Taperdex 7-Day Pak
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
Glucocorticoid; Anti-inflammatory; Immunosuppressant
Pharmacologic Class
Corticosteroid
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 by reducing inflammation (swelling and irritation) and suppressing the immune system. It's used to treat many conditions like allergies, asthma, arthritis, and certain skin or blood disorders. The Taperdex 7-Day Pak is designed to help you gradually reduce your dose over a week to minimize side effects.
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 effective and safe:
Store it at room temperature in a dry place, avoiding 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 medications. You may also want to explore 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 scheduled dose, skip the missed dose and resume your regular dosing schedule.
* Do not take two doses at the same time or take extra doses to make up for a missed dose.
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 effective and safe:
Store it at room temperature in a dry place, avoiding 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 medications. You may also want to explore 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 scheduled dose, skip the missed dose and resume your regular dosing schedule.
* Do not take two doses at the same time or take extra doses to make up for a missed dose.
Lifestyle & Tips
- Take exactly as prescribed, especially following the tapering schedule of the 7-Day Pak. Do not stop abruptly without consulting your doctor.
- Take with food or milk to reduce stomach upset.
- Avoid contact with people who are sick or have infections, as this medicine can weaken your immune system.
- Report any signs of infection (fever, chills, sore throat) immediately.
- Monitor blood sugar if you have diabetes, as this medicine can increase blood glucose levels.
- Limit sodium intake to help prevent fluid retention.
- Ensure adequate calcium and vitamin D intake, especially with longer-term use, to protect bone health.
- Carry a steroid warning card if on long-term therapy, indicating you are taking a corticosteroid.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
Taperdex 7-Day Pak follows a pre-determined tapering schedule. For general dexamethasone, initial dose varies widely based on condition, typically 0.75 mg to 9 mg daily.
Dose Range:
0.75 - 9 mg
Condition-Specific Dosing:
Taperdex 7-Day Pak:
Follow specific instructions on the Taperdex 7-Day Pak, which typically involves a decreasing dose over 7 days (e.g., Day 1: 6 tablets, Day 2: 5 tablets, etc., of a specific strength like 1.5 mg or 0.75 mg).
Inflammatory/Immunosuppressive:
0.75 mg to 9 mg daily, in single or divided doses, adjusted based on patient response and tolerance.
Cerebral Edema:
10 mg IV initially, then 4 mg IM/IV every 6 hours until symptoms subside.
Pediatric Dosing
Neonatal:
Not established for routine use; specific conditions (e.g., bronchopulmonary dysplasia) may use 0.05-0.1 mg/kg/day in divided doses.
Infant:
Dosing highly individualized based on condition and weight (e.g., 0.02-0.3 mg/kg/day in divided doses).
Child:
Dosing highly individualized based on condition and weight (e.g., 0.02-0.3 mg/kg/day in divided doses). For anti-inflammatory/immunosuppressive: 0.08-0.3 mg/kg/day or 2.5-10 mg/m2/day in 1-4 divided doses.
Adolescent:
Similar to adult dosing, highly individualized based on condition.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment needed.
Moderate:
No specific adjustment needed.
Severe:
No specific adjustment needed.
Dialysis:
Not significantly removed by dialysis; no supplemental dose needed.
Hepatic Impairment:
Mild:
No specific adjustment needed.
Moderate:
May require dose reduction in severe hepatic impairment due to altered metabolism and clearance.
Severe:
Consider dose reduction and monitor for increased side effects.
Pharmacology
Mechanism of Action
Dexamethasone is a synthetic adrenocortical steroid that is approximately 25 times more potent than hydrocortisone and 5-10 times more potent than prednisone. It binds to specific cytoplasmic glucocorticoid receptors in target tissues, forming a steroid-receptor complex that translocates into the nucleus. This complex then binds to specific DNA sequences (glucocorticoid response elements), modulating gene transcription. This leads to the synthesis of anti-inflammatory proteins (e.g., lipocortin) and inhibition of pro-inflammatory mediators (e.g., prostaglandins, leukotrienes, cytokines like IL-1, IL-6, TNF-alpha). It also suppresses immune responses by inhibiting the function of lymphocytes and macrophages.
