Decadron 4mg Tablets
It is used for many health problems like allergy signs, asthma, adrenal gland problems, blood problems, skin rashes, or swelling problems. This is not a list of all health problems that this drug may be used for. Talk with the doctor.
Drug Class
Adrenal corticosteroid; Anti-inflammatory agent; Immunosuppressant
Pharmacologic Class
Glucocorticoid
Pregnancy Category
Category C
FDA Approved
May 1958
DEA Schedule
Not Controlled
Overview
What is this medicine?
Dexamethasone is a type of steroid medicine that works like a natural hormone your body makes. It's used to reduce swelling, inflammation, and allergic reactions, and to suppress the immune system. It can treat many conditions like arthritis, severe allergies, asthma, certain blood disorders, and some cancers.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely.
If you take your medication once a day, it's best to take it in the morning.
Take your medication with food to help prevent stomach upset.
Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel well.
If you're also taking cholestyramine, you may need to take it at a different time than your other medication. Be sure to talk to your pharmacist about the best schedule for your medications.
Storing and Disposing of Your Medication
To keep your medication safe and effective:
Store it at room temperature in a dry place, away from the bathroom.
Keep all medications in a safe location, out of the reach of children and pets.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist.
Check with your pharmacist for guidance on the best way to dispose of your medication. You may also want to ask about drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However:
If it's close to the time for your next dose, skip the missed dose and return to your regular schedule.
* Do not take two doses at the same time or take extra doses to make up for a missed one.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely.
If you take your medication once a day, it's best to take it in the morning.
Take your medication with food to help prevent stomach upset.
Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel well.
If you're also taking cholestyramine, you may need to take it at a different time than your other medication. Be sure to talk to your pharmacist about the best schedule for your medications.
Storing and Disposing of Your Medication
To keep your medication safe and effective:
Store it at room temperature in a dry place, away from the bathroom.
Keep all medications in a safe location, out of the reach of children and pets.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist.
Check with your pharmacist for guidance on the best way to dispose of your medication. You may also want to ask about drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However:
If it's close to the time for your next dose, skip the missed dose and return to your regular schedule.
* Do not take two doses at the same time or take extra doses to make up for a missed one.
Lifestyle & Tips
- Take with food or milk to reduce stomach upset.
- Do not stop taking this medicine suddenly, especially if you've been on it for a long time or at high doses. Your doctor will tell you how to slowly reduce your dose to prevent withdrawal symptoms.
- Avoid contact with people who are sick or have infections (e.g., chickenpox, measles) as this medicine can weaken your immune system.
- Report any signs of infection (fever, sore throat, body aches) to your doctor immediately.
- Limit salt intake to help prevent fluid retention and high blood pressure.
- Eat a diet rich in potassium (e.g., bananas, oranges) and calcium/Vitamin D (e.g., dairy, fortified foods) to counteract potential side effects.
- Regular exercise, including weight-bearing activities, can help maintain bone health.
- Carry a steroid identification card or wear medical alert jewelry if on long-term therapy, indicating you are taking a steroid.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Highly variable depending on indication. Typical initial dose for many inflammatory conditions: 0.75 mg to 9 mg daily, in single or divided doses.
Dose Range:
0.75 - 40 mg
Condition-Specific Dosing:
Inflammatory/Allergic Conditions:
0.75 mg to 9 mg daily, in single or divided doses. Tapering often required.
Cerebral Edema:
Initial: 10 mg IV, then 4 mg IM/IV every 6 hours until symptoms subside. Oral maintenance: 1-3 mg 3 times daily.
Multiple Myeloma:
40 mg orally once weekly (often in combination with other agents).
COVID-19 (severe):
6 mg orally or IV once daily for up to 10 days.
Pediatric Dosing
Neonatal:
Not established for routine use; specific conditions (e.g., bronchopulmonary dysplasia) may use 0.05-0.1 mg/kg/day divided every 12-24 hours, for short courses.
Infant:
Not established for routine use; specific conditions (e.g., croup, asthma exacerbation) may use 0.25-0.6 mg/kg/day (max 10 mg/day) for short courses.
Child:
0.02-0.3 mg/kg/day (max 10 mg/day) orally in 1-4 divided doses, depending on indication (e.g., asthma, croup, antiemetic).
