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DEXAMETHASONE instructions for use (injections in ampoules, eye drops, tablets). DEXAMETHASONE is a powerful synthetic glucocorticoid (containing adrenal hormones and their synthetic analogues) drug intended for the regulation of protein, carbohydrate and mineral metabolism.

Dexamethasone instructions for use, reviews, analogs and release forms (tablets 0.5 mg, injections in ampoules (solution for injection), eye drops oftan) drugs for the treatment of inflammation in adults, children and pregnancy.

Compound

• Active substance - dexamethasone sodium phosphate (in terms of dexamethasone phosphate) - 4.0 mg/8.0 mg;
• Excipients: glycerin, disodium phosphate dihydrate, disodium edetate, water for injection.

Release forms

1. Tablets 0.5 mg;
2. Solution in ampoules for intravenous and intramuscular administration (injections for injections) 4 mg/ml;
3. Oftan eye drops 0.1%;
4. Ophthalmic suspension 0.1%

DEXAMETHASONE instructions for use of the drug

Oral administration of Dexamethasone in the form of tablets involves the administration of 10-15 mg of the drug per day at the initial stage of treatment, 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 (after or during 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.

Indications for use of Dexamethasone

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

• Shock (burn, traumatic, surgical, toxic) - when vasoconstrictors, plasma replacement drugs and other symptomatic therapy are ineffective;
• Severe allergic reactions, anaphylactic shock;
• Blood diseases: acute hemolytic anemia, agranulocytosis, idiopathic thrombocytopenic purpura in adults;
• Endocrine diseases: acute adrenal insufficiency, primary or secondary insufficiency, congenital hyperplasia, subacute thyroiditis;
• Local application (in the area of ​​pathological formation): keloids, discoid lupus erythematosus, granuloma annulare;
• Rheumatic diseases - Dexamethasone instructions for use;
• In ophthalmological practice (subconjunctival, retrobulbar or parabulbar administration): allergic conjunctivitis, keratitis, keratoconjunctivitis without damage to the epithelium, iritis, iridocyclitis, blepharitis, blepharoconjunctivitis, scleritis, episcleritis, inflammatory process after eye injuries and surgical interventions, sympathetic ophthalmia, immunosuppressive treatment after transplantation corneas;
• 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;
• Severe infectious diseases (in combination with antibiotics);
• Brain edema (with a tumor, traumatic brain injury, neurosurgical intervention, hemorrhage, encephalitis, meningitis, radiation injury);
• Systemic connective tissue diseases;
• Asthmatic status; severe bronchospasm (exacerbation of bronchial asthma, chronic obstructive bronchitis).

Why are Dexamethasone tablets prescribed?

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

Why are Dexamethasone drops prescribed?

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

Why are injections in Dexamethasone ampoules prescribed?

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

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.

Carefully the drug should be prescribed for the following diseases and conditions:

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 is increased by sodium-containing drugs and nutritional supplements, severe hypokalemia, heart failure and osteoporosis is increased 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. Dexamethasone instructions for use.

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.

Directions for use and doses

Intended for intravenous, intramuscular, intraarticular, periarticular and retrobulbar administration. The dosage regimen is individual and depends on the indications, the patient’s condition and his response to therapy.

For the purpose of preparation for intravenous drip infusion, an isotonic sodium chloride solution or 5% dextrose solution should be used. 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 single 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. Children - IM at a dose of 0.02776-0.16665 mg/kg every 12-24 hours.

1. Soft tissue: 2 to 6 mg;
2. Large joints (eg knee joint): 2 to 4 mg;
3. Joint capsules: from 2 to 3 mg;
4. Small joints (eg, interphalangeal, temporal joint): from 0.8 to 1 mg;
5. Nerve ganglia: 1 to 2 mg;
6. Tendons: from 0.4 to 1 mg.

The drug is re-prescribed at intervals from 3 days to 3 weeks as needed; The maximum dose for adults is 80 mg per day. For shock, adults - 20 mg intravenously once, then 3 mg/kg over 24 hours as a continuous infusion or intravenously 2-6 mg/kg once, 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. For adrenal insufficiency (children), IM 0.0233 mg/kg (0.67/mg/m2) per day in 3 injections every third 24 hours, or daily 0.00776-0.01165 mg/kg ( 0.233-0.335 mg/m2) per day.