Pharmacokinetics
Absorption:
Bioavailability:
80-90%
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:
Approximately 77% (primarily to albumin, less to corticosteroid-binding globulin)
CnssPenetration:
Yes (readily crosses the blood-brain barrier)
Elimination:
HalfLife:
Plasma half-life: 3-4.5 hours; Biological half-life: 36-54 hours
Clearance:
Approximately 2.8-4.3 mL/min/kg
ExcretionRoute:
Renal (primarily 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
DurationOfAction:
Biological effects persist for 36-72 hours due to long biological half-life, even after plasma levels decline.
Safety & Warnings
Side Effects
Serious 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 experience any of the following symptoms, contact your doctor or seek medical attention immediately:
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, trouble 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 changed sputum production, 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 problem): severe stomach pain, severe back pain, or severe nausea and vomiting.
Signs of high blood pressure: severe headache or 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, increased 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 bumps or patches on the skin or in the mouth.
Abnormal heartbeat: fast, slow, or irregular.
Chest pain or pressure.
Swelling, warmth, numbness, color changes, or pain in a leg or arm.
Changes in menstrual period.
Bone or joint pain.
Muscle pain or weakness.
Changes in vision.
Changes in behavior or mood.
Seizures.
Burning, numbness, or tingling sensations.
Unexplained bruising or bleeding.
Severe stomach pain.
Black, tarry, or bloody stools, or vomiting blood or coffee ground-like material.
Other Side Effects
Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you experience any of the following side effects, or if they bother you or don't go away, contact your doctor:
Nausea or vomiting.
Insomnia.
Restlessness.
Excessive sweating.
Hair thinning.
Headache.
Dizziness, fatigue, or weakness.
Weight gain.
Increased appetite.
Hiccups.
This is not a complete list of possible side effects. If you have questions or concerns about side effects, contact 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 experience any of the following symptoms, contact your doctor or seek medical attention immediately:
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, trouble 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 changed sputum production, 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 problem): severe stomach pain, severe back pain, or severe nausea and vomiting.
Signs of high blood pressure: severe headache or 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, increased 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 bumps or patches on the skin or in the mouth.
Abnormal heartbeat: fast, slow, or irregular.
Chest pain or pressure.
Swelling, warmth, numbness, color changes, or pain in a leg or arm.
Changes in menstrual period.
Bone or joint pain.
Muscle pain or weakness.
Changes in vision.
Changes in behavior or mood.
Seizures.
Burning, numbness, or tingling sensations.
Unexplained bruising or bleeding.
Severe stomach pain.
Black, tarry, or bloody stools, or vomiting blood or coffee ground-like material.
Other Side Effects
Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you experience any of the following side effects, or if they bother you or don't go away, contact your doctor:
Nausea or vomiting.
Insomnia.
Restlessness.
Excessive sweating.
Hair thinning.
Headache.
Dizziness, fatigue, or weakness.
Weight gain.
Increased appetite.
Hiccups.
This is not a complete list of possible side effects. If you have questions or concerns about side effects, contact 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:
- Signs of infection: fever, chills, sore throat, body aches, flu symptoms, cough, shortness of breath, painful urination, unusual sores.
- High blood sugar: increased thirst, increased urination, dry mouth, fruity breath odor.
- Fluid retention: swelling in your hands, ankles, or feet; rapid weight gain.
- Mood changes: severe depression, unusual thoughts or behavior, seizures.
- Gastrointestinal issues: severe stomach pain, black/tarry stools, vomiting blood.
- Adrenal insufficiency (if stopped too quickly): severe weakness, dizziness, nausea, vomiting, loss of appetite, joint/muscle pain.
