Category:

• Miscellaneous

Description:

• Potent, synthetic anti-inflammatory steroid

Indications:

• Adrenocortical insufficiency, congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis, rheumatoid arthritis, epicondylitis, pemphigus

• Stevens-Johnson syndrome, severe psoriasis, sever seborrheic dermatitis, ankylosing spondylitis, dermatitis herpetiformis, mycosis fungoides, exfoliative dermatitis

• Ulcerative colitis, regional enteritis, severe and incapacitating allergic states

• Acute exacerbations of multiple sclerosis, idiopathic thrombocytopenia purpura (IV only, IM contraindicated), optic neuritis, allergic conjunctivitis, keratitis

Contraindications:

• Premature infants (due to benzyl alcohol in the diluent; associated with fatal “gasping syndrome”

• Systemic fungal infections

Precautions:

• No information on use in pregnancy.  Use only if  benefit outweighs potential risk.

• May cause corneal perforation in patients with herpes simples

• Prolonged use may cause cataracts

• Drug induced adrenocortical insufficiency may be minimized by gradual dose reduction

• May mask signs of infection and new infections may appear

Adverse Reactions (Side Effects):

• psychic derangements, sodium/fluid retention, CHF, muscle weakness, arthralgia

• Kaposi’s sarcoma, tendon rupture, pathologic fracture of long bones, facial erythema

• aseptic necrosis of femoral/humeral heads, Cushingoid state, convulsions, vertigo, glaucoma, exophthalmos, increased intraocular pressure, subcapsular cataracts

• hyper/hypopigmentation, urticaria, sterile abscess, cardiac arrythmias, menstrual irregularities, decreased carbohydrate tolerance

• Osteoporosis, vertebral compression fractures

Dosage:

Administered intravenously, intramuscularly

• High dose therapy: IV 30 mg/kg over at least 30 minutes; may be repeated every 4-6 hours for 48 hours (rarely, 48-72 hours)

• In general: Dose 10-40mg depending upon clinical problem being treated.  The larger doses may be required for short-term management of severe, acute conditions.  The initial dose usually should be given IV over several minutes.  Subsequent doses may be given IV or IM at intervals dictated by the patient’s response and clinical condition.

• Infants and children: Generally reduce the dose, but treatment should be governed more by the severity of the condition and response of the patient than by age or size.  It should not be less than  0.5 mg/kg every 24 hours

Dosage must be decreased or discontinued gradually when the drug has been administered for more than a few days.  If a period of spontaneous remission occurs in a chronic condition, treatment should be discontinues.  Routine blood studies and chest X-rays should be made at regular intervals during prolonged therapy.

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001