Category:

• Miscellaneous

Description:

• Adrenal corticosteroid

Indications:

• Anti-inflammatory or immunosuppressant agent in the treatment of  a variety of diseases including those of hematologic, allergic, inflammatory, neoplastic, and autoimmune origin

Contraindications:

• Systemic fungal infections

• Hypersensitivity to any component of the product, including sulfites.  Dexamethasone sodium phosphate contains sodium bisulfite, a sulfite that may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people.

Precautions:

• Pregnancy category C: Newborns may exhibit signs of adrenal insufficiency; excreted in breast milk and may suppress growth and cause other unwanted effects

• Psychotic derangements may appear

• Following prolonged therapy, withdrawal symptoms may include fever, myalgia, arthralgia, and malaise

• Use lowest possible dose

Adverse Reactions (Side Effects):

• METAB: sodium retention, fluid retention, CHF, potassium loss, hypokalemic acidosis, hypertension, negative nitrogen balance

• MS: muscle weakness, osteoporosis, steroid myopathy, tendon rupture, pathological fracture of long bones, vertebral compression fractures

• GI: peptic ulcer, pancreatitis, abdominal distention, ulcerative esophagitis

• SKIN: erythema, increased sweating, petechiae and ecchymoses, urticaria

• ENDO: cushionoid state, supressed growth, menstrual irregularities, hirsutism, secondary adrenocortical and pituitary unresponsiveness

• NEURO: convulsions, vertigo, headache, psychic disturbances, increased intracranial pressure with papilledema

• OTHER: weight gain, increased appetite, thromboemolism, hiccups, nausea, malaise  

Dosage:

For intravenous, intramuscular, intraarticular, intralesional, and soft tissue injection

Dexamethasone sodium phosphate injection can be given directly from the vial, or it can be added to Sodium Chloride Injection or Dextrose Injection and adminsitered by intravenous drip.

• Adult:   

  • Shock: 

    • IV 1-6 mg/kg or 40mg every 2-6 hours

  • Prophylaxis during premature labor: (to prevent infant respiratory distress due to immature lungs)

    •  6mg every 12 hours for 4 doses

  • Intra-articular and soft tissue: 

    • large joints 2-4mg

    • small joints 0.8-1mg

    • bursae 2-3mg

    • tendon sheaths 0.4-1mg, soft tissue infiltration 2-6mg

    • ganglia 1-2mg

Dosage requirements are variable and must be individualized on the basis of the disease and the response of the patient.

Persons on immunosuppressant doses should avoid exposure to chickenpox or measles; if exposed, they should seek medical advice without delay

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