Dexamethasone is available with or without a prescription. Dexamethasone (solution for injection) instructions for use, contraindications, side effects, reviews. Respiratory system diseases

Dexamethasone ampoules 4 mg, 1 ml, 25 pcs. — average price 185 rub.

Dexamethasone is a drug that has anti-inflammatory and immunosuppressive effects. The solution for intravenous and intramuscular administration is a clear, colorless or light yellow liquid.

• Latin name: Dexamethasone
• ATX code: S01BA01
• Active substance: Dexamethasone
• Manufacturer: RUE “Belmedpreparaty” (Republic of Belarus), JSC “Lekhim-Kharkov”, PJSC “Farmak”, CJSC FF “Darnitsa” (Ukraine)

Compound

Active substance:

Dexamethasone sodium phosphate (dexamethasone phosphate disodium salt) in terms of 100% substance - 4.0 mg.

Excipients:

• glycerol (distilled glycerin) - 22.5 mg;
• disodium edetate (trilon B) - 0.1 mg;
• sodium hydrogen phosphate dodecahydrate (sodium phosphate disubstituted 12-water) - 0.8 mg;
• water for injection - up to 1 ml.

pharmachologic effect

Dexamethasone is a hormonal drug with antiallergic, anti-inflammatory, immunosuppressive, desensitizing, antitoxic, and antishock activity.

Able to interact with specific cytoplasmic receptors:

1. forms a complex that penetrates the cell nucleus and stimulates mRNA synthesis;
2. the latter induces the formation of proteins, incl. lipocortin, mediating cellular effects. Lipocortin inhibits phospholipase A2, suppresses the release of arachidonic acid and inhibits the biosynthesis of endoperoxides, prostaglandins, leukotrienes, which contribute to inflammation, allergies and others.

Eye drops with dexamethasone also have antiallergic, antiexudative and anti-inflammatory effects.

Pharmacodynamics and pharmacokinetics

The use of Dexamethasone increases the sensitivity of outer cell membrane proteins (beta-adrenergic receptors) to endogenous catecholamines (mediators of intercellular interaction).

Dexamethasone regulates protein metabolism, reducing synthesis and increasing protein catabolism in muscle tissue, reducing the amount of globulins in plasma, increasing albumin synthesis in the liver and kidneys. By influencing carbohydrate metabolism, Dexamethasone promotes the absorption of carbohydrates from the digestive tract, increasing the flow of glucose into the blood from the liver, and the development of hyperglycemia, which in turn activates the production of insulin. The participation of Dexamethasone in water-electrolyte metabolism is manifested in a decrease in bone tissue mineralization, sodium and water retention in the body, and a decrease in calcium absorption from the gastrointestinal tract.

The anti-inflammatory and antiallergic properties of Dexamethasone are 35 times more active than the similar effects of cortisone.

In the blood it binds (60-70%) to a specific transporter protein - transcortin. Easily passes through histohematic barriers (including the blood-brain barrier and placental barrier). A small amount is excreted in breast milk. Metabolized in the liver (mainly by conjugation with glucuronic and sulfuric acids) to inactive metabolites. Excreted through the kidneys.

Indications for use

The instructions recommend using Dexamethasone tablets in the following cases:

• acute and subacute thyroiditis (inflammation of the thyroid gland);
• hypothyroidism (a condition with a persistent lack of thyroid hormones);
• progressive ophthalmopathy (increase in the volume of eye tissue) associated with thyrotoxicosis (intoxication with thyroid hormones);
• Addison-Beermer disease (loss of the adrenal glands' ability to produce hormones in sufficient quantities);
• bronchial asthma;
• connective tissue diseases;
• rheumatoid arthritis in the acute phase;
• autoimmune hemolytic anemia;
• serum sickness (immune reaction to foreign serum proteins);
• agranulocytosis (decrease in the level of neutrophils in the blood);
• acute erythroderma (redness of the skin);
• pemphigus (a skin disease that manifests itself in the form of blisters on the hands, genitals, mouth, etc.);
• acute eczema;
• malignant tumors (symptomatic therapy);
• cerebral edema;
• congenital adrenogenital syndrome (hyperfunction of the adrenal cortex and increased levels of androgens in the body).

Dexamethasone in ampoules is used for:

• shock of various origins;
• asthmatic status;
• cerebral edema;
• severe allergic reactions;
• acute hemolytic anemia;
• thrombocytopenia;
• agranulicytosis;
• acute lymphoblastic leukemia (a malignant disease that affects the bone marrow, spleen, lymph nodes, thymus gland and other organs);
• severe infectious diseases;
• acute croup (inflammation of the larynx and upper respiratory tract);
• acute adrenal insufficiency; joint diseases.

Dexamethasone drops are used in ophthalmic practice for:

• non-purulent and allergic conjunctivitis (inflammation of the mucous membrane of the eye);
• keratitis (inflammation of the cornea);
• keratoconjunctivitis (simultaneous inflammation of the conjunctiva and cornea of ​​the eye) without damage to the epithelium;
• iritis (inflammation of the iris);
• iridocyclitis (inflammation of the iris and ciliary body); blepharitis (inflammation of the edges of the eyelids);
• scleritis (inflammation of the deep layers of the sclera of the eye);
• episcleritis (inflammation of the connective tissue between the conjunctiva and sclera); inflammatory processes after eye injuries or operations;
• sympathetic ophthalmia (inflammatory lesions of the eye).

Instructions for use of Dexamethasone

At the initial stage of treatment, the use of Dexamethasone (orally) in the form of tablets is preferred at 10-15 mg of the drug per day, followed by a reduction in the daily dose to 2-4.5 mg during maintenance therapy.

The instructions recommend dividing the daily dose of Dexamethasone into 2-3 doses (during or after meals). Maintenance small doses should be taken once a day, preferably in the morning.

Dexamethasone in ampoules is intended for intravenous (drip or stream), intramuscular, perarticular and intra-articular administration. The recommended daily dose of Dexamethasone for these routes of administration is 4-20 mg. Dexamethasone in ampoules is usually used 3-4 times a day for 3-4 days, followed by switching to tablets.

Dexamethasone drops are used in ophthalmology: in acute conditions, 1-2 drops of the drug are instilled into the conjunctival sac every 1-2 hours, when the condition improves - every 4-6 hours.

Chronic processes require the use of Dexamethasone drops 2 times a day. The duration of treatment depends on the clinical course of the disease, so Dexamethasone drops can be used from several days to four weeks.

Use during pregnancy

The use of Dexamethasone during pregnancy is possible only for health reasons, if the expected benefit of therapy for the mother exceeds the potential risk associated with treatment.
If it is necessary to carry out treatment with the drug during breastfeeding, breastfeeding should be stopped.

Overdose

Excessive administration of the drug can cause an overdose, which is manifested by increased side effects, as well as hypercortisolism syndrome (Cushing's syndrome).

Therapy is symptomatic; at the same time, a dose reduction or discontinuation of the drug for a while is required.

Side effects

According to the instructions, Dexamethasone may cause the following reactions:

• decreased glucose tolerance, suppression of adrenal function, steroid diabetes mellitus, Itsenko-Cushing syndrome;
• hypocalcemia, hypokalemia, hyponatremia, increased calcium excretion, increased body weight, increased sweating;
• increased intracranial pressure, anxiety, depression, paranoia, dizziness, headache, convulsions;
• vomiting, nausea, steroid ulcer, pancreatitis, erosive esophagitis, hiccups, flatulence;
• bradycardia, arrhythmias, increased blood pressure;
• exophthalmos, trophic changes in the cornea, tendency to develop eye infections, increased intraocular pressure, posterior subcapsular cataract;
• slow ossification in children, muscle tendon rupture, osteoporosis, decreased muscle mass, steroid myopathy; dermatological and allergic reactions.

Contraindications for use

The use of Dexamethasone is contraindicated in those patients who have very hypersensitivity to the components of the drug.

The drug is incompatible with other drugs, as it can form insoluble compounds with them.

The injection solution can be mixed in the following cases:

1. only with 5% glucose solution;
2. NaCl solution 0.9%.

Release form

1. In ampoules of 1 ml or 2 ml in package No. 10,
2. In ampoules of 1 ml or 2 ml in blister packs No. 5×1, No. 5×2.

Storage conditions and shelf life

In a place protected from light at a temperature not exceeding 25 ° C.
Keep out of the reach of children.

Shelf life - 2 years.

Dexamethasone analogs

Analogues of solution and tablets:

• Dexazon,
• Dexamethasone-Vial,
• Dexamed,
• Megadexane,
• Dexamethasone-Ferrain.

Similar preparations for eye drops:

• Dexamethasone-LENS,
• Dexapos,
• Ozurdex,
• Maxidex,
• Dexamethasonelong.

The drug Maxidez, unlike other analogues, has 2 dosage forms: drops and eye ointment. Dexamethasone ointment can be replaced with Hydrocortisone ointment.

Description

Transparent colorless or yellowish solution.

Compound

For one ampoule: active substance- dexamethasone phosphate (in the form of dexamethasone sodium phosphate) - 4.0 mg (1 ml ampoule) and 8.0 mg (2 ml ampoule); Excipients: glycerin, disodium phosphate dihydrate, disodium edetate, water for injection.

Pharmacotherapeutic group

Corticosteroids for systemic use. Glucocorticoids.
ATS code: N02AB02.

pharmachologic effect

Dexamethasone is a synthetic fluorinated glucocorticosteroid that has anti-inflammatory, antiallergic, immunosuppressive effects, has antiexudative and antifibroblastogenic properties, and has virtually no mineralocorticosteroid effect. Interacts with specific cytoplasmic receptors and forms a complex that penetrates the cell nucleus and stimulates mRNA synthesis; the latter induces the formation of proteins that mediate cellular effects, including lipocortin, which inhibits phospholipase A2, suppresses the liberation of arachidonic acid and inhibits the biosynthesis of endoperoxides, prostaglandins, leukotrienes, which contribute to the processes of inflammation, allergies, etc. Dexamethasone inhibits the expression of protein genes involved in the development of inflammatory diseases reactions. Prevents the release of inflammatory mediators from eosinophils and mast cells. Inhibits the activity of hyaluronidase, collagenase and proteases. Suppresses fibroblast activity and collagen formation. Reduces capillary permeability, stabilizes cell membranes, including lysosomal membranes, inhibits the release of cytokines from lymphocytes and macrophages.

Indications for use

Diseases requiring the administration of a fast-acting glucocorticosteroid, as well as cases where oral administration of the drug is not possible. Addison's disease, congenital adrenal hyperplasia, adrenal insufficiency (usually in combination with mineralocorticoids), adrenogenital syndrome, subacute thyroiditis, tumor hypercalcemia, shock (anaphylactic, post-traumatic, postoperative, cardiogenic, blood transfusion, etc.), rheumatoid arthritis in the acute phase, acute rheumatic carditis , collagenoses (rheumatic diseases - as an additional therapy for short-term treatment of exacerbation of the disease, disseminated lupus erythematosus, etc.), joint diseases (post-traumatic osteoarthritis, acute gouty arthritis, psoriatic arthritis, synovitis in osteoarthritis, acute nonspecific tenosynovitis, bursitis, epicondylitis, disease Bekhterev, etc.), bronchial asthma, status asthmaticus, anaphylactoid reactions, incl. caused by drugs; cerebral edema (due to tumors, traumatic brain injury, neurosurgical intervention, cerebral hemorrhage, encephalitis, meningitis); nonspecific ulcerative colitis, sarcoidosis, berylliosis, disseminated tuberculosis (only in combination with anti-tuberculosis drugs), Loeffler's disease and other severe respiratory diseases; anemia (autoimmune, hemolytic, congenital, hypoplastic, idiopathic, erythroblastopenia), idiopathic thrombocytopenic purpura (in adults), secondary thrombocytopenia, lymphoma (Hodgkin and non-Hodgkin), leukemia, lymphocytic leukemia (acute, chronic), serum sickness, allergic reactions during blood transfusion , acute infectious laryngeal edema (adrenaline is the drug of first choice), trichinosis with damage to the nervous system or involvement of the myocardium, nephrotic syndrome, severe inflammatory processes after eye injuries and operations, skin diseases: pemphigus, Stevens-Johnson syndrome, exfoliative dermatitis, bullous dermatitis herpetiformis , severe seborrheic dermatitis, severe psoriasis, atopic dermatitis.