Adolescent:
Dosing similar to adult for specific indications, adjusted by weight/surface area as appropriate.
Dose Adjustments
Renal Impairment:
Mild:
No specific dose adjustment required.
Moderate:
No specific dose adjustment required.
Severe:
No specific dose adjustment required.
Dialysis:
Dexamethasone is not significantly removed by hemodialysis. No supplemental dose needed post-dialysis.
Hepatic Impairment:
Mild:
No specific dose adjustment required.
Moderate:
No specific dose adjustment required.
Severe:
Use with caution; monitor for increased side effects due to altered metabolism. Dose adjustment may be considered based on clinical response and adverse effects, but no specific guidelines.
Pharmacology
Mechanism of Action
Dexamethasone is a synthetic adrenocortical steroid that is approximately 25 times more potent than hydrocortisone and 5 times more potent than prednisone. It binds to specific intracellular glucocorticoid receptors in target tissues, forming a steroid-receptor complex that translocates to the nucleus. This complex then interacts with DNA (glucocorticoid response elements), modulating gene transcription. This leads to the synthesis of anti-inflammatory proteins (e.g., lipocortin-1) and inhibition of pro-inflammatory mediators (e.g., cytokines, prostaglandins, leukotrienes), resulting in potent anti-inflammatory, immunosuppressive, and anti-allergic effects. It also affects carbohydrate, protein, and fat metabolism, and maintains vascular integrity.
Pharmacokinetics
Absorption:
Bioavailability:
80-90% (oral)
Tmax:
1-2 hours (oral)
FoodEffect:
Food may slightly delay absorption but does not significantly affect the extent of absorption.
Distribution:
Vd:
0.8 L/kg
ProteinBinding:
77% (primarily to albumin, less to corticosteroid-binding globulin)
CnssPenetration:
Yes (readily crosses blood-brain barrier)
Elimination:
HalfLife:
3-4.5 hours (plasma half-life); 36-54 hours (biological half-life)
Clearance:
Not readily available, but primarily hepatic metabolism followed by renal excretion.
ExcretionRoute:
Renal (as inactive metabolites)
Unchanged:
<10%
Pharmacodynamics
OnsetOfAction:
Hours to days (depending on indication and route)
PeakEffect:
Variable, often within 1-2 days for anti-inflammatory effects, but can be immediate for some acute effects.
DurationOfAction:
Biological half-life of 36-54 hours, allowing for once-daily dosing for many indications.
Confidence:
Medium
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Signs of infection: fever, chills, severe sore throat, ear or sinus pain, cough, increased or discolored sputum, painful urination, mouth sores, or a wound that won't heal.
Signs of low potassium levels: muscle pain or weakness, muscle cramps, or an irregular heartbeat.
Signs of pancreatitis (pancreas problems): severe abdominal pain, severe back pain, or severe nausea and vomiting.
Signs of high blood pressure: severe headache, dizziness, fainting, or changes in vision.
Signs of adrenal gland problems: severe nausea and vomiting, severe dizziness or fainting, muscle weakness, fatigue, mood changes, decreased appetite, or weight loss.
Signs of Cushing's syndrome: weight gain in the upper back or abdomen, moon face, severe headache, or slow wound healing.
Signs of high blood sugar: confusion, drowsiness, excessive thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath.
Shortness of breath, sudden weight gain, or swelling in the arms or legs.
Skin changes: acne, stretch marks, slow healing, or excessive hair growth.
Purple, red, blue, brown, or black spots or patches on the skin or in the mouth.
Abnormal heartbeat, chest pain, or pressure.
Swelling, warmth, numbness, color changes, or pain in a leg or arm.
Changes in menstrual periods.
Bone or joint pain.
Muscle pain or weakness.
Changes in vision.
Changes in behavior or mood.
Seizures.
Unusual burning, numbness, or tingling sensations.
Unexplained bruising or bleeding.
Severe abdominal pain.
Black, tarry, or bloody stools, or vomiting blood or coffee ground-like material.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for advice:
Nausea or vomiting.
Difficulty sleeping.
Restlessness.
Excessive sweating.
Hair thinning.
Headache.
Dizziness, fatigue, or weakness.
Weight gain.
Increased appetite.
* Hiccups.
