Dexamethasone

Details About Generic Salt ::  Dexamethasone 

Main Medicine Class:: #N/A   Sub Medicine Class ::  #N/A

3B. CORTICOSTEROIDS in 3. OCULAR
DEXAMETHASONE
GLUCOCORTICOID | ANTI-INFLAMMATORY
also comes under 8H. Corticosteroids in 8. Endocrine/Steroid Hormones & Metabolic System,  
PK: A: Rapid M: Hepatic E: Urine & feces

Indications & Dose: ALLERGIC DISORDERS IM Adult Initially 4-8mg IM (day 1), then 1.5mg BID PO (day 2 & 3), 0.75mg BID (day 4), 0.75mg OD (day 5 & 6), then discontinue | CEREBRAL EDEMA IV Adult Initially 10mg IV followed by 4mg IM q6h, continue till symptoms subside. Slowly taper the dose after 2-4 days and discontinue over a period of 5-7 days. When possible, oral dexamethasone (1-3mg TID) should replace IM administration of the drug Child <35 kg: Initially 16.7mg, then 3.3mg q3h 3 days, then 3.3mg q6h 1 day, then 1.7mg q6h 4 days, then decrease by 0.8mg/day, >35 kg: Initially 20.8mg, then 3.3mg q2h for 3 days, then 3.3mg q4h 1 day, then 3.3mg q6h 4 days, then decrease by 1.7mg/day | CHEMOTHERAPY INDUCED NAUSEA/VOMITING PO/IV Adult 10mg BID on each treatment day for continuous infusion regimen | Prophylactic therapy PO/IV Adult 10-20mg 15-30min before treatment on each treatment day | PO/IV/IM Adult 4mg q4-6 (mildly emetogenic therapy) | IV Adult 10 mg/m2/dose OD/BID on days of chemotherapy (prior to therapy) for severely emetogenic chemotherapy courses | CONJUNCTIVITIS/IRITIS/CYCLITIS TP Adult Solution: Instill 1-2 drops into conjunctival sac q1h during the day & every other hour during the night, gradually reduce dose to q3-4h, then to 3-4 times/day, Suspension: Instill 1-2 drops into conjunctival sac up to 4-6 times/day, may use hourly in severe disease, taper prior to discontinuation Child Solution/suspension: Instill 1-2 drops q1h during the day & every other hour during the night, gradually reduce dose to q3-4h, then to 3-4 times/day | INFLAMMATORY DISEASES Intrasynovial/IL/IAT Adult Large joints (knee): 2-4mg, smaller joints: 0.8-1mg, repeated q2-3wk | INFLAMMATORY/ALLERGIC DISORDERS PO Child 1 month-18 yr: 10-100µg/kg/day in 1-2 divided doses, adjusted according to response. Up to 300µg/kg/day may be required in emergency situations | IV/IM Child 1 month-12 yr: 83-333µg/kg/day in 1-2 divided doses in 1–2 divided doses, max 20mg/day, 12-18 yr: Initially 0.4-20mg/day | MACULAR EDEMA Intravitreal Adult Inj: 0.7mg implant injected in affected eye | NON-INFECTIVE UVEITIS Intravitreal Adult Inj: 0.7mg implant injected in affected eye | SHOCK Severe IV Adult 1-6mg/kg as single Inj or 40-mg q2-6h if needed. High-Dose therapy should be continued only until the patient’s condition has stabilized & usually should not be continued beyond 48-72h | TENDON SHEATH INFLAMMATION Adult Soft tissue inj: 0.4-1mg, may be given upto 2-6mg for soft tissue infiltration | TUBERCULOUS MENINGITIS IM Adult 8-12mg/day tapered over 6-8 wk

Contra: Hypersensitivity, systemic fungal infect, cerebral malaria, presence of acute infect, administration of live vaccines, active/suspected quiescent TB

Precautions: HF, DM, GI diseases, head injury, hepatic/renal impairment, myasthenia gravis, acute MI, cataracts/glaucoma, osteoporosis, history of seizure disorder, thyroid disease, elderly, pediatrics, during drug withdrawal

ADR: Serious: Raised IOP, reduced visual function, hypokalemic alkalosis, disturbances of electrolyte balance, osteoporosis, Churg-Strauss syndrome, ocular changes, benign intracranial HTN, acute pancreatitis, avascular necrosis of bone, thromboembolic complications, increased susceptibility to infect, cardiovascular collapse, hypersensitivity reactions, increased severity of varicella & measles, Others: menstrual irregularities, mental & neurological disturbances, adrenal atrophy, growth retardation in children, Cushingoid symptoms, muscle wasting & nitrogen depletion, hyperglycemia, increased appetite, impaired tissue repair & immune function

DDI: Serious Phenobarbital decreases therapeutic effects drug (systemic), Albendazole efficacy increase in systemic worm infect by drug, Methotrexate increase acute hepatotoxicity by drug, Ephedrine/Carbamazepine increases drug clearance, Aprepitant increases drug levels, Itraconazole increases the levels and/or effects of inhaled drug, Saquinavir/Indinavir levels reduces by drug, Rifampicin/Phenytoin markedly reduces therapeutic effects of drug, Valdecoxib metabolism increases by drug, Delavirdine plasma level decreases & increases drug level, Aminoglutethimide reduce/abolishes drug effect, Antacids reduces the absorption of drug

Diet: With food

Monitor: Hb, occult blood loss, serum K, glucose growth in children

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