dexamethasone (cont.)

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Dexamethasone is used in the treatment of cancers of the white blood cells (leukemias), and lymph gland cancers (lymphomas). Blood diseases involving destruction by the body's own immune system of platelets (idiopathic thrombocytopenia purpura), and red blood cells (autoimmune hemolytic anemia) also are treated with dexamethasone. Other miscellaneous conditions treated with dexamethasone include thyroiditis and sarcoidosis. Finally, dexamethasone is used as replacement therapy in patients whose adrenal glands are unable to produce sufficient amounts of corticosteroids.

Many of the medical problems treated by this drug are “off label”; that is, its use is not sanctioned or approved by the FDA.

DOSING: Dosage requirements of corticosteroids vary greatly among individuals and the diseases being treated. In general, the lowest possible effective dose is used. The initial oral dose is 0.75 mg to 9 mg daily depending on the disease. The initial dose should be adjusted based on response. Corticosteroids given in multiple doses (2 to 4 times daily) throughout the day are more effective but also are more toxic as compared with the same total daily dose given once daily, or every other day.

DRUG INTERACTIONS: Corticosteroids may increase or decrease the effect of blood thinners, for example, warfarin (Coumadin). Blood clotting should be monitored and the dose of blood thinner adjusted in order to achieve the desired level of blood thinning when patients receiving blood thinners are begun on corticosteroids, including dexamethasone.

Phenobarbital, ephedrine, phenytoin (Dilantin), and rifampin (Rifadin, Rimactane) may increase the breakdown of corticosteroids by the liver, resulting in lower blood levels and reduced effects. Therefore, the dose of corticosteroid may need to be increased if treatment with any of these agents is begun.

Mifepristone may reduce the action of corticosteroids via unknown mechanisms. Dexamethasone may decrease blood levels of mifepristone. Mifepristone should not be combined with steroids.

Medically Reviewed by a Doctor on 10/28/2014


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