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 a combination of parenteral and oral administration: dexamethasone instructions for use injection solution 4 mg/ml: 1 day, 1 or 2 ml (4 or 8 mg ) intramuscularly; dexamethasone tablets 0.75 mg: the second and third days, 4 pieces in 2 doses per day, the fourth - 2 pieces in 2 doses, the fifth and sixth days - 1 piece. daily, on the seventh day - without treatment, day 8 - observation.

Side effects

Dexamethasone instructions for use are 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:

1. From the senses: posterior subcapsular cataract, increased intraocular pressure with possible damage to the optic nerve, a 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 shells, scalp, possible deposition of drug crystals in the vessels of the eye);
2. From the skin and mucous membranes: delayed wound healing, petechiae, ecchymoses, thinning of the skin, hyper- or hypopigmentation, steroid acne, stretch marks, tendency to develop pyoderma and candidiasis;
3. From the endocrine system: decreased glucose tolerance, steroid diabetes mellitus or manifestation of latent diabetes mellitus, suppression of adrenal function, Itsenko-Cushing syndrome (moon-shaped face, pituitary-type obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, muscle weakness, stretch marks) , delayed sexual development in children;
4. Metabolic: increased calcium excretion, hypocalcemia, weight gain, negative nitrogen balance (increased protein breakdown), severe sweating. Caused by mineralocorticoid activity - fluid and sodium retention (peripheral edema), hypsarnatremia, hypokalemia syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue);
5. From the musculoskeletal system: slowing of growth and ossification processes in children (premature closure of the epiphyseal growth plates), osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the head of the humerus and femur), rupture of muscle tendons, steroid myopathy, decreased muscle mass (atrophy). Dexamethasone instructions for use;
6. From the cardiovascular system: arrhythmias, bradycardia (up to cardiac arrest); development (in predisposed patients) or increased severity of heart failure, changes in the electrocardiogram characteristic of hypokalemia, increased blood pressure, hypercoagulation, thrombosis. In patients with acute and subacute myocardial infarction - the spread of necrosis, slowing down the formation of scar tissue, which can lead to rupture of the heart muscle;
7. From the digestive system: 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, hiccups. In rare cases, increased activity of liver transaminases and alkaline phosphatase;
8. From the nervous system: delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increased intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, pseudotumor of the cerebellum, headache, convulsions.

Allergic reactions: skin rash, itching, anaphylactic shock, local allergic reactions.

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

Others: development or exacerbation of infections (the appearance of this side effect is facilitated by jointly used immunosuppressants and vaccination), leukocyturia, “flushing” of blood to the face, “withdrawal” syndrome.

Price of the drug DEXAMETHASONE

• Dexamethasone, tablets 0.5 mg, 10 pcs. — 45 rub.;
• Dexamethasone, eye drops 0.1%, 5 ml - 34 rubles;
• Dexamethasone, ampoules 4 mg, 1 ml, 25 pcs. — 202 rub.;
• Dexamethasone solution for injection 4 mg/ml 1 ml ampoule, 25 pcs. 144 rub.;
• Dexamethasone eye drops, 10 ml - 82 rub.

special instructions

• It should be used with caution in acute and subacute myocardial infarction - it is possible to spread the necrosis focus, slow down the formation of scar tissue and rupture of the heart muscle;
• 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 patients with latent infectious diseases of the kidneys and urinary tract, Dexamethasone can cause leukocyturia, which may have diagnostic value;
• 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 (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 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;
• Dexamethasone increases the content of 11- and 17-hydroxyketocorticosteroid metabolites;
• 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, with limited fat, carbohydrates and table salt;
• In patients with diabetes mellitus, blood glucose levels should be monitored and therapy adjusted if necessary.
  X-ray monitoring of the osteoarticular system is indicated (images of the spine, hand);
• 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;
• 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. Dexamethasone instructions for use.

Video review of the drug DEXAMETHASONE

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Agents with glucocorticosteroid activity for topical use

Dexamethasone is a hormonal drug that is used to treat various diseases. Use only as prescribed by a doctor in strictly prescribed dosages. The drug is available in the form of eye drops, tablets and solution for injection.

In contact with

Composition and mechanism of action

Dexamethasone has the following component composition:

• Dexamethasone phosphate in the amount of 4 mg;
• propylene glycol;
• disodium edetate;
• buffer solution.

