Dexamethasone

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Dexamethasone

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Doses are set individually for each patient, depending on the nature of the disease, the expected duration of treatment, the tolerability of the drug and the patient's response to therapy.

Recommended starting dose for adults ranges from 0.5 mg to 9 mg / day.

The usual maintenance dose is from 0.5 mg to 3 mg / day.

The minimum effective daily dose is 0.5-1 mg.

The maximum daily dose is 10-15 mg.

The daily dose can be divided into 2-4 doses.

After reaching the therapeutic effect, the dose is gradually reduced (usually by 0.5 mg every 3 days until the maintenance dose is reached).

With long-term use of high doses by mouth, the drug is recommended to be taken during meals, and in the intervals between meals, antacids should be taken. The duration of dexamethasone use depends on the nature of the pathological process and the effectiveness of treatment and ranges from several days to several months or more. The treatment is stopped gradually (at the end, several injections of corticotropin are prescribed).

• with bronchial asthma, rheumatoid arthritis, ulcerative colitis - 1.5-3 mg / day;
• with systemic lupus erythematosus - 2-4.5 mg /;
• with hematologic diseases - 7.5-10 mg.

For the treatment of acute allergic diseases, it is advisable to combine parenteral and oral administration: 1 day - 4-8 mg parenterally; 2 day - inside, 4 mg 3 times a day; 3, 4 days - inside, 4 mg 2 times a day; 5, 6 day - 4 mg / day, inside; Day 7 - the abolition of the drug.

Dosing in children

Children (depending on age) are prescribed 2.5-10 mg / m2 of body surface area /, dividing the daily dose into 3-4 doses.

Diagnostic tests for hyperfunction of the adrenal cortex

Short 1-mg dexamethasone test: 1 mg of dexamethasone inside at 11.00; blood sampling to determine serum cortisol at 8.00 the next day.

Special 2-day test with 2 mg of dexamethasone: 2 mg of dexamethasone orally every 6 hours for 2 days; daily urine is collected to determine the concentration of 17-hydroxycorticosteroids.

Adverse reactions

On the part of the immune system: infrequently, hypersensitivity reactions, reduced immune response and increased susceptibility to infections.

On the part of the endocrine system: often - transient adrenal insufficiency, growth retardation in children and adolescents, adrenal insufficiency and atrophy (reduction of the stress response), Itsenko-Cushing syndrome, menstrual disorder, hirsuitism, the transition of latent diabetes mellitus to clinically manifest, increased insulin or oral hypoglycemic drugs in patients with diabetes mellitus, sodium and water retention, increased potassium loss; very rarely, hypokalemic alkalosis, negative nitrogen balance due to protein catabolism.

Metabolism and nutrition disorders: often - reduced tolerance to carbohydrates, increased appetite and weight gain, obesity; infrequently - hypertriglyceridemia.

From the nervous system: often - mental disorders; infrequently, swelling of the papillae of the optic nerve and increased intracranial pressure (brain pseudo-tumor) after discontinuation of therapy, dizziness, headache; very rarely - convulsions, euphoria, insomnia, irritability, hyperkinesia, depression; rarely - psychosis.

From the digestive system: infrequently - peptic ulcers, acute pancreatitis, nausea, hiccups, stomach or duodenal ulcers; very rarely - esophagitis, perforation of the ulcer and bleeding of the gastrointestinal tract (hematomesis, melena), pancreatitis, perforation of the gallbladder and intestines (especially in patients with chronic inflammatory diseases of the large intestine).

From the senses: infrequently - posterior subcapsular cataract, increased intraocular pressure, a tendency to develop secondary bacterial, fungal or viral infections of the eye, trophic changes of the cornea, exophthalmos.

Since the cardiovascular system: infrequently - arterial hypertension, hypertensive encephalopathy; very rarely, polyfocal ventricular extrasystoles, transient bradycardia, heart failure, myocardial rupture after a recent acute heart attack.

On the part of the skin: often - erythema, thinning and brittleness of the skin, delayed healing of wounds, striae, petechiae and ecchymosis, increased sweating, steroid acne, suppression of the skin reaction during allergological tests; very rarely - anginevrotic edema, allergic dermatitis, urticaria.

From the musculoskeletal system: often - muscle atrophy, osteoporosis, muscle weakness, steroid myopathy (muscle weakness due to catabolism of muscle tissue); infrequently - aseptic bone necrosis; very rarely - compression vertebral fractures, tendon ruptures (especially when some quinolones are used together), damage to articular cartilage, and bone necrosis (associated with frequent intra-articular injections).

