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TIME/ACTION PROFILE (anti-inflammatory activity)
1
dexamethasone (dex-a-meth-a-sone)
Decadron, DexPak
Classification
Therapeutic: anti-inflammatories (steroidal)
Pregnancy Category C
Used systemically and locally in a wide variety of chronic diseases including: Inflammatory, Allergic, Hematologic, Endocrine, Neoplastic, Dermatologic, Autoimmune
disorders, Management of cerebral edema, Diagnostic agent in adrenal disorders.
Unlabeled Use: Short-term administration to high-risk mothers before delivery to
prevent respiratory distress syndrome in the newborn. Adjunctive management of
nausea and vomiting from chemotherapy. Treatment of airway edema prior to extubation. Used in neonates with bronchopulmonary dysplasia to facilitate ventilator
weaning.
Action
In pharmacologic doses, suppresses inflammation and the normal immune response. Has numerous intense metabolic effects (see Adverse Reactions and Side Effects). Suppresses adrenal function at chronic doses of 0.75 mg/day. Has negligible
mineralocorticoid activity. Therapeutic Effects: Suppression of inflammation
and modification of the normal immune response.
Pharmacokinetics
Absorption: Well absorbed after oral administration. Sodium phosphate salt is
rapidly absorbed after IM administration. Absorption from local sites (intra-articular, intralesional) is slow but complete.
Distribution: Widely distributed, crosses the placenta, and appears to enter breast
milk.
Metabolism and Excretion: Mostly metabolized by the liver.
Half-life: Low birth weight infants with BPD: 9.3 hr; Children 3 mo– 16 yr: 4.3 hr;
Adults: 3– 4.5 hr (plasma), 36– 54 hr (tissue); adrenal suppression lasts 2.75 days.
⫽ Genetic Implication.
ONSET
PEAK
DURATION
PO
IM, IV (phosphate)
unknown
rapid
1–2 hr
unknown
72 hr
72 hr
Contraindications/Precautions
Contraindicated in: Active untreated infections (may be used in patients being
Indications
⫽ Canadian drug name.
ROUTE
treated for tuberculous meningitis); Known alcohol or bisulfite hypersensitivity or intolerance (some products contain these and should be avoided in susceptible patients); Lactation: Avoid chronic use.
Use Cautiously in: Chronic treatment (will lead to adrenal suppression; use lowest possible dose for shortest period of time); Stress (surgery, infections); supplemental doses may be needed; Potential infections (may mask signs); OB: Safety not
established; Pedi: Early postnatal administration of high doses can cause significant
and persistent reductions in neuromotor and cognitive functioning; results inp
growth; use lowest possible dose for shortest period of time.
Adverse Reactions/Side Effects
Adverse reactions/side effects are much more common with high-dose/long-term
therapy CNS: depression, euphoria, hallucinations, headache,qintracranial pressure (children only), insomnia, personality changes, psychoses, restlessness.
EENT: cataracts,qintraocular pressure. CV: hypertension, edema. GI: PEPTIC ULCERATION, anorexia, nausea,qappetite, vomiting. Derm: acne,pwound healing, ecchymoses, hirsutism, petechiae. Endo: adrenal suppression, hyperglycemia. F and
E: amenorrhea, hypokalemia, alkalosis. Hemat: THROMBOEMBOLISM, thrombophlebitis. Metab: weight gain. MS: muscle wasting, osteoporosis, avascular necrosis of joints, muscle pain. Misc: cushingoid appearance (moon face, buffalo hump),
qsusceptibility to infection.
Interactions
Drug-Drug:qrisk of hypokalemia with thiazide and loop diuretics, amphotericin B, piperacillin, or ticarcillin. Hypokalemia mayqrisk of digoxin toxicity.
Mayqrequirement for insulin or oral hypoglycemic agents. Mayplevels ofphenytoin and isoniazid. Levels may beqwith oral contraceptives.qrisk of adverse GI effects with NSAIDs (including aspirin),alcohol and caffeine. At chronic
doses that suppress adrenal function, maypthe antibody response to andqrisk of
adverse reactions from live-virus vaccines. Mayqorpthe effects of warfarin. Lev-
CAPITALS indicate life-threatening, underlines indicate most frequent.
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● Monitor intake and output ratios and daily weights. Observe patient for peripheral
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els may bepwhen used with phenytoin, phenobarbital, or rifampin. Mayqrisk
of tendon rupture when used with fluoroquinolones.
Route/Dosage
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edema, steady weight gain, rales/crackles, or dyspnea. Notify physician or other
health care professional should these occur.
Children should have periodic evaluations of growth.
Cerebral Edema: Assess for changes in level of consciousness and headache
throughout therapy.
