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dexamethasone sodium phosphate
Pharmacologic class: Glucocorticoid
Therapeutic class: Anti-inflammatory
Pregnancy risk category C
Unclear. Reduces inflammation by suppressing polymorphonuclear leukocyte migration, reversing increased capillary permeability, and stabilizing leukocyte lysosomal membranes. Also suppresses immune response (by reducing lymphatic activity), stimulates bone marrow, and promotes protein, fat, and carbohydrate metabolism.
Elixir: 0.5 mg/5 ml
Intravitreal implant: 0.7 mg
Oral solution: 0.5 mg/5 ml, 1 mg/ml
Solution for injection (sodium phosphate): 4 mg/ml, 10 mg/ml, 20 mg/ml, 24 mg/ml
Tablets: 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg
Indications and dosages
➣ Macular edema following branch retinal vein occlusion or central retinal vein occlusion; noninfectious uveitis affecting posterior segment of eye
Adults: 0.7 mg by intravitreal implant
➣ Allergic and inflammatory conditions
Adults: 0.75 to 9 mg/day (dexamethasone) P.O. as a single dose or in divided doses; in severe cases, much higher dosages may be needed. Dosage requirements vary and must be individualized based on disease and patient response.
➣ Cerebral edema
Adults: Initially, 10 mg (sodium phosphate) I.V., followed by 4 mg I.M. q 6 hours. Then reduce dosage gradually over 5 to 7 days.
➣ Suppression test for Cushing's syndrome
Adults: 1 mg P.O. at 11 P.M. or 0.5 mg P.O. q 6 hours for 48 hours (with urine collection testing, as ordered)
• Acute altitude sickness
• Bacterial meningitis
• Bronchopulmonary dysplasia in preterm infants
• Suppression test for detection, diagnosis, or management of depression
• Hypersensitivity to drug, benzyl alcohol, bisulfites, EDTA, creatinine, polysorbate 80, or methylparaben
• Systemic fungal infections
• Active or suspected ocular or periocular infections, advanced glaucoma (intravitreal implant)
Use cautiously in:
• renal insufficiency, cirrhosis, diabetes mellitus, diverticulitis, GI disease, cardiovascular disease, hypoprothrombinemia, hypothyroidism, myasthenia gravis, glaucoma, osteoporosis, infections, underlying immunosuppression, psychotic tendencies
• pregnant or breastfeeding patients
• Give P.O. dose with food or milk.
• When giving I.M., inject deep into gluteal muscle; rotate sites as needed.
• For I.V. use, drug may be given undiluted as a single dose over 1 minute or added to dextrose or I.V. saline solutions and given as an intermittent infusion at prescribed rate.
CNS: headache, malaise, vertigo, psychiatric disturbances, increased intracranial pressure, seizures
CV: hypotension, thrombophlebitis, myocardial rupture after recent myocardial infarction, thromboembolism
EENT: cataracts; elevated intraocular pressure (IOP), conjunctival hemorrhage (with intravitreal implant)
GI: nausea, vomiting, abdominal distention, dry mouth, anorexia, peptic ulcer, bowel perforation, pancreatitis, ulcerative esophagitis
Metabolic: decreased carbohydrate tolerance, hyperglycemia, cushingoid appearance (moon face, buffalo hump), decreased growth (in children), latent diabetes mellitus, sodium and fluid retention, negative nitrogen balance, adrenal suppression, hypokalemic alkalosis
Musculoskeletal: muscle wasting, muscle pain, osteoporosis, aseptic joint necrosis, tendon rupture, long bone fractures
Skin: diaphoresis, angioedema, erythema, rash, pruritus, urticaria, contact dermatitis, acne, decreased wound healing, bruising, skin fragility, petechiae
Other: facial edema, weight gain or loss, increased susceptibility to infection, hypersensitivity reactions
Drug-drug. Barbiturates, phenytoin, rifampin: decreased dexamethasone effects
Digoxin: increased risk of digoxin toxicity
Ephedrine: increased dexamethasone clearance
Estrogen, hormonal contraceptives: blocking of dexamethasone metabolism
Fluoroquinolones: increased risk of tendon rupture
Itraconazole, ketoconazole: increased dexamethasone blood level and effects
Live-virus vaccines: decreased antibody response to vaccine, increased risk of adverse reactions
Loop and thiazide diuretics: additive hypokalemia
Nonsteroidal anti-inflammatory drugs: increased risk of GI adverse effects
Somatrem, somatropin: decreased response to these drugs
Drug-diagnostic tests. Calcium, potassium: decreased levels
Cholesterol, glucose: increased levels
Nitroblue tetrazolium test: false-negative result
Drug-herbs. Echinacea: increased immune-stimulating effect
Ginseng: potentiation of immunemodulating response
Drug-behaviors. Alcohol use: increased risk of gastric irritation and GI ulcers
• Monitor blood glucose level closely in diabetic patients receiving drug orally.
