Dexamethasone
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
- 5mg IV[1]
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
- Adult
- Hepatic Dosing
- Adult
- Not defined
- Pediatric
- Not defined
- Adult
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
- ↑ 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
- ↑ 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
- ↑ 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