Dexamet

Dexamethasone Na phosphate

Use in endocrine & non-endocrine disorders responsive to corticosteroid therapy. Recommended for systemic administration by IV or IM inj when oral therapy is not feasible in the following conditions: Endocrine disorders (primary or secondary adrenocortical insufficiency); non-endocrine disorders (angioneurotic edema, anaphylaxis; Crohn's disease, ulcerative colitis; miliary TB, endotoxic shock; raised ICP secondary to cerebral tumors & infantile spasms; bronchial asthma, aspiration pneumonitis; TEN; adjunctive treatment in shock). Suitable for IA or soft tissue inj as adjunctive therapy for short-term administration in: Soft tissue disorders eg, carpal tunnel syndrome & tenosynovitis. IA disorders eg, RA & OA w/ inflammatory components. May be injected intralesional in selected skin disorders eg, cystic acne vulgaris, localized lichen simplex & keloids.

IV & IM  Initially 0.5 mg-20 mg (0.125 mL-5 mL) daily. In situations of less severity, lower doses will suffice. Chronic dosage should not exceed 500 mcg daily. Emergency: 4 mg-20 mg (1 mL-5 mL) via IV. After initial improvement, single doses of 2 mg-4 mg (0.5 mL-1 mL), repeated as necessary, should be sufficient. Total daily dosage usually need not exceed 80 mg (20 mL), even in severe conditions. When constant maximal effect is desired, dosage must be repeated at 3 hr or 4-hr intervals or maintained by slow IV drip. IV & IM inj are advised in acute illness. When the acute stage has passed, oral steroid therapy should be substituted as soon as feasible. Frequency of inj: Once every 3-5 days to once every 2-3 wk depending on response. Childn Dosage should be limited to a single dose on alternate days.

Hypersensitivity to sulphites. Systemic fungal infection. Administration of live virus vaccines.

False -ve results in the dexamethasone suppression test in patients being treated w/ indomethacin. Corticosteroids may affect the nitroblue tetrazolium test for bacterial infection & produce false -ve results. Soln used for IV administration or further dilution should be preservative-free when used in the neonate, especially premature infant. Pregnancy & lactation. Elderly.

Hypothalamic-pituitary-adrenal suppression; Na or fluid retention, CHF in susceptible patients, K loss, hypokalemic alkalosis, HTN, increased Ca excretion; muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis (especially in post-menopausal females), vertebral compression fractures, aseptic necrosis of femoral & humeral heads, pathological fracture of long bones, tendon rupture, post-inj flare (following IA use); peptic ulcer w/ possible perforation & hemorrhage of the small & large bowel, particularly in patients w/ inflammatory bowel disease, pancreatitis, abdominal distension, ulcerative esophagitis, dyspepsia, esophageal candidiasis; impaired wound healing, thin fragile skin, petechiae, ecchymoses, erythema, striae, telangiectasia, acne, increased sweating, possible suppression of skin tests, burning or tingling especially in the perennial area (after IV inj), other cutaneous reactions eg, allergic dermatitis, urticaria, angioneurotic edema & hypo- or hyper-pigmentation; convulsions, increased ICP w/ papilledema (pseudotumor cerebri) usually after treatment, vertigo, headache, psychic disturbances (eg, euphoria, psychological dependence, depression, insomnia); menstrual irregularities, amenorrhea, development of Cushingoid state, suppression of growth in childn & adolescents, secondary adrenocortical & pituitary unresponsiveness (particularly in time of stress, as in trauma, surgery, or illness), decreased carbohydrate tolerance, manifestations of latent DM, increased requirements for insulin or oral hypoglycemic agents in diabetes, hirsutism; increased susceptibility & severity of infections w/ suppression of clinical symptoms and signs, opportunistic infections, recurrence of dormant TB; posterior subcapsular cataracts, increased IOP, papilledema, corneal or scleral thinning, exacerbation or ophth viral disease, glaucoma, exophthalmos, blindness associated w/ intra-lesion therapy around the face & head, retinopathy of prematurity; -ve nitrogen balance (due to protein catabolism) & Ca balance; myocardial rupture following recent MI, hypertrophic cardiomyopathy in low birth-wt infants; hypersensitivity, including anaphylaxis, leukocytosis, thromboembolism, wt gain, increased appetite, nausea, malaise, hiccups, sterile abscess. Withdrawal symptoms & signs (acute adrenal insufficiency, hypotension).

Aspirin should be used cautiously in conjunction w/ other corticosteroids in hypoprothrombinemia. Renal clearance of salicylates is increased by corticosteroid therefore, salicylate dosage should be reduced along w/ steroid withdrawal. Decreased blood levels & reduced physiological activity w/ phenytoin, barbiturates, ephedrine, rifabutin, carbamazepine, rifampicin, & aminoglutethimide. Efficacy of coumarin anticoagulants may be changed by concurrent corticosteroid treatment (prothrombin time should be checked frequently). Desired effects of hypoglycemic agents (including insulin) are antagonized by corticosteroids. When administered concomitantly w/ K-depleting diuretics, patients should be observed closely for development of hypokalemia.

Corticosteroid Hormones

H02AB02 - dexamethasone ; Belongs to the class of glucocorticoids. Used in systemic corticosteroid preparations.

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