Nurses Compass
Drug Guide
Dexamethasone
Classification
Therapeutic: Anti-inflammatory, immunosuppressant, corticosteroid
Pharmacological: Glucocorticoid receptor agonist
FDA Approved Indications
- Inflammatory conditions (e.g., allergic reactions, skin conditions, respiratory diseases)
- Adrenal insufficiency
- Certain cancers
- To reduce cerebral edema
- Ocular inflammation
Mechanism of Action
Dexamethasone binds to glucocorticoid receptors, modulating gene expression to suppress inflammation and immune responses, and affecting carbohydrate, protein, and fat metabolism.
Dosage and Administration
Adult: Varies widely based on indication; e.g., oral doses range from 0.5 mg to 10 mg once daily or in divided doses. For specific indications, consult prescribing information.
Pediatric: Dosing determined by weight and condition; typical ranges are 0.02-0.3 mg/kg/day in divided doses.
Geriatric: Start at lower doses, monitor closely due to increased risk of adverse effects.
Renal Impairment: Dose adjustment may be necessary; consult specific guidelines.
Hepatic Impairment: Use with caution; dose reduction may be required.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed; penetrates cerebrospinal fluid, saliva, and other tissues.
Metabolism: Metabolized in the liver via CYP3A4 enzyme.
Excretion: Excreted primarily in urine as active and inactive metabolites.
Half Life: Approximately 3-4.5 hours; biological effects can last longer.
Contraindications
- Fungal infections
- Hypersensitivity to dexamethasone
Precautions
- Use with caution in patients with infections, diabetes, hypertension, osteoporosis, psychiatric disorders, and ocular herpes simplex. Pregnancy category C; Use only if clearly needed during pregnancy and breastfeeding.
Adverse Reactions - Common
- Increased blood sugar (Common)
- Fluid retention (Common)
- Gastrointestinal upset (Common)
- Mood changes (Common)
Adverse Reactions - Serious
- Psychosis (Rare)
- Osteoporosis (Less common)
- Peptic ulcers (Less common)
- Adrenal suppression (Potential with prolonged use)
Drug-Drug Interactions
- NSAIDs (risk of GI bleeding)
- Vaccines (reduce effectiveness)
- CYP3A4 inducers/inhibitors (alter dexamethasone levels)
Drug-Food Interactions
- No specific interactions identified
Drug-Herb Interactions
- Potential interactions with St. John's Wort, ginseng
Nursing Implications
Assessment: Monitor blood glucose, electrolytes, signs of infection, pressure in the eyes, mood changes.
Diagnoses:
- Risk for infection
- Imbalanced fluid volume
- Altered mental status
Implementation: Administer as prescribed; monitor for adverse effects; avoid live vaccines during therapy.
Evaluation: Assess patient’s response and monitor for adverse reactions.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report signs of infection, mood changes, or muscle weakness.
- Avoid live vaccines during therapy.
- Monitor blood sugar levels if diabetic.
Special Considerations
Black Box Warnings:
- Risk of secondary infection, especially in immunocompromised patients.
- Potential for immune suppression leading to increased infection risk.
Genetic Factors: Variability in metabolism through CYP3A4 enzyme can affect drug levels.
Lab Test Interference: May increase serum glucose, calcium, and blood pressure readings.
Overdose Management
Signs/Symptoms: Symptoms of overdose may include hyperglycemia, infection, adrenal suppression, and Cushingoid features.
Treatment: Discontinue medication; supportive management, monitor vital signs, treat symptoms as needed.
Storage and Handling
Storage: Store at room temperature, away from light and moisture.
Stability: Stable for 2-3 years depending on formulation.