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# IV Dexamethasone ## Overview Dexamethasone is a potent, long-acting synthetic glucocorticoid with minimal mineralocorticoid activity. It provides profound anti-inflammatory and immunosuppressive effects. ## Primary Indications * Cerebral edema (associated with brain tumors, neurosurgery) * Severe allergic reactions / Anaphylaxis (adjunctive) * Bacterial meningitis (to reduce neurological sequelae) * Palliative oncology (symptom control) * COVID-19 (in patients requiring supplemental oxygen) * Anti-emesis (chemotherapy-induced) ## Adult Dosing * **Cerebral Edema:** Initial 10 mg IV, followed by 4 mg IV every 6 hours. * **COVID-19:** 6 mg IV once daily for up to 10 days. * **Anti-emesis (Chemotherapy):** 10–20 mg IV 30 minutes prior to chemotherapy. * **Bacterial Meningitis:** 10 mg IV every 6 hours for 4 days (ideally administered 15–20 minutes prior to/with the first dose of antibiotics). ## Pediatric Dosing * **Bacterial Meningitis:** 0.15 mg/kg IV every 6 hours for 4 days. * **Cerebral Edema:** Loading 1–2 mg/kg IV, followed by 1–1.5 mg/kg/day divided every 4–6 hours (max dose depends on clinical protocol). * **Anti-emesis:** 0.25–0.5 mg/kg (max 20 mg) IV as a single dose. * **Croup:** 0.6 mg/kg (max 10–16 mg) IV as a single dose. ## Dose Adjustments * **Renal/Hepatic Impairment:** Generally no adjustment required for short-term use. * **Chronic Corticosteroid Users:** Tapering is required if therapy duration exceeds 7–10 days to prevent adrenal insufficiency. ## Contraindications * Systemic fungal infections. * Hypersensitivity to dexamethasone or any component of the formulation. * Administration of live or live-attenuated vaccines during high-dose immunosuppressive therapy. ## Adverse Effects * **Short-term:** Hyperglycemia, agitation, insomnia, mood swings, increased appetite, GI irritation (rarely ulceration). * **Long-term:** Hypertension, fluid retention, immunosuppression, electrolyte imbalances (hypokalemia), psychiatric changes, osteonecrosis. ## Key Drug Interactions * **CYP3A4 Inducers (e.g., phenytoin, rifampin, phenobarbital):** Increase dexamethasone clearance; may require higher doses. * **Fluoroquinolones:** Increased risk of tendon rupture. * **NSAIDs/Aspirin:** Increased risk of GI ulceration/bleeding. * **Diuretics:** Potential for additive potassium loss (hypokalemia). ## Monitoring * Serum glucose (especially in diabetic patients). * Blood pressure. * Signs of infection or fluid retention. * Electrolytes (if prolonged use). * Psychiatric status (mood/behavioral changes). ## Clinical Pearls * **Administration:** IV push is typically administered over 1–5 minutes. * **Steroid Potency:** Dexamethasone has no clinically significant mineralocorticoid (salt-retaining) activity, making it ideal for cerebral edema where fluid restriction is required. * **Infection Masking:** Glucocorticoids can mask signs of systemic infection (fever). * **Site Stability:** Always verify local hospital protocols for specific indications, as dosing varies significantly by institutional guidelines (e.g., trauma vs. oncology). *** **Educational Disclaimer:** This information is for educational purposes only. Always consult your institution’s current drug formulary, protocols, and up-to-date prescribing information (e.g., Lexicomp, Micromedex) before administering any medication. Clinical judgment must be used based on the specific patient's history and condition.