This is not an exhaustive list of possible side effects. If you have questions or concerns, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Signs of infection: fever, chills, severe sore throat, ear or sinus pain, cough, increased or discolored sputum, painful urination, mouth sores, or a wound that won't heal.
Signs of low potassium levels: muscle pain or weakness, muscle cramps, or an irregular heartbeat.
Signs of pancreatitis (pancreas problems): severe abdominal pain, severe back pain, or severe nausea and vomiting.
Signs of high blood pressure: severe headache, dizziness, fainting, or changes in vision.
Signs of adrenal gland problems: severe nausea and vomiting, severe dizziness or fainting, muscle weakness, fatigue, mood changes, decreased appetite, or weight loss.
Signs of Cushing's syndrome: weight gain in the upper back or abdomen, moon face, severe headache, or slow wound healing.
Signs of high blood sugar: confusion, drowsiness, excessive thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath.
Shortness of breath, sudden weight gain, or swelling in the arms or legs.
Skin changes: acne, stretch marks, slow healing, or excessive hair growth.
Purple, red, blue, brown, or black spots or patches on the skin or in the mouth.
Abnormal heartbeat, chest pain, or pressure.
Swelling, warmth, numbness, color changes, or pain in a leg or arm.
Changes in menstrual periods.
Bone or joint pain.
Muscle pain or weakness.
Changes in vision.
Changes in behavior or mood.
Seizures.
Unusual burning, numbness, or tingling sensations.
Unexplained bruising or bleeding.
Severe abdominal pain.
Black, tarry, or bloody stools, or vomiting blood or coffee ground-like material.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for advice:
Nausea or vomiting.
Difficulty sleeping.
Restlessness.
Excessive sweating.
Hair thinning.
Headache.
Dizziness, fatigue, or weakness.
Weight gain.
Increased appetite.
* Hiccups.
This is not an exhaustive list of possible side effects. If you have questions or concerns, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe mood changes (depression, anxiety, irritability, euphoria)
- Swelling in your hands, ankles, or feet
- Unusual weight gain
- Muscle weakness or pain
- Vision problems (blurred vision, eye pain)
- Increased thirst or urination (signs of high blood sugar)
- Black, tarry stools or severe stomach pain (signs of GI bleeding)
- Signs of infection (fever, chills, sore throat, body aches, cough, painful urination)
- Slow wound healing
- Easy bruising or thinning skin
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
The presence of any infection, including bacterial, viral, or fungal infections, as well as specific conditions like:
+ Amoeba infection (e.g., traveler's diarrhea)
+ Herpes infection of the eye
+ Malaria infection in the brain
+ Threadworm infestation
+ Any other type of infection
Nerve problems affecting the eye
Stomach or bowel problems, including:
+ Diverticulitis
+ Ulcerative colitis
+ Ulcers
+ Recent bowel surgery
This list is not exhaustive, and it is crucial to disclose all your health issues and medications to your doctor. Provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Natural products and vitamins you are using
* Any health problems you have
Your doctor will assess the safety of taking this medication with your existing health conditions and medications. Do not initiate, stop, or adjust the dosage of any medication without consulting your doctor first.
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
The presence of any infection, including bacterial, viral, or fungal infections, as well as specific conditions like:
+ Amoeba infection (e.g., traveler's diarrhea)
+ Herpes infection of the eye
+ Malaria infection in the brain
+ Threadworm infestation
+ Any other type of infection
Nerve problems affecting the eye
Stomach or bowel problems, including:
+ Diverticulitis
+ Ulcerative colitis
+ Ulcers
+ Recent bowel surgery
This list is not exhaustive, and it is crucial to disclose all your health issues and medications to your doctor. Provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Natural products and vitamins you are using
* Any health problems you have
Your doctor will assess the safety of taking this medication with your existing health conditions and medications. Do not initiate, stop, or adjust the dosage of any medication without consulting your doctor first.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Your doctor will likely recommend regular blood tests to monitor your condition. If you are taking this medication long-term, you may also need to have your eye pressure and bone density checked.
This medication can affect the results of certain laboratory tests. Be sure to notify all your healthcare providers and laboratory personnel that you are taking this medication.
There is a risk of developing high blood pressure while taking this medication. Your doctor will monitor your blood pressure regularly, so it is crucial to follow their instructions for checking your blood pressure.