Directions for use and doses

Intended for intravenous (IV), intramuscular (IM), intra-articular, periarticular and retrobulbar administration. The dosage regimen is individual and depends on the indications, the patient’s condition and his response to therapy. To prepare a solution for intravenous drip infusion, you should use an isotonic sodium chloride solution or a 5% dextrose solution. Administration of high doses of dexamethasone can be continued only until the patient's condition has stabilized, which usually does not exceed 48 to 72 hours. For adults in acute and emergency conditions, it is administered intravenously slowly, in a stream or drip, or intramuscularly at a dose of 4-20 mg 3-4 times a day. The maximum daily dose is 80 mg. Maintenance dose - 0.2-9 mg per day. The course of treatment is 3-4 days, then switch to oral administration of Dexamethasone.
For shock, adults - iv 20 mg once, then 3 mg/kg over 24 hours as a continuous infusion or iv once 2-6 mg/kg, or iv 40 mg every 2-6 hours.
For cerebral edema (adults) - 10 mg IV, then 4 mg every 6 hours IM until symptoms disappear; the dose is reduced after 2-4 days and gradually - over 5-7 days - treatment is stopped.
In case of an acute allergic reaction or exacerbation of a chronic allergic disease, dexamethasone should be prescribed according to the following schedule, taking into account parenteral and oral administration: 1 day - intravenous injection solution 4 mg/ml in a dose of 1-2 ml (4-8 mg); Days 2 and 3 - 1 mg orally (2 tablets of 0.5 mg each) 2 times a day; Days 4 and 5 - 0.5 mg orally (1 tablet of 0.5 mg) 2 times a day; Days 6 and 7 - once orally, 1 tablet of 0.5 mg; on day 8, the effectiveness of therapy is assessed.
For injection into a joint, recommended doses range from 0.4 mg to 4 mg. The dose depends on the size of the affected joint:
- large joints (for example, knee joint): 2-4 mg;
- small (for example, interphalangeal, temporal joint): 0.8-1 mg. If repeated administration is necessary, it is possible no earlier than after 3-4 weeks.
Injections into the same joint may be performed three or four times over the course of a lifetime. More frequent intra-articular injection may damage articular cartilage and cause bone necrosis.
The dose of dexamethasone, which is injected into the synovial bursa, is usually 2-3 mg, into the tendon sheath - 0.4-1 mg. Dexamethasone can be administered simultaneously to no more than two sites of injury. Doses for injection into soft tissue (around the joint) are 2-6 mg.
Children
For adrenal insufficiency, the dose for children during replacement therapy is 0.0233 mg/kg (0.67 mg/m2 body surface area) IM, divided into 3 injections every 3rd day, or 0.00776 - 0. 01165 mg/kg (0.233 - 0.335 mg/m2 body surface area) daily.
When used for other indications, the recommended dose is 0.02776 - 0.16665 mg/kg (0.833 - 5 mg/m2 body surface area) every 12-24 hours.

Side effect

The frequency of side effects is given in the following gradation: very common (≥1/10); frequent (≥1/100, Side effects associated with short-term dexamethasone treatment include:
From the immune system: uncommon - hypersensitivity reactions.
: frequent - transient adrenal insufficiency.
: frequent - decreased tolerance to carbohydrates, increased appetite and weight gain; uncommon - hypertriglyceridemia.
Psychiatric disorders: frequent - mental disorders.
: uncommon - peptic ulcers and acute pancreatitis.
Side effects associated with long-term dexamethasone treatment include:
From the immune system: uncommon - decreased immune response and increased susceptibility to infections.
From the endocrine system: common - long-term adrenal insufficiency, growth retardation in children and adolescents.
Metabolic and nutritional disorders: frequent - upper type of obesity.
Visual impairment: uncommon - cataracts, glaucoma.
: uncommon - arterial hypertension.
: frequent - thinning and fragility of the skin.
: frequent - muscle atrophy, osteoporosis; uncommon - aseptic bone necrosis.
The following side effects associated with dexamethasone treatment may also occur (they are presented in order of decreasing importance).
From the lymphatic system and hematopoietic system: rare - thromboembolic complications, decrease in the number of monocytes and/or lymphocytes, leukocytosis, eosinophilia (as with other glucocorticoids), thrombocytopenia and non-thrombocytopenic purpura.
From the immune system: rare - rash, bronchospasm, anaphylactic reactions; very rare - angioedema.
From the outsidehearts: very rare - polyfocal ventricular extrasystoles, transient bradycardia, heart failure, myocardial rupture after a recent acute infarction.
From the vascular system: uncommon - hypertensive encephalopathy.
Psychiatric disorders: infrequent - changes in personality and behavior, which are most often manifested by euphoria, insomnia, irritability, hyperkinesia, depression; rarely - psychosis.
From the endocrine system: often - adrenal insufficiency and atrophy (decreased response to stress), Itsenko-Cushing syndrome, irregular menstrual cycle, hirsutism.
Metabolic and nutritional disorders: rarely - the transition of latent diabetes mellitus to clinically manifest, increased need for insulin or oral hypoglycemic drugs in patients with diabetes mellitus, sodium and water retention, increased potassium loss; very rarely - hypokalemic alkalosis, negative nitrogen balance due to protein catabolism.
From the digestive system: uncommon - nausea, hiccups, stomach or duodenal ulcers; very rarely - esophagitis, ulcer perforation and bleeding of the gastrointestinal tract (hematomesis, melena), pancreatitis, perforation of the gallbladder and intestines (especially in patients with chronic inflammatory diseases of the large intestine).
From the musculoskeletal system and connective tissue: frequent - muscle weakness, steroid myopathy (muscle weakness due to catabolism of muscle tissue); very rare - compression fractures of the vertebrae, tendon ruptures (especially with the combined use of certain quinolones), necrosis of the cartilage tissue of the joint and bones (with frequent intra-articular injections).
From the skin and subcutaneous tissue: frequent - slow healing of wounds, striae, petechiae and ecchymosis, increased sweating, acne, suppression of skin reactions during allergy tests; very rarely - allergic dermatitis, urticaria.
Visual impairment: uncommon - increased intraocular pressure; very rarely - exophthalmos.
From the reproductive system and mammary glands: rarely - impotence.
General disorders and disorders at the injection site: very rare - edema, hyper- and hypopigmentation of the skin, atrophy of the skin or subcutaneous tissue, sterile abscess and redness of the skin.
Signs and symptoms of glucocorticosteroid withdrawal syndrome.
If a patient taking glucocorticosteroids for a long time quickly reduces the dose of the drug, signs of adrenal insufficiency, arterial hypotension, and death may develop.
In some cases, withdrawal symptoms may be similar to symptoms and signs of exacerbation or relapse of the disease for which the patient was being treated. If severe adverse events develop, treatment should be discontinued.
If the above adverse reactions or adverse reactions not listed in these instructions for medical use of the drug occur, you should consult a doctor.

Contraindications

Hypersensitivity to the active substance or other ingredients of the drug, acute viral, bacterial and systemic fungal infections (without appropriate treatment), amoebic infections, infectious lesions of the joints and periarticular soft tissues, active forms of tuberculosis, the period before and after preventive vaccinations (especially antiviral ones), glaucoma, acute purulent eye infection (retrobulbar administration), Cushing's syndrome, vaccination with live vaccine, intramuscular administration is contraindicated in patients with severe disorders of the blood coagulation system.

Overdose

There are isolated reports of cases of acute overdose or death due to acute overdose. Overdose usually does not occur until several weeks of overdosing and can cause most of the undesirable effects listed in the Adverse Reactions section, most notably Cushing's syndrome.
There is no known specific antidote. Treatment is supportive and symptomatic. Hemodialysis is not effective in accelerating the elimination of dexamethasone from the body.

Precautionary measures

Restricted for use in: peptic ulcers of the gastrointestinal tract, peptic ulcer of the stomach and duodenum, esophagitis, gastritis, intestinal anastomosis (in the immediate history); congestive heart failure, arterial hypertension, thrombosis, diabetes mellitus, osteoporosis, Itsenko-Cushing's disease, acute renal and/or liver failure, psychosis, convulsive states, myasthenia gravis, open-angle glaucoma, AIDS, pregnancy, breastfeeding. With long-term treatment (more than 3 weeks) in high doses (more than 1 mg of Dexamethasone per day) to prevent secondary adrenal insufficiency, Dexamethasone is discontinued gradually. This condition can last for several months, so if stress occurs (including during general anesthesia, surgery or trauma), an increase in the dose or administration of Dexamethasone is necessary. Topical use of Dexamethasone may lead to systemic effects. When administered intra-articularly, it is necessary to exclude local infectious processes (septic arthritis). Frequent intra-articular administration can lead to damage to joint tissue and osteonecrosis. Patients are not recommended to overload the joints (despite the reduction in symptoms, inflammatory processes in the joint continue).
Caution should be exercised when prescribing against the background of ulcerative colitis, intestinal diverticulitis, and hypoalbuminemia. Prescription in case of intercurrent infections, tuberculosis, septic conditions requires preliminary and then simultaneous antibacterial therapy. GCS may increase susceptibility or mask symptoms of infectious diseases. Chickenpox, measles and other infections can be more severe and even fatal in non-immunized individuals. Immunosuppression often develops with long-term use of GCS, but can also occur with short-term treatment. Against the background of concomitant tuberculosis, it is necessary to carry out adequate antimycobacterial chemotherapy. Concomitant use of dexamethasone in high doses with inactivated viral or bacterial vaccines may not produce the desired result. Immunization against the background of GCS replacement therapy is acceptable. It is necessary to take into account the increased effect in hypothyroidism and cirrhosis of the liver, aggravation of psychotic symptoms and emotional lability at their high initial level, masking of some symptoms of infection, the likelihood of relative adrenal insufficiency persisting for several months (up to 1 year) after discontinuation of Dexamethasone (especially in the case of long-term use ). During a long course, the dynamics of growth and development of children are carefully monitored, an ophthalmological examination is systematically carried out, and the condition of the hypothalamic-pituitary-adrenal system and blood glucose levels are monitored. Stop therapy only gradually. It is recommended to be careful when performing any kind of surgery, the occurrence of infectious diseases, injuries, avoid immunization, and avoid drinking alcohol. In case of contact with patients with measles, chickenpox and other infections, concomitant preventive therapy is prescribed.
In rare cases, anaphylactoid reactions may occur in patients receiving parenteral corticosteroids. Patients should take appropriate precautions prior to administration, especially if the patient has a history of allergy to any drug.
Corticosteroids may aggravate systemic fungal infections and therefore should not be used in the presence of such infections.
Corticosteroids can activate latent amoebiasis. Therefore, it is recommended to exclude latent or active amebiasis before starting corticosteroid therapy.
Moderate to high doses of cortisone or hydrocortisone can cause increased blood pressure, salt and water retention, and increased potassium excretion. In this case, it may be necessary to limit salt and potassium. All corticosteroids increase calcium excretion.
Use corticosteroids with great caution in patients with recent myocardial infarction due to the risk of ventricular wall rupture.
Corticosteroids should be used with caution in patients with eye infection due to herpes simplex due to the risk of corneal perforation.
Aspirin should be used with caution in combination with corticosteroids due to the risk of hypoprothrombinemia.
In some patients, steroids may increase or decrease sperm motility and count.
May be observed:
- loss of muscle mass;
- pathological fractures of long tubular bones;
- compression fractures of the vertebrae;
- aseptic necrosis of the head of the femur and humerus.
During treatment with dexamethasone, diabetes mellitus may worsen or latent diabetes may transform into a form with clinical manifestations.
The drug contains 0.0196 mmol (0.045 mg) sodium per dose.
Children
In children, in order to avoid overdose, the dose is calculated based on the body surface area. Dexamethasone is used in children and adolescents only under strict indications. During treatment with dexamethasone, the growth and development of children and adolescents should be carefully monitored.
Premature infants: There is evidence of a negative effect on subsequent neurological development of early use ( Elderly patients
Adverse effects of systemic corticosteroids, such as hypokalemia, osteoporosis, hypertension, diabetes mellitus, increased susceptibility to infection, and skin thinning, may have more serious consequences in older patients. To avoid life-threatening adverse reactions, clinical observation is recommended.

