Dexamethasone

Should be taken with food.

Systemic fungal infection; systemic infection unless being treated with specific anti-infectives; stomach or duodenal ulcer. Administration of live vaccines. Epithelial herpes simplex keratitis (dendritic keratitis); active infectious stages of vaccinia, varicella, and many other viral diseases of cornea and conjunctiva; mycobacterial or fungal infection of the eye (ophthalmic). Drum membrane perforation (otic). Glaucoma with cup to disc ratios of >0.8, torn or ruptured posterior lens because of the risk of migration into the anterior chamber (intravitreal implant).

Patient with myasthenia gravis, ocular herpes simplex, diabetes mellitus, CV disease (e.g. recent MI, heart failure, hypertension), migraine, glaucoma, systemic sclerosis, thyroid disease; high risk of tumour lysis syndrome (e.g. high proliferative rate, high tumour burden, high sensitivity to cytotoxic agents); known or suspected Strongyloides (threadworm) infestation; gastrointestinal diseases (e.g. diverticulitis, fresh intestinal anastomoses, active or latent peptic ulcer, ulcerative colitis, abscess, other pyogenic infections), suspected or confirmed phaeochromocytoma; history of seizure disorder; chickenpox, measles; subjected to unusual stress (e.g. intercurrent illness, trauma, surgical procedure). Avoid abrupt withdrawal or rapid dose reduction. Renal and hepatic impairment (including cirrhosis). Neonates, children, and elderly. Pregnancy and lactation. Patient Counselling This drug may cause confusional state, hallucinations, dizziness, somnolence, fatigue, syncope, and blurred vision, if affected, do not drive or operate machinery. Monitoring Parameters Monitor Hb, occult blood loss, blood glucose, creatine kinase (if myopathy occurs), serum K, BMD, blood pressure, IOP (with systemic use >6 weeks), height and weight in children, HPA axis suppression. Perform routine eye exams with chronic use. Intravitreal: Evaluate perfusion of optic nerve head immediately post inj; tonometry within 30 minutes, biomicroscopy between 2-7 days post inj.

Significant: Hypercotisolism or suppression of HPA axis; adrenocortical insufficiency, cushingoid appearance, serious anaphylactic reaction, visual disturbances, corneal perforation, increased IOP, open-angle glaucoma, subcapsular posterior cataract, psychological changes (e.g. euphoria, depression, psychotic reactions, suicidal tendencies), fluid retention, electrolyte disturbances, hypertension, myocardial rupture, reactivation of hepatitis B, gastrointestinal effects (e.g. peptic ulcer, dyspepsia, gastritis, abdominal distention, ulcerative oesophagitis), new-onset hyperglycaemia, exacerbation of diabetes mellitus, osteoporosis, vertebral compression fracture, myopathy, osteonecrosis; infection, including Pneumocystis jirovecii pneumonia (PJP), herpes zoster, tuberculosis, other common bacterial infections (prolonged use); tumour lysis syndrome (particularly in patients with haematological malignancies); acute adrenocortical failure (abrupt discontinuation of long-term therapy); dose-dependent inhibition of growth (infants and children); hypertrophic cardiomyopathy (premature infants); Charcot-like arthropathies (frequent intra-articular inj). Rarely, acute steroid myopathy. Intravitreal: Endophthalmitis, eye inflammation, retinal detachments. Blood and lymphatic system disorders: Leucocytosis, lymphopenia, eosinopenia, polycythemia, abnormal coagulation. Cardiac disorders: CHF, cardiac decompensation. Eye disorders: Eye pruritus, abnormal sensation in the eye (ophthalmic); conjunctival haemorrhage, ocular hypertension (intravitreal), vitreous opacities, photopsia, conjunctival oedema, conjunctival hyperaemia. Gastrointestinal disorders: Abdominal distention, dyspepsia, acute pancreatitis, flatulence, nausea, vomiting. Immune system disorders: Hypersensitivity reaction, urticaria, allergic dermatitis. Investigations: Weight gain, increased capillary fragility. Metabolism and nutrition disorders: Negative protein and Ca balance, increased appetite, hypokalaemic alkalosis, hypercholesterolaemia, hypertriglyceridaemia. Nervous system disorders: Vertigo, headache. Reproductive system and breast disorders: Impotence. Respiratory, thoracic and mediastinal disorders: Hiccups. Skin and subcutaneous tissue disorders: Hypertrichosis, skin atrophy, telangiectasia, striae, erythema, steroid acne, petechiae, thinning hair, hyperhidrosis, tendency to bruise, perioral dermatitis. Vascular disorders: Vasculitis, increased atherosclerosis and risk of thrombosis or thromboembolism, ecchymosis.
Potentially Fatal: Phaeochromocytoma crisis.

