Dexamethasone
DECADRON
What it isLong-acting glucocorticoid with negligible mineralocorticoid effect; cerebral edema, croup, antiemesis and COVID-19.
Why this oneIts potency and long half-life allow single or once-daily dosing, and the lack of sodium retention suits raised intracranial pressure.
What limits itProfound axis suppression from the long duration. Hyperglycemia is prominent; CYP3A4 substrate and inducer.
FDA-approved for
- inflammation (~1958)
Off-label
- antiemesis
- cerebral edema
- croup
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Corticosteroid-responsive disorders | Adults | 0.75–9 mg/day | lowest effective maintenance dose | varies by disease |
| Corticosteroid-responsive disorders | Pediatric | 0.02–0.3 mg/kg/day divided TID–QID | individualized | |
| Acute exacerbation of multiple sclerosis | Adults | 30 mg/day x 1 week | then 4–12 mg every other day x 1 month |
Renal Undefined
Hepatic Undefined
Instructions
- For oral administration; individualize dose to disease and response
- After favorable response, decrease in small decrements to lowest effective maintenance dose
- If stopping after long-term therapy, withdraw gradually rather than abruptly
- May need to increase dose transiently during stress/illness
Contraindications
- Systemic fungal infections
Cautions
- Immunosuppression/decreased resistance to infection
- Adrenal suppression; taper to withdraw
- Fluid retention, hypertension, hypokalemia
- Hyperglycemia/latent diabetes
- Peptic ulcer, GI perforation/bleeding
- Osteoporosis, growth suppression in children
- Neuropsychiatric effects (mood changes, psychosis)
Adverse reactions
- Fluid retention/edema
- Hyperglycemia
- Increased appetite/weight gain, cushingoid state
- Osteoporosis, muscle weakness
- Mood/behavioral changes, insomnia
- Impaired wound healing, thin fragile skin
Pregnancy Undefined
Lactation Undefined
NO BOXED WARNINGS
Principal riskAdrenal suppression; the longest-acting corticosteroid
Cost, est. cash$4–$300/month
Generic entry1982
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHyperglycemia, infection, osteoporosis and potentially severe mood, sleep or psychotic effects.
Mechanism of action: Dexamethasone ballicule
Open Dexamethasone in the interactive console ↗
Memory aids: mascots and interaction avatars
cushingoid moon face → corticosteroid
