Dexamethasone

Mechanism :

Glucocorticoids both natural and synthetic, are adrenocortical steroids that are readily absorbed from the gastrointestinal tract. Glucocorticoids cause varied metabolic effects, they modify the body immune responses to diverse stimuli. Naturally occurring glucocorticoids (hydrocortisone and cortisone) have sodium-retaining properties and are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs, including dexamethasone, are primarily used for their anti-inflammatory effects. At equipotent anti-inflammatory doses, dexamethasone almost completely lacks the sodium-retaining property of hydrocortisone.

Indication :

• Preterm pregnancy to accelerate surfactant production
• Bronchopulmonary dysplasia (BPD)
• Adrenal Insufficiency
• Croup
• Acute lymphoblastic leukemia
• Raised intracranial pressure
• Brain tumor induced cerebral edema
• Airway edema
• Inflammation
• Meningitis
• Spinal cord compression
• Adrenocortical Hyperfunction test
• Respiratory Distress Syndrome in Premature Infants

Contraindications :

Use in preterm infants may be associated with an increased risk of cerebral palsy. Continuous treatment for over 10 days can produce adrenal suppression for 3-4 weeks. Contraindicated in patients who are hypersensitive to any components of this product.

Systemic fungal infections, cerebral malaria, tuberculosis disease of eye.

Dosing :

Adverse Effect :

Hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction, edema, dry scaly skin, impaired wound healing, rash, striae, suppression of reactions to skin tests, thin fragile skin, thinning scalp hair, decreased carbohydrate and glucose tolerance, development of Cushingoid state, hyperglycemia, glycosuria, hirsutism, hypertrichosis, increased requirements for insulin or oral hypoglycemic agents in diabetes, menstrual irregularities, suppression of growth in pediatric patients, hypocalcemic alkalosis, potassium loss, sodium retention, increased appetite, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, aseptic necrosis of femoral and humeral heads, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures, depression, instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri), personality changes, glaucoma, increased intraocular pressure, posterior subcapsular cataracts.

Interaction :

Aminoglutethimide: Aminoglutethimide may diminish adrenal suppression by corticosteroids.
Amphotericin B injection and potassium-depleting agents: When corticosteroids are administered concomitantly with potassium-depleting agents patients should be observed closely for development of hypokalemia.
Antibiotics: Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance.

Renal Dose :

Hepatic Dose :