Use during pregnancy and lactation

Glucocorticoids cross the placenta and can reach high concentrations in the fetus. Dexamethasone is less intensively metabolized in the placenta compared, for example, with prednisolone, so high concentrations of dexamethasone can be detected in the fetus. Therapeutic doses of glucocorticoids may increase the risk of placental insufficiency, oligohydramnios, fetal growth restriction or fetal death, increase the number of white blood cells (neutrophils) in the child, and also the risk of developing adrenal insufficiency. Use during pregnancy is allowed if the expected effect of therapy outweighs the potential risk to the fetus. Breastfeeding should be stopped during treatment. Infants born to mothers who received significant doses of corticosteroids during pregnancy should be closely monitored for signs of adrenal hypofunction.

Impact on the ability to drive a car and other potentially dangerous mechanisms

During treatment, you should not drive vehicles or engage in potentially hazardous activities that require increased attention and speed of psychomotor reactions.

Interaction with other drugs

The therapeutic and toxic effects of Dexamethasone are reduced by barbiturates, phenytoin, rifabutin, carbamazepine, ephedrine and aminoglutethimide, rifampicin (accelerate metabolism); somatotropin; antacids (reduce absorption), enhance - estrogen-containing oral contraceptives. Concomitant use with cyclosporine increases the risk of developing seizures in children. The risk of arrhythmias and hypokalemia is increased by cardiac glycosides and diuretics, the likelihood of edema and arterial hypertension by sodium-containing drugs and nutritional supplements, severe hypokalemia, heart failure and osteoporosis by amphotericin B and carbonic anhydrase inhibitors; the risk of erosive and ulcerative lesions and bleeding from the gastrointestinal tract - non-steroidal anti-inflammatory drugs. When used simultaneously with live antiviral vaccines and against the background of other types of immunization, it increases the risk of viral activation and the development of infection. Concomitant use with thiazide diuretics, furosemide, ethacrynic acid, carbonic anhydrase inhibitors, amphotericin B can lead to severe hypokalemia, which can enhance the toxic effects of cardiac glycosides and non-depolarizing muscle relaxants. Weakens the hypoglycemic activity of insulin and oral antidiabetic agents; anticoagulant - coumarins; diuretic - diuretic diuretics; immunotropic - vaccination (suppresses antibody formation). Worsens the tolerance of cardiac glycosides (causes potassium deficiency), reduces the concentration of salicylates and praziquantel in the blood. It may increase the concentration of glucose in the blood, which requires dose adjustment of hypoglycemic drugs, sulfonylurea derivatives, and asparaginase. GCS increase the clearance of salicylates, therefore, after discontinuation of Dexamethasone, it is necessary to reduce the dose of salicylates. When used concomitantly with indomethacin, the Dexamethasone suppression test may give false negative results.
The combined use of dexamethasone and drugs that inhibit the activity of the CYP3A4 enzyme (ketoconazole, macrolides) may cause an increase in the concentration of dexamethasone in the serum. Dexamethasone is a moderate inducer of CYP3A4. Concomitant use with drugs that are metabolized by CYP3A4 (indinavir, erythromycin) may increase their clearance, which leads to a decrease in serum concentrations.
Concomitant use of dexamethasone and thalidomide may cause toxic epidermal necrolysis.
The simultaneous use of ritodrine and dexamethasone is contraindicated during childbirth, as this can lead to death of the woman in labor due to pulmonary edema.
During the treatment period, the simultaneous use of drugs and foods high in sodium is not recommended.

Storage conditions

In a place protected from light at a temperature not exceeding 25 °C.
Keep out of the reach of children.

Dexamethasone is a very powerful hormonal drug.

Dexamethasone injections are usually given in emergency situations: severe asthmatic attacks, cerebral edema, severe allergies (anaphylactic shock) and other life-threatening conditions.

It is rare that these injections are prescribed in courses - only for very severe illnesses and too frequent attacks.

If you inject Dexamethasone for 10 days in a row, you can slightly disrupt your endocrine system.

Whatever the doctors say, from the experience of the patients themselves, this drug is so full of side effects that there is nowhere else to go.

Taking Dexamethasone injections for three days is the safest thing for health.

A week is tolerable, but you will need a diet, in which it is necessary to exclude carbohydrates from the diet.

A month is the longest course that can be carried out with Dexamethasone injections and on a strict carbohydrate-free diet.

It is advisable, after several days of treatment with injections (3 - 5 days), to switch to the tablet form.

A synthetic glucocorticosteroid called Dexamethasone is used in medicine as an anti-inflammatory drug with an immunosuppressive effect.

Dexamethasone also has a strong antiallergic effect.

The duration of treatment with Dexamethasone depends on the disease and its severity.

In each specific case, the doctor must individually prescribe a treatment regimen, dosage and time for taking the drug.

For example, for cerebral edema, this drug can be used for up to 7 days, but usually the period of administration of dexamethasone injections should not exceed 4 days.

Is it possible to take IM Dexamethasone and simultaneously take pain relief with Tromodol or Dolmen? Thank you.

Injections with the drug dexamethasone are given to treat many diseases. It is necessary to highlight the main indications when starting to use this medicine.

To determine how long you can inject dexamethasone, be sure to study the instructions.

Any instructions for the medicine are useful, as they contain all the necessary information on the medicine that needs to be taken. There is a section in the instructions called: Methods of use and doses.

This section contains the information you need. From the instructions for dexamethasone it follows that the number of injections depends on the type of disease, so I am posting this section here:

Dexamethasone is a very serious drug, so it should be injected only after the recommendation of a doctor. He also selects the required dosage and number of injections.

The drug is usually prescribed for injection for no more than four days; in exceptional cases, the course of injections is extended.

The side effects of this drug are more than serious: confusion, hallucinations, restless behavior, disorientation, depression, decreased muscle mass, osteoporosis, weight gain, disruptions in the menstrual cycle, growth retardation in childhood, increased blood pressure, thrombosis, etc. .

Dexamethasone removes calcium from the body, so it’s good to take Calcium D3.

Inflammatory processes in modern medicine are treated with the help of hormonal drugs, which are analogues of the hormone of the adrenal cortex. These medications include Dexamethasone injections, which allows them to be used to treat joint diseases and relieve allergic reactions.

Dexamethasone has anti-inflammatory, desensitizing (reduces sensitivity to allergens), antiallergic, antishock and antitoxic properties. The use of Dexamethasone increases the sensitivity of proteins of the outer cell membrane. Properties of the drug and its use

The substance Dexamethasone is a synthetic analogue of the secretion of the adrenal cortex, which is normally produced in humans, and has the following effects on the body:

1. It reacts with the receptor protein, which allows the substance to penetrate directly into the nuclei of membrane cells.
2. Activates a number of metabolic processes by inhibiting the enzyme phospholipase.
3. Blocks mediators of inflammatory processes in the immune system.
4. Inhibits the production of enzymes that affect protein breakdown, thereby improving the metabolism of bone and cartilage tissue.
5. Reduces the production of leukocytes.
6. Reduces vascular permeability, thereby preventing the spread of inflammatory processes.

As a result of the listed properties, the substance Dexamethasone has a powerful antiallergic, anti-inflammatory, anti-shock, and immunosuppressive effect.

Important! A distinctive positive property of the drug is that when administered intravenously, it has an almost instantaneous effect (when administered intramuscularly, after 8 hours).

Dexamethasone in ampoules is used for the systemic treatment of pathologies, in cases where local therapy and internal medication have not produced any results, or their use is impossible.

Dexamethasone regulates protein metabolism, reducing synthesis and increasing protein catabolism in muscle tissue, reducing the amount of globulins in plasma, increasing albumin synthesis in the liver and kidneys

Dexamethasone injections can be purchased for 35-60 rubles, or replaced with analogues, including Oftan Dexamethasone, Maxidex, Metazon, Dexasone

Most often, Dexamethasone injections are used to relieve allergic reactions, as well as to treat joint diseases. The description of the drug indicates the following conditions and diseases for which Dexamethasone is used:

• Development of acute adrenal insufficiency;
• Rheumatic pathologies;
• Intestinal diseases of unknown nature;
• Shock conditions;
• Acute forms of thrombocytopenia, hemolytic anemia, severe types of diseases of an infectious nature;
• Skin pathologies: eczema, psoriasis, dermatitis;
• Bursitis, humeroscapular periarthritis, osteoarthritis, osteochondrosis;
• Acute laryngotracheitis in children;
• Multiple sclerosis;
• Swelling of the brain due to traumatic brain injuries, meningitis, tumors, hemorrhages, radiation injuries, neurosurgical interventions, encephalitis.

Note! Dexamethasone injections have a powerful anti-inflammatory and antiallergic effect, which is 35 times more effective than the use of cortisone.

Dexamethasone injections are used in the development of acute and emergency conditions, when human life depends on the effectiveness and speed of action of the drug. The drug is usually used for a short course, taking into account vital indications.

Dexamethasone instructions indicate that injections can be used starting from the first year of life, not only intramuscularly, but also intravenously. Determination of the dose depends on the form and severity of the disease, the presence and manifestations of side effects, and the age of the patient.

For adults, Dexamethasone can be administered in amounts from 4 mg to 20 mg, while the maximum daily dose should not exceed 80 ml, i.e. The drug is administered three to four times a day. In the event of acute, dangerous situations, the daily dosage can be increased with the consent and under the supervision of a physician.

In the form of injections, Dexamethasone is usually used for no more than 3-4 days, and if it is necessary to continue therapy, they switch to taking the drug in tablet form.

When the expected effect occurs, the dosage of the drug begins to be gradually reduced to a maintenance dose, and discontinuation of the drug is prescribed by the attending physician.

Important! For intravenous and intramuscular use, rapid administration of Dexamethasone in a large dose should not be allowed, because this can lead to heart complications.

For cerebral edema, the dosage of the drug in the initial stage of treatment should be no more than 16 mg. After this, 5 mg of the drug is administered intramuscularly or intravenously every 6 hours until a positive effect occurs.

Dexamethasone injection, 4 mg/ml, is used for acute and emergency conditions in which parenteral administration is vital. The drug is intended for short-term use for health reasons

Dexamethasone is administered to children intramuscularly. The dosage is determined according to the child’s weight - 0.2-0.4 mg per day per kilogram of weight. When treating children, treatment with the drug should not be prolonged, and the dosage should be kept to a minimum depending on the nature and severity of the disease.

Dexamethasone should be used with extreme caution during pregnancy, because active forms of the drug are able to penetrate through any barriers. The medicine can have a negative effect on the fetus and cause complications both in the fetus and in the subsequently born child. Therefore, the doctor decides whether the drug can be used during pregnancy, because this is advisable only when there is a threat to the mother’s life.

Treatment of joint diseases

When therapy for joint diseases using non-steroidal drugs does not bring the expected effect, doctors are forced to use Dexamethasone injections.

The use of Dexamethasone is permissible in the following conditions:

• Rheumatoid arthritis;
• Bursitis;
• Polyarthritis;
• Ankylosing spondylitis;
• Lupus;
• Synovitis;
• Scleroderma with articular lesions;
• Still's disease;
• Joint syndrome in psoriasis.

Note! To eliminate inflammatory processes in the joints, Dexamethasone injections can in some cases be injected directly into the joint capsule. However, long-term use inside joints is unacceptable, because may cause tendon rupture.

The medicine can be administered to the joint area no more than once per course. The drug can be re-administered in this way only after 3-4 months, i.e. per year, the use of intra-articular Dexamethasone should not exceed three to four times. Exceeding this norm can cause destruction of cartilage tissue.

The intra-articular dosage can vary from 0.4 to 4 mg depending on the patient's age, weight, size of the shoulder joint and severity of the pathology.

The drug is used for diseases requiring the administration of a fast-acting glucocorticosteroid, as well as in cases where oral administration of the drug is impossible. Treatment of allergic diseases

If allergies are accompanied by severe inflammatory processes, then conventional antihistamines will not be able to relieve this condition. In these cases, Dexamethasone is used, which is a derivative of prednisolone, which reduces the manifestation of allergic symptoms.

When are injections used:

• Hives;
• Dermatitis, eczema and other skin allergic manifestations;
• Inflammatory allergic reactions on the nasal mucosa;
• Quincke's edema;
• Angioedema and anaphylactic shock.