• Monitor hemoglobin and potassium levels.
• Assess for occult blood loss.
☞ In long-term therapy, never discontinue drug abruptly. Dosage must be tapered gradually.
• Monitor patient for increased IOP after intravitreal injection.
☞ Instruct patient to immediately report sudden weight gain, swelling of face or limbs, excessive nervousness or sleep disturbances, excessive body hair growth, vision changes, difficulty breathing, muscle weakness, persistent abdominal pain, or change in stool color.
• Tell patient to take oral drug with or after meals.
• Advise patient to report vision changes and if eye becomes red, sensitive to light, or painful after intravitreal implant, to promptly report this to ophthalmologist.
• Inform patient that drug makes him more susceptible to infection. Advise him to avoid crowds and exposure to illness.
☞ Caution patient not to stop taking drug abruptly.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
dexamethasone/dex·a·meth·a·sone/ (dek″sah-meth´ah-sōn) a synthetic glucocorticoid used primarily as an antiinflammatory in various conditions, including collagen diseases and allergic states; it is the basis of a screening test in the diagnosis of Cushing's syndrome; used also as the acetate or sodium phosphate salt.
dexamethasoneA synthetic CORTICOSTEROID drug used for its anti-inflammatory action and for its value in reducing OEDEMA of the brain. It is also used to treat severe inflammatory and allergic disorders, shock, congenital adrenal hyperplasia, vomiting caused by chemotherapy, and for the diagnosis of Cushing's disease. The drug is on the WHO official list. Brand names are Decadron and Dexsol. The drug is also used in various combinations.
glucocorticoidsthe group of corticosteroid hormones (mainly cortisol syn hydrocortisone, of which cortisone is the precursor) produced by the adrenal cortex, under the control of adrenocorticotrophic hormone (ACTH) from the anterior pituitary. Their major actions on nutrient metabolism have the net effect of promoting glucose and free fatty acid availability as fuels. Also vital for normal cellular processes as diverse, for example, as excitation-contraction coupling and the health of connective tissues. Synthetic steroids such as prednisolone and dexamethasone have similar actions and are used in the treatment of, for example, asthma and rheumatic conditions. Banned in sport due to their powerful anti-inflammatory action and effect of producing euphoria and masking pain. (Not to be confused with anabolic steroids). See also adrenal glands, hormones; Table 1.
|Site of production||Name of hormone||Main targets||Involved in regulating:||Secretion controlled by:|
|Hypothalamus||Releasing and inhibiting hormones||Anterior pituitary (via local blood vessels)||Secretion of anterior pituitary hormones||Other brain regions; feedback re regulated hormones and their actions|
|Neurohormones released from posterior pituitary:|
|Oxytocin||Uterus, breasts||Labour and lactation||Afferent information from target organs|
|Antidiuretic hormone (ADH, vasopressin)||Kidneys||Water loss: ECF volume and osmolality||Hypothalamic osmoreceptors|
|Anterior pituitary||(Human) growth hormone (H)GH||Most cells||Growth and metabolism||Hypothalamic releasing and inhibiting hormones via local blood vessels|
|Thyroid-stimulating (TSH)||Thyroid gland||Thyroid secretions|
|Gonadotrophins||Ovary or testis||Germ cell maturation and hormone secretions|
|Adrenocorticotrophic (ACTH)||Adrenal cortex||Cortisol secretion|
|Pineal body||Melatonin||Widespread, including brain, thymus, etc.||Hypothalamus; varying light input from retina|
|Parathyroids||Parathormone||Bone, kidneys, gut||ECF [Ca2+]|
|Medulla||Heart, smooth muscle, glands||Cardiovascular and metabolic adjustments to activity and stress||Sympathetic nervous system|
|Atrial wall||Atrial natriuretic hormone||Kidneys||Blood volume; increases sodium (therefore also water) loss in urine||Stretch of atrial wall by venous pressure|
|Gonads: Testis||Androgens (mainly testosterone)||Genitalia and other tissues||Reproductive function and sex characteristics||Anterior pituitary gonadotrophins|
|Ovary||Uterus, breasts and other tissues||Menstrual cycle, pregnancy, lactation|
|Pancreas||Blood levels, storage and cellular uptake of nutrients, notably glucose, but also proteins and fats||Blood levels of nutrients; autonomic nervous system; other gastrointesinal hormones|
|Stomach||Gastrin||Gastric acid-secreting cells||Gastrointestinal functions: motility, digestive juices and other secretions||Local chemical and mechanical factors in the alimentary tract|
|Small intestine||Several GI functions including bile flow, pancreatic enzyme and exocrine secretions||Ingestion of food, distension of GI tract|