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 discuss all your health conditions and medications with your doctor. Please inform your doctor and pharmacist about:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* Your complete medical history, including any health problems
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to ensure your safety. It is vital to verify that it is safe to take this medication with all your other medications and health conditions.
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 discuss all your health conditions and medications with your doctor. Please inform your doctor and pharmacist about:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* Your complete medical history, including any health problems
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to ensure your safety. It is vital to verify that it is safe to take this medication with all your other medications and health conditions.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Regular blood tests, as directed by your doctor, are crucial to monitor your condition. Additionally, if you are taking this medication long-term, you may need to undergo eye pressure and bone density checks.
This medication can interfere with certain laboratory tests, so it is vital to notify all your healthcare providers and lab personnel that you are taking this drug. Be aware that medications like this one can cause high blood pressure, so regular blood pressure checks, as advised by your doctor, are necessary.
This medication may also affect the results of allergy skin tests, so ensure that your doctor and lab workers are aware that you are taking this medication. Long-term use of this medication may increase the risk of developing cataracts or glaucoma, so discuss this with your doctor.
Prolonged use of this medication can lead to osteoporosis (weak bones), so talk to your doctor about your risk factors and any concerns you may have. You may need to reduce your salt intake and increase your potassium consumption, so consult with your doctor about making these changes.
If you have diabetes, it is crucial to closely monitor your blood sugar levels. 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 these infections or have a history of them, 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, practice good hygiene, such as frequent handwashing, and avoid close contact with individuals who have infections, colds, or flu. Notify your doctor if you experience any signs of infection.
In some cases, medications like this one can reactivate latent infections, such as tuberculosis or hepatitis B. If you have a history of these infections, inform your doctor. This medication can also suppress your body's natural production of steroids, which can affect your response to stress, such as fever, infection, surgery, or injury. In such situations, you may require additional steroid doses, so notify your doctor.
If you have been taking this medication for an extended period, do not stop abruptly without consulting your doctor, as this can lead to withdrawal symptoms such as fatigue, weakness, shakiness, rapid heartbeat, confusion, sweating, or dizziness.
Long-term use of this medication has been associated with an increased risk of Kaposi's sarcoma, a type of cancer. Discuss this risk with your doctor. Additionally, patients with cancer may be at a higher risk of developing tumor lysis syndrome (TLS), a potentially life-threatening condition, so 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 also affect growth in children and adolescents, so regular growth checks may be necessary. Furthermore, this medication can lower sperm counts, so if you have concerns, discuss them with your doctor.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor, as they will need to discuss the potential benefits and risks of this medication with you. If you took this medication during pregnancy, notify your baby's doctor.
This medication can interfere with certain laboratory tests, so it is vital to notify all your healthcare providers and lab personnel that you are taking this drug. Be aware that medications like this one can cause high blood pressure, so regular blood pressure checks, as advised by your doctor, are necessary.
This medication may also affect the results of allergy skin tests, so ensure that your doctor and lab workers are aware that you are taking this medication. Long-term use of this medication may increase the risk of developing cataracts or glaucoma, so discuss this with your doctor.
Prolonged use of this medication can lead to osteoporosis (weak bones), so talk to your doctor about your risk factors and any concerns you may have. You may need to reduce your salt intake and increase your potassium consumption, so consult with your doctor about making these changes.
If you have diabetes, it is crucial to closely monitor your blood sugar levels. 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 these infections or have a history of them, 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, practice good hygiene, such as frequent handwashing, and avoid close contact with individuals who have infections, colds, or flu. Notify your doctor if you experience any signs of infection.
In some cases, medications like this one can reactivate latent infections, such as tuberculosis or hepatitis B. If you have a history of these infections, inform your doctor. This medication can also suppress your body's natural production of steroids, which can affect your response to stress, such as fever, infection, surgery, or injury. In such situations, you may require additional steroid doses, so notify your doctor.
