Dexamethasone

Corticosteroid, Glucocorticoid (long-acting, high-potency), Immunosuppressant

Dexamethasone

Decadron (historical), Dexpak (taper pack), Hemady, Ozurdex (intravitreal)

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Summary

Classes

Corticosteroid, Glucocorticoid (long-acting, high-potency), Immunosuppressant

Pharmacy

Starting dose

Indication-specific: 0.5-9 mg PO/IV daily for inflammation; 4 mg IV q6h for cerebral edema; 40 mg PO once weekly in MM; 6 mg PO/IV daily ×10 days for severe COVID-19; 0.6 mg/kg PO single dose for croup (max 16 mg)

Preparations

0.5, 0.75, 1, 1.5, 2, 4, 6 mg tablets; oral solution; 4, 10, 20, 100 mg/mL IV; intravitreal implant (Ozurdex)

US FDA Max

Indication-specific

Pharmacology

Routes

Oral, IV, IM, intra-articular, intrathecal (rare), intravitreal

Onset

Hours

Duration

Biologic 36-72 hours (long-acting)

Half-life

Plasma ~3-4.5 hours; biologic ~36-72 hours

Bioavailability

~80% (oral)

Pregnancy

Used in antenatal lung maturation (24-34 weeks gestation; 6 mg IM q12h × 4 doses); broader use weighs benefits against fetal HPA suppression.^{[citation needed]}

Legal status

Rx-only in US

Purported mechanism

Dexamethasone is a synthetic fluorinated glucocorticoid with ~25-30× the potency of hydrocortisone, virtually no mineralocorticoid activity, and the longest biologic half-life of the routinely used glucocorticoids (36-72 hours).▲0▼ Activates the glucocorticoid receptor to broadly remodel inflammatory, immune, and metabolic transcription. The lack of mineralocorticoid effect makes it the preferred high-dose glucocorticoid for situations where sodium/water retention is undesirable (cerebral edema, CHF) but unsuitable as adrenal replacement.