Details
Dexamethasone Indications
Dexamethasone should be administered intravenously or intramuscularly in emergencies and when oral administration is not possible.
Diseases of the endocrine system:
· Replacement therapy of primary or secondary (pituitary) adrenal insufficiency (except for acute adrenal insufficiency, in which hydrocortisone or cortisone are more suitable due to their more pronounced hormonal effect);
· Acute adrenal insufficiency (hydrocortisone or cortisone are the drugs of choice; it may be necessary to use together with mineralocorticoids, especially when using synthetic analogues);
· Before operations and in cases of serious injuries or diseases in patients with established adrenal insufficiency or indeterminate adrenocortical stock;
· Shock, resistant to traditional therapy, with existing or suspected adrenal insufficiency;
· Congenital hyperplasia of the adrenal glands;
· Non-purulent inflammation of the thyroid gland and severe forms of radiation thyroiditis.
Rheumatological diseases:
(as adjunctive therapy in the period when the basic therapy did not work, ie in patients in whom the analgesic and anti-inflammatory effects of NSAIDs were unsatisfactory);
· Rheumatoid arthritis, including juvenile rheumatoid arthritis and extra-articular manifestations of rheumatoid arthritis (rheumatic lungs, changes in the heart, eyes, skin vasculitis);
· Synovitis in osteoarthritis; post-traumatic osteoarthritis; epicondylitis; acute nonspecific tendosynovitis; acute gouty arthritis; psoriatic arthritis; ankylosing spondylitis; systemic connective tissue diseases; vasculitis.
Skin diseases:
· Vesicles; severe erythema multiforme (Stevens-Johnson syndrome); exfoliative dermatitis; bullous herpetiform dermatitis; severe forms of exudative erythema; nodular erythema; severe forms of seborrheic dermatitis; severe forms of psoriasis; urticaria that does not respond to standard treatment; fungoid mycosis; dermatomyositis.
Allergic diseases:
(not amenable to traditional treatment)
· Bronchial asthma; contact dermatitis; atopic dermatitis; serum sickness; chronic or seasonal allergic rhinitis; drug allergy; urticaria after blood transfusion.
Diseases of the visual organs:
· Inflammatory eye diseases (acute central choroiditis, optic neuritis); allergic diseases (conjunctivitis, uveitis, scleritis, keratitis, iritis); systemic immune diseases (sarcoidosis, temporal arteritis); proliferative changes in the orbit (endocrine ophthalmopathy, pseudotumor); immunosuppressive therapy for corneal transplantation.
The solution can be administered systemically or topically (conjunctival injection and retrobulbar or parabulbar administration)
Gastrointestinal diseases:
for removing the patient from the critical period when:
· Ulcerative colitis (severe development); Crohn's disease (severe development); chronic autoimmune hepatitis; rejection reaction in liver transplantation.
Respiratory diseases:
· Symptomatic sarcoidosis (symptomatic); acute toxic bronchiolitis; chronic bronchitis and asthma (with exacerbation); focal or disseminated pulmonary tuberculosis (together with appropriate anti-tuberculosis therapy); beryllium (granulomatous inflammation); radiation or aspiration pneumonitis.
Hematological diseases:
· Acquired or congenital chronic aplastic anemia; autoimmune hemolytic anemia;
· Secondary thrombocytopenia in adults; erythroblastopenia; acute lymphoblastoma leukemia (induction therapy); idiopathic thrombocytopenic purpura in adults (intravenous only, intramuscular injection is contraindicated).
Kidney diseases:
· Immunosuppressive therapy for kidney transplantation; stimulation of diuresis or reduction of proteinuria in idiopathic nephrotic syndrome (without uremia) and renal dysfunction in systemic lupus erythematosus.
Malignant oncological diseases:
· Palliative treatment of leukemia and lymphoma in adults; acute leukemia in children; hypercalcemia in malignant diseases.
Brain edema:
· Cerebral edema due to primary or metastatic brain tumor, skull trepanation and traumatic brain injury.