Pharmacological effects The medicine is to provide antihistamine, anti-inflammatory, antitoxic, immunosuppressive, anti-shock effects.

The hormonal drug is of synthetic origin.

It has a beneficial effect on the following processes in the body:

• decreased capillary permeability;
• elimination of glucose utilization;
• decreased calcium absorption and excretion;
• fluid and sodium retention;
• acceleration of catabolism of protein structures.

If such a medicine is administered intramuscularly, then rapid absorption of the active substance into the body, the therapeutic effect occurs within 3 days. The breakdown process takes place in the liver, and the final products are excreted through the intestines and kidneys naturally.

Prescription of injections

Why are Dexamethasone injections prescribed, indications for use of the medicine:

• severe exacerbation of rheumatic diseases;
• extensive manifestations of allergic reactions in the body;
• shock of various origins;
• cerebral edema;
• autoimmune disorders;
• diseases of the blood and respiratory system;
• dermatoses during periods of exacerbation;
• carrying out special therapy for a lack of hormones.

Important! Injections can be used and injected only under the supervision of the attending physician, since the use of hormonal drugs is fraught with the development of a large number of side effects and contraindications.

Dexamethasone is prescribed to children for allergies, colds, inflammatory processes and many other diseases.

How to use

Dexamethasone instructions for use recommend intramuscular administration of the drug in severe cases of the disease or in cases where internal administration of tablets is impossible due to for a number of specific reasons.

The amount of medicine depends on the disease. Dexamethasone injections are used:

• in case of shock, 2 to 6 mg are administered every 6 hours. Therapy lasts no more than 72 hours and is carried out as necessary when a person’s health is in danger;
• for cerebral edema, an initial dosage of 10 mg is required and for further pain relief 4 mg after 6 hours.
• as maintenance therapy for oncology, the amount of medication is 2 mg three times a day;
• in case of exacerbation of the disease, the dosage for adults is 50 mg, and for children weighing up to 35 kg - 20 mg. After obtaining the desired effect, the dose of the drug is reduced in accordance with the prescribed course of treatment;
• allergic reactions are treated with Dexamethasone injections only at the beginning of treatment, and then transferred to internal use of the drug. The initial dosage is 4–8 mg, and within 8 days of treatment it is reduced to 0.5 mg, depending on the effect of therapy.

Important! The maximum daily dosage of Dexamethasone for intramuscular administration is no more than 80 mg. No more than 2 mg of medication can be injected into the same place.

How long can you use Dexamethasone injections and is it hormonal?

The drug is a synthetic corticosteroid in origin, so the duration of its use should be monitored by the attending physician.

Uncontrolled use of the drug leads to serious consequences.

In case of Dexamethasone overdose risk increases occurrence of side effects. To eliminate the negative reaction of the body, symptomatic therapy is prescribed in the form of cleansing the body by drip.

The drug is available in pharmacies only with a prescription. The shelf life is 2 years from the date of production. After the period indicated on the package, the use of the medicine is strictly prohibited. It must be stored at a temperature no higher than 15 degrees in a dry, dark place out of reach of children.

Dexamethasone injections, as a sedative, are widely used in veterinary medicine to eliminate the state of shock in cats and dogs during exacerbation of various diseases.

Use during pregnancy

Qualified doctors do not recommend Dexamethasone during pregnancy if it is progressing normally. The need for admission arises only if the woman’s body rejects the implanted embryo and there is a threat of miscarriage.

The drug suppresses the body's immune activity, and therefore helps maintain pregnancy. At the same time, the medicine has a considerable number of side effects in the form of changes in body weight, depression and hormonal imbalance in the body.

Side effects of Dexamethasone depend on many factors, but are quite impressive list:

• development of euphoria, depression, manic disorder in the nervous system;
• inflammation of the optic nerve, blurred vision and headaches;
• hallucinations, insomnia, migraine;
• possible occurrence of cataracts and glaucoma;
• arterial hypertension, thrombosis, increased blood flow to the brain;
• ulcerative manifestations in the stomach, intestines, pancreatitis of the pancreas;
• change in body weight, water retention in the body;
• the appearance of latent diabetes mellitus, absence of menstruation, impaired growth of children due to poor functioning of the endocrine system;
• weakness of muscle mass, development of osteoporosis, increased pain with intra-articular administration of the drug;
• various skin rashes, weak healing of wounds;
• urticaria in the form of skin itching, anaphylactic shock.

