Dexamethasone: Difference between revisions
 
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==General==
==General==
*Type: [[Corticosteroid]]
*Type: [[Corticosteroid]]
*Dosage Forms: PO; IM; IV
*Dosage Forms: PO; IM; IV, ophthalmic
*Common Trade Names:
*Common Trade Names: Decadron


==Adult Dosing==
==Adult Dosing==
===[[Anaphylaxis]]===
===[[Anaphylaxis]]===
*10mg IV or PO  
*10mg IV or PO  
===[[COVID]]===
*6mg Qday for 10 days
**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
===[[Nausea and Vomiting]]===
*5mg IV<ref>Wang, Jhi-Joung MD, DMS*,; Ho, Shung-Tai MD, MS†,; Uen, Yih-Huei MD‡,; Lin, Mao-Tsun PhD*,; Chen, Kuan-Ting MD*,; Huang, Jeng-Chai PhD*,; Tzeng, Jann-Inn MD* Small-Dose Dexamethasone Reduces Nausea and Vomiting After Laparoscopic Cholecystectomy: A Comparison of Tropisetron with Saline, Anesthesia & Analgesia: July 2002 - Volume 95 - Issue 1 - p 229-232 doi: 10.1097/00000539-200207000-00042</ref>
===[[Pharyngitis]]===
*Single 10mg PO dose decreases symptoms at 48 hours, but not 24 hours<ref>Hayward GN, Hay AD, Moore MV, et al. Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults: A Randomized Clinical Trial. JAMA. 2017;317(15):1535-1543. doi:10.1001/jama.2017.3417</ref>


==Pediatric Dosing==
==Pediatric Dosing==
===[[Anaphylaxis]]===
===[[Anaphylaxis]]===
*0.6mg/kg
*0.6 mg/kg
**Maximum dose of 10-18 mg/dose, variable by study
 
===[[Asthma]] Exacerbation===
===[[Asthma]] Exacerbation===
*0.6mg/kg once PO
*0.6 mg/kg once PO
**Maximum dose of 10-18 mg/dose, variable by study


===Post-operative Airway Edema===
===Post-operative Airway Edema===
*0.5 mg/kg PO q6hrs x1-2 days
*0.5 mg/kg PO q6hrs x1-2 days
**Maximum dose of 10-18 mg/dose, variable by study


==Special Populations==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*Lactation:
*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
*Renal Dosing
**Adult
**Adult
*** Not defined
**Pediatric
**Pediatric
*** Not defined
*Hepatic Dosing
*Hepatic Dosing
**Adult
**Adult
*** Not defined
**Pediatric
**Pediatric
*** Not defined


==Contraindications==
==Contraindications==
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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*There is some evidence to suggest small increases in the risk of sepsis, venous thromboembolism, and fractures in short courses of steroid use <ref>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 </ref>


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


==See Also==
==See Also==

Latest revision as of 22:14, 19 May 2023

General

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

Adult Dosing

Anaphylaxis

  • 10mg IV or PO

COVID

  • 6mg Qday for 10 days
    • 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

Nausea and Vomiting

Pharyngitis

  • Single 10mg PO dose decreases symptoms at 48 hours, but not 24 hours[2]

Pediatric Dosing

Anaphylaxis

  • 0.6 mg/kg
    • Maximum dose of 10-18 mg/dose, variable by study

Asthma Exacerbation

  • 0.6 mg/kg once PO
    • Maximum dose of 10-18 mg/dose, variable by study

Post-operative Airway Edema

  • 0.5 mg/kg PO q6hrs x1-2 days
    • Maximum dose of 10-18 mg/dose, variable by study

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 [3]

Common

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. ↑ Wang, Jhi-Joung MD, DMS*,; Ho, Shung-Tai MD, MS†,; Uen, Yih-Huei MD‡,; Lin, Mao-Tsun PhD*,; Chen, Kuan-Ting MD*,; Huang, Jeng-Chai PhD*,; Tzeng, Jann-Inn MD* Small-Dose Dexamethasone Reduces Nausea and Vomiting After Laparoscopic Cholecystectomy: A Comparison of Tropisetron with Saline, Anesthesia & Analgesia: July 2002 - Volume 95 - Issue 1 - p 229-232 doi: 10.1097/00000539-200207000-00042
  2. ↑ Hayward GN, Hay AD, Moore MV, et al. Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults: A Randomized Clinical Trial. JAMA. 2017;317(15):1535-1543. doi:10.1001/jama.2017.3417
  3. ↑ 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
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