Home Drug Guide Dexamethasone

Drug Guide

Generic Name

Dexamethasone

Brand Names Decadron, Hexadrol, Decaspray, Maxidex, Decaderm, Ozurdex, Aeroseb-dex, Dexone 1.5, Dexone 0.5, Dexone 4, Dexone 0.75, Dexamethasone Intensol, Dextenza, Dexycu Kit, Hemady

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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.