Dexamethasone

Dosages

Interactions

Contraindicated

• apixaban
• artemether/lumefantrine
• cariprazine
• cobimetinib
• dienogest/estradiol valerate
• elbasvir/grazoprevir
• elvitegravir/cobicistat/emtricitabine/tenofovir DF
• lumacaftor/ivacaftor
• lumefantrine
• lurasidone
• mifepristone
• naloxegol
• ombitasvir/paritaprevir/ritonavir & dasabuvir
• panobinostat
• praziquantel
• regorafenib
• rilpivirine
• roflumilast
• vandetanib

Serious

• abemaciclib
• acalabrutinib
• adenovirus types 4 and 7 live, oral
• aldesleukin
• anthrax vaccine
• apalutamide
• apremilast
• axicabtagene ciloleucel
• axitinib
• BCG vaccine live
• bedaquiline
• bosutinib
• brigatinib
• cabozantinib
• carbamazepine
• ceritinib
• chloramphenicol
• cimetidine
• clarithromycin
• cobicistat
• copanlisib
• dabrafenib
• dihydroergotamine
• dihydroergotamine intranasal
• diphtheria & tetanus toxoids/ acellular pertussis vaccine
• diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine
• dronedarone
• eliglustat
• elvitegravir
• erdafitinib
• ergotamine
• erythromycin base
• erythromycin ethylsuccinate
• erythromycin lactobionate
• erythromycin stearate
• ethinylestradiol
• everolimus
• hepatitis A vaccine inactivated
• hepatitis a/b vaccine
• hepatitis a/typhoid vaccine
• hepatitis b vaccine
• human papillomavirus vaccine, nonavalent
• human papillomavirus vaccine, quadrivalent
• ibrutinib
• idelalisib
• influenza virus vaccine quadrivalent
• influenza virus vaccine quadrivalent, intranasal
• influenza virus vaccine trivalent
• influenza virus vaccine trivalent, adjuvanted
• ivabradine
• ivacaftor
• ivosidenib
• ixazomib
• Japanese encephalitis virus vaccine
• ketoconazole
• lasmiditan
• lovastatin
• macimorelin
• macitentan
• measles (rubeola) vaccine
• measles mumps and rubella vaccine, live
• measles, mumps, rubella and varicella vaccine, live
• meningococcal A C Y and W-135 polysaccharide vaccine combined
• midostaurin
• naldemedine
• nefazodone
• neratinib
• netupitant/palonosetron
• nivolumab
• olaparib
• osimertinib
• palbociclib
• perampanel
• pneumococcal vaccine 13-valent
• pneumococcal vaccine heptavalent
• pneumococcal vaccine polyvalent
• ponatinib
• quinidine
• rabies vaccine
• rabies vaccine chick embryo cell derived
• ranolazine
• rifabutin
• rifampin
• rolapitant
• romidepsin
• rotavirus oral vaccine, live
• rubella vaccine
• silodosin
• simeprevir
• simvastatin
• sirolimus
• smallpox (vaccinia) vaccine, live
• sofosbuvir/velpatasvir
• sonidegib
• squill
• St John’s Wort
• testosterone intranasal
• tetanus toxoid adsorbed or fluid
• tezacaftor
• tick borne encephalitis vaccine
• tisagenlecleucel
• tofacitinib
• tolvaptan
• trabectedin
• travelers diarrhea and cholera vaccine inactivated
• tucatinib
• typhoid polysaccharide vaccine
• typhoid vaccine live
• ulipristal
• valbenazine
• varicella virus vaccine live
• vemurafenib
• venetoclax
• vorapaxar
• voxelotor
• yellow fever vaccine
• zoster vaccine live

