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# IV Dexamethasone ## Overview Dexamethasone is a potent, long-acting synthetic glucocorticoid with minimal mineralocorticoid activity. It is highly effective for reducing inflammation and edema. ## Primary Indications * Cerebral edema (associated with tumors, craniotomy, or head injury). * Anti-emetic prophylaxis (chemotherapy-induced). * Croup (laryngotracheobronchitis). * Bacterial meningitis (adjunct to antibiotics). * Severe allergic reactions/anaphylaxis. * Dexamethasone suppression testing. ## Adult Dosing * **Cerebral Edema:** Initial 10 mg IV, followed by 4 mg IM/IV every 6 hours. * **Anti-emetic (CINV):** 8–20 mg IV once before chemotherapy. * **Allergic Reaction/Anaphylaxis:** 4–20 mg IV as a single dose. * **Bacterial Meningitis:** 10 mg IV every 6 hours for 4 days (ideally given 15–20 minutes before or concurrent with the first antibiotic dose). ## Pediatric Dosing * **Croup:** 0.6 mg/kg IV/IM (max 10 mg) as a single dose. * **Bacterial Meningitis:** 0.15 mg/kg IV every 6 hours for 4 days (up to 10 mg/dose). * **Cerebral Edema:** Initial loading dose 1.5 mg/kg IV (max 10 mg), then 0.5 mg/kg/dose every 6 hours (max 4 mg/dose). * **Anti-emetic:** 0.1–0.5 mg/kg/dose (max 10–20 mg depending on protocol). ## Dose Adjustments * **Hepatic Impairment:** Clearance may be decreased; monitor closely for toxicity. * **Renal Impairment:** No standard adjustment required, but patients are at higher risk for electrolyte disturbances. * **Dose Tapering:** Required for long-term therapy (>7–10 days) to prevent adrenal insufficiency. ## Contraindications * Systemic fungal infections. * Hypersensitivity to any component of the formulation. * Administration of live or live-attenuated vaccines during immunosuppressive dosing. ## Adverse Effects * **Metabolic:** Hyperglycemia, hypokalemia, fluid retention, sodium retention. * **Psychiatric:** Insomnia, mood swings, agitation, psychosis (dose-dependent). * **Gastrointestinal:** Peptic ulceration, gastritis. * **Infection:** Increased susceptibility to infection and masking of clinical signs. * **Dermatologic:** Thinning skin, delayed wound healing. ## Key Drug Interactions * **CYP3A4 Inducers (e.g., Phenytoin, Rifampin, Phenobarbital):** May decrease dexamethasone efficacy. * **CYP3A4 Inhibitors (e.g., Ritonavir, Ketoconazole):** May increase dexamethasone exposure. * **NSAIDs:** Increased risk of gastrointestinal ulceration/bleeding. * **Warfarin:** Glucocorticoids can unpredictably alter INR; monitor frequently. ## Monitoring * **Baseline/Ongoing:** Blood glucose (frequent in diabetics), blood pressure, electrolyte levels (potassium), and signs of GI distress. * **Long-term:** Weight, bone mineral density, and ophthalmologic exams (cataracts/glaucoma). ## Clinical Pearls * **Administration:** IV push may be given undiluted. High-dose rapid infusion may cause perineal burning; slow injection or dilution in 50–100 mL of fluid is recommended. * **Efficacy:** Dexamethasone is preferred for cerebral edema due to its poor mineralocorticoid activity, minimizing sodium/water retention compared to other steroids. * **Specific Protocols:** Always check institutional guidelines for dose variances in meningitis or oncology-specific protocols. *** *Disclaimer: This information is for educational purposes only. Clinical practice guidelines change frequently. Always verify current, institution-specific prescribing information, weight-based calculations, and patient-specific contraindications via official references (e.g., Lexicomp/UpToDate) before administering medication.*