugars
Hypersensitivity: rare
Infection: immunosuppression with long term use, impaired wound healing

Warning And Precautions

Dexamethasone is not effective for management of adrenal insufficiency as it does not provide any mineralocorticoid activity
Use with caution if decompensated heart failure or significantly uncontrolled hypertension
Pregnancy in the first trimester – weigh the risks and benefits
Corticosteroids have been associated with myocardial rupture when used in acute myocardial infarction

Drug Interactions

If there are concerns related to the adverse effects of steroids with the following drug interactions, the risk of administering steroids likely outweighs the benefit.

NSAIDs: May enhance the risk of gastrointestinal ulceration
Phenytoin: may decrease serum concentrations of phenytoin
Warfarin: increases the INR and bleeding risk