Increased risk of tendinitis and tendon rupture with fluoroquinolones. Increased incidence and severity of gastric ulcers with NSAIDs. May increase the renal clearance of salicylates. May decrease the therapeutic effect of antidiabetic drugs (e.g. insulin, sulfonylurea, metformin). May increase the hypokalaemic effect of acetazolamide, loop diuretics, thiazide diuretics, kaliuretics, amphotericin B inj (glucomineral)-corticosteroids, tetracosactide, laxatives. Increased risk of hypokalaemia with carbenoxolone. Increased risk of myopathies and cardiomyopathies with chloroquine, hydroxychloroquine, mefloquine. Increased risk of blood disorders with ACE inhibitors. Increased risk of toxic epidermal necrolysis with thalidomide. Concurrent use with cholinesterase inhibitors may cause serious muscle weakness in patients with myasthenia gravis. Increased risk of systemic side-effects with CYP3A inhibitors (including cobicistat-containing drugs). Increased plasma concentrations with CYP3A4 inhibitors (e.g. azole antifungals, HIV protease inhibitors, macrolides). Decreased plasma concentrations with CYP3A4 inducers (e.g. ephedrine, barbiturates, rifabutin, rifampicin, phenytoin, carbamazepine). Concomitant administration with aminoglutethimide can accelerate the reduction of dexamethasone and decrease its efficacy. Decreased absorption with bile acid resins (e.g. cholestyramine). Enhanced effect with estrogens (including oral contraceptives). May decrease plasma concentrations of praziquantel. Increased risk for cerebral seizures with ciclosporin. May either potentiate or weaken the effect of oral anticoagulants. Increased IOP with atropine and other anticholinergics. May reduce the effect of somatropin. Reduced increase in TSH with protirelin. May decrease plasma concentrations of isoniazid.

Corticosteroid Hormones / Ear Corticosteroids / Eye Corticosteroids

C05AA09 - dexamethasone ; Belongs to the class of products containing corticosteroids for topical use. Used in the treatment of hemorrhoids and anal fissures.
H02AB02 - dexamethasone ; Belongs to the class of glucocorticoids. Used in systemic corticosteroid preparations.
D10AA03 - dexamethasone ; Belongs to the class of topical corticosteroids used in the treatment of acne.
S01BA01 - dexamethasone ; Belongs to the class of corticosteroids. Used in the treatment of inflammation of the eye.
S02BA06 - dexamethasone ; Belongs to the class of corticosteroids used in the treatment of inflammation of the ear.
A01AC02 - dexamethasone ; Belongs to the class of local corticosteroid preparations. Used in the treatment of diseases of the mouth.
D07XB05 - dexamethasone ; Belongs to the class of moderately potent (group II) corticosteroids in other combinations. Used in the treatment of dermatological diseases.
S03BA01 - dexamethasone ; Belongs to the class of corticosteroids used in ophthalmologic and otologic preparations.
D07AB19 - dexamethasone ; Belongs to the class of moderately potent (group II) corticosteroids. Used in the treatment of dermatological diseases.
S01CB01 - dexamethasone ; Belongs to the class of corticosteroids/antiinfectives/mydriatics combinations. Used in the treatment of eye diseases.
R01AD03 - dexamethasone ; Belongs to the class of topical corticosteroids used for prophylaxis and treatment of allergic rhinitis.