When using injections Dexamethasone must take into account all contraindications to the use of the drug:

• infectious diseases of bacterial and viral origin;
• mycoses of a systemic nature;
• state of immunodeficiency;
• the period before or after vaccination;
• diabetes mellitus in a progressive form;
• stomach and intestinal ulcers;
• serious disorders of the kidneys and liver;
• the presence of myasthenia gravis and systemic osteoporosis;
• nervous disorders (psychosis, prolonged depression).

Important! In the presence of the contraindications described above, injections are prohibited, as this can lead to exacerbation of existing chronic diseases and cause severe complications.

Analogs

If Dexamethasone causes a side effect, the doctor may change it to similar drugs with similar composition and pharmacological effects.

Common substitutes:

Dexazone. An analogue of Dexamethasone of hormonal origin in the form of tablets and solution for injection. The scope of application of the medicine is the treatment and relief of acute syndrome in the development of various diseases. Contraindications: systemic mycoses, osteoporosis, intolerance to components, viral infections, polio, lymphadenitis, vaccination. Price 150–200 rubles.

Metazon. A close substitute containing identical active ingredients of a new generation.

The drug is presented in the form of ampoules containing a solution for internal administration. The medicine is prescribed for acute diseases of various origins.

Contraindications: allergic manifestations, mycoses, viral infections, pregnancy, breastfeeding, children. Price 150–180 rubles.

Maxidex. An effective analogue of Dexamethasone with a high degree of impact. Indications for use: allergic and acute eye diseases. Contraindications: intolerance to the active substance, chicken pox, purulent infections, development of keratitis. Price 180–200 rubles.

Dexamed. Hormonal drug of synthetic origin in the form of tablets and solution for injection. The medicine is prescribed for the treatment of a wide range of diseases developing in the vital systems of the body. Contraindications: allergic manifestations, mycoses, viral infections, pregnancy, lactation, liver and kidney dysfunction. Price 1000–1200 rubles.

Megadexane. A structural analog containing Dexamethasone, used to treat diseases of various etiologies. Contraindications: first trimester of pregnancy, breastfeeding, systemic mycosis, liver and kidney dysfunction, stomach and intestinal ulcers, viruses, lactose intolerance. Price 550–600 rubles.

Important! The attending physician, who has carefully studied the clinical picture of the current disease, must decide whether the patient should take Dexamethasone or not.

Video: dexamethasone in ampoules

Conclusion

Dexamethasone is classified as a hormonal drug with a high degree of effectiveness. The medicine has a considerable number of contraindications and side effects, so it requires careful use under the supervision of a doctor. Obtaining the expected effect depends on compliance with the prescribed dosage and taking into account the advisability of taking the solution.

In contact with

Dexamethasone is a drug belonging to the group of glucocorticosteroids and is a hormonal agent.

It is widely used in medicine in various fields. It is produced in the form of a solution, which is used for injection intravenously, intramuscularly and for instillation into the conjunctiva of the eyes.

On this page you will find all the information about Dexamethasone: complete instructions for use for this drug, average prices in pharmacies, complete and incomplete analogues of the drug, as well as reviews of people who have already used Dexamethasone injections. Would you like to leave your opinion? Please write in the comments.

Clinical and pharmacological group

GCS for injection.

Conditions for dispensing from pharmacies

Dispensed with a doctor's prescription.

Prices

How much does Dexamethasone cost? The average price in pharmacies is 100 rubles.

Release form and composition

The drug solution, which is sold in pharmacies in ampoules, contains dexamethasone sodium phosphate. This active substance takes 4 or 8 mg.

The auxiliary components are glycerin, disodium phosphate dihydrate, disodium edetate and purified water to obtain a solution of the desired concentration. Dexamethasone solution for internal administration appears as a clear, colorless or yellowish liquid.

Pharmacological effect

Dexamethasone is a homologue of hydrocortisone, a hormone produced by the adrenal cortex.