Monitor Closely

• abiraterone
• aceclofenac
• acemetacin
• albiglutide
• alitretinoin
• almotriptan
• alprazolam
• amiodarone
• amobarbital
• antithrombin alfa
• antithrombin III
• aprepitant
• argatroban
• aripiprazole
• armodafinil
• artemether/lumefantrine
• aspirin
• aspirin rectal
• aspirin/citric acid/sodium bicarbonate
• atazanavir
• atorvastatin
• atracurium
• avanafil
• bazedoxifene/conjugated estrogens
• belatacept
• bemiparin
• benzhydrocodone/acetaminophen
• bexarotene
• bivalirudin
• bortezomib
• bosentan
• bosutinib
• brentuximab vedotin
• brexpiprazole
• budesonide
• buprenorphine
• buprenorphine buccal
• buprenorphine subdermal implant
• buprenorphine, long-acting injection
• buspirone
• butabarbital
• butalbital
• calcifediol
• carbamazepine
• celecoxib
• cenobamate
• cholera vaccine
• cholestyramine
• choline magnesium trisalicylate
• cilostazol
• cinacalcet
• ciprofloxacin
• cisatracurium
• clarithromycin
• clopidogrel
• clotrimazole
• clozapine
• colchicine
• conivaptan
• conjugated estrogens
• conjugated estrogens, vaginal
• corticorelin
• cortisone
• crizotinib
• crofelemer
• cyclosporine
• dabrafenib
• dalteparin
• darifenacin
• darunavir
• dasatinib
• deferasirox
• dengue vaccine
• denosumab
• DHEA, herbal
• diazepam
• dichlorphenamide
• diclofenac
• diflunisal
• diltiazem
• doxorubicin
• doxorubicin liposomal
• dronabinol
• dronedarone
• duvelisib
• efavirenz
• elagolix
• eletriptan
• eliglustat
• elvitegravir/cobicistat/emtricitabine/tenofovir DF
• encorafenib
• enoxaparin
• erlotinib
• erythromycin base
• erythromycin ethylsuccinate
• erythromycin lactobionate
• erythromycin stearate
• eslicarbazepine acetate
• estradiol
• estradiol vaginal
• estrogens conjugated synthetic
• estrogens esterified
• estropipate
• ethotoin
• etodolac
• etoposide
• etravirine
• eucalyptus
• exemestane
• exenatide injectable solution
• exenatide injectable suspension
• fedratinib
• felodipine
• fenbufen
• fenoprofen
• fentanyl
• fentanyl intranasal
• fentanyl transdermal
• fentanyl transmucosal
• fesoterodine
• fingolimod
• flibanserin
• fluconazole
• fludrocortisone
• flurbiprofen
• fondaparinux
• fosamprenavir
• fosphenytoin
• fostamatinib
• gefitinib
• gemifloxacin
• glecaprevir/pibrentasvir
• glycerol phenylbutyrate
• grapefruit
• griseofulvin
• guanfacine
• haemophilus influenzae type b vaccine
• hemin
• heparin
• hydrocodone
• hydrocortisone
• hydroxyprogesterone caproate
• ibuprofen
• ibuprofen IV
• ifosfamide
• iloperidone
• indacaterol, inhaled
• indinavir
• indomethacin
• influenza A (H5N1) vaccine
• influenza virus vaccine (H5N1), adjuvanted
• influenza virus vaccine quadrivalent, recombinant
• influenza virus vaccine trivalent, recombinant
• insulin degludec
• insulin degludec/insulin aspart
• insulin inhaled
• irinotecan
• irinotecan liposomal
• isoniazid
• istradefylline
• itraconazole
• ivacaftor
• ixabepilone
• ketoconazole
• ketoprofen
• ketorolac
• ketorolac intranasal
• lapatinib
• letermovir
• levofloxacin
• levonorgestrel intrauterine
• levonorgestrel oral
• levonorgestrel oral/ethinylestradiol/ferrous bisglycinate
• liraglutide
• lomitapide
• lopinavir
• loratadine
• lornoxicam
• lovastatin
• lumefantrine
• maraviroc
• marijuana
• meclofenamate
• medroxyprogesterone
• mefenamic acid
• meloxicam
• meningococcal group B vaccine
• mestranol
• methadone
• methylprednisolone
• metronidazole
• miconazole vaginal
• midazolam
• mitotane
• modafinil
• moxifloxacin
• nabumetone
• naproxen
• nefazodone
• nelfinavir
• nevirapine
• nicardipine
• nifedipine
• nilotinib
• nisoldipine
• ocrelizumab
• ofloxacin
• olodaterol inhaled
• ondansetron
• ospemifene
• oxaprozin
• oxcarbazepine
• oxiconazole
• oxycodone
• ozanimod
• paclitaxel
• paclitaxel protein bound
• pancuronium
• parecoxib
• pazopanib
• pentobarbital
• phenindione
• phenobarbital
• phenytoin
• pimavanserin
• piroxicam
• poliovirus vaccine inactivated
• pomalidomide
• ponatinib
• posaconazole
• prednisolone
• prednisone
• primidone
• protamine
• quercetin
• quetiapine
• quinidine
• quinupristin/dalfopristin
• ranolazine
• repaglinide
• ribociclib
• rifampin
• rifapentine
• riociguat
• ritonavir
• rivaroxaban
• rocuronium
• rufinamide
• salicylates (non-asa)
• salsalate
• saquinavir
• sarecycline
• secobarbital
• selexipag
• sildenafil
• simvastatin
• sipuleucel-T
• sirolimus
• sodium picosulfate/magnesium oxide/anhydrous citric acid
• sodium sulfate/potassium sulfate/magnesium sulfate
• sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol
• solifenacin
• somatrem
• sorafenib
• spironolactone
• St John’s Wort
• stiripentol
• succinylcholine
• sulfasalazine
• sulindac
• sunitinib
• suvorexant
• tacrolimus
• tadalafil
• tamoxifen
• tasimelteon
• tazemetostat
• tecovirimat
• temsirolimus
• theophylline
• ticagrelor
• tinidazole
• tipranavir
• tofacitinib
• tolfenamic acid
• tolmetin
• tolterodine
• tolvaptan
• topiramate
• toremifene
• tramadol
• trastuzumab
• trastuzumab deruxtecan
• trazodone
• triamcinolone acetonide injectable suspension
• triazolam
• tucatinib
• ubrogepant
• vardenafil
• vecuronium
• vemurafenib
• verapamil
• vilazodone
• voriconazole
• vortioxetine
• warfarin
• xipamide
• zafirlukast
• zoster vaccine recombinant

