DEXAMETHASON

Dosage:
The anti-inflammatory activity of 750 micrograms of dexamethasone is equivalent to about 5mg prednisolone.
Children: 0.02 – 0.3mg dexamethasone/kg/day, or 0.6 – 10mg/m2/day divided into 3 – 4 doses.
(If this product is not appropriate for use in children according to their weight, other dosage forms may be replaced, such as elixir or syrup).
Adults dosage froms: 0.75 – 9mg dexamethasone/day, depending on the disease and usually divided into 2 – 4 doses. Doses lower than 0.75mg/day, may suffice in less severe disease, and doses over 9mg/day may be required in more severe cases.
Cerebral oedema: In cerebral edema, dexamethasone injection is combined with oral admimistration.
Dexamethasone sodium phosphate intravenous injection is administered initially in a dosage of 10mg followed by 4mg intramuscularly every 6 hours until the symptoms of cerebral edema subside. Response is usually apparent within 12 – 24 hours and the dosage may be reduced after 2 – 4 days and gradually discontinued over a period of five to seven days. If possible, oral dexamethasone (1 – 3mg once, three times a day) can be used instead of muscular injection.
Allergic disorders: In acute, self-limited allergic disorders or acute exacerbations of chronic allergic disorders, the combination of parenteral and oral therapy is suggested.
On the first day, Dexamethasone sodium phosphate injection was given at the dose of 4 – 8mg intramuscularly. Oral therapy is followed. On second and third day, oral administration of 3mg in 2 divided doses each day; fourth day, 1.5mg in two divided doses; fifth and sixth days, a single dose of 0.75mg each day; then stopping the treatment, and follow-up visit.
Prophylaxis and management of chemotherapy-induced nausea and vomiting:
Prophylaxis: 10 – 20mg orally, 15 – 30 minutes before chemotherapy on each treatment day.
For continuous infusion of chemotherapy: 10mg orally every 12 hours on each treatment day.
For mildly emetogenic therapy: 4mg orally, every 4 to 6 hours.
Delayed nausea and vomiting: 4 – 10mg mg once orally, 1 – 2 times daily for 2 – 4 days or 8mg every 12 hours for 2 days; then 4mg every 12 hours for 2 days or 20mg orally 1 hour before chemotherapy; then 10mg orally 12 hours after chemotherapy; then 8mg orally every 12 hours for 4 doses; then 4mg orally every 12 hours for 4 doses.
Croup: Mild croup is largely self-limiting; however, the disease can be healed with 0.15mg/kg dexamethasone in a single dose. In severe cases (or mild disease with development of complications) patients should be hospitalized. Dose of 0.15mg/kg administered at the hospital usually diminishes symptoms; if necessary, repeat the dose after 12 hours.
Extubation or airway edema: 0.5 – 2mg/kg/day, give in divided doses every 6 hours, 24 hours prior to extubation and then continue using 4 – 6 doses.
Diagnosis for Cushing's syndrome: 0.5mg dexamethasone is given every 6 hours for 48 hours (Twenty-four hour urine collections are made for determination of 17-hydroxycorticosteroid excretion).
Test to distinguish Cushing's syndrome due to pituitary ACTH excess from Cushing's syndrome due to other causes: 2.0mg of dexamethasone is orally given every 6 hours for 48 hours (Twenty-four hour urine collections are made for determination of 17-hydroxycorticosteroid excretion).
General principles: Dosage requirements are variable and must be individualized on the basis of the disease under treatment (degree, extent and site of inflammation) and the response of the patient. In order to minimise side effects, the lowest possible dosage adequate to control the disease process should be used.
Dexamethasone has long duration of effect (36 to 54 hours), therefore, it is not recommended for alternate-day therapy because the time to recover adrenal activity between doses is not adequate.
Secondary adrenocortical insufficiency may result from too rapid withdrawal of corticosteroids and may be minimised by gradual dosage reduction, being tapered off over weeks and months, depending on the dose and duration of treatment, but may persist for months after discontinuation of therapy.
Drinks containing alcohol or caffeine should be avoided; dose reduction or abrupt discontinuation of dexamethasone without physician’s instruction must be avoided; avoid exposure to measles, chicken pox, if exposed, immediately notify the physician; notify physician if acute illness including fever or other signs of infection occurs. Tell doctor that you are being treated with dexamethasone involving wound treatment or before you receive certain surgery.