Lab Test Considerations: Monitor serum electrolytes and glucose. May cause
hyperglycemia, especially in patients with diabetes. Monitor hematologic values,
serum electrolytes, and serum and urine glucose in patients on prolonged therapy. May causepWBC counts. May causepserum potassium and calcium andq
serum sodium concentrations.
Guaiac test stools. Promptly report presence of guaiac-positive stools.
May causeqserum cholesterol and lipid values. Maypuptake of thyroid 123I or
131
I.
Suppresses reactions to allergy skin tests.
Periodic adrenal function tests may be ordered to assess degree of hypothalamicpituitary-adrenal axis suppression in systemic and chronic topical therapy.
Dexamethasone Suppression Test: To diagnose Cushing’s syndrome, obtain
baseline cortisol level; administer dexamethasone at 11 PM and obtain cortisol levels at 8 AM the next day. Normal response is a decreased cortisol level.
Alternative method: Obtain baseline 24-hr urine for 17-hydroxycorticosteroid
(OHCS) concentrations, then begin 48-hr administration of dexamethasone. Second 24-hr urine for 17-OHCS is obtained after 24 hr of dexamethasone.
PO, IM, IV (Adults): Anti-inflammatory— 0.75– 9 mg daily in divided doses q 6–
12 hr. Airway edema or extubation— 0.5– 2 mg/kg/day divided q 6 hr; begin 24 hr
prior to extubation and continue for 24 hr post-extubation. Cerebral edema— 10
mg IV, then 4 mg IM or IV q 6 hr until maximal response achieved, then switch to PO
regimen and taper over 5– 7 days.
PO, IM, IV (Children): Airway edema or extubation— 0.5– 2 mg/kg/day divided
q 6 hr; begin 24 hr prior to extubation and continue for 24 hr post-extubation. Antiinflammatory— 0.08– 0.3 mg/kg/day or 2.5– 10 mg/m2/day divided q 6– 12 hr.
Physiologic replacement— 0.03– 0.15 mg/kg/day or 0.6– 0.75 mg/m2/day divided
q 6– 12 hr.
PO (Adults): Suppression test— 1 mg at 11PM or 0.5 mg q 6 hr for 48 hr.
IV (Children): Chemotherapy induced emesis— 5– 20 mg given 15– 30 min before treatment. Cerebral edema— Loading dose 1– 2 mg/kg followed by 1– 1.5 mg/
kg/day divided q 4– 6 hr for 5 days (not to exceed 16 mg/day); then taper over 1– 6
wk. Bacterial meningitis— 0.6 mg/kg/day divided q 6 hr x 4 days (start at time of
first antibiotic dose).
IV, PO (Adults): Chemotherapy induced emesis— 10– 20 mg given 15– 30 min
before each treatment or 10 mg q 12 hr on each treatment day. Delayed nausea/
vomiting— 4– 10 mg PO 1– 2 times/day for 2– 4 days or 8 mg PO q 12 hr for 2 days,
then 4 mg PO q 12 hr for 2 days or 20 mg PO 1 hr before chemotherapy, then 10 mg
PO q 12 hr after chemotherapy, then 8 mg PO q 12 hr for 2 days, then 4 mg PO q 12 hr
for 2 days.
IS (Adults): 0.4– 6 mg/day.
●
NURSING IMPLICATIONS
Assessment
● Periods of stress, such as surgery, may require supplemental systemic corticoste-
● Indicated for many conditions. Assess involved systems before and periodically
during therapy.
● Assess for signs of adrenal insufficiency (hypotension, weight loss, weakness, nau-
sea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically
during therapy.
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Potential Nursing Diagnoses
Risk for infection (Side Effects)
Disturbed body image (Side Effects)
Implementation
● If dose is ordered daily or every other day, administer in the morning to coincide
with the body’s normal secretion of cortisol.
roids.
● PO: Administer with meals to minimize GI irritation.
● Tablets may be crushed and administered with soft food, chocolate syrup, or fluids
for patients with difficulty swallowing.
● Use calibrated measuring device to ensure accurate dosage of liquid forms.
● IM: IM doses should not be administered when rapid effect is desirable. Do not
dilute with other solution or admix.
䉷 2015 F.A. Davis Company
CONTINUED
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CONTINUED
dexamethasone
IV Administration
● pH: 7.0– 8.5.
● Direct IV: Diluent: May be given undiluted. Concentration: 4– 10 mg/mL.
Rate: Administer over 1– 4 min if dose is ⬍10 mg.
● Intermittent Infusion: Diluent: High-dose therapy should be added to D5W
or 0.9% NaCl solution. Solution should be clear and colorless to light yellow; use
diluted solution within 24 hr. Concentration: Up to 10 mg/mL. Rate: Administer infusions over 15– 30 min.