The description of the use of injections indicates that for allergies it is advisable to use injections in conjunction with oral medications. Typically, injections are given only on the first day of therapy - 4-8 mg intravenously. Next, tablets are prescribed for 7-8 days.

Side effects and contraindications

If there are serious complications and the risk of developing severe conditions, the main contraindication to the use of Dexamethasone is the presence of individual intolerance of the patient to the components of the drug.

For chronic pathologies and the use of the drug as prophylaxis, the following contraindications for use are taken into account:

Development of immunodeficiency (acquired and congenital);

• Severe form of osteoporosis;
• Esophagitis;
• Diabetes;
• Joint fractures;
• Infectious diseases of viral, fungal and bacterial nature in the active phase;
• Acute form of tuberculosis;
• Peptic ulcer;
• Myocardial infarction;
• Internal bleeding;
• Mental disorders.

The advisability of using Dexamethasone in the presence of contraindications should be taken into account in each individual case separately. In some cases, the use of the drug for any contraindication may lead to the development of side effects.

Use during pregnancy is allowed if the expected effect of therapy outweighs the potential risk to the fetus. Breastfeeding should be stopped during treatment. Infants born to mothers who received significant doses of corticosteroids during pregnancy should be closely monitored for signs of adrenal hypofunction.

Dexamethasone has a certain effect on the body, which can cause side effects:

1. It has a depressing effect on the immune system, which increases the risk of tumors and the development of severe infectious diseases;
2. Prevents healthy bone formation because inhibits calcium absorption;
3. Redistributes deposits of fat cells, which causes fat tissue to be deposited on the torso;
4. Retains sodium ions and water in the kidneys, which interferes with the removal of adrenocorticotropic hormone from the body.

These properties of the drug can cause negative side reactions:

• Arterial hypertension;
• Decrease in the level of monocytes and lymphocytes;
• Insomnia, mental disorders, hallucinations, depression;
• Stomach ulcer, nausea, vomiting, internal bleeding, hiccups, pancreatitis;
• Slow healing of wounds, erythema, itching, bruising, increased sweating;
• Development of impotence;
• Allergic dermatitis, urticaria, rash;
• Heart pathologies, heart failure;
• Encephalopathy;
• Sleep disorders, convulsions, dizziness;
• Adrenal atrophy;
• Swelling of the optic disc;
• Weight gain, menstrual irregularities, growth problems in children;
• Osteoporosis, muscle weakness, damage to articular cartilage, tendon rupture;
• Glaucoma, increased intraocular pressure, cataracts, exacerbations of infectious processes in the eyes.

At the injection site, pain and local symptoms may occur - scarring, atrophy of the skin.

Note! You can reduce the negative impact of the drug by reducing the dosage, but in some cases only stopping the drug helps. In any case, if you feel unwell, you should immediately inform your doctor.

Negative consequences can occur if the course of therapy is abruptly completed without medical consent. In such cases, the development of arterial hypertension, adrenal insufficiency, and sometimes death was observed.

Advantages and disadvantages

Reviews from doctors about the use of Dexamethasone indicate that the danger of hormonal drugs is somewhat exaggerated, and their use is very effective in the treatment of allergic conditions, cerebral edema, and joint lesions.

The main advantages of the drug are:

• Wide spectrum of action;
• Low price;
• Pronounced positive and rapid effect;
• Possibility of using the drug in complex therapy.

The disadvantages of the drug include:

• Limited use during pregnancy;
• The need for monitoring during the period of use of the medicine;
• Large list of side effects;
• The need to select the lowest possible dosage.

To avoid the negative effects of the drug, it is enough to take into account the presence or absence of contraindications, and select the dosage taking into account the patient’s age, weight, and test results.

The broad-spectrum drug Dexamethasone is available in the form of a solution used for injection. One ampoule contains 1 ml of liquid that is colorless or slightly yellowish.

Compound

One milliliter of medicine contains the following components:

• The active substance is dexamethasone sodium phosphate;
• By-product chemical elements in the form of disodium phosphate dihydrate, disodium edetate, glycerol;
• Water for preparing injections.

The drug belongs to corticosteroids intended for systemic use, glucocorticosteroids.

pharmachologic effect

Injections with the drug Dexamethasone are given both into a vein and into a muscle. It should be noted that the effect on the body occurs in different ways. With intravenous administration, the maximum effect of the drug on the blood plasma is achieved within five minutes, while after an intramuscular injection, a similar concentration will occur only after one hour.

Injecting the medicine into a vein gives a much greater therapeutic effect in the treatment of diseases than using injections into muscles or joint tissues, since absorption occurs several times slower.

There is also a difference in the duration of action of the drug after different uses:

• Intramuscularly – from 18-27 days;
• Local administration – 3 - 21 days.

Dexamethasone has a half-life of 23 to 72 hours. Metabolization occurs to a greater extent in the liver, less in the kidneys and other tissue structures. The main route of excretion is the kidneys.

The biological effect of the drug is such that almost 78% of the active substance is able to bind to albumin (protein), the rest is able to bind to other plasma proteins. It easily dissolves fats and is able to penetrate the cell, thus acting from the inside and between the cells, disintegrating within it.

Peripheral tissues are also susceptible to its action, Dexamethasone binds in them and influences the cytoplasm through membrane receptors.

Pharmacological dynamics

This drug is a synthetic adrenal hormone or corticosteroid. The main effect on the human body is its ability to resist inflammatory processes, immunosuppressive ability, and the ability to influence metabolism and glucose. It affects the pituitary gland and hypothalamus, bringing secretion into an active state.

The mechanism of action of the drug is not fully understood, but an important fact has been confirmed - it is able to influence the cell and act as if from the inside. In this way, glucocorticoid receptors communicate with corticoids, which allows the levels of sodium, potassium, and water-electrolyte balance to be normalized. Due to the connection of hormones with receptors, a unique process occurs that makes them closer to DNA. Considering that receptors are present in almost all types of tissues, we can conclude that the action of glucocorticoids occurs in most cells of the body.

For what diseases is it used?

Dexamethasone is used when it becomes impossible to take the medicine in tablet form, but mainly in cases that require a quick effect of glucocorticosteroids on the body. This help is required:

• With Addison's disease;
• For pathologies of the adrenal glands, including congenital ones;
• For shocks of various origins;
• During acute arthritis and other ailments of a rheumatoid nature, joint diseases;
• Asthma, cerebral edema, hemorrhages in the brain area;
• For injuries, neurosurgical operations;
• Tuberculosis manifestations, colitis, leukemia, severe respiratory diseases;
• For swelling caused by infection, dermatitis and psoriasis, as well as other skin diseases and allergic reactions;
• For children when acute laryngotracheitis is diagnosed.

This is just a small general list of a large list of diseases for which the use of Dexamethasone injections is not only indicated, but also extremely necessary.

This is especially true for conditions where emergency care is vital. The drug is not intended for long-term use, but only for short-term emergency use when the patient’s life is threatened by serious deterioration or even death.

Instructions for use, dosage

There are several ways to use the medicine:

• Intravenously;
• Intramuscularly;
• Inside the joints;
• Periarticular method;
• Retrobulbar.

The dosage and the regimen itself according to which therapy is carried out are strictly individual and depend on the condition and indicators of each patient, as well as on the personal reaction to the drug.

For droppers and intravenous administration of the drug, the solution is usually prepared using an isotonic sodium chloride solution; you can also take a five percent dextrose solution. For adult patients who are in a serious or acute condition requiring immediate assistance, the medicine is injected into a vein in different ways: drip, jet or slow. The dose can be different, from 4 to 20 mg up to three or four times throughout the day. The highest dose reaches 80 mg. To maintain a stable condition, you can use from 0.2 to 9 mg per day, with a course of no more than four days, after which you need to switch to Dexamethasone tablets.

For children, there is a dose several times smaller, it is limited to 0.02776 - 0.16665 mg per kilogram of the child’s weight. It is administered in periods of 12 or 24 hours.

If we talk about local therapy, then various doses are also used here, which are recommended by the attending physician, based on the medical history and general condition of the person. We can only give approximate figures that may correspond to various pathological conditions:

• For diseases of large joints, such as knees, you can give injections with the medicine in a dose of 2 to 4 mg;
• If smaller joints, such as the interphalangeal parts, hurt, then the dosage is lower, from 0.9 to 1 mg;
• For pain in the joint capsules – 2-3 mg;
• For tendon lesions - 0.4 - 1 mg;
• For soft tissues – 2-6 mg.

When an adult patient has shock of any origin, a single dose of up to 20 mg into a vein is required.

With subsequent administration in the same way but at a lower dose - 3 mg by continuous infusion throughout the day or a single dose of 40 mg every 6 hours.

If an adult patient is affected by cerebral edema, first administer 10 mg, followed by 4 mg each for the next six hours until the acute symptoms disappear. After a period of 3 to 4 days, the dose is reduced and then the drug is stopped.

For allergies in the acute stage or chronic allergic disease, Dexamethasone is prescribed with a combination of oral and injection use according to a special schedule:

• First day: injections from 1 to 8 mg and tablets 0.75 mg;
• On the second day, two tablets twice a day;
• The third day is the same;
• Fourth day, two tablets twice;
• On the fifth and sixth days, take a tablet 2 times a day;
• Next observation.

It should be noted that independent use of tablets, and especially self-medication, is strictly prohibited, since this medicine can cause the most severe health consequences, exacerbations and complications that are life-threatening to the patient.

Without prescription and without supervision from a competent specialist, a drug of such a strong effect is not recommended for use.

The dosage must be strictly observed, especially when it comes to children, as they are more sensitive. A reaction to an exceeded dose will not be long in coming in the form of negative side effects and an unpredictable reaction of the body.

Side effects

• If the overdose is incorrect, due to retention of fluid in the tissue structures, gastrointestinal lesions of an erosive-ulcerative nature, exacerbations and bleeding may occur, accompanied by vomiting, hiccups, and bloating.
• A hypersensitivity reaction to the drug may occur in the form of urticaria, dermatitis, and angioedema.
• Patients who have recently had a heart attack may experience cardiac rupture, cardiac arrest, failure, and many other heart complications.
• Behavioral changes such as states of euphoria, loss of sleep, psychosis, depressive behavior and paranoia often occur. Hallucinations are not uncommon; exacerbations of the condition are dangerous for people with schizophrenia and epilepsy.
• Blood and eye pressure may “jump,” cataracts and glaucoma may develop, and infections of the eye organs may be provoked.
• At high doses, a burning sensation, tissue necrosis, and swelling are felt.

Side effects of VRI intravenous use are often expressed by arrhythmia, convulsions and sudden flushes of blood to the face.

When the medicine is injected into the joint, there is often a feeling of increased pain.

Intracranial administration is often fraught with nosebleeds.

Abrupt cessation or reduction of the previous dose is life-threatening for those people who have been on Dexamethasone for a long time. Adrenal insufficiency can occur, leading to a sharp drop in blood pressure and death.

If the patient has any severe adverse reactions, the drug should be discontinued.

Contraindications

Particular attention should be paid to the list of health conditions and diseases for which the use of this medication is extremely undesirable, these include:

• Hypersensitivity to one of the ingredients of the medicine;
• The presence of any fungal infections, if there is no therapeutic treatment;
• Not for Cushing's syndrome;
• If the patient has poor blood clotting;
• When vaccinated with a live vaccine;
• For stomach and duodenal ulcers;
• For osteoporotic phenomena;
• During pregnancy and breastfeeding;
• For mental disorders and epilepsy;
• For various eye ailments;
• If you have kidney failure, hepatitis or cirrhosis;
• For sexually transmitted diseases and tuberculosis.

A severe overdose inevitably leads to death, this once again confirms what a serious drug this group represents

What you should know

Before starting the treatment process with Dexamethasone injections, special attention should be paid to the fact that allergic reactions are possible; all measures taken will help avoid serious complications.

• The medicine should be discontinued gradually; the dose should not be sharply reduced, as the body will react in its own way with dizziness, drowsiness, pain in the bones, joints and muscles. Fever, runny nose, and conjunctivitis may be caused.
• In the postoperative period, for patients who are in a stressful state during the period of therapeutic intervention, it is necessary to slightly increase the dose size, or replace it with drugs such as cortisone or hydrocortisone.
• Close medical attention is required for those with osteoporosis, diabetes of both types, tuberculosis, gastrointestinal pathologies, and elderly people. They require increased attention and strictly observed doses of the drug.
• If treatment is continued for a long period, it is necessary to monitor the level of potassium in the blood serum.