This medication may interfere with allergy skin tests. Inform your doctor and laboratory personnel that you are taking this medication to ensure accurate test results.
Long-term use of this medication may increase the risk of developing cataracts or glaucoma. Discuss this potential risk with your doctor.
Prolonged use of this medication can also lead to weak bones (osteoporosis). Talk to your doctor to determine if you are at higher risk of developing osteoporosis or if you have any questions about this potential side effect.
You may need to reduce your salt intake and increase your potassium consumption while taking this medication. Consult with your doctor to determine the best course of action.
If you have diabetes, it is crucial to closely monitor your blood sugar levels while taking this medication.
Before consuming alcohol, discuss the potential risks with your doctor. Additionally, consult with your doctor before receiving any vaccinations, as some vaccines may not be effective or may increase the risk of infection when taken with this medication.
It is essential to avoid close contact with individuals who have chickenpox or measles, as these infections can be severe or even life-threatening in people taking steroid medications like this one. If you have been exposed to chickenpox or measles, inform your doctor immediately. Steroid medications, including this one, can increase the risk of infection, which can be mild or severe. To minimize this risk, wash your hands frequently, avoid close contact with individuals who have infections, colds, or flu, and notify your doctor if you experience any signs of infection.
In some cases, this medication can reactivate latent infections, such as tuberculosis or hepatitis B. Inform your doctor if you have a history of these infections.
This medication can suppress the production of natural steroids in your body. If you experience fever, infection, surgery, or injury, inform your doctor, as your body's response to these stresses may be affected. You may require additional doses of steroid medication in these situations.
If you have been taking this medication for an extended period, consult with your doctor before stopping or reducing the dosage. You may need to gradually taper off the medication to avoid withdrawal symptoms. If you have missed a dose or recently stopped taking this medication and experience fatigue, weakness, shakiness, rapid heartbeat, confusion, sweating, or dizziness, inform your doctor immediately.
Long-term use of this medication has been associated with an increased risk of developing Kaposi's sarcoma, a type of cancer. Discuss this potential risk with your doctor. Additionally, patients with cancer may be at higher risk of developing tumor lysis syndrome (TLS), a potentially life-threatening condition. Inform your doctor if you have cancer.
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
This medication can affect growth in children and adolescents. Regular growth checks may be necessary to monitor the potential impact of this medication on growth and development. Discuss this potential risk with your doctor.
This medication may lower sperm counts in some individuals. If you have concerns about fertility, consult with your doctor.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor to discuss the potential benefits and risks of this medication. If you took this medication during pregnancy, inform your baby's doctor.
It is crucial to follow your doctor's instructions and attend all scheduled appointments to minimize the risks associated with this medication and ensure the best possible outcome.
This medication can affect the results of certain laboratory tests. Be sure to notify all your healthcare providers and laboratory personnel that you are taking this medication.
There is a risk of developing high blood pressure while taking this medication. Your doctor will monitor your blood pressure regularly, so it is crucial to follow their instructions for checking your blood pressure.
This medication may interfere with allergy skin tests. Inform your doctor and laboratory personnel that you are taking this medication to ensure accurate test results.
Long-term use of this medication may increase the risk of developing cataracts or glaucoma. Discuss this potential risk with your doctor.
Prolonged use of this medication can also lead to weak bones (osteoporosis). Talk to your doctor to determine if you are at higher risk of developing osteoporosis or if you have any questions about this potential side effect.
You may need to reduce your salt intake and increase your potassium consumption while taking this medication. Consult with your doctor to determine the best course of action.
If you have diabetes, it is crucial to closely monitor your blood sugar levels while taking this medication.
Before consuming alcohol, discuss the potential risks with your doctor. Additionally, consult with your doctor before receiving any vaccinations, as some vaccines may not be effective or may increase the risk of infection when taken with this medication.
It is essential to avoid close contact with individuals who have chickenpox or measles, as these infections can be severe or even life-threatening in people taking steroid medications like this one. If you have been exposed to chickenpox or measles, inform your doctor immediately. Steroid medications, including this one, can increase the risk of infection, which can be mild or severe. To minimize this risk, wash your hands frequently, avoid close contact with individuals who have infections, colds, or flu, and notify your doctor if you experience any signs of infection.
