Please check your internet connection and try again.
# IV Dexamethasone
## Overview
Dexamethasone is a potent, long-acting synthetic glucocorticoid with negligible mineralocorticoid activity. It provides intense anti-inflammatory and immunosuppressive effects.
## Primary Indications
* Cerebral edema (associated with brain tumors, neurosurgery)
* Refractory shock or adrenal insufficiency
* Severe allergic reactions/anaphylaxis
* COVID-19 (requiring supplemental oxygen)
* Bacterial meningitis (adjunctive)
* Croup (pediatric)
* Antiemetic prophylaxis (CINV)
## Adult Dosing
* **Cerebral Edema:** 10 mg IV loading dose, then 4 mg IV q6h.
* **COVID-19:** 6 mg IV daily for up to 10 days.
* **Antiemetic (CINV):** 8–20 mg IV as a single dose prior to chemotherapy.
* **Anaphylaxis/Allergy:** 4–20 mg IV single dose.
* **Bacterial Meningitis:** 10 mg IV q6h for 4 days (administer with first antibiotic dose).
## Pediatric Dosing
* **Croup:** 0.6 mg/kg (max 10 mg) IV/IM/PO as a single dose.
* **Bacterial Meningitis:** 0.15 mg/kg IV q6h for 2–4 days (administer with first antibiotic dose).
* **Cerebral Edema:** 0.5–1.5 mg/kg IV loading dose, followed by 0.2–0.5 mg/kg/day divided q6h.
* **Antiemetic:** 0.1–0.5 mg/kg (max 10–20 mg) as a single dose.
## Dose Adjustments
* **Hepatic Impairment:** Clearance may be reduced in severe hepatic dysfunction; monitor for toxicity.
* **Renal Impairment:** No standard adjustment required, but patients may be more sensitive to side effects.
## Contraindications
* Systemic fungal infections.
* Hypersensitivity to the drug or components.
* Avoid live or attenuated virus vaccines during high-dose therapy.
## Adverse Effects
* **Common:** Hyperglycemia/insulin resistance, insomnia, mood changes/psychosis, fluid retention, increased risk of infection, leukocytosis.
* **Serious:** GI ulceration/perforation, hypertension, HPA axis suppression (long-term use), osteoporosis/myopathy.
## Key Drug Interactions
* **CYP3A4 Inducers (e.g., phenytoin, rifampin, phenobarbital):** Can decrease dexamethasone levels.
* **CYP3A4 Inhibitors (e.g., ritonavir, ketoconazole):** May increase dexamethasone levels.
* **NSAIDs/Warfarin:** Increased risk of gastrointestinal bleeding.
* **Antidiabetic agents:** Dexamethasone significantly antagonizes hypoglycemic control.
## Monitoring
* **Blood glucose:** Frequent monitoring, especially in diabetics or at high doses.
* **Electrolytes:** Potassium (risk of hypokalemia).
* **Blood pressure:** Monitor for treatment-induced hypertension.
* **Psychiatric:** Monitor for agitation, confusion, or insomnia.
* **Signs of infection:** Assess frequently during prolonged therapy.
## Clinical Pearls
* **Rapid Admin:** May be administered by IV push; direct injection rate should not exceed 10 mg/min to prevent perineal pruritus/burning.
* **Tapering:** Patients on chronic systemic steroids (>2–3 weeks) require a systematic taper to prevent adrenal crisis.
* **COVID-19:** Clinical benefit is restricted to patients requiring supplemental oxygen; use in mild cases may be harmful.
* **Local Variations:** Dosing for specific neurological protocols or antiemetic regimens can vary significantly by institutional policy; always verify against local order sets.
***
**Educational Disclaimer:** This summary is for informational purposes only and does not constitute medical advice. Dosing, contraindications, and drug interactions can change. Always verify current prescribing information, institutional protocols, and patient-specific factors before administration.