Storage and analogues

Ampoules with medicine should be stored at room temperature, but it should not exceed +25 degrees. They should be hidden from the sun and especially from children!

The shelf life of the medicine is no more than two years. The medicine is dispensed strictly according to the prescription prescribed by the doctor.

Analogs include: Prednisolone, Diprospan, Hydrocortisone, Solu-Medrol.

Reviews

Dmitry, 51 years old, Rostov-on-Don“A medicine that has been used for many years. Old but golden. I personally treat joint and spine pain with it. The doctor sometimes puts blockades on him, which helps a lot. But you can’t be treated with it for a long time, since the pressure in the eyes rises only when it’s completely unbearable to walk.”

Olga - doctor, 48 years old, Chelyabinsk“A well-proven medicine. I've been using it for so many years now. Perfectly relieves symptoms of psoriasis, eczema in severe degrees and forms. The main thing is that this drug is effective and inexpensive. The only thing I regret is that older people have a hard time tolerating its components.”

Marina, 35 years old, Moscow“I was pleasantly surprised when I started using Dexamethasone. I am an experienced allergy sufferer. The effect came literally immediately after the injection. Swelling and redness from the face are gone. The doctor said that you can’t use it for a long time, it’s a pity, the medicine is great and isn’t expensive at all, and this is very important for ordinary people.”

In this article you can read the instructions for use of the drug Dexamethasone. Reviews of site visitors - consumers of this medicine, as well as the opinions of specialist doctors on the use of Dexamethasone in their practice are presented. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Dexamethasone analogues in the presence of existing structural analogues. Use for the treatment of inflammatory and systemic diseases, including the eyes, in adults, children, as well as during pregnancy and lactation.

Dexamethasone- synthetic glucocorticosteroid (GCS), a methylated derivative of fluoroprednisolone. It has anti-inflammatory, antiallergic, immunosuppressive effects, increases the sensitivity of beta-adrenergic receptors to endogenous catecholamines.

Interacts with specific cytoplasmic receptors (receptors for GCS are found in all tissues, especially in the liver) to form a complex that induces the formation of proteins (including enzymes that regulate vital processes in cells.)

Protein metabolism: reduces the amount of globulins in plasma, increases albumin synthesis in the liver and kidneys (with an increase in the albumin/globulin ratio), reduces synthesis and increases protein catabolism in muscle tissue.

Lipid metabolism: increases the synthesis of higher fatty acids and triglycerides, redistributes fat (fat accumulation occurs mainly in the shoulder girdle, face, abdomen), leads to the development of hypercholesterolemia.

Carbohydrate metabolism: increases the absorption of carbohydrates from the gastrointestinal tract; increases the activity of glucose-6-phosphatase (increasing the flow of glucose from the liver into the blood); increases the activity of phosphoenolpyruvate carboxylase and the synthesis of aminotransferases (activation of gluconeogenesis); promotes the development of hyperglycemia.

Water-electrolyte metabolism: retains Na+ and water in the body, stimulates the excretion of K+ (mineralocorticoid activity), reduces the absorption of Ca+ from the gastrointestinal tract, reduces bone mineralization.

The anti-inflammatory effect is associated with inhibition of the release of inflammatory mediators by eosinophils and mast cells; inducing the formation of lipocortins and reducing the number of mast cells that produce hyaluronic acid; with a decrease in capillary permeability; stabilization of cell membranes (especially lysosomal) and organelle membranes. Acts on all stages of the inflammatory process: inhibits the synthesis of prostaglandins (Pg) at the level of arachidonic acid (lipocortin inhibits phospholipase A2, suppresses the liberation of arachidonic acid and inhibits the biosynthesis of endoperoxides, leukotrienes, which contribute to inflammation, allergies, etc.), the synthesis of “proinflammatory cytokines” ( interleukin 1, tumor necrosis factor alpha, etc.); increases the resistance of the cell membrane to the action of various damaging factors.

The immunosuppressive effect is caused by the involution of lymphoid tissue, inhibition of the proliferation of lymphocytes (especially T-lymphocytes), suppression of the migration of B cells and the interaction of T and B lymphocytes, inhibition of the release of cytokines (interleukin-1, 2; interferon gamma) from lymphocytes and macrophages and decreased antibody formation.

The antiallergic effect develops as a result of a decrease in the synthesis and secretion of allergy mediators, inhibition of the release of histamine and other biologically active substances from sensitized mast cells and basophils, a decrease in the number of circulating basophils, T- and B-lymphocytes, mast cells; suppressing the development of lymphoid and connective tissue, reducing the sensitivity of effector cells to allergy mediators, inhibiting antibody formation, changing the body's immune response.

In obstructive diseases of the respiratory tract, the effect is due mainly to inhibition of inflammatory processes, prevention or reduction of the severity of swelling of the mucous membranes, reduction of eosinophilic infiltration of the submucosal layer of the bronchial epithelium and deposition of circulating immune complexes in the bronchial mucosa, as well as inhibition of erosion and desquamation of the mucosa. Increases the sensitivity of beta-adrenergic receptors of small and medium-sized bronchi to endogenous catecholamines and exogenous sympathomimetics, reduces the viscosity of mucus by reducing its production.

Suppresses the synthesis and secretion of ACTH and, secondarily, the synthesis of endogenous corticosteroids.

Inhibits connective tissue reactions during the inflammatory process and reduces the possibility of scar tissue formation.

The peculiarity of the action is significant inhibition of pituitary function and the almost complete absence of mineralocorticosteroid activity.

Doses of 1-1.5 mg per day inhibit the function of the adrenal cortex; biological half-life - 32-72 hours (duration of inhibition of the hypothalamic-pituitary-adrenal cortex system).

In terms of the strength of glucocorticoid activity, 0.5 mg of dexamethasone corresponds to approximately 3.5 mg of prednisone (or prednisolone), 15 mg of hydrocortisone or 17.5 mg of cortisone.

Pharmacokinetics

Easily passes through histohematic barriers (including blood-brain and placental). Metabolized in the liver (mainly by conjugation with glucuronic and sulfuric acids) to inactive metabolites. Excreted by the kidneys (a small part by the lactating glands).

Indications

Diseases requiring the administration of fast-acting corticosteroids, as well as cases when oral administration of the drug is impossible:

• endocrine diseases: acute adrenal insufficiency, primary or secondary adrenal insufficiency, congenital adrenal hyperplasia, subacute thyroiditis;
• shock (burn, traumatic, surgical, toxic) - if vasoconstrictors, plasma replacement drugs and other symptomatic therapy are ineffective;
• cerebral edema (with a brain tumor, traumatic brain injury, neurosurgical intervention, cerebral hemorrhage, encephalitis, meningitis, radiation injury);
• status asthmaticus; severe bronchospasm (exacerbation of bronchial asthma, chronic obstructive bronchitis);
• severe allergic reactions, anaphylactic shock;
• rheumatic diseases;
• systemic connective tissue diseases;
• acute severe dermatoses;
• malignant diseases: palliative treatment of leukemia and lymphoma in adult patients; acute leukemia in children; hypercalcemia in patients suffering from malignant tumors when oral treatment is not possible;
• blood diseases: acute hemolytic anemia, agranulocytosis, idiopathic thrombocytopenic purpura in adults;
• severe infectious diseases (in combination with antibiotics);
• In ophthalmological practice (subcontonctival, retrobulbar or parabulbaric administration): allergic conjunctivitis, keratitis, keratoconjunitivitis without damage to the epithelium, irritation, iridocyclite, blepharitis, bluffaroconcotivitis, scleritis, inflammatory process after eye injuries and surgical interventions, sympathetic ophtal miya, immunosuppressive treatment after transplantation corneas;
• local application (in the area of ​​pathological formation): keloids, discoid lupus erythematosus, granuloma annulare.

Release forms

Tablets 0.5 mg.

Solution in ampoules for intravenous and intramuscular administration (injections for injections) 4 mg/ml.

Oftan eye drops 0.1%.

Ophthalmic suspension 0.1%.

Instructions for use and dosage

The dosage regimen is individual and depends on the indications, the patient’s condition and his response to therapy. The drug is administered intravenously slowly in a stream or drip (for acute and emergency conditions); intramuscularly; local (into the pathological formation) administration is also possible. To prepare a solution for intravenous drip infusion (dropper), you should use an isotonic sodium chloride solution or a 5% dextrose solution.

In the acute period for various diseases and at the beginning of therapy, Dexamethasone is used in higher doses. During the day, you can administer from 4 to 20 mg of Dexamethasone 3-4 times.

Doses of the drug for children (intramuscular):

The dose of the drug during replacement therapy (for adrenal insufficiency) is 0.0233 mg/kg body weight or 0.67 mg/m2 body surface area, divided into 3 doses, every 3rd day or 0.00776 - 0.01165 mg/kg body weight or 0.233 - 0.335 mg/m2 body surface area daily. For other indications, the recommended dose is from 0.02776 to 0.16665 mg/kg body weight or 0.833 to 5 mg/m2 body surface area every 12-24 hours.

When the effect is achieved, the dose is reduced to maintenance or until treatment is stopped. The duration of parenteral use is usually 3-4 days, then they switch to maintenance therapy with dexamethasone tablets.

Long-term use of high doses of the drug requires a gradual dose reduction in order to prevent the development of acute adrenal insufficiency.

Conjunctivally, adults and children over 12 years of age in acute inflammatory conditions: 1-2 drops 4-5 times a day for 2 days, then 3-4 times a day for 4-6 days.

Chronic conditions: 1-2 drops 2 times a day for a maximum of 4 weeks (no more).

In post-operative and post-traumatic cases: starting from the 8th day after surgery for strabismus, retinal detachment, cataract extraction and from the moment of injury - 1-2 drops 2-4 times a day for 2-4 weeks; for antiglaucoma filtering surgery - on the day of surgery or the day after it.

Children from 6 to 12 years old with allergic inflammatory conditions: 1 drop 2-3 times a day for 7-10 days, if necessary, treatment is continued after monitoring the condition of the cornea on the 10th day.

Side effect

Dexamethasone is usually well tolerated. It has low mineralocorticoid activity, i.e. its effect on water-electrolyte metabolism is small. As a rule, low and medium doses of Dexamethasone do not cause sodium and water retention in the body or increased potassium excretion. The following side effects are described:

• decreased glucose tolerance;
• steroid diabetes mellitus or manifestation of latent diabetes mellitus;
• suppression of adrenal function;
• Itsenko-Cushing syndrome (moon face, pituitary obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, muscle weakness, stretch marks);
• delayed sexual development in children;
• nausea, vomiting;
• pancreatitis;
• steroid ulcer of the stomach and duodenum;
• erosive esophagitis;
• gastrointestinal bleeding and perforation of the wall of the gastrointestinal tract;
• increased or decreased appetite;
• indigestion;
• flatulence;
• arrhythmias;
• bradycardia (up to cardiac arrest);
• increased blood pressure;
• hypercoagulability;
• thrombosis;
• euphoria;
• hallucinations;
• affective insanity;
• depression;
• paranoia;
• increased intracranial pressure;
• nervousness or restlessness;
• insomnia;
• dizziness;
• headache;
• convulsions;
• increased intraocular pressure with possible damage to the optic nerve;
• tendency to develop secondary bacterial, fungal or viral eye infections;
• trophic changes in the cornea;
• exophthalmos;
• sudden loss of vision (with parenteral administration in the head, neck, nasal turbinates, scalp, deposition of drug crystals in the vessels of the eye is possible);
• hypocalcemia;
• weight gain;
• negative nitrogen balance (increased protein breakdown);
• increased sweating;
• fluid and sodium retention (peripheral edema);
• slower growth and ossification processes in children (premature closure of epiphyseal growth zones);
• osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the head of the humerus and femur);
• muscle tendon rupture;
• delayed wound healing;
• steroid acne;
• striae;
• tendency to develop pyoderma and candidiasis;
• skin rash;
• anaphylactic shock;
• local allergic reactions.

Local for parenteral administration: burning, numbness, pain, tingling at the injection site, infection at the injection site, rarely - necrosis of surrounding tissues, scarring at the injection site; atrophy of the skin and subcutaneous tissue with intramuscular injection (injection into the deltoid muscle is especially dangerous).