If you have been taking this medication for an extended period, do not stop abruptly without consulting your doctor, as this can lead to withdrawal symptoms such as fatigue, weakness, shakiness, rapid heartbeat, confusion, sweating, or dizziness.
Long-term use of this medication has been associated with an increased risk of Kaposi's sarcoma, a type of cancer. Discuss this risk with your doctor. Additionally, patients with cancer may be at a higher risk of developing tumor lysis syndrome (TLS), a potentially life-threatening condition, so 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 also affect growth in children and adolescents, so regular growth checks may be necessary. Furthermore, this medication can lower sperm counts, so if you have concerns, discuss them with your doctor.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor, as they will need to discuss the potential benefits and risks of this medication with you. If you took this medication during pregnancy, notify your baby's doctor.
Overdose Information
Overdose Symptoms:
- Severe nausea or vomiting
- Unusual weakness or fatigue
- Swelling in the face or extremities
- Skin thinning or easy bruising
- Muscle weakness
- Changes in menstrual periods
- Acne
- Increased hair growth
What to Do:
Seek immediate medical attention or call Poison Control at 1-800-222-1222. Overdose is generally not life-threatening but can lead to increased side effects. Treatment is supportive.
Drug Interactions
Contraindicated Interactions
- Live or live-attenuated vaccines (during immunosuppressive doses of corticosteroids)
- Systemic fungal infections (unless used as part of specific anti-fungal regimen)
Major Interactions
- CYP3A4 inducers (e.g., rifampin, phenytoin, carbamazepine, barbiturates): May decrease dexamethasone levels and efficacy.
- CYP3A4 inhibitors (e.g., ketoconazole, ritonavir, clarithromycin): May increase dexamethasone levels and side effects.
- NSAIDs (e.g., ibuprofen, naproxen): Increased risk of gastrointestinal ulceration and bleeding.
- Anticoagulants (e.g., warfarin): May alter anticoagulant effect (increase or decrease INR); monitor closely.
- Antidiabetic agents (e.g., insulin, metformin): Dexamethasone can increase blood glucose, requiring dose adjustments of antidiabetics.
- Diuretics (thiazide or loop): Increased risk of hypokalemia.
- Digoxin: Increased risk of digoxin toxicity due to hypokalemia.
Moderate Interactions
- Oral contraceptives/estrogens: May increase dexamethasone levels.
- Cholestyramine, colestipol: May decrease dexamethasone absorption.
- Cyclosporine: Increased risk of seizures and other CNS effects for both drugs.
- Vaccines (inactivated): Reduced immune response to vaccines.
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
Blood Pressure
Rationale: Corticosteroids can cause fluid retention and hypertension.
Timing: Prior to initiation
Blood Glucose
Rationale: Corticosteroids can induce hyperglycemia, especially in predisposed individuals.
Timing: Prior to initiation
Serum Electrolytes (Potassium, Sodium)
Rationale: Risk of hypokalemia and sodium retention.
Timing: Prior to initiation
Weight
Rationale: Monitor for fluid retention.
Timing: Prior to initiation
Bone Mineral Density (for long-term use)
Rationale: Risk of osteoporosis.