● Syringe Compatibility: caffeine citrate, dimenhydrate, furosemide, granisetron,
ketamine, metoclopramide, octreotide, palonosetron, ranitidine, sufentanil.
● Syringe Incompatibility: doxapram, glycopyrrolate, haloperidol, pantoprazole, prochlorperazine, vancomycin.
● Y-Site Compatibility: acyclovir, alfentanil, allopurinol, amifostine, amikacin,
aminophylline, amphotericin B cholesteryl, amphotericin B liposome, amsacrine,
anidulafungin, argatroban, ascorbic acid, atracurium, atropine, aztreonam, benztropine, bivalirudin, bumetanide, buprenorphine, butorphanol, carboplatin, carmustine, cefazolin, cefepime, cefonocid, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, chloramphenicol, cisatracurium, cisplatin,
cladribine, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexmedetomidine, digoxin, docetaxel, dopamine, doripenem, doxacurium, doxorubicin, doxorubicin liposome, enalaprilat, ephedrine, epinephrine, epoetin alfa, eptifibatide, ertapenem, etoposide,
etoposide phosphate, famotidine, fentanyl, filgrastim, fluconazole, fludarabine,
fluorouracil, folic acid, foscarnet, furosemide, ganciclovir, gemcitabine, glycopyrrolate, granisetron, heparin, hetastarch, hydrocortisone, hydromorphone, ifosfamide, imipenem/cilastatin, indomethacin, insulin, isoproterenol, ketorolac, levofloxacin, lidocaine, linezolid, lorazepam, mannitol, mechlorethamine,
melphalan, meropenem, metaraminol, methadone, methoxamine, methyldopate,
methylprednisolone, metoclopramide, metoprolol, metronidazole, miconazole,
milrinone, morphine, multivitamin, nafcillin, nalbuphine, naloxone, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxy⫽ Canadian drug name.
⫽ Genetic Implication.
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tocin, paclitaxel, palonosetron, pamidronate, pemetrexed, penicillin G, pentobarbital, phenobarbital, phenylephrine, phytonadione, piperacillin/tazobactam,
potassium acetate, potassium chloride, procainamide, propofol, propranolol,
pyridoxime, ranitidine, remifentanil, rituximab, sargramostim, sodium acetate,
sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tolazoline, trastuzumab, trimetaphan, vancomycin, vasopressin,
vecuronium, verapamil, vincristine, vinorelbine, vitamin B complex with C, voriconazole, zidovudine, zoledronic acid.
● Y-Site Incompatibility: amphotericin B colloidal, calcium chloride, calcium
gluconate, caspofungin, cefuroxime, chlorpormazine, ciprofloxacin, dantrolene,
diazepam, diazoxide, diphenhydramine, dobutamine, doxycycline, epirubicin,
erythromycin, esmolol, fenoldopam, gentamicin, haloperidol, hydroxyzine, idarubicin, labetalol, magnesium sulfate, midazolam, mitoxantrone, mycophenolate,
pantoprazole, papaverine, pentamidine, pentazocine, phentolamine, phenytoin,
prochlorperazine, promethazine, protamine, quinapristin/dalfopristin, tobramycin, topotecan, trimethoprim/sulfamethoxazole.
Patient/Family Teaching
● Instruct patient on correct technique of medication administration. Advise patient
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to take medication as directed. Take missed doses as soon as remembered unless
almost time for next dose. Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness,
fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately; may be life-threatening.
Corticosteroids cause immunosuppression and may mask symptoms of infection.
Instruct patient to avoid people with known contagious illnesses and to report
possible infections immediately.
Caution patient to avoid vaccinations without first consulting health care professional.
Review side effects with patient. Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occur. Patient
should also report unusual swelling, weight gain, tiredness, bone pain, bruising,
nonhealing sores, visual disturbances, or behavior changes.
Advise patient to notify health care professional of medication regimen before
treatment or surgery.
Discuss possible effects on body image. Explore coping mechanisms.
CAPITALS indicate life-threatening, underlines indicate most frequent.
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● Instruct patient to inform health care professional if symptoms of underlying dis-
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ease return or worsen.
● Advise patient to carry identification describing disease process and medication
regimen in the event of emergency in which patient cannot relate medical history.
● Explain need for continued medical follow-up to assess effectiveness and possible
side effects of medication. Periodic lab tests and eye exams may be needed.
Evaluation/Desired Outcomes
● Decrease in presenting symptoms with minimal systemic side effects.
● Suppression of the inflammatory and immune responses in autoimmune disor-
ders, allergic reactions, and neoplasms.
● Decrease in intracranial pressure.
● Management of symptoms in adrenal insufficiency.
Why was this drug prescribed for your patient?
䉷 2015 F.A. Davis Company