Contraindications

For short-term use for health reasons, the only contraindication is hypersensitivity to dexamethasone or the components of the drug.

In children during the growth period, GCS should be used only according to absolute indications and under the particularly careful supervision of the attending physician.

The drug should be prescribed with caution for the following diseases and conditions:

Use during pregnancy and breastfeeding

During pregnancy (especially in the 1st trimester), the drug can be used only when the expected therapeutic effect outweighs the potential risk to the fetus. With long-term therapy during pregnancy, the possibility of impaired fetal growth cannot be excluded. If used at the end of pregnancy, there is a risk of atrophy of the adrenal cortex in the fetus, which may require replacement therapy in the newborn.

If it is necessary to carry out treatment with the drug during breastfeeding, breastfeeding should be stopped.

special instructions

During treatment with Dexamethasone (especially long-term), observation by an ophthalmologist, monitoring of blood pressure and water-electrolyte balance, as well as peripheral blood patterns and blood glucose levels are necessary.

In order to reduce side effects, antacids can be prescribed, and the intake of K+ into the body should be increased (diet, potassium supplements). Food should be rich in proteins, vitamins, and limit the content of fats, carbohydrates and table salt.

The effect of the drug is enhanced in patients with hypothyroidism and liver cirrhosis. The drug may worsen existing emotional instability or psychotic disorders. If a history of psychosis is indicated, Dexamethasone in high doses is prescribed under the strict supervision of a physician.

It should be used with caution in acute and subacute myocardial infarction - the necrosis may spread, the formation of scar tissue may slow down, and the heart muscle may rupture.

In stressful situations during maintenance treatment (for example, surgery, trauma or infectious diseases), the dose of the drug should be adjusted due to an increased need for glucocorticosteroids. Patients should be carefully monitored for a year after the end of long-term therapy with Dexamethasone due to the possible development of relative insufficiency of the adrenal cortex in stressful situations.

With sudden withdrawal, especially in the case of previous use of high doses, the development of withdrawal syndrome (anorexia, nausea, lethargy, generalized musculoskeletal pain, general weakness) is possible, as well as an exacerbation of the disease for which Dexamethasone was prescribed.

During treatment with Dexamethasone, vaccination should not be carried out due to a decrease in its effectiveness (immune response).

When prescribing Dexamethasone for intercurrent infections, septic conditions and tuberculosis, it is necessary to simultaneously treat with bactericidal antibiotics.

In children during long-term treatment with Dexamethasone, careful monitoring of the dynamics of growth and development is necessary. Children who during the treatment period were in contact with patients with measles or chickenpox are prescribed specific immunoglobulins prophylactically.

Due to the weak mineralocorticoid effect, Dexamethasone is used in combination with mineralocorticoids for replacement therapy for adrenal insufficiency.

In patients with diabetes mellitus, blood glucose levels should be monitored and therapy adjusted if necessary.

X-ray monitoring of the osteoarticular system (images of the spine, hand) is indicated.

In patients with latent infectious diseases of the kidneys and urinary tract, Dexamethasone can cause leukocyturia, which may have diagnostic value.

Drug interactions

There may be pharmaceutical incompatibility of dexamethasone with other IV drugs - it is recommended to administer it separately from other drugs (IV bolus, or through another dropper, as a second solution). When mixing a solution of dexamethasone with heparin, a precipitate forms.

Simultaneous administration of dexamethasone with:

• inducers of hepatic microsomal enzymes (phenobarbital, rifampicin, phenytoin, theophylline, ephedrine) leads to a decrease in its concentration;
• diuretics (especially thiazide and carbonic anhydrase inhibitors) and amphotericin B - can lead to increased excretion of K+ from the body and an increased risk of developing heart failure;
• with sodium-containing drugs - to the development of edema and increased blood pressure;
• cardiac glycosides - their tolerability worsens and the likelihood of developing ventricular extrasytolia increases (due to caused hypokalemia);
• indirect anticoagulants - weakens (less often enhances) their effect (dose adjustment required);
• anticoagulants and thrombolytics - the risk of bleeding from ulcers in the gastrointestinal tract increases;
• ethanol (alcohol) and nonsteroidal anti-inflammatory drugs - increases the risk of erosive and ulcerative lesions in the gastrointestinal tract and the development of bleeding (in combination with NSAIDs in the treatment of arthritis, it is possible to reduce the dose of glucocorticosteroids due to the summation of the therapeutic effect);
• paracetamol - the risk of developing hepatotoxicity increases (induction of liver enzymes and the formation of a toxic metabolite of paracetamol);
• acetylsalicylic acid - accelerates its elimination and reduces its concentration in the blood (when dexamethasone is discontinued, the level of salicylates in the blood increases and the risk of side effects increases);
• insulin and oral hypoglycemic drugs, antihypertensive drugs - their effectiveness decreases;
• vitamin D - its effect on the absorption of Ca2+ in the intestine is reduced;
• growth hormone - reduces the effectiveness of the latter, and with praziquantel - its concentration;
• M-anticholinergics (including antihistamines and tricyclic antidepressants) and nitrates - helps increase intraocular pressure;
• isoniazid and mexiletine - increases their metabolism (especially in “slow” acetylators), which leads to a decrease in their plasma concentrations.

Carbonic anhydrase inhibitors and loop diuretics may increase the risk of osteoporosis.

Indomethacin, displacing dexamethasone from its association with albumin, increases the risk of developing its side effects.

ACTH enhances the effect of dexamethasone.

Ergocalciferol and parathyroid hormone prevent the development of osteopathy caused by dexamethasone.

Cyclosporine and ketoconazole, by slowing down the metabolism of dexamethasone, can in some cases increase its toxicity.

The simultaneous administration of androgens and steroidal anabolic drugs with dexamethasone promotes the development of peripheral edema and hirsutism, and the appearance of acne.

Estrogens and oral contraceptives containing estrogen reduce the clearance of dexamethasone, which may be accompanied by an increase in the severity of its action.

When used simultaneously with live antiviral vaccines and against the background of other types of immunization, it increases the risk of viral activation and the development of infections.

Antipsychotics (neuroleptics) and azathioprine increase the risk of developing cataracts when dexamethasone is prescribed.

When used simultaneously with antithyroid drugs, the clearance of dexamethasone decreases and with thyroid hormones increases.

Analogs of the drug Dexamethasone

Structural analogues of the active substance:

• Decadron;
• Dexaven;
• Dexazone;
• Dexamed;
• Dexamethasone Bufus;
• Dexamethasone Nycomed;
• Dexamethasone-Betalek;
• Dexamethasone Vial;
• Dexamethasone-LENS;
• Dexamethasone-Ferein;
• Dexamethasone sodium phosphate;
• Dexamethasone phosphate;
• Dexamethasonelong;
• Dexapos;
• Dexafar;
• Dexon;
• Maxidex;
• Oftan Dexamethasone;
• Fortecortin.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps and look at the available analogues for the therapeutic effect.

In this article you can read the instructions for use of the drug Dexamethasone. Reviews of site visitors - consumers of this medicine, as well as the opinions of specialist doctors on the use of Dexamethasone in their practice are presented. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Dexamethasone analogues in the presence of existing structural analogues. Use for the treatment of inflammatory and systemic diseases, including the eyes, in adults, children, as well as during pregnancy and lactation.

Dexamethasone- synthetic glucocorticosteroid (GCS), a methylated derivative of fluoroprednisolone. It has anti-inflammatory, antiallergic, immunosuppressive effects, increases the sensitivity of beta-adrenergic receptors to endogenous catecholamines.

Interacts with specific cytoplasmic receptors (receptors for GCS are found in all tissues, especially in the liver) to form a complex that induces the formation of proteins (including enzymes that regulate vital processes in cells.)

Protein metabolism: reduces the amount of globulins in plasma, increases albumin synthesis in the liver and kidneys (with an increase in the albumin/globulin ratio), reduces synthesis and increases protein catabolism in muscle tissue.

Lipid metabolism: increases the synthesis of higher fatty acids and triglycerides, redistributes fat (fat accumulation occurs mainly in the shoulder girdle, face, abdomen), leads to the development of hypercholesterolemia.

Carbohydrate metabolism: increases the absorption of carbohydrates from the gastrointestinal tract; increases the activity of glucose-6-phosphatase (increasing the flow of glucose from the liver into the blood); increases the activity of phosphoenolpyruvate carboxylase and the synthesis of aminotransferases (activation of gluconeogenesis); promotes the development of hyperglycemia.

Water-electrolyte metabolism: retains Na+ and water in the body, stimulates the excretion of K+ (mineralocorticoid activity), reduces the absorption of Ca+ from the gastrointestinal tract, reduces bone mineralization.

The anti-inflammatory effect is associated with inhibition of the release of inflammatory mediators by eosinophils and mast cells; inducing the formation of lipocortins and reducing the number of mast cells that produce hyaluronic acid; with a decrease in capillary permeability; stabilization of cell membranes (especially lysosomal) and organelle membranes. Acts on all stages of the inflammatory process: inhibits the synthesis of prostaglandins (Pg) at the level of arachidonic acid (lipocortin inhibits phospholipase A2, suppresses the liberation of arachidonic acid and inhibits the biosynthesis of endoperoxides, leukotrienes, which contribute to inflammation, allergies, etc.), the synthesis of “proinflammatory cytokines” ( interleukin 1, tumor necrosis factor alpha, etc.); increases the resistance of the cell membrane to the action of various damaging factors.

The immunosuppressive effect is caused by the involution of lymphoid tissue, inhibition of the proliferation of lymphocytes (especially T-lymphocytes), suppression of the migration of B cells and the interaction of T and B lymphocytes, inhibition of the release of cytokines (interleukin-1, 2; interferon gamma) from lymphocytes and macrophages and decreased antibody formation.

The antiallergic effect develops as a result of a decrease in the synthesis and secretion of allergy mediators, inhibition of the release of histamine and other biologically active substances from sensitized mast cells and basophils, a decrease in the number of circulating basophils, T- and B-lymphocytes, mast cells; suppressing the development of lymphoid and connective tissue, reducing the sensitivity of effector cells to allergy mediators, inhibiting antibody formation, changing the body's immune response.

In obstructive diseases of the respiratory tract, the effect is due mainly to inhibition of inflammatory processes, prevention or reduction of the severity of swelling of the mucous membranes, reduction of eosinophilic infiltration of the submucosal layer of the bronchial epithelium and deposition of circulating immune complexes in the bronchial mucosa, as well as inhibition of erosion and desquamation of the mucosa. Increases the sensitivity of beta-adrenergic receptors of small and medium-sized bronchi to endogenous catecholamines and exogenous sympathomimetics, reduces the viscosity of mucus by reducing its production.

Suppresses the synthesis and secretion of ACTH and, secondarily, the synthesis of endogenous corticosteroids.

Inhibits connective tissue reactions during the inflammatory process and reduces the possibility of scar tissue formation.

The peculiarity of the action is significant inhibition of pituitary function and the almost complete absence of mineralocorticosteroid activity.

Doses of 1-1.5 mg per day inhibit the function of the adrenal cortex; biological half-life - 32-72 hours (duration of inhibition of the hypothalamic-pituitary-adrenal cortex system).

In terms of the strength of glucocorticoid activity, 0.5 mg of dexamethasone corresponds to approximately 3.5 mg of prednisone (or prednisolone), 15 mg of hydrocortisone or 17.5 mg of cortisone.

Pharmacokinetics

Easily passes through histohematic barriers (including blood-brain and placental). Metabolized in the liver (mainly by conjugation with glucuronic and sulfuric acids) to inactive metabolites. Excreted by the kidneys (a small part by the lactating glands).