It interacts with glucocorticoid receptors, regulates sodium and potassium metabolism, water balance and glucose homeostasis. Stimulates the production of enzyme proteins in the liver, affects the synthesis of mediators of inflammation and allergies, and inhibits their formation. As a result, the product gives an anti-inflammatory, anti-allergic, immunosuppressive, and anti-shock effect.

When administered intramuscularly, the therapeutic effect is observed after 8 hours, after intravenous infusion, faster. The effect lasts from 3 days to 3 weeks when administered locally, 17 - 28 days after administration intravenously. Dexamethasone has a strong anti-inflammatory and antiallergic effect. It is 35 times more effective than cortisone.

Why is Dexamethasone prescribed?

1. For gastrointestinal diseases: and ulcerative colitis.
2. For systemic connective tissue diseases: acute rheumatic carditis; .
3. For endocrine disorders: insufficiency of the adrenal cortex and their congenital hyperplasia; subacute form of inflammation of the thyroid gland.
4. For rheumatic diseases: bursitis; ; psoriatic and gouty arthritis; osteoarthritis; synovitis; nonspecific tenosynovitis; ankylosing spondylitis; epicondylitis accompanying osteoarthritis.
5. For allergic diseases: contact and atopic; status asthmaticus; serum sickness; allergies to food and certain medications; angioedema; (seasonal or chronic); ; associated with blood transfusion.
6. For skin diseases: severe erythema multiforme; pemphigus; exfoliative, bullous herpetiform and severe seborrheic dermatitis; fungoid mycosis; .
7. For eye diseases: optic neuritis; symptomatic ophthalmia; allergic corneal ulcers; keratitis; iridocyclitis; iritis; uveitis (anterior and posterior); allergic forms.
8. For respiratory diseases: Loeffler's syndrome; ; sarcoidosis 2nd-3rd degree; aspiration pneumonia; berylliosis.
9. For kidney diseases: impaired renal function associated with systemic wolf's lichen erythematosus; idiopathic nephrotic syndrome.
10. For malignant diseases: leukemia (acute) in children; lymphoma and leukemia in adults.
11. In case of shock: shock that cannot be treated with classical methods; anaphylactic shock; shock in patients suffering from insufficiency of the adrenal cortex.
12. For hematological diseases: idiopathic thrombocytopenic purpura; erythroblastopenia; congenital hypoplastic anemia; autoimmune hemolytic anemia; thrombocytopenia secondary.
13. For other indications: myocardial trichinosis; trichinosis with neurological signs; tuberculous meningitis.

Contraindications

The use of Dexamethasone is contraindicated in patients with hypersensitivity to the components of the drug.

The use of Dexamethasone by pregnant and lactating women, as well as children, should only be prescribed by a doctor after taking into account all possible risks.

Use during pregnancy and lactation

Dexamethasone in the form of tablets and drops is prohibited for use during pregnancy and lactation. If during breastfeeding there is a need for treatment with Dexamethasone, the child is transferred to artificial formula.

Dexamethasone injections during pregnancy are given only for health reasons. For example, the drug may be prescribed when the immune system begins to perceive the embryo as a foreign body. Dexamethasone suppresses immune activity, which eliminates the threat of miscarriage and maintains pregnancy.

Instructions for use

The instructions for use indicate that the dosage regimen is individual and depends on the indications, the patient’s condition and his response to therapy.

1. The drug is administered intravenously in a slow stream or drip (for acute and emergency conditions); i/m; local (into the pathological formation) administration is also possible. To prepare a solution for intravenous drip infusion, you should use an isotonic sodium chloride solution or a 5% dextrose solution.
2. 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 (i.m.):

• 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.

Side effects

During treatment with Dexamethasone in the form of injections, patients may experience the development of the following side effects:

