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# IV Dexamethasone
## Overview
Dexamethasone is a potent, long-acting synthetic glucocorticoid with minimal mineralocorticoid activity. It exerts profound anti-inflammatory and immunosuppressive effects.
## Primary Indications
* Cerebral edema (management/prevention)
* Severe allergic reactions/anaphylaxis (adjunctive therapy)
* Acute exacerbation of asthma/COPD
* COVID-19 (in patients requiring oxygen support)
* Chemotherapy-induced nausea and vomiting (CINV) prophylaxis
* Bacterial meningitis (adjunctive therapy to prevent neurological complications)
## Adult Dosing
* **Cerebral Edema:** 10 mg IV load, followed by 4 mg IV q6h.
* **COVID-19:** 6 mg IV daily for up to 10 days.
* **CINV Prophylaxis:** 10–20 mg IV once prior to chemotherapy.
* **Bacterial Meningitis:** 10 mg IV q6h for 4 days; administer with or 15–20 minutes before the first antibiotic dose.
* **Anaphylaxis/Severe Allergic Reaction:** 4–20 mg IV single dose.
## Pediatric Dosing
* **Cerebral Edema:** Initial 1.5 mg/kg IV, followed by 0.375 mg/kg IV q6h.
* **Bacterial Meningitis:** 0.15 mg/kg IV q6h for 4 days; initiate with or immediately prior to first antibiotic dose.
* **Croup:** 0.6 mg/kg (max 10 mg) IV/IM as a single dose.
* **COVID-19:** 0.15 mg/kg (max 6 mg) IV daily for up to 10 days.
## Dose Adjustments
* **Hepatic Impairment:** No specific adjustment, but monitor for increased systemic exposure.
* **Renal Impairment:** Generally no adjustment required.
* **Titration:** For long courses, taper dose gradually to avoid adrenal insufficiency.
## Contraindications
* Systemic fungal infections.
* Known hypersensitivity to dexamethasone or components of the formulation.
* Administration of live or live-attenuated vaccines while receiving immunosuppressive doses.
## Adverse Effects
* **Endocrine:** Hyperglycemia, secondary adrenal insufficiency (with prolonged use).
* **Psychiatric:** Insomnia, mood swings, psychosis, anxiety.
* **Gastrointestinal:** Peptic ulcer disease, dyspepsia.
* **Cardiovascular:** Hypertension, fluid retention/edema.
* **Infection:** Increased susceptibility to secondary infections.
## Key Drug Interactions
* **CYP3A4 Inducers (e.g., phenytoin, carbamazepine, rifampin):** Decreased dexamethasone levels.
* **CYP3A4 Inhibitors (e.g., ritonavir, ketoconazole):** Increased risk of glucocorticoid toxicity.
* **NSAIDs:** Increased risk of gastrointestinal ulceration/bleeding.
* **Antidiabetic Agents:** Reduced efficacy; requires monitoring of blood glucose.
## Monitoring
* Serum glucose (frequent checks in diabetic patients).
* Blood pressure.
* Electrolytes (specifically potassium, if used long-term).
* Signs of infection or fluid overload.
## Clinical Pearls
* **Administration:** IV injection may be given undiluted; IV infusion can be diluted in D5W or NS.
* **Potency:** 0.75 mg of dexamethasone is approximately equivalent to 5 mg of prednisone.
* **Bacterial Meningitis:** Timing is critical; administration after antimicrobial therapy has begun significantly reduces efficacy.
* **Local Policy:** Always defer to institutional protocols for COVID-19 or specialized oncology regimens, as these may evolve rapidly.
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*Disclaimer: This information is for educational purposes and does not substitute for clinical judgment. Always verify current prescribing information, institutional guidelines, and drug compatibility from reliable resources such as Lexicomp, Micromedex, or the hospital pharmacy.*
