Dexamethasone

PHARMACOLOGY

Decreases inflammation by changing the permeability of capillaries and decreasing neutrophil migration.
In comparison to many other corticosteroids, dexamethasone has high glucorticoid activity but insignificant mineralocorticoid effect.

Duration of action: 36-54 h
Time to peak plasma: 1-2 h PO, 8 h SC

DOSING

  • Anorexia: 2-4 mg once daily PO
  • Anti-emetic: 2-4-8 mg once daily-bid PO
  • Raised intracranial pressure: 8-20 mg once daily PO
  • Spinal cord compression: 16 mg once daily PO
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  • 2-5 years: 0.5-1 mg bid PO/SC/IV
  • 6-12 years: 1-2 mg bid PO/SC/IV
  • 12 (plus): 2-4 mg bid PO/SC/IV

UNWANTED EFFECTS

  • Short term: hyperglycemia and diabetes mellitus, increased susceptibility to infection (e.g. thrush), mental disturbances (insomnia, depression, euphoria, paranoid psychosis), peptic ulceration (especially if given with an NSAID)
  • Longer term: muscles wasting and weakness, osteoporosis, Cushing’s syndrome (moonface, striae, acne), avascular bone necrosis

PITFALLS/CONCERNS

  • May exacerbate or precipitate diabetes mellitus
  • Abrupt cessation of corticosteroids can precipitate an adrenal crisis
  • If used with NSAIDs there is a high risk of peptic ulceration

NOTE

This information is drawn from a number of sources (see below). The reader is encouraged to access these and other relevant literature for more detail. As always, sound clinical judgment should be used in individual clinical cases. In particular, it should be remembered that there may be significant variation in the pharmokinetics of a drug resulting from a number of factors, including the individual patient’s metabolism/disease status and how the medication has been formulated.

SOURCES/REFERENCES

  1. Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman’s: the pharmacological basis of therapeutics. 11th ed. McGraw-Hill Professional; 2006.
  2. Twycross R, Wilcock A. Palliative care formulary. 3rd ed. Radcliffe Medical Press Ltd; 2008.
  3. Repchinsky C, editor. Compendium of pharmaceuticals and specialties (CPS): the Canadian drug reference for health professionals. 44th ed. Canadian Pharmacists Association; 2009.
  4. Goldman A, Hain R, Liben S. Oxford textbook of palliative care for children. 1st ed. Oxford University Press; 2006.

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