In some cases, this medication can reactivate latent infections, such as tuberculosis or hepatitis B. Inform your doctor if you have a history of these infections.
This medication can suppress the production of natural steroids in your body. If you experience fever, infection, surgery, or injury, inform your doctor, as your body's response to these stresses may be affected. You may require additional doses of steroid medication in these situations.
If you have been taking this medication for an extended period, consult with your doctor before stopping or reducing the dosage. You may need to gradually taper off the medication to avoid withdrawal symptoms. If you have missed a dose or recently stopped taking this medication and experience fatigue, weakness, shakiness, rapid heartbeat, confusion, sweating, or dizziness, inform your doctor immediately.
Long-term use of this medication has been associated with an increased risk of developing Kaposi's sarcoma, a type of cancer. Discuss this potential risk with your doctor. Additionally, patients with cancer may be at higher risk of developing tumor lysis syndrome (TLS), a potentially life-threatening condition. Inform your doctor if you have cancer.
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
This medication can affect growth in children and adolescents. Regular growth checks may be necessary to monitor the potential impact of this medication on growth and development. Discuss this potential risk with your doctor.
This medication may lower sperm counts in some individuals. If you have concerns about fertility, consult with your doctor.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor to discuss the potential benefits and risks of this medication. If you took this medication during pregnancy, inform your baby's doctor.
It is crucial to follow your doctor's instructions and attend all scheduled appointments to minimize the risks associated with this medication and ensure the best possible outcome.
Overdose Information
Overdose Symptoms:
- Acute overdose is rare and usually does not cause life-threatening problems.
- Symptoms may include increased side effects such as fluid retention, high blood pressure, hyperglycemia, and psychiatric disturbances.
What to Do:
Call 1-800-222-1222 (Poison Control Center) immediately. Treatment is generally supportive and symptomatic. Long-term high-dose exposure may require gradual withdrawal.
Drug Interactions
Major Interactions
- Live or live attenuated vaccines (risk of disseminated infection)
- Mifepristone (antagonizes corticosteroid effects)
- Aminoglutethimide (may decrease dexamethasone efficacy)
- Barbiturates, Carbamazepine, Phenytoin, Rifampin (CYP3A4 inducers, decrease dexamethasone levels)
- Ketoconazole, Itraconazole, Ritonavir, Cobicistat (CYP3A4 inhibitors, increase dexamethasone levels)
- Warfarin (may alter anticoagulant effect, monitor INR)
- NSAIDs (increased risk of GI ulceration/bleeding)
- Diuretics (thiazide and loop) (increased risk of hypokalemia)
- Antidiabetic agents (may increase blood glucose, requiring dose adjustment)
Moderate Interactions
- Cyclosporine (increased levels of both drugs, increased risk of seizures)
- Digoxin (increased risk of digitalis toxicity with hypokalemia)
- Neuromuscular blockers (prolonged weakness/myopathy with high-dose corticosteroids)
- Oral contraceptives/Estrogens (may increase dexamethasone effects)
- Salicylates (decreased salicylate levels, increased risk of GI bleeding)
- Anticholinesterase agents (may cause severe weakness in myasthenia gravis patients)
Minor Interactions
- Grapefruit juice (mild CYP3A4 inhibition, potential for slight increase in dexamethasone levels)
Monitoring
Baseline Monitoring
Blood Pressure
Rationale: Corticosteroids can cause fluid retention and hypertension.
Timing: Prior to initiation
Serum Electrolytes (Na, K, Ca)
Rationale: Risk of hypokalemia, hypernatremia, and hypocalcemia.
Timing: Prior to initiation
Blood Glucose
Rationale: Risk of hyperglycemia, especially in predisposed individuals.
Timing: Prior to initiation
Bone Mineral Density (DEXA scan)
Rationale: Long-term use increases risk of osteoporosis.
Timing: Prior to initiation for anticipated long-term therapy
Ophthalmologic Exam (intraocular pressure)
Rationale: Risk of cataracts and glaucoma with prolonged use.
Timing: Prior to initiation for anticipated long-term therapy
Complete Blood Count (CBC)
Rationale: May cause leukocytosis, lymphopenia, eosinopenia.