Timing: Prior to initiation if long-term use is anticipated
Routine Monitoring
Blood Pressure
Frequency: Daily to weekly, then periodically
Target: Individualized, maintain within normal limits
Action Threshold: Significant elevation (e.g., >140/90 mmHg) or symptomatic hypertension
Blood Glucose
Frequency: Daily to weekly, then periodically (more frequently in diabetics)
Target: Fasting <126 mg/dL, Postprandial <200 mg/dL
Action Threshold: Persistent hyperglycemia (>200 mg/dL) requiring intervention
Serum Electrolytes (Potassium)
Frequency: Weekly initially, then periodically
Target: 3.5-5.0 mEq/L
Action Threshold: Potassium <3.5 mEq/L or symptomatic hypokalemia
Weight
Frequency: Weekly
Target: Stable
Action Threshold: Significant weight gain (>2 kg in a week) suggesting fluid retention
Signs of Infection
Frequency: Continuously
Target: Absence of fever, localized pain, redness, swelling
Action Threshold: New onset of fever, chills, unexplained pain, or other signs of infection
Adrenal Function (for prolonged use or withdrawal)
Frequency: As clinically indicated during tapering or after discontinuation
Target: Normal cortisol response
Action Threshold: Symptoms of adrenal insufficiency (fatigue, weakness, hypotension, nausea, vomiting)
Symptom Monitoring
- Signs of infection (fever, chills, sore throat, unexplained pain)
- Hyperglycemia (increased thirst, urination, fatigue)
- Fluid retention (swelling in ankles/feet, weight gain, shortness of breath)
- Mood changes (irritability, anxiety, depression, euphoria)
- Gastrointestinal upset (stomach pain, black/tarry stools)
- Muscle weakness or pain
- Vision changes (blurred vision, eye pain)
- Skin changes (thinning, bruising, acne)
- Symptoms of adrenal insufficiency upon withdrawal (severe fatigue, weakness, dizziness, nausea, vomiting, loss of appetite, joint/muscle pain)
Special Patient Groups
Pregnancy
Use during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus. Dexamethasone crosses the placenta. Prolonged or repeated use during pregnancy may increase the risk of fetal growth restriction and neonatal adrenal suppression.
Trimester-Specific Risks:
First Trimester:
Limited data, but generally avoided unless essential due to potential for increased risk of oral clefts (though data is conflicting and overall risk is low).
Second Trimester:
Risk of fetal growth restriction and premature delivery with prolonged use.
Third Trimester:
Risk of neonatal adrenal suppression, requiring monitoring of the infant for signs of hypoadrenalism.
Lactation
Dexamethasone is excreted into breast milk. While the amount is generally low, high doses or prolonged use may cause adverse effects in the infant, such as growth suppression or interference with endogenous corticosteroid production. Use with caution; monitor infant for adverse effects.
Infant Risk:
Low to moderate risk, depending on dose and duration. Potential for growth suppression, adrenal suppression, or other systemic effects in the infant. Consider using the lowest effective dose for the shortest duration possible, or consider an alternative if possible.
Pediatric Use
Corticosteroids can cause growth retardation in children. Monitor growth and development carefully. Children are also more susceptible to adrenal suppression and increased intracranial pressure. Use the lowest effective dose for the shortest duration. Alternate-day therapy may reduce growth suppression.
Geriatric Use
Elderly patients may be at increased risk for adverse effects, including osteoporosis, fluid retention, hypertension, diabetes, cataracts, and glaucoma. Use the lowest effective dose and monitor closely for side effects.
Clinical Information
Clinical Pearls
- Always emphasize the importance of following the specific tapering schedule of the Taperdex 7-Day Pak to prevent adrenal insufficiency.
- Educate patients on the signs and symptoms of adrenal insufficiency and the need to seek medical attention if they occur after stopping the medication.
- Advise patients to take dexamethasone with food or milk to minimize gastrointestinal irritation.
- Counsel patients about increased susceptibility to infection and to report any signs of illness promptly.
- For patients on long-term therapy, consider bone protection strategies (calcium, vitamin D, bisphosphonates) and regular eye exams for cataracts/glaucoma.
Alternative Therapies
- Other systemic corticosteroids (e.g., prednisone, methylprednisolone, hydrocortisone)
- NSAIDs (for inflammatory conditions, if appropriate)
- Immunosuppressants (for autoimmune conditions, depending on severity and specific disease)
- Biologic agents (for specific inflammatory/autoimmune diseases)
Cost & Coverage
Average Cost:
$10 - $50 per 30 tablets (generic dexamethasone)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (for generic dexamethasone)
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 emergency medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.