II. Indications

  1. See Dexamethasone Suppression Test
  2. FDA approved indications
    1. Antiinflammatory or Immunosuppression
    2. Multiple Sclerosis acute exacerbation
    3. Cerebral edema
  3. Non-FDA Approved (Off-Label) indications
    1. Preterm Labor Management for Fetal Lung Maturity (off label use)
    2. Immune Thrombocytopenic Purpura
    3. Bacterial Meningitis (before first dose of Antibiotics for for HaemophilusInfluenzae or pneumococcal Meningitis)
    4. Antiemetic in Chemotherapy
    5. Acute Asthma exascerbation
    6. Bronchopulmonary Dysplasia
    7. Dexamethasone Suppression Test (Cushing"s Syndrome)

III. Mechanism

  1. See Systemic Corticosteroid
  2. See Pharmacokinetics below for relative potency

IV. Medications

  1. Dexamethasone (Decadron)
    1. Tablets: 0.5 mg, 0.75 mg, 1.0 mg, 1.5 mg, 2 mg, 4 mg, 6 mg
    2. Solution or Elixir: 0.5 mg/5 ml
  2. Non-Systemic formulations
    1. See Intra-articular Corticosteroid

V. Dosing

  1. Adult
    1. Antiinflammatory or Immunosuppression
      1. Dexamethasone 0.5 to 10 mg/day PO/IM/IV divided every 6-12 hours
    2. Multiple Sclerosis acute exacerbation
      1. Dexamethasone 30 mg/day for 1 week, then 4 to 12 mg every other day for 4 weeks
    3. Preterm Labor Management for Fetal Lung Maturity (off label use)
      1. Dexamethasone 6 mg IM every 12 hours for 4 doses
    4. Cerebral edema
      1. Load: 10 to 20 mg IV load
      2. Maintenance: 4 mg IV or IM every 6 hours (or 1 to 3 mg orally three times daily)
    5. Bacterial Meningitis (before first dose of Antibiotics for HaemophilusInfluenzae or pneumococcal Meningitis)
      1. Start Dexamethasone 15 minutes before first Antibiotic dose
      2. Dexamethasone 10 mg IV q6 hours for 4 days
    6. Antiemetic in Chemotherapy
      1. Treatment: 10 to 20 mg IV every 4 to 6 hours
      2. Prophylaxis: 8 mg IV or 12 mg orally before Chemotherapy, then 8 mg orally daily for 2 to 4 days
  2. Child
    1. General
      1. Dexamethasone 0.02 to 0.3 mg/kg/day divided every 6 to 8 hours
    2. Asthma Exacerbation (off-label)
      1. Dexamethasone 0.3 to 0.6 mg/kg/day up to 10-15 mg for 1-2 days
    3. Croup (off-label)
      1. Dexamethasone 0.15 to 0.6 mg/kg once up to 10 mg
      2. See Dexamethasone in Croup
    4. Bacterial Meningitis (before first dose of Antibiotics for pneumococcal Meningitis)
      1. Start Dexamethasone 15 minutes before first Antibiotic dose
      2. Dexamethasone 0.4 mg/kg every 12 hours IV for 2 days (or 0.15 mg/kg every 6 hours IV for 4 days)
    5. Bronchopulmonary Dysplasia in Premature Infants (off-label)
      1. Dexamethasone 0.5 mg/kg orally or IV divided every 12 hours for 3 days (followed by taper)

VI. Pharmacokinetics

  1. Dexamethasone has high oral Bioavailability (80%) with onset of action within 1-2 hours
  2. Long Half-Life (36 to 54 hours)
  3. High potency
  4. High anti-inflammatory potency
  5. No Mineralocorticoid Activity

VII. Adverse Effects

VIII. Safety

  1. See Systemic Corticosteroid
  2. Pregnancy category C
  3. Avoid in Lactation

X. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. Swadron and Hope in Herbert (2018) EM:Rap 18(9):16-8
  3. Dvorin (2020) Am Fam Physician 101(2): 89-94 [PubMed]
  4. Lane (1998) Endocrinol Metab Clin North Am 27:465-83 [PubMed]

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Related Studies

Cost: Medications

dexamethasone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
DEXAMETHASONE 0.1% EYE DROP Generic $7.20 per ml
DEXAMETHASONE 0.5 MG TABLET Generic $0.10 each
DEXAMETHASONE 0.5 MG/5 ML ELX Generic $0.09 per ml
DEXAMETHASONE 0.5 MG/5 ML LIQ Generic $0.16 per ml
DEXAMETHASONE 0.75 MG TABLET Generic $0.18 each
DEXAMETHASONE 1 MG TABLET Generic $0.23 each
DEXAMETHASONE 1.5 MG TABLET Generic $0.29 each
DEXAMETHASONE 120 MG/30 ML VL Generic $1.25 per ml
DEXAMETHASONE 2 MG TABLET Generic $0.43 each
DEXAMETHASONE 4 MG TABLET Generic $0.38 each
DEXAMETHASONE 6 MG TABLET Generic $0.99 each
DEXAMETHASONE INTENSOL 1 MG/ML Generic $0.75 per ml