From the hemopoietic system: rarely, thromboembolic complications, a decrease in the number of monocytes and / or lymphocytes, leukocytosis, eosinophilia (as with other glucocorticosteroids), thrombocytopenia, and not thrombocytopenic purpura.

Allergic reactions: rarely - skin rash, itching, angioedema, bronchospasm, anaphylactic shock.

From the genitourinary system: rarely - impotence.

Contraindications

For short-term use for "vital" indications, the only contraindication is hypersensitivity to the active substance or auxiliary components of the drug.

The drug is contraindicated in patients with galactosemia, lactase deficiency and glucose-galactose malabsorption syndrome, due to the fact that the preparation contains lactose.

Carefully.Parasitic and infectious diseases of a viral, fungal or bacterial nature (currently or recently transferred, including recent contact with a patient) - herpes simplex, herpes zoster (viremic phase), chicken pox, measles; amebiasis, strongyloidiasis (established or suspected); systemic mycosis; active and latent tuberculosis, pre-and post-vaccination period (8 weeks before and 2 weeks after vaccination), lymphadenitis after BCG vaccination, immunodeficiency states (including AIDS or HIV infection).

Diseases of the gastrointestinal tract:peptic ulcer and 12 duodenal ulcer, esophagitis, gastritis, acute or latent peptic ulcer, a newly created intestinal anastomosis, ulcerative colitis with the threat of perforation or abscess formation, diverticulitis.

Diseases of the cardiovascular system,including recent myocardial infarction (in patients with acute and subacute myocardial infarction, necrosis can spread, slowing the formation of scar tissue and, as a result, cardiac muscle rupture), decompensated chronic heart failure, arterial hypertension, hyperlipidemia.

Endocrine diseases:diabetes mellitus (including the violation of tolerance to carbohydrates), thyrotoxicosis, hypothyroidism, Itsenko-Cushing's disease.

Severe chronic renal and / or liver failure, nephroluritiasis; hypoalbuminemia and conditions predisposing to its occurrence; systemic osteoporosis, myasthenia gravis, acute psychosis, obesity (III-IV cent.), polio (with the exception of the form of bulbar encephalitis), open-angle and angle-closure glaucoma, lactation period.

Drug interactions

The simultaneous use of dexamethasone and nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of developing and forming ulcers of the gastrointestinal tract.

The effect of dexamethasone is reduced with the simultaneous use of CYPZA4 isoenzyme inducers (for example, phenytoin, phenobarbitone, carbamazepine, primidone, rifabutin, rifampicin) or drugs that increase the metabolic clearance of glucocorticoids (ephedrine and amino glutetimid); in such cases, it is necessary to increase the dose of dexamethasone.

The interaction between dexamethasone and the drugs listed above may distort the results of dexamethasone suppression samples.If samples with dexamethasone are to be conducted during therapy with one of the listed drugs, this interaction should be taken into account when interpreting the results of the samples.

Simultaneous use of dexamethasone and inhibitors of the CYPZA4 isoenzyme (for example, ketoconazole, macrolide antibiotics) can lead to an increase in the concentration of dexamethasone in the blood.

The simultaneous use of drugs that are metabolized by CYPZA4 (for example, indinavir, erythromycin) may increase their clearance, which may be accompanied by a decrease in their serum concentrations.

Dexamethasone reduces the effectiveness of hypoglycemic drugs, antihypertensive drugs, praziquantel and natriuretics (it is necessary to increase the dose of these drugs); increases the activity of heparin, albendazole and potassium-sparing diuretics (if necessary, reduce the dose of these drugs).

Dexamethasone can change the effect of coumarin anticoagulants, therefore during therapy more frequent monitoring of prothrombin time is recommended. Antacids reduce the absorption of dexamethasone in the stomach. Smoking does not affect the pharmacokinetics of dexamethasone.

With simultaneous use of oral contraceptives, T1 / 2 glucocorticosteroids may increase, with a corresponding increase in their biological effects and an increase in the incidence of adverse side effects.

Simultaneous use of ritodrine and dexamethasone during labor is contraindicated, as this may lead to the death of the mother due to pulmonary edema. The combined use of dexamethasone and thalidomide can cause toxic epidermal necrolysis.

Potential therapeutically beneficial interactions:simultaneous application of dexamethasone and metoclopramide, diphenhydramine, prochlorperazine or antagonists of 5-HT3 receptor antagonists (serotonin or 5-hydroxytryptamine receptors of 3 types), such as ondansetron or granisetron, is effective in the prevention of nausea and vomiting caused by chemotherapy (cisplatin, cyclophosphamide, methotrexate, fluorouracil) .

Pregnancy and Lactation

Special instructions

Overdosage