Timing: Prior to initiation
Routine Monitoring
Blood Pressure
Frequency: Regularly (e.g., weekly to monthly, depending on duration)
Target: Within patient's normal range
Action Threshold: Sustained elevation requiring intervention
Serum Electrolytes (K)
Frequency: Periodically (e.g., monthly for long-term therapy)
Target: 3.5-5.0 mEq/L
Action Threshold: <3.5 mEq/L
Blood Glucose
Frequency: Periodically (e.g., weekly to monthly, more frequently in diabetics)
Target: Fasting <100 mg/dL, Postprandial <140 mg/dL
Action Threshold: Sustained elevation, especially >200 mg/dL
Weight
Frequency: Weekly to monthly
Target: Stable
Action Threshold: Significant, rapid weight gain (fluid retention)
Growth (pediatric patients)
Frequency: Regularly (e.g., every 3-6 months)
Target: Normal growth curve
Action Threshold: Growth retardation
Signs of Infection
Frequency: Ongoing clinical assessment
Target: Absence of fever, localized pain, redness, swelling
Action Threshold: Presence of signs/symptoms of infection
Symptom Monitoring
- Mood changes (irritability, anxiety, depression, euphoria)
- Sleep disturbances (insomnia)
- Increased appetite/weight gain
- Fluid retention/edema
- Muscle weakness/fatigue
- Easy bruising/thinning skin
- Gastrointestinal upset (heartburn, indigestion)
- Vision changes
- Signs of infection (fever, sore throat, cough, painful urination)
- Adrenal insufficiency symptoms upon withdrawal (fatigue, weakness, nausea, vomiting, hypotension)
Special Patient Groups
Pregnancy
Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Animal studies have shown teratogenic effects. Human data are limited but suggest a potential for adverse effects, particularly with prolonged or high-dose use.
Trimester-Specific Risks:
First Trimester:
Potential for increased risk of oral clefts, though human data are inconsistent and overall risk appears low.
Second Trimester:
Risk of fetal growth restriction, adrenal suppression, and premature rupture of membranes with prolonged use.
Third Trimester:
Risk of fetal adrenal suppression, which may require monitoring of the neonate for signs of hypoadrenalism.
Lactation
L3 (Moderately Safe). Dexamethasone is excreted into breast milk. Low doses are generally considered compatible with breastfeeding, but high or prolonged doses may cause adverse effects in the infant (e.g., growth suppression, interference with endogenous corticosteroid production).
Infant Risk:
Potential for growth suppression, adrenal suppression, and other corticosteroid-related side effects. Monitor infant for signs of adverse effects. Consider using the lowest effective dose and avoiding prolonged use.
Pediatric Use
Corticosteroids can cause growth retardation in children. Long-term use should be carefully monitored, and the lowest effective dose should be used. Increased susceptibility to infections. Monitor for signs of Cushing's syndrome and intracranial hypertension.
Geriatric Use
Elderly patients may be more susceptible to the adverse effects of corticosteroids, particularly osteoporosis, fluid retention, hypertension, and diabetes. Close monitoring is recommended.
Clinical Information
Clinical Pearls
- Always taper the dose of dexamethasone gradually when discontinuing, especially after prolonged therapy, to prevent adrenal insufficiency.
- Administer with food or milk to minimize gastrointestinal irritation.
- Consider alternate-day therapy for long-term use to minimize adrenal suppression and other side effects, if clinically appropriate.
- Patients on corticosteroids are at increased risk of infection; advise them to report any signs of infection promptly.
- Monitor blood glucose levels closely, especially in diabetic or pre-diabetic patients, as corticosteroids can cause hyperglycemia.
- Educate patients about potential psychiatric side effects (mood changes, insomnia) and to report them to their healthcare provider.
- Long-term use necessitates monitoring for bone density, cataracts, and glaucoma.
Alternative Therapies
- NSAIDs (for inflammatory conditions, less potent)
- Immunosuppressants (e.g., methotrexate, azathioprine, cyclosporine for autoimmune diseases)
- Biologic agents (for specific inflammatory/autoimmune conditions)
- Disease-modifying antirheumatic drugs (DMARDs) for rheumatic diseases
Cost & Coverage
Average Cost:
Varies widely, typically $10-$50 per 30 tablets (4mg)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.