There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
<!--Non–Guideline-Supported Use (Adult)-->
|offLabelAdultNoGuideSupport======Condition1=====
* Dosing Information
:* Dosage
=====Condition2=====
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
<!--Pediatric Indications and Dosage-->
<!--FDA-Labeled Indications and Dosage (Pediatric)-->
|fdaLIADPed======Condition1=====
* Dosing Information
:* Dosage
=====Condition2=====
There is limited information regarding <i>FDA-Labeled Use</i> of {{PAGENAME}} in pediatric patients.
<!--Off-Label Use and Dosage (Pediatric)-->
<!--Guideline-Supported Use (Pediatric)-->
|offLabelPedGuideSupport======Condition1=====
* Developed by:
* Class of Recommendation:
* Strength of Evidence:
* Dosing Information
:* Dosage
=====Condition2=====
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
<!--Non–Guideline-Supported Use (Pediatric)-->
|offLabelPedNoGuideSupport======Condition1=====
* Dosing Information
:* Dosage
=====Condition2=====
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
<!--Contraindications-->
|contraindications=* Condition1
<!--Warnings-->
|warnings=* Description
====Precautions====
* Description
<!--Adverse Reactions-->
<!--Clinical Trials Experience-->
|clinicalTrials=There is limited information regarding <i>Clinical Trial Experience</i> of {{PAGENAME}} in the drug label.
=====Body as a Whole=====
=====Cardiovascular=====
=====Digestive=====
=====Endocrine=====
=====Hematologic and Lymphatic=====
=====Metabolic and Nutritional=====
=====Musculoskeletal=====
=====Neurologic=====
=====Respiratory=====
=====Skin and Hypersensitivy Reactions=====
=====Special Senses=====
=====Urogenital=====
=====Miscellaneous=====
<!--Postmarketing Experience-->
|postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} in the drug label.
=====Body as a Whole=====
=====Cardiovascular=====
=====Digestive=====
=====Endocrine=====
=====Hematologic and Lymphatic=====
=====Metabolic and Nutritional=====
=====Musculoskeletal=====
=====Neurologic=====
=====Respiratory=====
=====Skin and Hypersensitivy Reactions=====
=====Special Senses=====
=====Urogenital=====
=====Miscellaneous=====
<!--Drug Interactions-->
|drugInteractions=* Drug
:* Description
<!--Use in Specific Populations-->
|useInPregnancyFDA=* '''Pregnancy Category'''
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
<!--Administration and Monitoring-->
|administration=* Oral
* Intravenous
|monitoring=There is limited information regarding <i>Monitoring</i> of {{PAGENAME}} in the drug label.
* Description
<!--IV Compatibility-->
|IVCompat=There is limited information regarding <i>IV Compatibility</i> of {{PAGENAME}} in the drug label.
<!--Overdosage-->
|overdose====Acute Overdose===
====Signs and Symptoms====
* Description
====Management====
* Description
{{CMG}}
===Chronic Overdose===
There is limited information regarding <i>Chronic Overdose</i> of {{PAGENAME}} in the drug label.
<!--Pharmacology-->
'''Dexamethasone''' is a potent synthetic member of the [[glucocorticoid]] class of [[steroid]] [[hormone]]s. It acts as an [[anti-inflammatory]] and [[immunosuppressive drug|immunosuppressant]]. Its potency is about 40 times that of [[hydrocortisone]].
<!--Drug box 2-->
|drugBox=<!--Mechanism of Action-->
|mechAction=*
==Therapeutic use==
<!--Structure-->
Dexamethasone is used to treat many [[inflammation|inflammatory]] and [[autoimmune disease|autoimmune]] conditions, e.g., [[rheumatoid arthritis]]. It is also given to [[cancer]] patients undergoing [[chemotherapy]], to counteract certain [[Adverse drug reaction|side-effects]] of their antitumor treatment. Dexamethasone can augment the [[antiemetic]] effect of [[5-HT3 antagonist|5-HT<sub>3</sub> receptor antagonists]] like [[ondansetron]]. It is also given in small amounts (usually 5-6 tablets) before and/or after some forms of [[dental surgery]], such as the extraction of the [[wisdom teeth]], an operation which often leaves the patient with puffy, swollen cheeks.
|structure=*
In [[brain tumour]]s (primary or metastatic), dexamethasone is used to counteract the development of [[edema]], which could eventually compress other brain structures. Dexamethasone is also given in [[cord compression]] where a tumor is compressing the spinal cord.