Indications

Diseases requiring the administration of fast-acting corticosteroids, as well as cases when oral administration of the drug is impossible:

• endocrine diseases: acute adrenal insufficiency, primary or secondary adrenal insufficiency, congenital adrenal hyperplasia, subacute thyroiditis;
• shock (burn, traumatic, surgical, toxic) - if vasoconstrictors, plasma replacement drugs and other symptomatic therapy are ineffective;
• cerebral edema (with a brain tumor, traumatic brain injury, neurosurgical intervention, cerebral hemorrhage, encephalitis, meningitis, radiation injury);
• status asthmaticus; severe bronchospasm (exacerbation of bronchial asthma, chronic obstructive bronchitis);
• severe allergic reactions, anaphylactic shock;
• rheumatic diseases;
• systemic connective tissue diseases;
• acute severe dermatoses;
• malignant diseases: palliative treatment of leukemia and lymphoma in adult patients; acute leukemia in children; hypercalcemia in patients suffering from malignant tumors when oral treatment is not possible;
• blood diseases: acute hemolytic anemia, agranulocytosis, idiopathic thrombocytopenic purpura in adults;
• severe infectious diseases (in combination with antibiotics);
• In ophthalmological practice (subcontonctival, retrobulbar or parabulbaric administration): allergic conjunctivitis, keratitis, keratoconjunitivitis without damage to the epithelium, irritation, iridocyclite, blepharitis, bluffaroconcotivitis, scleritis, inflammatory process after eye injuries and surgical interventions, sympathetic ophtal miya, immunosuppressive treatment after transplantation corneas;
• local application (in the area of ​​pathological formation): keloids, discoid lupus erythematosus, granuloma annulare.

Release forms

Tablets 0.5 mg.

Solution in ampoules for intravenous and intramuscular administration (injections for injections) 4 mg/ml.

Oftan eye drops 0.1%.

Ophthalmic suspension 0.1%.

Instructions for use and dosage

The dosage regimen is individual and depends on the indications, the patient’s condition and his response to therapy. The drug is administered intravenously slowly in a stream or drip (for acute and emergency conditions); intramuscularly; local (into the pathological formation) administration is also possible. To prepare a solution for intravenous drip infusion (dropper), you should use an isotonic sodium chloride solution or a 5% dextrose solution.

In the acute period for various diseases and at the beginning of therapy, Dexamethasone is used in higher doses. During the day, you can administer from 4 to 20 mg of Dexamethasone 3-4 times.

Doses of the drug for children (intramuscular):

The dose of the drug during replacement therapy (for adrenal insufficiency) is 0.0233 mg/kg body weight or 0.67 mg/m2 body surface area, divided into 3 doses, every 3rd day or 0.00776 - 0.01165 mg/kg body weight or 0.233 - 0.335 mg/m2 body surface area daily. For other indications, the recommended dose is from 0.02776 to 0.16665 mg/kg body weight or 0.833 to 5 mg/m2 body surface area every 12-24 hours.

When the effect is achieved, the dose is reduced to maintenance or until treatment is stopped. The duration of parenteral use is usually 3-4 days, then they switch to maintenance therapy with dexamethasone tablets.

Long-term use of high doses of the drug requires a gradual dose reduction in order to prevent the development of acute adrenal insufficiency.

Drops

Conjunctivally, adults and children over 12 years of age in acute inflammatory conditions: 1-2 drops 4-5 times a day for 2 days, then 3-4 times a day for 4-6 days.

Chronic conditions: 1-2 drops 2 times a day for a maximum of 4 weeks (no more).

In post-operative and post-traumatic cases: starting from the 8th day after surgery for strabismus, retinal detachment, cataract extraction and from the moment of injury - 1-2 drops 2-4 times a day for 2-4 weeks; for antiglaucoma filtering surgery - on the day of surgery or the day after it.

Children from 6 to 12 years old with allergic inflammatory conditions: 1 drop 2-3 times a day for 7-10 days, if necessary, treatment is continued after monitoring the condition of the cornea on the 10th day.

Side effect

Dexamethasone is usually well tolerated. It has low mineralocorticoid activity, i.e. its effect on water-electrolyte metabolism is small. As a rule, low and medium doses of Dexamethasone do not cause sodium and water retention in the body or increased potassium excretion. The following side effects are described:

• decreased glucose tolerance;
• steroid diabetes mellitus or manifestation of latent diabetes mellitus;
• suppression of adrenal function;
• Itsenko-Cushing syndrome (moon face, pituitary obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, muscle weakness, stretch marks);
• delayed sexual development in children;
• nausea, vomiting;
• pancreatitis;
• steroid ulcer of the stomach and duodenum;
• erosive esophagitis;
• gastrointestinal bleeding and perforation of the wall of the gastrointestinal tract;
• increased or decreased appetite;
• indigestion;
• flatulence;
• arrhythmias;
• bradycardia (up to cardiac arrest);
• increased blood pressure;
• hypercoagulability;
• thrombosis;
• euphoria;
• hallucinations;
• affective insanity;
• depression;
• paranoia;
• increased intracranial pressure;
• nervousness or restlessness;
• insomnia;
• dizziness;
• headache;
• convulsions;
• increased intraocular pressure with possible damage to the optic nerve;
• tendency to develop secondary bacterial, fungal or viral eye infections;
• trophic changes in the cornea;
• exophthalmos;
• sudden loss of vision (with parenteral administration in the head, neck, nasal turbinates, scalp, deposition of drug crystals in the vessels of the eye is possible);
• hypocalcemia;
• weight gain;
• negative nitrogen balance (increased protein breakdown);
• increased sweating;
• fluid and sodium retention (peripheral edema);
• slower growth and ossification processes in children (premature closure of epiphyseal growth zones);
• osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the head of the humerus and femur);
• muscle tendon rupture;
• delayed wound healing;
• steroid acne;
• striae;
• tendency to develop pyoderma and candidiasis;
• skin rash;
• anaphylactic shock;
• local allergic reactions.

Local for parenteral administration: burning, numbness, pain, tingling at the injection site, infection at the injection site, rarely - necrosis of surrounding tissues, scarring at the injection site; atrophy of the skin and subcutaneous tissue with intramuscular injection (injection into the deltoid muscle is especially dangerous).

Contraindications

For short-term use for health reasons, the only contraindication is hypersensitivity to dexamethasone or the components of the drug.

In children during the growth period, GCS should be used only according to absolute indications and under the particularly careful supervision of the attending physician.

The drug should be prescribed with caution for the following diseases and conditions:

Use during pregnancy and breastfeeding

During pregnancy (especially in the 1st trimester), the drug can be used only when the expected therapeutic effect outweighs the potential risk to the fetus. With long-term therapy during pregnancy, the possibility of impaired fetal growth cannot be excluded. If used at the end of pregnancy, there is a risk of atrophy of the adrenal cortex in the fetus, which may require replacement therapy in the newborn.

If it is necessary to carry out treatment with the drug during breastfeeding, breastfeeding should be stopped.

special instructions

During treatment with Dexamethasone (especially long-term), observation by an ophthalmologist, monitoring of blood pressure and water-electrolyte balance, as well as peripheral blood patterns and blood glucose levels are necessary.

In order to reduce side effects, antacids can be prescribed, and the intake of K+ into the body should be increased (diet, potassium supplements). Food should be rich in proteins, vitamins, and limit the content of fats, carbohydrates and table salt.

The effect of the drug is enhanced in patients with hypothyroidism and liver cirrhosis. The drug may worsen existing emotional instability or psychotic disorders. If a history of psychosis is indicated, Dexamethasone in high doses is prescribed under the strict supervision of a physician.

It should be used with caution in acute and subacute myocardial infarction - the necrosis may spread, the formation of scar tissue may slow down, and the heart muscle may rupture.

In stressful situations during maintenance treatment (for example, surgery, trauma or infectious diseases), the dose of the drug should be adjusted due to an increased need for glucocorticosteroids. Patients should be carefully monitored for a year after the end of long-term therapy with Dexamethasone due to the possible development of relative insufficiency of the adrenal cortex in stressful situations.

With sudden withdrawal, especially in the case of previous use of high doses, the development of withdrawal syndrome (anorexia, nausea, lethargy, generalized musculoskeletal pain, general weakness) is possible, as well as an exacerbation of the disease for which Dexamethasone was prescribed.

During treatment with Dexamethasone, vaccination should not be carried out due to a decrease in its effectiveness (immune response).

When prescribing Dexamethasone for intercurrent infections, septic conditions and tuberculosis, it is necessary to simultaneously treat with bactericidal antibiotics.

In children during long-term treatment with Dexamethasone, careful monitoring of the dynamics of growth and development is necessary. Children who during the treatment period were in contact with patients with measles or chickenpox are prescribed specific immunoglobulins prophylactically.

Due to the weak mineralocorticoid effect, Dexamethasone is used in combination with mineralocorticoids for replacement therapy for adrenal insufficiency.

In patients with diabetes mellitus, blood glucose levels should be monitored and therapy adjusted if necessary.

X-ray monitoring of the osteoarticular system (images of the spine, hand) is indicated.

In patients with latent infectious diseases of the kidneys and urinary tract, Dexamethasone can cause leukocyturia, which may have diagnostic value.

Drug interactions

There may be pharmaceutical incompatibility of dexamethasone with other IV drugs - it is recommended to administer it separately from other drugs (IV bolus, or through another dropper, as a second solution). When mixing a solution of dexamethasone with heparin, a precipitate forms.

Simultaneous administration of dexamethasone with:

• inducers of hepatic microsomal enzymes (phenobarbital, rifampicin, phenytoin, theophylline, ephedrine) leads to a decrease in its concentration;
• diuretics (especially thiazide and carbonic anhydrase inhibitors) and amphotericin B - can lead to increased excretion of K+ from the body and an increased risk of developing heart failure;
• with sodium-containing drugs - to the development of edema and increased blood pressure;
• cardiac glycosides - their tolerability worsens and the likelihood of developing ventricular extrasytolia increases (due to caused hypokalemia);
• indirect anticoagulants - weakens (less often enhances) their effect (dose adjustment required);
• anticoagulants and thrombolytics - the risk of bleeding from ulcers in the gastrointestinal tract increases;
• ethanol (alcohol) and nonsteroidal anti-inflammatory drugs - increases the risk of erosive and ulcerative lesions in the gastrointestinal tract and the development of bleeding (in combination with NSAIDs in the treatment of arthritis, it is possible to reduce the dose of glucocorticosteroids due to the summation of the therapeutic effect);
• paracetamol - the risk of developing hepatotoxicity increases (induction of liver enzymes and the formation of a toxic metabolite of paracetamol);
• acetylsalicylic acid - accelerates its elimination and reduces its concentration in the blood (when dexamethasone is discontinued, the level of salicylates in the blood increases and the risk of side effects increases);
• insulin and oral hypoglycemic drugs, antihypertensive drugs - their effectiveness decreases;
• vitamin D - its effect on the absorption of Ca2+ in the intestine is reduced;
• growth hormone - reduces the effectiveness of the latter, and with praziquantel - its concentration;
• M-anticholinergics (including antihistamines and tricyclic antidepressants) and nitrates - helps increase intraocular pressure;
• isoniazid and mexiletine - increases their metabolism (especially in “slow” acetylators), which leads to a decrease in their plasma concentrations.

Carbonic anhydrase inhibitors and loop diuretics may increase the risk of osteoporosis.

Indomethacin, displacing dexamethasone from its association with albumin, increases the risk of developing its side effects.

ACTH enhances the effect of dexamethasone.

Ergocalciferol and parathyroid hormone prevent the development of osteopathy caused by dexamethasone.

Cyclosporine and ketoconazole, by slowing down the metabolism of dexamethasone, can in some cases increase its toxicity.

The simultaneous administration of androgens and steroidal anabolic drugs with dexamethasone promotes the development of peripheral edema and hirsutism, and the appearance of acne.

Estrogens and oral contraceptives containing estrogen reduce the clearance of dexamethasone, which may be accompanied by an increase in the severity of its action.

When used simultaneously with live antiviral vaccines and against the background of other types of immunization, it increases the risk of viral activation and the development of infections.

Antipsychotics (neuroleptics) and azathioprine increase the risk of developing cataracts when dexamethasone is prescribed.

When used simultaneously with antithyroid drugs, the clearance of dexamethasone decreases and with thyroid hormones increases.

Analogs of the drug Dexamethasone

Structural analogues of the active substance:

• Decadron;
• Dexaven;
• Dexazone;
• Dexamed;
• Dexamethasone Bufus;
• Dexamethasone Nycomed;
• Dexamethasone-Betalek;
• Dexamethasone Vial;
• Dexamethasone-LENS;
• Dexamethasone-Ferein;
• Dexamethasone sodium phosphate;
• Dexamethasone phosphate;
• Dexamethasonelong;
• Dexapos;
• Dexafar;
• Dexon;
• Maxidex;
• Oftan Dexamethasone;
• Fortecortin.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.

