Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: dexamethasone oral
BRAND NAME: Decadron, DexPak
DRUG CLASS AND MECHANISM: Dexamethasone is a synthetic (man-made)
corticosteroid. Corticosteroids are naturally-occurring chemicals produced by
the adrenal glands located above the kidneys. Corticosteroids affect the
function of many cells within the body and suppress the immune system.
Corticosteroids also block inflammation and are used in a wide variety of
inflammatory diseases affecting many organs.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 0.25, 0.5, 0.75, 1, 1.5, 2, 4, and 6 mg.
Elixir: 0.5 mg /5 mL. Solution: 0.5, 1 mg/5 ml
STORAGE: Dexamethasone should be stored at 68-77 F (20-25 C) and not
frozen.
PRESCRIBED FOR: Dexamethasone is used for reducing inflammation in
many conditions. Some examples include rheumatoid arthritis, systemic lupus,
acute gouty arthritis, psoriatic arthritis, ulcerative colitis, and
Crohn's
disease. Severe allergic conditions that fail to respond to other treatments
also may respond to dexamethasone. Examples include bronchial asthma,
allergic
rhinitis, drug-induced dermatitis, and contact and atopic dermatitis. Chronic
skin conditions treated with dexamethasone include dermatitis herpetiformis,
pemphigus, severe psoriasis and severe seborrheic dermatitis. Chronic allergic
and inflammatory conditions of the
uvea,
iris,
conjunctiva and optic nerves of
the eyes also are treated with dexamethasone.
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.
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 to 9 mg daily depending on
the disease. The initial dose should be adjusted based on response.
Corticosteroids given in multiple doses 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.
PREGNANCY: Dexamethasone has not been adequately evaluated in
pregnant
women.
NURSING MOTHERS: Dexamethasone has not been adequately evaluated in
nursing mothers. Corticosteroids appear in
breast milk and may cause side
effects in infants.
SIDE EFFECTS: Side effects of dexamethasone depend on the dose, the
duration and the frequency of administration. Short courses of dexamethasone
usually are well tolerated with few and mild side effects. Long term, high dose
dexamethasone usually will produce predictable and potentially serious side
effects. Whenever possible, the lowest effective dose of dexamethasone should be
used for the shortest possible length of time to minimize side effects.
Alternate day dosing also can help reduce side effects.
Side effects of dexamethasone and other corticosteroids range from mild
annoyances to serious irreversible damage. Side effects include fluid retention,
weight gain, high blood pressure, loss of potassium, headache, muscle weakness,
puffiness of and hair growth on the face, thinning and easy bruising of skin,
glaucoma, cataracts, peptic ulceration, worsening of diabetes, irregular menses,
growth retardation in children, convulsions, and psychic disturbances. Psychic
disturbances include depression, euphoria, insomnia, mood swings, personality
changes, and even psychotic behavior.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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