Dexamethasone
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Dexamethasone
Decadron (historical), Dexpak (taper pack), Hemady, Ozurdex (intravitreal)
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Summary
Common uses
Cerebral edema (brain tumors, neurosurgery)0, Multiple myeloma (combination chemotherapy backbone)0, Adjunctive bacterial meningitis (early)0, Severe COVID-19 requiring oxygen (RECOVERY trial)0, Chemotherapy-induced nausea and vomiting0, Croup0, ARDS (selected protocols)0, Dexamethasone suppression test (Cushing's diagnosis)0
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[1]
Bioavailability
~80% (oral)[1]
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[1].
References
edit- ↑ 1.0 1.1 1.2 FDA Prescribing Information, dexamethasone tablets, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/011664s065lbl.pdf