Minor

• acarbose
• albendazole
• alfentanil
• alfuzosin
• alosetron
• ambrisentan
• amitriptyline
• amlodipine
• amphotericin B deoxycholate
• armodafinil
• aspirin
• aspirin rectal
• aspirin/citric acid/sodium bicarbonate
• atazanavir
• balsalazide
• bendroflumethiazide
• bosentan
• bumetanide
• calcium acetate
• calcium carbonate
• calcium chloride
• calcium citrate
• calcium gluconate
• caspofungin
• cevimeline
• chlorothiazide
• chlorpropamide
• chlorthalidone
• choline magnesium trisalicylate
• chromium
• clarithromycin
• clomipramine
• colestipol
• cyclopenthiazide
• cyclosporine
• danazol
• dapsone
• desipramine
• diflunisal
• disopyramide
• docetaxel
• donepezil
• dutasteride
• efavirenz
• eplerenone
• esomeprazole
• ethacrynic acid
• eucalyptus
• feverfew
• finasteride
• fluoxymesterone
• furosemide
• galantamine
• glimepiride
• glipizide
• glyburide
• hydrochlorothiazide
• imatinib
• imipramine
• indapamide
• insulin aspart
• insulin detemir
• insulin glargine
• insulin glulisine
• insulin lispro
• insulin NPH
• insulin regular human
• isoniazid
• isradipine
• ketoconazole
• lansoprazole
• mesalamine
• mesterolone
• metformin
• methyclothiazide
• methyltestosterone
• metolazone
• metyrapone
• miglitol
• montelukast
• nateglinide
• nimodipine
• nitrendipine
• omeprazole
• oxandrolone
• oxybutynin
• oxymetholone
• paclitaxel
• paclitaxel protein bound
• pantoprazole
• parecoxib
• pimozide
• pioglitazone
• porfimer
• propafenone
• quinine
• rabeprazole
• ramelteon
• repaglinide
• rosiglitazone
• salicylates (non-asa)
• salsalate
• sargramostim
• saxagliptin
• sitagliptin
• somatropin
• sufentanil
• sulfasalazine
• tacrolimus
• testosterone
• testosterone buccal system
• testosterone topical
• tolazamide
• tolbutamide
• torsemide
• troleandomycin
• vesnarinone
• vildagliptin
• vinblastine
• vincristine
• vincristine liposomal
• vinorelbine
• willow bark
• zaleplon
• ziprasidone
• zolpidem
• zonisamide