1. From the skin and mucous membranes: delayed wound healing, petechiae, ecchymosis, skin thinning, hyper- or hypopigmentation, steroid acne, stretch marks, tendency to develop pyoderma and candidiasis;
2. From the senses: posterior subcapsular cataract, 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 possible deposition of drug crystals in the blood vessels of the eye);
3. Metabolism: increased calcium excretion, hypocalcemia, weight gain, negative nitrogen balance (increased protein breakdown), increased sweating. Caused by mineralocorticoid activity - fluid and sodium retention (peripheral edema), hypsarnatremia, hypokalemia syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue);
4. From the endocrine system: decreased glucose tolerance, steroid diabetes mellitus or manifestation of latent diabetes mellitus, suppression of adrenal function, Itsenko-Cushing syndrome (moon-shaped face, pituitary-type obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, muscle weakness, stretch marks), delayed sexual development in children;
5. Cardiovascular systems: arrhythmias, bradycardia (up to cardiac arrest); development (in predisposed patients) or increased severity of heart failure, changes in the electrocardiogram characteristic of hypokalemia, increased blood pressure, hypercoagulation, thrombosis. In patients with acute and subacute myocardial infarction - the spread of necrosis, slowing down the formation of scar tissue, which can lead to rupture of the heart muscle;
6. From the musculoskeletal system: slower growth and ossification processes in children (premature closure of the epiphyseal growth plates), osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the head of the humerus and femur), rupture of muscle tendons, steroid myopathy, decreased muscle mass (atrophy). Dexamethasone instructions for use;
7. From the nervous system: delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increased intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, pseudotumor of the cerebellum, headache, convulsions.
8. From the digestive system: 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, hiccups. In rare cases, increased activity of liver transaminases and alkaline phosphatase;

Overdose

If you use Dexamethasone too actively for several weeks, an overdose is possible, which is manifested by the symptoms listed among the side effects.

Treatment is carried out according to the manifested factors, and consists of reducing the dose or temporarily discontinuing the drug. In case of overdose, there is no special antidote; hemodialysis is not effective.

special instructions

1. For patients with liver abnormalities, Dexamethasone is prescribed with particular caution.
2. In order to reduce the risk of side effects, the patient should follow a diet high in potassium. Food should be rich in proteins, carbohydrate and salt intake should be slightly reduced.
3. During treatment with Dexamethasone, patients should constantly monitor blood pressure, the state of the visual organs, water and electrolyte balance and the clinical picture of the blood.
4. Treatment with the drug should not be stopped abruptly, as in this case the risk of developing withdrawal syndrome increases, a condition that is accompanied by an increase in the primary symptoms of the disease and suppression of adrenal function.
5. Patients with diabetes mellitus should constantly monitor blood glucose levels and, if necessary, adjust the daily dose of hypoglycemic drugs.
6. When using the drug in pediatric practice, you should carefully monitor the dynamics of the child's growth, since long-term use of the drug in large doses can lead to inhibition of the patient's growth.

Drug interactions

Instructions for use of Dexamethasone highlight the following drug interactions:

1. The ability to enhance the effect of antibiotics;
2. Phenobarbital, ephedrine reduce the effectiveness of the drug;
3. When taken with other glucocorticosteroids, there is an increased risk of hypokalemia;
4. When used with oral contraceptives, the half-life of Dexamethasone increases;
5. Ritodrine should not be used concomitantly with the drug in question due to the risk of death;
6. Dexamethasone reduces the effectiveness of hypoglycemic, anticoagulant, and antihypertensive medications;
7. To prevent nausea and vomiting after chemotherapy, it is recommended to use Dexamtheazone and Metoclopramide, Diphenhydramine, Prochlorperazine, Ondansetron, Granisetron simultaneously.

INN: Dexamethasone

Manufacturer: KRKA, d.d., Novo Mesto

Anatomical-therapeutic-chemical classification: Dexamethasone

Registration number in the Republic of Kazakhstan: No. RK-LS-5 No. 003394

Registration period: 05.08.2016 - 05.08.2021

Instructions

Tradename

Dexamethasone

International nonproprietary name

Dexamethasone

Dosage form

Solution for injection, 4 mg/ml

Compound

One ampoule contains

active substance- dexamethasone sodium phosphate 4.37 mg (equivalent to dexamethasone phosphate 4.00 mg),

Vexcipients: glycerin, disodium edetate, sodium hydrogen phosphate dihydrate, water for injection.

Description

Transparent, colorless to light yellow solution

Pharmacotherapeutic group

Corticosteroids for systemic use. Glucocorticosteroids. Dexamethasone.

