Home Drug Guide Dexamethasone Sodium Phosphate

Drug Guide

Generic Name

Dexamethasone Sodium Phosphate

Brand Names Decadron, Dexacort, Hexadrol, Dexamethasone Sodium Phosphate Preservative Free, Maxidex, Dexacen-4, Dexair, Dexamethasone

Classification

Therapeutic: Anti-inflammatory, Immunosuppressant

Pharmacological: Glucocorticoid

FDA Approved Indications

Inflammation and allergic conditions
Rheumatoid arthritis
Cerebral edema
Certain cancers
Endocrine disorders

Mechanism of Action

Dexamethasone binds to glucocorticoid receptors, modulating gene expression for anti-inflammatory and immunosuppressive effects.

Dosage and Administration

Adult: Dosage varies based on condition; typical doses range from 0.75 mg to 9 mg daily, administered orally, IM, IV, or topical.

Pediatric: Dosing depends on weight and indication; typically 0.02-0.3 mg/kg/day divided into 1-4 doses.

Geriatric: Start at lower doses due to increased sensitivity; monitor closely for adverse effects.

Renal Impairment: Adjust dose based on severity of impairment; consult specific guidelines.

Hepatic Impairment: Use with caution; metabolized hepatically.

Pharmacokinetics

Absorption: Good oral absorption.

Distribution: Widely distributed; crosses blood-brain barrier.

Metabolism: Metabolized in the liver.

Excretion: Eliminated mainly in urine as metabolites.

Half Life: 3-5 hours in plasma.

Contraindications

Systemic fungal infections
Hypersensitivity to dexamethasone

Precautions

Use with caution in infections, diabetes, osteoporosis, psychiatric disorders, or peptic ulcer disease.
Pregnancy category C; risk-benefit analysis required.

Adverse Reactions - Common

Insomnia, increased appetite, fluid retention (Common)
Elevated blood glucose, mood changes (Common)

Adverse Reactions - Serious

Adrenal suppression, osteoporosis, psychological disturbances (Serious)
Infections, ocular effects, allergic reactions (Serious)

Drug-Drug Interactions

NSAIDs (gastric bleeding), CYP3A4 inhibitors (increased levels), vaccines (decreased efficacy)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor glucose levels, electrolytes, infection signs, bone density, mood changes.

Diagnoses:

Risk for infection
Impaired skin integrity
Potential for altered mood or cognitive function

Implementation: Administer with food or milk to minimize GI upset. Taper doses gradually to prevent adrenal insufficiency.

Evaluation: Assess for reduction of inflammation, stabilization of condition, adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed.
Report signs of infection, mood changes, or unusual symptoms.
Do not stop abruptly.
Use additional contraception if on long-term therapy.

Special Considerations

Black Box Warnings:

Potential for immune suppression leading to severe infections

Genetic Factors: Limited specific data.

Lab Test Interference: Can increase blood glucose, may affect electrolyte levels.

Overdose Management

Signs/Symptoms: Cushingoid features, hyperglycemia, hypertension, hypokalemia.

Treatment: Discontinue drug; supportive care; manage symptoms; consider activated charcoal if ingestion recent.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended conditions for the shelf life indicated.