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# IV Dexamethasone ## Overview Dexamethasone is a potent, long-acting synthetic glucocorticoid with negligible mineralocorticoid activity. It exerts profound anti-inflammatory and immunosuppressive effects. ## Primary Indications * Cerebral edema (associated with neoplasm, craniotomy, or head injury). * Anti-emetic therapy (chemotherapy-induced nausea and vomiting). * Acute airway edema or croup. * Severe allergic reactions/anaphylaxis (adjunctive). * Refractory COVID-19 (requiring supplemental oxygen). ## Adult Dosing * **Cerebral Edema:** 10 mg IV loading dose, followed by 4 mg IV q6h. * **Anti-emetic (CINV):** 10–20 mg IV once prior to chemotherapy. * **COVID-19:** 6 mg IV daily for up to 10 days. * **Anaphylaxis/Allergy:** 4–20 mg IV, titrated to severity. ## Pediatric Dosing * **Croup:** 0.6 mg/kg (max 10 mg) IV/IM/PO as a single dose. * **Cerebral Edema:** Loading dose 1–2 mg/kg IV; maintenance 0.2–0.5 mg/kg per day in divided doses q6h. * **Anti-emetic:** 0.15–0.5 mg/kg (max 10–20 mg) IV once. * *Note: Dosing often varies based on institutional protocols; verify specialty guidelines.* ## Dose Adjustments * **Renal/Hepatic Impairment:** Usually no formal adjustment required; however, clinical monitoring is required for cumulative toxicity. * **Corticosteroid Taper:** Necessary for long-term therapy (>1–2 weeks) to prevent adrenal insufficiency. ## Contraindications * Systemic fungal infections. * Known hypersensitivity to dexamethasone or components (e.g., sulfites). * Live virus vaccines (when on immunosuppressive doses). ## Adverse Effects * **Common:** Hyperglycemia, fluid retention, insomnia, agitation, mood swings, increased appetite. * **Serious:** GI ulceration/perforation, immunosuppression (secondary infection risk), psychosis, adrenal suppression, myopathy, osteonecrosis. ## Key Drug Interactions * **Anticoagulants:** May alter INR; monitor closely. * **NSAIDs:** Increased risk of GI ulceration. * **CYP3A4 Inducers (e.g., Phenytoin, Rifampin, Carbamazepine):** Decrease dexamethasone efficacy. * **Fluoroquinolones:** Increased risk of tendon rupture. ## Monitoring * Serum glucose (especially in patients with diabetes). * Electrolytes (hypokalemia risk). * Blood pressure. * Signs of GI bleeding (melena, hematemesis). * Infection status (leukocytosis may be masked by steroids). ## Clinical Pearls * **Potency:** Dexamethasone is ~25–30 times more potent than hydrocortisone. * **"No Mineralocorticoid Effect":** Does not cause sodium retention or hypertension to the extent of hydrocortisone or prednisone. * **Half-life:** Long biological half-life (36–54 hours) makes it unsuitable for every-other-day dosing strategies. * **Parenteral to Oral:** When conversion is possible, the oral dosage is generally equivalent to the IV dose. *** **Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Clinical protocols vary by institution. Always verify dosages, contraindications, and drug-drug interactions via current internal hospital guidelines and official prescribing information (e.g., FDA labels or package inserts) prior to administration.