ATX code H02AB02

Pharmacological properties

Pharmacokinetics

After intravenous administration, the drug begins to act quickly, and after intramuscular administration, the clinical effect is achieved within 8 hours. The effect of the drug is prolonged and lasts from 17 to 28 days after intramuscular administration and from 3 days to 3 weeks after local application (to the affected area). A dose of 0.75 mg dexamethasone is equivalent to a dose of 4 mg methylprednisolone and triamcinolone, 5 mg prednisone and prednisolone, 20 mg hydrocortisone, and 25 mg cortisone. In blood plasma, about 77% of dexamethasone binds to blood plasma proteins, and the majority is converted to albumin. Only minimal amounts of dexamethasone bind to non-albumin proteins. Dexamethasone is a fat-soluble compound. The drug is initially metabolized in the liver. Small amounts of dexamethasone are metabolized in the kidneys and other organs. The predominant excretion occurs through urine. The half-life (T1\2) is about 190 minutes.

Pharmacodynamics

Dexamethasone is a synthetic adrenal hormone (corticosteroid) with glucocorticoid action. The drug has a pronounced anti-inflammatory, antiallergic and desensitizing effect, and has immunosuppressive activity.

To date, enough information has been accumulated about the mechanism of action of glucocorticoids to imagine how they act at the cellular level. There are two well-defined receptor systems found in the cytoplasm of cells. Through glucocorticoid receptors, corticosteroids exert anti-inflammatory and immunosuppressive effects and regulate glucose homeostasis; through mineralocorticoid receptors they regulate sodium and potassium metabolism, as well as water and electrolyte balance.

Indications for use

Dexamethasone is administered intravenously or intramuscularly in acute cases or when oral therapy is not possible:

replacement therapy for primary and secondary (pituitary) adrenal insufficiency

congenital adrenal hyperplasia

subacute thyroiditis and severe forms of post-radiation thyroiditis

rheumatic fever

acute rheumatic carditis

pemphigus, psoriasis, dermatitis (contact dermatitis affecting a large surface of the skin, atopic, exfoliative, bullous herpetiformis, seborrheic, etc.), eczema

toxicerma, toxic epidermal necrolysis (Lyell's syndrome)

malignant exudative erythema (Stevens-Johnson syndrome)

allergic reactions to drugs and food products

serum sickness, drug exanthema

urticaria, angioedema

allergic rhinitis, hay fever

diseases that threaten vision loss (acute central chorioretinitis, inflammation of the optic nerve)

allergic conditions (conjunctivitis, uveitis, scleritis, keratitis, iritis)

systemic immune diseases (sarcoidosis, temporal arteritis)

proliferative changes in the orbit (endocrine ophthalmopathy, pseudotumors)

sympathetic ophthalmia

immunosuppressive therapy for corneal transplantation

The drug is used systemically or locally (in the form of subconjunctival, retrobulbar or parabulbar injections):

ulcerative colitis

Crohn's disease

local enteritis

sarcoidosis (symptomatic)

acute toxic bronchiolitis

chronic bronchitis and asthma (exacerbations)

agranulocytosis, panmyelopathy, anemia (including autoimmune hemolytic, congenital hypoplastic, erythroblastopenia)

idiopathic thrombocytopenic purpura

secondary thrombocytopenia in adults, lymphoma (Hodgkin, non-Hodgkin)

leukemia, lymphocytic leukemia (acute, chronic)

kidney diseases of autoimmune origin (including acute glomerulonephritis)

nephrotic syndrome

palliative therapy for leukemia and lymphoma in adults

acute leukemia in children

hypercalcemia in malignant neoplasms

cerebral edema due to primary tumors or metastases to the brain, due to craniotomy or head trauma.

Shock of various origins

shock unresponsive to standard therapy

shock in patients with adrenal insufficiency

anaphylactic shock (intravenously, after administration of adrenaline)

Other indications

Indications for intra-articular injection of dexamethasone or injection into soft tissues:

rheumatoid arthritis (severe inflammation in a single joint)

ankylosing spondylitis (when inflamed joints do not swell to standard therapy)

psoriatic arthritis (oligoarticular lesions and tenosynovitis)

monoarthritis (after removal of intra-articular fluid)

osteoarthritis (only in the presence of exudate and synoviitis)

extra-articular rheumatism (epicondylitis, tenosynovitis, bursitis)

Local administration (injection into the lesion):

• hypertrophic, inflamed and infiltrated foci of lichen, psoriasis, granuloma annulare, sclerosing folliculitis, discoid lupus and cutaneous sarcoidosis

  localized alopecia

Directions for use and doses

Doses are set individually for each patient depending on the nature of the disease, the expected duration of treatment, tolerability of corticosteroids and the patient's response to therapy.