: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
Dexamethasone is also used in certain [[hematological malignancy|hematological malignancies]], especially in the treatment of [[multiple myeloma]], in which dexamethasone is given alone or together with [[thalidomide]] (thal-dex) or a combination of [[adriamycin]] and [[vincristine]] (VAD). It is injected into the heel when treating [[plantar fasciitis]], sometimes in conjunction with [[triamcinolone acetonide]].
<!--Pharmacodynamics-->
|PD=There is limited information regarding <i>Pharmacodynamics</i> of {{PAGENAME}} in the drug label.
It is useful to counteract allergic shock, if given in high doses. It is present in certain [[eye drop]]s and as a [[nasal spray]] (trade name '''Dexacort''').
<!--Pharmacokinetics-->
|PK=There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.
Dexamethasone can be used in the context of [[congenital adrenal hyperplasia]], to prevent [[virilisation]] of a female fetus. If one or both parents are carriers of mutations to the CYP21A gene, the mother may start dexamethasone treatment within 7 weeks of [[conception]]. At the 12th week, a [[chorionic villus sampling|chorionic villus sample]] will determine whether the fetus is male (in which case the dexamethasone is stopped) or female. Subsequent DNA analysis can then reveal whether the female fetus is a carrier of the mutation, in which case dexamethasone treatment must continue until birth. The side-effects for the mother can be severe and the long-term impact on the child is not clear.
<!--Nonclinical Toxicology-->
|nonClinToxic=There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.
Dexamethasone is used in the treatment of [[high altitude pulmonary edema]].
<!--Clinical Studies-->
|clinicalStudies=There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.
==Diagnostic use==
<!--How Supplied-->
Dexamethasone is also used in a ''diagnostic'' context, namely in its property to suppress the natural [[Hypothalamic-pituitary-adrenal axis|pituitary-adrenal axis]].
|howSupplied=*
Patients presenting with clinical signs of [[glucocorticoid]] excess ([[Cushing's syndrome]]) are generally diagnosed by a 24-hour urine collection for [[cortisol]] or by a ''[[dexamethasone suppression test]]''. During the latter, the response of the body to a high dose of glucocorticoids is monitored. Various forms are performed. In the most common form, a patient takes a nighttime dose of either 1 or 4 mg of dexamethasone, and the serum [[cortisol]] levels are measured in the morning. If the levels are relatively high (over 5 µg/dl or 150 nmol/l), then the test is positive and the patient has an autonomous source of either [[cortisol]] or [[ACTH]], indicating [[Cushing's syndrome]] where the tumor does not have a feedback mechanism. If ACTH levels are lowered by at least 50%, this would indicate [[Cushing's Disease]], since the [[pituitary adenoma]] has a feedback mechanism that has been reset to a higher level of cortisol. Longer versions rely on urine collections on oral dexamethasone over various days.
==Veterinary use==
<!--Patient Counseling Information-->
Combined with [[marbofloxacin]] and [[clotrimazole]], dexamethasone is available under the name ''Aurizon '', [[CAS number]] 115550-35-1, and used to treat difficult ear infections, especially in dogs.
|fdaPatientInfo=There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.
==Contraindications==
<!--Precautions with Alcohol-->
Some of these [[contraindications]] are relative:
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
* Existing gastrointestinal [[ulceration]]
* [[Cushing's syndrome]]
* Severe forms of heart insufficiency
* Severe [[hypertension]]
* Uncontrolled [[diabetes mellitus]]
* Systemic [[tuberculosis]]
* Severe systemic viral, bacterial, and fungal infections
* Preexisting wide angle [[glaucoma]]
* [[Osteoporosis]]
==Side effects==
<!--Brand Names-->
If dexamethasone is given orally or by injection (parenteral) over a period of more than a few days, side-effects common to systemic glucocorticoids may occur. These may include:
|brandNames=* ®<ref>{{Cite web | title = | url = }}</ref>
* Stomach upset, increased sensitivity to stomach acid to the point of ulceration of esophagus, stomach, and duodenum
* Increased appetite leading to significant weight gain
* A latent diabetes mellitus often becomes manifest. Glucose intolerance is worsened in patients with preexisting diabetes.
* Immunsuppressant action, particularly if given together with other immunosuppressants such as ciclosporine. Bacterial, viral, and fungal disease may progress more easily and can become life-threatening. Fever as a warning symptom is often suppressed.
