22/10/2019 Decadron, Dexamethasone Intensol (dexamethasone) dosing, indications, interactions, adverse effects, and more

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dexamethasone (Rx)
Brand and Other Names: Decadron DSC, Dexamethasone Intensol, Baycadron, Hemady
Classes: Corticosteroids;
Anti-Inflammatory Agents

Dosing & Uses

Adult Pediatric

Dosage Forms & Strengths

tablet

0.5mg (generic)
0.75mg (generic)
1mg (generic)
1.5mg (generic)
2mg (generic)
4mg (generic)
6mg (generic)
20mg (Hemady)

injectable suspension

4mg/mL (generic)
10mg/mL (generic)

elixir/oral solution

0.5mg/5mL (generic, Baycadron)

oral concentrate

1mg/1mL (Dexamethasone Intensol)

Inflammation
0.75-9 mg/day IV/IM/PO divided q6-12hr

Intra-articular, intralesional, or soft tissue: 0.2-6 mg/day

Multiple Sclerosis (Acute Exacerbation)

30 mg/day PO for 1 week; follow by 4-12 mg/day for 1 mo

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22/10/2019 Decadron, Dexamethasone Intensol (dexamethasone) dosing, indications, interactions, adverse effects, and more

Cerebral Edema

10 mg IV, then 4 mg IM q6hr until clinical improvement is observed; may be reduced after 2-4 days
and gradually discontinued over 5-7 days

Shock

1-6 mg/kg IV once or 40 mg IV q2-6hr PRN

Alternative: 20 mg IV, then 3 mg/kg/day by continuous IV infusion

High-dose treatment not to be continued beyond 48-72 hours

Allergic Conditions

For control of severe or incapacitating allergic conditions intractable to adequate trials of conventional
treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or
seasonal allergic rhinitis, and serum sickness

Day 1: 4-8 mg IM

Days 2-3: 3 mg/day PO divided q12hr

Day 4: 1.5 mg/day PO divided q12hr

Days 5-6: 0.75 mg/day PO in single daily dose

Day 7: No treatment

Dexamethasone Suppression Test

Low-dose test

Screening for Cushing syndrome

Overnight test: 1 mg PO between 11:00 PM and midnight; cortisol level tested between 8:00 and
9:00 AM on following morning
Standard 2-day test: 0.5 mg PO q6hr (9:00 AM, 3:00 PM, 9:00 PM, 3:00 AM) for 2 days; cortisol
level tested 6 hours after final dose (9:00 AM)

High-dose test

Confirmed Cushing syndrome in which further workup is needed to identify whether hormone
excess is the result of Cushing syndrome or other causes
Standard 2-day test: After determination of baseline serum cortisol or 24-hr urinary free cortisol,
2 mg PO q6hr for 2 days; urine for free cortisol is collected during test, and serum cortisol is
checked 6 hours after final dose
Overnight test: After determination of baseline serum cortisol, 8 mg (typically) PO between 11:00
PM and midnight; cortisol level tested between 8:00 and 9:00 AM on following morning
IV test: After determination of baseline serum cortisol, 1 mg/hr by continuous IV infusion for 5-7
hours

Multiple Myeloma

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22/10/2019 Decadron, Dexamethasone Intensol (dexamethasone) dosing, indications, interactions, adverse effects, and more

Indicated in combination with other antimyeloma products for multiple myeloma (MM)

Note: Hemady is approved only for multiple myeloma

20 or 40 mg PO qDay on specific days as per specific treatment regimen

Refer to the prescribing information of the other antimyeloma products used in combination with
dexamethasone for specific dosing

Chemotherapy-Induced Nausea & Vomiting (Off-label)

8-12 mg PO/IV alone or in combination with other antiemetics before chemotherapy, then 8 mg PO/IV
q24hr for 1-3 days after chemotherapy (days 2-4)

Altitude Sickness (Off-label)

Prophylaxis

2 mg PO q6hr or 4 mg PO q12hr beginning on day of ascent; may be discontinued after 2- to 3-

day stay at same elevation or initiation of descent

Treatment

Acute mountain sickness (AMS): 4 mg PO/IV/IM q6hr

High-altitude cerebral edema (HACE): 8 mg once followed by 4 mg PO/IV/IM q6hr until
symptoms resolve

Spinal Cord Compression (Off-label)

10-100 mg IV, then 4-24 mg IV q6hr during radiation therapy, then tapered

Dosage Forms & Strengths

tablet

0.5mg (generic)
0.75mg (generic)
1mg (generic)
1.5mg (generic)
2mg (generic)
4mg (generic)
6mg (generic)
20mg (Hemady)

injectable suspension

4mg/mL (generic)
10mg/mL (generic)

elixir/oral solution

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22/10/2019 Decadron, Dexamethasone Intensol (dexamethasone) dosing, indications, interactions, adverse effects, and more

0.5mg/5mL (generic, Baycadron)

oral concentrate

1mg/1mL (Dexamethasone Intensol)

Airway Edema

0.5-2 mg/kg/day PO/IV/IM divided q6hr, starting 24 hours before extubation and continued for 4-6
doses afterward

Croup
0.6 mg/kg PO/IV/IM once; not to exceed 16 mg

Inflammation

0.08-0.3 mg/kg/day IV/PO/IM divided q6hr or q12hr

Meningitis
>6 weeks: 0.6 mg/kg/day IV divided q6hr for first 2-4 days of antibiotic therapy, starting 10-20 minutes
before or simultaneously with first antibiotic dose

Cerebral Edema Associated With Brain Tumor

1-2 mg/kg IV/IM once; maintenance: 1-1.5 mg/kg/day IV/IM divided q4-6hr; not to exceed 16 mg/day

Spinal Cord Compression

2 mg/kg/day IV divided q6hr

Adrenal Cortical Hyperfunction Test

After determination of baseline cortisol level, 1 mg PO at bedtime

Plasma cortisol level then determined at 8:00 AM on following morning; level will be decreased in
normal individuals but at baseline level in Cushing syndrome

Respiratory Distress Syndrome in Premature Infants (Off-label)

Prophylaxis

4 mg IM q8hr administered to mother for 2 days before delivery

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