Ontology: Dexamethasone (C0011777)

Definition (CHV) a kind of steroid drug
Definition (CHV) a kind of steroid drug
Definition (NCI) A synthetic adrenal corticosteroid with potent anti-inflammatory properties. In addition to binding to specific nuclear steroid receptors, dexamethasone also interferes with NF-kB activation and apoptotic pathways. This agent lacks the salt-retaining properties of other related adrenal hormones. (NCI04)
Definition (NCI_NCI-GLOSS) A synthetic steroid (similar to steroid hormones produced naturally in the adrenal gland). Dexamethasone is used to treat leukemia and lymphoma and may be used to treat some of the problems caused by other cancers and their treatment.
Definition (CSP) anti-inflammatory 9-fluoro-glucocorticoid.
Definition (MSH) An anti-inflammatory 9-fluoro-glucocorticoid.
Definition (PSY) A synthetic analogue of cortisol.
Definition (PDQ) A synthetic adrenal corticosteroid with potent anti-inflammatory properties. In addition to binding to specific nuclear steroid receptors, dexamethasone also interferes with NF-kB activation and apoptotic pathways. This agent lacks the salt-retaining properties of other related adrenal hormones. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39789&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39789&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C422" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Steroid (T110)
MSH D003907
SnomedCT 325354000, 116568000, 372584003, 7561000
LNC LP32530-5, LP18549-3, MTHU004621
English Dexamethasone, Hexadecadrol, Methylfluorprednisolone, Pregna-1,4-diene-3,20-dione, 9-fluoro-11,17,21-trihydroxy-16-methyl-, (11beta,16alpha)-, 1-Dehydro-16alpha-methyl-9alpha-fluorohydrocortisone, 9Alpha-fluoro-11beta,17alpha,21-trihydroxy-16alpha-methylpregna-1,4-diene-3,20-dione, 9Alpha-fluoro-16alpha-methylprednisolone, 9alpha-Fluoro-16alpha- methylprednisolone, Fluoro-9alpha Methyl-16alpha Prednisolone, (11Beta,16alpha)-9-fluoro-11,17,21-trihydroxy-16-methylpregna-1,4-diene-3,20-dione, 16Alpha-methyl-9alpha-fluoro-1,4-pregnadiene-11beta,17alpha,21-triol-3,20-dione, 16Alpha-methyl-9alpha-fluoro-delta1-hydrocortisone, 16Alpha-methyl-9alpha-fluoroprednisolone, dexamethasone, Dexamethasonum, Desamethasone, Dexamethasone [endocrine use], DEXAMETHASONE, dexamethasone (medication), Dexamethasone [Chemical/Ingredient], dexamethasone (DMX), Dexamethasone (product), Dexamethasone [endocrine use] (product), Dexamethasone preparation, Dexamethasone (substance), Dexamethasone preparation (product), DXM, DM, Dexamethasone [endocrine use] (substance), Dexamethasone preparation (substance)
Swedish Dexametason
Czech dexamethason
Finnish Deksametasoni
Russian DEKSAMETAZON, GEKSADEKADROL, ГЕКСАДЕКАДРОЛ, ДЕКСАМЕТАЗОН
Japanese コルソン, デキサA, デキサメサゾン, ダブM, デカドロン, ビスオDS, ミタゾーン, オイラゾンD, デカドロンN, デキサ・チョーセイ, デキサ・ママレット, デキサメ, ヘキサデカドロール, デルゾン, サンテゾーン, デキサルチン, フルメプレドニゾロン, マキシデックス, デキサメタゾン, エースミン
Spanish preparado con dexametasona (producto), dexametasona (producto), preparado con dexametasona, dexametasona (uso endocrino), dexametasona (uso endocrino) (producto), dexametasona (sustancia), dexametasona, preparado de dexametasona (producto), preparado de dexametasona (sustancia), preparado de dexametasona, Dexametasona, Hexadecadrol
Italian Metil-fluoro-prednisolone, Esadecadrol, Desametasone
Croatian DEKSAMETAZON
Polish Deksametazon
Norwegian Dexametason
French Dexaméthasone
German Dexamethason, Hexadecadrol
Portuguese Dexametasona, Hexadecadrol