Adverse Effects

• Allergic reactions: Anaphylactoid reaction, anaphylaxis, angioedema
• Cardiovascular: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction, edema, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis
• Dermatologic: Acne, allergic dermatitis, dry scaly skin, ecchymoses and petechiae, erythema, impaired wound healing, increased sweating, rash, striae, suppression of reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria
• Endocrine: Decreased carbohydrate and glucose tolerance, development of the cushingoid state, hyperglycemia, glycosuria, hirsutism, hypertrichosis, increased requirements for insulin or oral hypoglycemic agents in diabetes, manifestations of latent diabetes mellitus, menstrual irregularities, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in pediatric patients
• Fluid and electrolyte disturbances: Congestive heart failure in susceptible patients, fluid retention, hypokalemic alkalosis, potassium loss, sodium retention, tumor lysis syndrome
• Gastrointestinal: Abdominal distention, elevation in serum liver enzyme levels (usually reversible upon discontinuation), hepatomegaly, increased appetite, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with inflammatory bowel disease), ulcerative esophagitis
• Metabolic: Negative nitrogen balance due to protein catabolism
• Musculoskeletal: Aseptic necrosis of femoral and humeral heads, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures
• Neurological/Psychiatric: Convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychic disorders, vertigo
• Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts, vision blurred
• Other: Abnormal fat deposits, decreased resistance to infection, hiccups, increased or decreased motility and number of spermatozoa, malaise, moon face, weight gain

Warnings

Contraindications

• Systemic fungal infection
• Documented hypersensitivity
• Cerebral malaria
• Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids

Cautions

• Use with caution in cirrhosis, diverticulitis, myasthenia gravis, peptic ulcer disease, ulcerative colitis, renal insufficiency, pregnancy
• Average and large doses of corticosteroids can cause elevation of blood pressure, sodium and water retention, and increased excretion of potassium; these effects are less likely to occur with synthetic derivatives except when used in large doses; dietary salt restriction and potassium supplementation may be necessary; all corticosteroids increase calcium excretion
• Corticosteroids can produce reversible hypothalamic-pituitary adrenal (HPA) axis suppression with potential for glucocorticosteroid insufficiency after withdrawal of treatment; adrenocortical insufficiency may result from too rapid withdrawal; may be minimized by gradual reduction of dosage; relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, reinstitute hormone therapy; if patient is receiving steroids already, may increase dosage
• Metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients; changes in thyroid status of patient may necessitate adjustment in dosage
• May exacerbate systemic fungal infections
• Latent disease may be activated or there may be an exacerbation of intercurrent infections due to pathogens, including those caused by Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, toxoplasma; rule out latent amebiasis or active amebiasis before initiating corticosteroid therapy in any patient who has spent time in the tropics or any patient with unexplained diarrhea
• Use with great care in patients with known or suspected Strongyloides (threadworm) infestation; corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia; not for use in cerebral malaria
• Close observation necessary if corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity; reactivation of the disease may occur; during prolonged corticosteroid therapy, these patients should receive chemoprophylaxis
• Use of oral corticosteroids not recommended in treatment of optic neuritis and may lead to increase in risk of new episodes; corticosteroids should not be used in active ocular herpes simplex
• Use lowest possible dose to control condition under treatment; risk/benefit decision must be made in each individual case as to dose and duration of treatment and as to whether daily or intermittent therapy should be used
• May lead to inhibition of bone growth in pediatric patients and development of osteoporosis at any age; special consideration should be given to patients at increased risk of osteoporosis (e.g., postmenopausal women) before initiating corticosteroid therapy
• Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations; existing emotional instability or psychotic tendencies may also be aggravated by corticosteroids
• Thromboembolic disorders
• Myopathy has been reported
• Delayed wound healing
• If exposed to chickenpox, prophylaxis with varicella zoster immune globulin (VZIG) may be indicated; if exposed to measles, prophylaxis with immune globulin (IG) may be indicated; if chickenpox develops, treatment with antiviral agents should be considered
• Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored)
• Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy
• Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts with possible damage to optic nerves, and may enhance establishment of secondary ocular infections due to bacteria, fungi, or viruses; consider referral to ophthalmologist for patients who develop ocular symptoms or use corticosteroid-containing products for more than 6 weeks
• Prolonged therapy has been associated with development of Kaposi sarcoma
• May affect velocity growth in children; monitor routinely
• Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (eg, for Addison’s disease)