* Psychiatric disturbances, including personality changes, irritability, euphoria, mania
* Osteoporosis under long term treatment, pathologic fractures (e.g., hip)
* Muscle atrophy, negative protein balance (catabolism)
* Allergic reactions (though infrequently): [[Anaphylactoid_reactions|Anaphylactoid reaction]], [[anaphylaxis]], [[angioedema]]. (Highly unlikely, since dexamethasone is given to ''prevent'' anaphylactoid reactions.)
Other side-effects have been noted, and should cause concern if they are more than mild.
<!--Look-Alike Drug Names-->
|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web | last = | first = | title = http://www.ismp.org | url = http://www.ismp.org | publisher = | date = }}</ref>
The short time treatment for allergic reaction, shock, and diagnostic purposes usually does not cause serious side effects.
<!--Drug Shortage Status-->
|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
<!--Pill Image-->
==Interactions==
* NSAIDs and alcohol: increased risk of gastrointestinal ulceration
* Mineralocorticoids: increased risk of hypertension, edema and heart problems
* Oral antidiabetic drugs and insulin: antidiabetic therapy may have to be adjusted
Other interactions (with certain antibiotics, estrogens, ephedrine, digoxin) are known.
==Dosage==
<!--Label Display Image-->
* Shock: 4 to 8 mg intravenously initially, repeat if necessary to a total dose of 24 mg.
* Autoimmune diseases and inflammations: longterm therapy with 0.5 to 1.5 mg oral per day. Avoid more than 1.5 mg daily, because serious side effects are more frequently encountered with higher doses.
* Adjuvant to or part of chemotherapy: individual schedule
* Diagnostic purposes: special schedule
==Sports doping==
In [[2005]], [[Poland|Polish]] [[cross country skier]] [[Justyna Kowalczyk]] was disqualified from the Under 23 (U23) OPA (Alpine nations) Intercontinential Competition in [[Germany]] and issued a 2-year suspension for her doping offenses on dexamethasone.<ref>[http://www.fis-ski.com/data/document/info-kowalczyk.pdf June 13, 2005 FIS Doping Control statement on Kowalcyzk (Digitized version).] - Accessed [[July 30]], [[2006]]</ref> This was eventually reduced to one year during 2005 and later rescinded by the [[Court of Arbitration for Sport]] in December 2005.<ref>[http://www.fis-ski.com/data/document/fisnewsflash2005_12_14.pdf December 14, 2005 FIS Newsflash on her overturned suspension (Digitized version).] - Accessed July 30, 2006</ref> She would later earn a bronze in the women's 30 km freestyle mass start at the [[2006 Winter Olympics]] in [[Turin]].
==References==
<references/>
==External links==
* [http://www.myeloma.org/main.jsp?source=link&source_link_id=2117&type=article&tab_id=13&menu_id=94&id=1749 Understanding Dexamethasone and Other Steroids]
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Black Box Warning
ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
Content
Overview
Dexamethasone (injection) is a {{{drugClass}}} that is FDA approved for the {{{indicationType}}} of {{{indication}}}. There is a Black Box Warning for this drug as shown here. Common adverse reactions include .
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
Condition1
Dosing Information
Dosage
Condition2
Dosing Information
Dosage
Condition3
Dosing Information
Dosage
Condition4
Dosing Information
Dosage
Off-Label Use and Dosage (Adult)
Guideline-Supported Use
Condition1
Developed by:
Class of Recommendation:
Strength of Evidence:
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Guideline-Supported Use of Dexamethasone (injection) in adult patients.
Non–Guideline-Supported Use
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Dexamethasone (injection) in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding FDA-Labeled Use of Dexamethasone (injection) in pediatric patients.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
Condition1
Developed by:
Class of Recommendation:
Strength of Evidence:
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Guideline-Supported Use of Dexamethasone (injection) in pediatric patients.
Non–Guideline-Supported Use
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Dexamethasone (injection) in pediatric patients.
Contraindications
Condition1
Warnings
ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
Content
Description
Precautions
Description
Adverse Reactions
Clinical Trials Experience
There is limited information regarding Clinical Trial Experience of Dexamethasone (injection) in the drug label.
Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous
Postmarketing Experience
There is limited information regarding Postmarketing Experience of Dexamethasone (injection) in the drug label.
01.png){kind=link}