Shock:
· Shock, which is not amenable to classical treatment; shock in patients with adrenal insufficiency; anaphylactic shock (intravenously after adrenaline); before surgery to prevent shock in case of suspicion or established insufficiency of the adrenal cortex.
Other indications:
· Tuberculous meningitis with subarachnoid blockade (together with appropriate anti-tuberculosis therapy); trichinosis with neurological symptoms or trichinosis of the myocardium; cystic tumor of the aponeurosis or tendon (ganglion).
Indications for intra-articular or soft tissue administration:
· Rheumatoid arthritis (severe inflammation of a single joint); ankylosing spondylitis (when inflamed joints do not respond to traditional treatment); psoriatic arthritis (oligoarticular form and tendovaginitis); monoarthritis (after evacuation
Contraindications
Hypersensitivity to the active substance or to any other ingredient of the drug.
Acute viral, bacterial or systemic fungal infections (if not treated properly).
Cushing's syndrome.
Vaccination with live vaccine.
Breastfeeding period (except in emergencies).
Intramuscular administration is contraindicated in patients with severe coagulation disorders.
Topical administration is contraindicated in bacteremia, systemic fungal infections, patients with unstable joints, infections at the site of application, including septic arthritis due to gonorrhea or tuberculosis.
Dosage & Administration
Dexamethasone solution for injection should be given to adults and children from birth.
The solution for injection can be administered intravenously (by injection or infusion with glucose solution or sodium chloride solution), intramuscularly or topically (by injection into the joint or injection into the affected area on the skin or into the infiltrate). in soft tissues). Use 0.9% sodium chloride solution or 5% glucose solution as the solvent for intravenous infusion.
Solutions intended for intravenous administration or subsequent dissolution of the drug should not contain preservatives when used for infants, especially premature infants.
Sterile safety measures should be observed when mixing the product with the solvent for infusion. The mixture should be used within 24 hours, as solutions for infusion usually do not contain preservatives. Preparations for parenteral administration should be visually inspected for the presence of foreign inclusions and discoloration each time before administration.
The dose should be determined individually according to the disease of a particular patient, the expected period of treatment, tolerability of corticoids and the body's response.
Parenteral administration
Dexamethasone should be administered parenterally in urgent cases, in cases where oral therapy is not possible and in the cases listed in the section "Indications for use".
The solution for injection should be administered intravenously, intramuscularly or by infusion (with glucose solution or sodium chloride solution).
The recommended average initial daily dose for intravenous or intramuscular administration is 0.5-9 mg per day, the dose can be increased if necessary. Initial doses should be administered until a clinical response occurs, and then the dose should be gradually reduced to the lowest clinically effective dose.
When prescribing high doses over several days, gradually reduce the dose over the next few days or longer.
Local application
Doses from 0.4 mg to 4 mg are recommended for injection into the joint. The dose depends on the size of the affected joint. Usually inject 2-4 mg into large joints and 0.8-1 mg into small ones. Re-introduction into the joint is possible after 3-4 months. The administration can be performed three or four times in one joint throughout life and at the same time no more than 2 joints. More often, intra-articular injection can damage articular cartilage and cause bone necrosis.
The dose of dexamethasone injected into the synovial sac is usually 2-3 mg, the dose into the tendon sheath is 0.4-1 mg, in the ganglion - from 1 to 2 mg.
The dose of dexamethasone administered at the site of injury is equivalent to the intra-articular dose. Dexamethasone can be administered simultaneously to no more than two sites of injury.
Doses for injection into soft tissues (around the joint) are 2-6 mg.
Doses for children
When administered intramuscularly, the recommended dose for replacement therapy is 0.02 mg / kg body weight or 0.67 mg / m2 body surface area, divided into 3 doses administered every third day, or 0.008-0.01 mg / kg body weight or 0.2-0.3 mg / m2 body surface area per day.
For all other indications, the recommended dose is 0.02-0.1 mg / kg body weight or 0.8-5 mg / m2 body surface area every 12-24 hours.