Hormonal drugs are sometimes used to treat many diseases. They are synthetic analogues of hormones produced by the adrenal glands. Typically, such drugs easily bind to proteins and penetrate cells, so they quickly relieve inflammation, pain, swelling, and allergic reactions. One of the most common drugs used in emergency cases or as part of complex therapy is the drug Dexamethasone. Its effectiveness is much higher than that of some other hormonal agents, and its low price makes treatment accessible to every patient. Despite the presence of many side effects, Dexamethasone injections are often used, as they can significantly improve the patient's condition or even save his life.

General characteristics of the drug

Dexamethasone belongs to the group of glucocorticoid drugs. This is a synthetic hormone of the adrenal cortex. The international nonproprietary name (in short INN) is “Dexamethasone”, but you can purchase a medicine with this composition under the names Dexazone, Metazon, Maxidex. These are all drugs from the group of glucocorticoids. They are used for many pathologies, as they affect the body at the cellular level.

Dexamethasone is the most popular drug from this group. Its advantages include low price, wide scope of application, and the ability to be used in the complex treatment of many diseases. In addition, the effectiveness of its use is 30 times higher than that of Cortisone. This medicine is inexpensive, the price of a package ranges from 35 to 100 rubles, depending on the form of release and dosage.

This drug is available in ampoules, tablets and eye drops. In addition, it is added to some complex medicines for internal and external use. The solution for intravenous or intramuscular administration contains dexamethasone sodium phosphate, glycerin, disodium phosphate and water for injection.

Dexamethasone in ampoules

Dexamethasone injections are given in cases where for some reason it is impossible to use tablets. Usually these are severe conditions, severe pain, and serious allergic reactions. Injections are given for no longer than 3-5 days, then, if necessary, they switch to oral administration of the drug.

Dexamethasone solution is administered intravenously or intramuscularly. This depends on the age of the patient and the severity of his condition. It is very important that the use of this drug is under the supervision of a doctor, as serious side effects may develop. Therefore, pharmacies sell this medicine only by prescription.

Dexamethasone is packaged in ampoules of 1 ml. The solution is usually clear, slightly yellowish. Each ampoule contains 4 mg of active substance. The package includes 10 or 20 ampoules placed in contour cells, as well as instructions for use. Each ampoule usually has a sticker with its name. Sometimes they have a dot or ring on them to indicate the break point. Otherwise, a scarifier is included with the package to break off the tip of the ampoule.

Dexamethasone should be stored out of the reach of children. This does not have to be a refrigerator, the main thing is that the temperature does not exceed 25 degrees, but the drug cannot be frozen either. It is necessary to protect the solution from exposure to sunlight, so the ampoules should always be kept in closed packaging. Once opened, the solution cannot be stored and can no longer be used.

Important: you should also not use a drug that has expired, the sealing or storage conditions have been violated.

What effect does

The use of Dexamethasone injections is justified for many diseases. It is prescribed when other therapy is ineffective. This glucocorticoid is a popular drug due to its strong anti-inflammatory, anti-stress and anti-shock effects. In addition, it has the ability to relieve allergic reactions, activate metabolic processes and reduce abnormal activity of the immune system.

Dexamethasone is often used in ampoules, usually administered intramuscularly or intravenously

The effect of the drug when administered intramuscularly occurs after 6-8 hours, so in emergency cases it is usually administered intravenously. And if it is impossible to use the drug orally, it is injected into soft tissues. With this method of entry into the body, the active substance quickly reacts with cell receptor proteins, which allows it to penetrate into the nucleus.

It turns out that the effect of the drug is manifested at the cellular level. This explains its effectiveness in many pathological conditions. Dexamethasone is able to regulate metabolic processes. It inhibits the production of certain enzymes that can slow down metabolism or speed up the breakdown of proteins. Thanks to this, the condition of cartilage tissue and bones improves.

In addition, the use of Dexamethasone can reduce the activity of leukocytes and the immune system. This helps reduce the inflammatory process in autoimmune pathologies. And by reducing vascular permeability, this medicine prevents the spread of inflammation.

Indications for use

Injections of this drug are used only for health reasons, usually after other treatment has been tried and was unsuccessful. Emergency doctors can give a Dexamethasone injection in cases of shock, adrenal gland dysfunction, or rapidly increasing cerebral edema, for example, after a traumatic brain injury.

Indications for such treatment include brain tumors, meningitis, and radiation damage. The drug is used after injuries, surgeries, tumors, allergies or inflammatory diseases of the joints.

Joint pathologies

The main indications for the use of Dexamethasone are various joint diseases. Glucocorticoids quickly relieve inflammation and pain, so they are often prescribed when conventional therapy does not bring positive results. And Dexamethasone works more effectively than other similar drugs, so sometimes one injection is enough.

This drug improves the patient's condition with rheumatoid arthritis, ankylosing spondylitis, scleroderma, systemic lupus erythematosus, and psoriasis. It accelerates recovery from various inflammatory diseases, such as bursitis, polyarthritis, epicondylitis or synovitis.

Caution: It is usually administered intramuscularly, but sometimes injections are given directly into the affected joint. In this case, the injection can be repeated only after 3 months. And you can enter from 0.4 to 4 mg.

Long-term use of such injections or exceeding the recommended dose is unacceptable. The active ingredient of this drug can negatively affect the condition of cartilage tissue and even cause weakening or rupture of tendons. Therefore, for pathologies such as osteoarthritis or osteochondrosis, it is rarely used and only under the supervision of a doctor.

Allergic reactions

Not everyone knows why Dexamethasone is prescribed, but many people with allergies are familiar with it. This is one of the most common pathologies now. Usually, correct behavior and the use of medications prescribed by a doctor can normalize the condition. But sometimes severe allergic reactions occur that can threaten the health or even the life of the patient. Often in such cases, conventional remedies do not help relieve severe swelling or itching, so Dexamethasone is prescribed. It can quickly remove all allergy symptoms.

This drug is used most often in emergency cases: with Quincke's edema, angioedema or anaphylactic shock. But its use is also indicated for severe urticaria, dermatitis, eczema, conjunctivitis, hay fever. Usually, for these pathologies, it is recommended to inject Dexamethasone 4-8 mg for 1-2 days. After relieving acute symptoms, it is better to switch to the use of tablets.

Respiratory system diseases

This drug penetrates well into the bronchi and lungs, quickly relieving swelling and inflammation. Therefore, it is often used for severe pathologies of the respiratory system, except for infectious ones. Dexamethasone is effective for status asthmaticus, bronchial asthma or obstructive bronchitis. It significantly improves the patient's condition.

Such injections are used in emergency cases, for example, with Quincke's edema or bronchial asthma

This drug is especially often used for such pathologies in childhood, since edema quickly develops in children and respiratory function may be impaired. Even acute laryngotracheitis can cause such complications, which is why complex treatment includes glucocorticoid injections.

Contraindications

When prescribing any drug, the presence of contraindications must be taken into account. This is especially important in relation to Dexamethasone. There are many pathologies for which the drug cannot be used, as this can lead to the development of serious side effects.

Attention: such injections are not prescribed for certain pathologies of the musculoskeletal system. Dexamethasone can slow down regeneration processes and also destroy cartilage and bone tissue. Its high concentration in the blood leads to the leaching of calcium from the bones. Therefore, it is contraindicated to use it for osteoporosis, severe osteoarthritis, and after fractures.

It is very important not to use such medicine for various infectious diseases. Dexamethasone has an immunosuppressive effect, that is, it suppresses the immune system. If there are viruses, bacteria or fungi in the body, they begin to multiply quickly. Therefore, such injections are not given for tuberculosis.

In addition, contraindications also include the following pathologies:

• diabetes;
• stomach ulcer;
• heart attack;
• presence of bleeding;
• mental disorders;
• renal or liver failure;
• individual hypersensitivity to the drug.

Side effects

The instructions for use necessarily warn about possible side effects. Dexamethasone penetrates cells and changes metabolic processes. When used in large doses, the immune system is suppressed, fat metabolism is disrupted, calcium is washed out of bone tissue and fluid accumulates in the intercellular space. Because of this, after a course of such therapy, a person may develop serious infectious diseases, swelling appears, fatty deposits accumulate and the risk of fractures increases.

This drug has many side effects, so they try to prescribe it in the lowest possible doses. But still, many patients after a course of Dexamethasone injections develop the following pathologies:

• depression, hallucinations;
• increased blood pressure;
• gastric ulcer, pancreatitis;
• blood composition disorder;
• insomnia;
• disruption of the heart;
• impotence;
• dermatitis, urticaria;
• slow wound healing;
• convulsions;
• decreased vision, cataracts;
• muscle weakness.

Negative phenomena also appear at the injection site. Often there is pain, burning or numbness, and a hematoma or lump forms. A scar may appear at the injection site, and the skin may atrophy.

Instructions for using injections

Injection use of glucocorticoids is possible only under medical supervision. In addition to the fact that the correct dosage is very important, there are certain rules for the administration of such drugs. The main thing is that Dexamethasone must be administered very slowly. Intravenous injections are best done as a dropper. To do this, the solution is diluted with glucose or sodium chloride. But it is prohibited to mix this drug with other drugs in the same syringe.

It is advisable that the injection be given by a medical professional

But intramuscular injections also need to be done very slowly. With rapid administration of the drug, it is possible to increase blood pressure and interfere with heart function.

Typically, the course of injections is 3-5 days. But abruptly stopping treatment is not recommended. Dexamethasone often leads to the development of withdrawal syndrome, when after the drug has stopped entering the body, the patient's condition worsens. Therefore, after a course of injections, they switch to oral administration of the drug. Moreover, its dosage is gradually reduced under the guidance of a doctor.

Important: Long-term use of glucocorticoids sometimes causes adrenal insufficiency, which may appear some time after treatment.

In addition, large doses of Dexamethasone lead to severe losses of potassium, which negatively affects the functioning of the heart muscle. The development of mental disorders is also possible, so it is sometimes recommended to administer the required dose once a day in the morning.

Correct dosage

In order for Dexamethasone treatment to be effective, but the possibility of side effects to decrease, it is important to administer it in certain doses, which are usually determined individually, depending on the patient’s age, the severity of his condition and the presence of chronic pathologies. Adult patients are administered from 4 to 20 mg at a time. Sometimes one injection is enough, since the effect of the drug is felt for up to 3 weeks. But in severe cases, 3-4 injections are given per day. The maximum dosage per day is 80 mg.

The dosage of Dexamethasone solution depends not only on the individual characteristics of the patient, but also on the purposes of use. For example, for cerebral edema, 16 mg of the drug is first administered, the next injection is given 6 hours later, but this time 5 mg. At this dosage, injections are given every 6 hours.

Use during pregnancy

Any medicine can be used by women while carrying a child only as directed by a doctor. And Dexamethasone solution easily penetrates the placental barrier, as it acts at the cellular level. Therefore, the drug can negatively affect an unborn child, causing various disturbances in its development. Then the baby may develop adrenal dysfunction.

This drug is used only when the woman’s condition is severe and the benefits of such treatment outweigh the risk of side effects.

Features of use in children

This remedy can be used from birth. Children are given only intramuscular injections strictly according to the doctor's indications. The dosage must be calculated very carefully to prevent side effects. Depending on the severity of the condition, from 0.2 to 0.4 mg per kg of the child’s weight is administered. This is a daily dose, which can be divided into 3-4 applications. It is advisable to use the minimum possible dosage and duration of treatment.

Drug interactions

Dexamethasone is usually used as part of complex treatment. But it is very important to consider its compatibility with other medications. Some of them may reduce the effectiveness of the drug or increase the risk of side effects. It is unacceptable to self-medicate and you need to warn your doctor about the medications you are taking before starting treatment.

Do not take the drug together with other glucocorticoids or non-steroidal anti-inflammatory drugs. The risk of severe side effects also increases when used together with birth control or Ritodrine.

conclusions

Dexamethasone injection solution is a fairly common treatment for various emergency conditions. Despite the possibility of side effects, this drug is used quite often. But it is necessary that the treatment be prescribed by a doctor. The dosage is also selected individually. Failure to comply with medical recommendations during therapy can lead to serious consequences.

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