· Indications See Pronunciation · 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/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. Contraind./Precautions Contraindicated in:  · Active untreated infections (may be used in patients being treated for tuberculous meningitis) · Known alcohol or bisulfite hypersensitivity or intolerance (some products contain these and should be avoided in susceptible patients) · Epidural use (may result in serious neurological injury or death) · 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 in  growth; use lowest possible dose for shortest period of time. Adv. Reactions/Side Effects Adverse reactions/side effects are much more common with high-dose/long-term therapy CNS: depression, euphoria, hallucinations, headache, intracranial pressure (children only), insomnia, personality changes, psychoses, restlessness. EENT: cataracts,  intraocular pressure. CV: hypertension, edema. GI: PEPTIC ULCERATION, anorexia, nausea,  appetite, vomiting. Derm: acne, wound healing, ecchymoses, hirsutism, petechiae. Endo: adrenal suppression, hyperglycemia. F and E: amenorrhea, hypokalemia, alkalosis. Hemat: THROMBOEMBOLISM, thrombophlebitis. Metab: weight ga ...

1. · Indications
See Pronunciation
· 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.

2. Absorption from local sites (intra-articular, intralesional) is
slow but complete.
Distribution: Widely distributed, crosses the placenta, and
appears to enter breast milk.
Metabolism/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.
Contraind./Precautions
Contraindicated in:
· Active untreated infections (may be used in patients being
treated for tuberculous meningitis)
· Known alcohol or bisulfite hypersensitivity or intolerance
(some products contain these and should be avoided in
susceptible patients)
· Epidural use (may result in serious neurological injury or
death)
· 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 in growth; use lowest possible
dose for shortest period of time.
Adv. Reactions/Side Effects
Adverse reactions/side effects are much more common with
high-dose/long-term therapy
CNS: depression, euphoria, hallucinations,
headache, intracranial pressure (children only), insomnia,
personality changes, psychoses, restlessness.
EENT: cataracts, intraocular pressure.

3. CV: hypertension, edema.
GI: PEPTIC ULCERATION, anorexia, nausea, appetite,
vomiting.
Derm: acne, wound 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), susceptibility to infection.
Interactions
Drug-Drug:
· risk of hypokalemia with thiazide and loop
diuretics, amphotericin B, piperacillin, or ticarcillin.
· Hypokalemia may risk of digoxin toxicity.
· May requirement for insulin or oral hypoglycemic agents.
· May levels of phenytoin and isoniazid.
· Levels may be with oral contraceptives.
· risk of adverse GI effects
with NSAIDs (including aspirin), alcohol and caffeine.
· At chronic doses that suppress adrenal function, may the
antibody response to and risk of adverse reactions from live-
virus vaccines.
· May or the effects of warfarin.
· Levels may be when used with phenytoin, phenobarbital,
or rifampin.
· May risk of tendon rupture when used with fluoroquinolones.
Route/Dosage
· 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,

4. 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. Anti-inflammatory — 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.
Implementation
· If dose is ordered daily or every other day, administer in the
morning to coincide with the body's normal secretion of
cortisol.
· Periods of stress, such as surgery, may require supplemental
systemic corticosteroids.
· 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

5. desirable. Do not dilute with other solution or admix.
IV Administration: .
· IV Push:
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.
· Administer infusions over 15–30 min.Rate:
· Y-Site Compatibility:
· acetaminophen
· acyclovir
· alfentanil
· allopurinol
· amifostine
· amikacin
· aminocaproic acid
· aminophylline
· amphotericin B lipid complex
· amphotericin B liposome
· anidulafungin
· argatroban

6. · ascorbic acid
· atropine
· azithromycin
· aztreonam
· benztropine
· bivalirudin
· bleomycin
· bumetanide
· buprenorphine
· butorphanol
· cangrelor
· carboplatin
· carmustine
· cefazolin
· cefepime
· cefotaxime
· cefotetan
· cefoxitin
· ceftaroline
· ceftazidime
· ceftriaxone
· chloramphenicol
· cisatracurium
· cisplatin
· cladribine

7. · clindamycin
· cyanocobalamin
· cyclophosphamide
· cyclosporine
· cytarabine
· dacarbazine
· dactinomycin
· daptomycin
· dexmedetomidine
· digoxin
· diltiazem
· dimenhydrinate
· docetaxel
· dopamine
· doripenem
· doxorubicin
· doxorubicin liposome
· enalaprilat
· ephedrine
· epinephrine
· epoetin alfa
· eptifibatide
· ertapenem
· etoposide
· etoposide phosphate

8. · famotidine
· fentanyl
· filgrastim
· fluconazole
· fludarabine
· fluorouracil
· folic acid
· fosaprepitant
· foscarnet
· furosemide
· ganciclovir
· gemcitabine
· glycopyrrolate
· granisetron
· heparin
· hetastarch
· hydrocortisone sodium succinate
· hydromorphone
· ifosfamide
· imipenem/cilastatin
· indomethacin
· insulin
· irinotecan
· isoproterenol
· ketorolac

9. · leucovorin
· levofloxacin
· lidocaine
· linezolid
· lorazepam
· mannitol
· mechlorethamine
· melphalan
· meropenem
· mesna
· methohexital
· methyldopate
· methylprednisolone sodium succinate
· metoclopramide
· metoprolol
· metronidazole
· miconazole
· milrinone
· morphine
· moxifloxacin
· multivitamin
· nafcillin
· nalbuphine
· naloxone
· nitroglycerin

10. · nitroprusside
· norepinephrine
· octreotide
· ondansetron
· oxaliplatin
· oxytocin
· paclitaxel
· palonosetron
· pamidronate
· pemetrexed
· penicillin G
· pentobarbital
· phenobarbital
· phenylephrine
· phytonadione
· piperacillin/tazobactam
· potassium acetate
· potassium chloride
· procainamide
· propofol
· propranolol
· pyridoxine
· ranitidine
· remifentanil
· rituximab

11. · sargramostim
· sodium acetate
· sodium bicarbonate
· streptokinase
· succinylcholine
· sufentanil
· tacrolimus
· telavancin
· teniposide
· theophylline
· thiamine
· thiotepa
· tigecycline
· tirofiban
· trastuzumab
· vancomycin
· vasopressin
· vecuronium
· verapamil
· vinblastine
· vincristine
· vinorelbine
· vitamin B complex with C
· voriconazole
· zidovudine

12. · zoledronic acid
· Y-Site Incompatibility:
· alemtuzumab
· amiodarone
· amphotericin B colloidal
· caspofungin
· cefuroxime
· ciprofloxacin
· dacarbazine
· dantrolene
· diazepam
· diphenhydramine
· dobutamine
· doxycycline
· epirubicin
· esmolol
· fenoldopam
· haloperidol
· hydroxyzine
· idarubicin
· labetalol
· magnesium sulfate
· midazolam
· mitoxantrone
· mycophenolate

13. · pantoprazole
· papaverine
· pentamidine
· pentazocine
· phenytoin
· prochlorperazine
· protamine
· quinapristin/dalfopristin
· tobramycin
· topotecan
· trimethoprim/sulfamethoxazole
US Brand Names
Decadron, DexPak
Canadian Brand Names
Dexasone
Pregnancy Category
Category C
Classifications
Therapeutic Classification: corticosteroids
Availability
(Generic available)
· Tablets: 0.5 mg; 0.75 mg; 1 mg; 1.5 mg; 2 mg; 4 mg; 6 mg;
· Elixir (raspberry flavor): 0.5 mg/5 mL;
· Oral solution (cherry flavor): 0.5 mg/5 mL; 1 mg/mL;
·