Epidural injection

• Serious neurologic events, some resulting in death, have been reported with epidural injection
• Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke
• These serious neurologic events have been reported with and without use of fluoroscopy
• Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use

Drug interaction overview

• Strong CYP3A4 inhibitors: Coadministration of strong and moderate CYP3A4 inhibitors increased dexamethasone exposure, which may increase the risk of adverse reactions
• Strong CYP3A4 inducers: Coadministration of strong CYP3A4 inducers may decrease dexamethasone exposure, which may result in loss of efficacy
• Cholestyramine: Cholestyramine may increase clearance of corticosteroids and potentially decrease corticosteroid exposure
• Anticholinesterases: Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hr before initiating corticosteroid therapy
• Ephedrine: Ephedrine may decrease dexamethasone exposure and may result in loss of efficacy. Consider increasing the dexamethasone dose when used with ephedrine
• Estrogens: Estrogens may decrease the hepatic metabolism of certain corticosteroids and increase exposures, which may increase the risk of adverse reactions
• CYP3A4 substrates: Coadministration of dexamethasone with substrates may decrease the concentration of these drugs, resulting in loss of efficacy of these drugs
• Oral anticoagulants: Coadministration of anticoagulants with corticosteroids may reduce the response to anticoagulants; frequently monitor coagulation indices to maintain the desired anticoagulant effect
• Amphotericin B injection and potassium-depleting agents: Sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroid; closely monitor potassium levels
• Antidiabetics: Corticosteroids may increase blood glucose concentrations; consider adjusting the dose of antidiabetic agents, as necessary
• Isoniazid: Serum concentrations of isoniazid may be decreased with corticosteroids
• Cyclosporine: Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. Convulsions have been reported with this concurrent use
• Digitalis glycosides: Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia
• Nonsteroidal Anti-Inflammatory Agents (NSAIDS): Concomitant use of aspirin (or other NSAIDS) and corticosteroids increases the risk of gastrointestinal side effects; clearance of salicylates may be increased with concurrent use of corticosteroids; monitor for toxicity
• Phenytoin: Reports of both increases and decreases in phenytoin levels with dexamethasone coadministration, leading to alterations in seizure control
• Vaccines: Patients on corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines due to inhibition of antibody response. Corticosteroids may also potentiate the replication of some organisms contained in live attenuated vaccines. If possible, defer routine administration of vaccines or toxoids until therapy is discontinued
• Concomitant therapies that may increase the risk of thromboembolism: Erythropoietic agents, or other agents that may increase the risk of thromboembolism, such as estrogen containing therapies, coadministered with dexamethasone may increase the risk of thromboembolism; monitor for risk of thromboembolism
• Thalidomide: Toxic epidermal necrolysis has been reported with concomitant use of thalidomide. Closely monitor for toxicity
• Skin tests: Corticosteroids may suppress reactions to skin tests

Safety Advice

🍺   Alcohol: Caution

Pharmacology

Mechanism of Action: Decreases inflammation by suppressing migration of polymorphonuclear leukocytes (PMNs) and reducing capillary permeability; stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentration, and inhibits prostaglandin and proinflammatory cytokines; suppresses lymphocyte proliferation through direct cytolysis, inhibits mitosis, breaks down granulocyte aggregates, and improves pulmonary microcirculation

Absorption

Onset: Between a few minutes and several hours; dependent on indication and route of administration

Peak serum time: 8hr (IM); 1-2 hr (PO)

Distribution: Vd: 2 L/kg

Metabolism: Metabolized in liver

Elimination: Half-life: 1.8-3.5 hr (normal renal function)

Excretion: Urine (mainly), feces (minimally)

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