Parenteral use

The injection solution is administered intravenously or intramuscularly, as well as in the form of intravenous infusions (with glucose or saline).

The recommended average initial daily dose for intravenous or intramuscular administration varies from 0.5 mg to 9 mg and, if necessary, more. The initial dose of dexamethasone should be continued until clinical response is achieved; then the dose is gradually reduced to the minimum effective. During the day, you can administer from 4 to 20 mg of Dexamethasone 3-4 times. The duration of parenteral administration is usually 3-4 days, then they switch to maintenance therapy with the oral form of the drug.

Local administration

The recommended single dose of dexamethasone for intra-articular administration is from 0.4 mg to 4 mg. Intra-articular administration can be repeated after 3-4 months. Injections can only be given to the same joint 3-4 times in a lifetime, and injections should not be given to more than two joints at the same time. More frequent administration of dexamethasone can lead to damage to intra-articular cartilage and bone necrosis. The dose depends on the size of the affected joint. The usual dose of dexamethasone is 2 mg to 4 mg for large joints and 0.8 mg to 1 mg for small joints.

The usual dose of dexamethasone for intrabursa administration is 2 mg to 3 mg, for tendon sheath administration 0.4 mg to 1 mg, and tendon administration 1 mg to 2 mg.

When administered into limited lesions, the same doses of dexamethasone are used as for intra-articular administration. The drug can be administered simultaneously into a maximum of two lesions.

Dosing in children

When administered intramuscularly, the dose for replacement therapy is 0.02 mg/kg body weight or 0.67 mg/m2 body surface area, which is divided into 3 injections with an interval of 2 days, or from 0.008 mg to 0.01 mg/kg body weight body or from 0.2 mg to 0.3 mg/m2 body surface area daily. For other indications, the recommended dose is 0.02 mg to 0.1 mg/kg body weight or 0.8 mg to 5 mg/m2 body surface area, every 12 to 24 hours.

Side effects

decreased glucose tolerance, “steroid” diabetes mellitus or manifestation of latent diabetes mellitus

Itsenko-Cushing syndrome, weight gain

hiccups, nausea, vomiting, increased or decreased appetite, flatulence, increased activity of liver transaminases and alkaline phosphatase, pancreatitis

"steroid" ulcer of the stomach and duodenum, erosive zophagitis, bleeding and perforation of the gastrointestinal tract

arrhythmias, bradycardia (up to cardiac arrest), development (in predisposed patients) or increased severity of chronic heart failure, increased blood pressure

hypercoagulability, thrombosis

delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia

increased intracranial pressure, nervousness, anxiety, insomnia, headache, dizziness, convulsions, vertigo

pseudotumor of the cerebellum

sudden loss of vision (with parenteral administration, deposition of drug crystals in the vessels of the eye is possible), posterior subcapsular cataract, increased intraocular pressure with possible damage to the optic nerve, trophic changes in the cornea, exophthalmos, development of secondary bacterial, fungal or viral eye infections

negative nitrogen balance (increased protein breakdown), hyperlipoproteinemia

increased sweating

fluid and sodium retention (peripheral edema), hyperkalemia syndrome (hypokalemia, arrhythmia, myalgia or muscle spasms, unusual weakness and fatigue)

slower growth and ossification processes in children (premature closure of epiphyseal growth zones)

increased calcium excretion, osteoporosis, pathological bone fractures, avascular necrosis of the head of the humerus and femur, tendon rupture

"steroid" myopathy, muscle atrophy

delayed wound healing, tendency to develop pyoderma and candidiasis

petechiae, ecchymoses, skin thinning, hyper- or hypopigmentation,

steroid acne, stretch marks

generalized and local allergic reactions

decreased immunity, development or exacerbation of infections

leukocyturia

violation of the secretion of sex hormones (menstrual irregularities, hirsutism, impotence, delayed sexual development in children

withdrawal syndrome

burning, numbness, pain, paresthesia and infection, necrosis of surrounding tissues, scar formation at the injection site, atrophy of the skin and subcutaneous tissue with intramuscular injection (injection into the deltoid muscle is especially dangerous), arrhythmias, “flushes” of blood to the face, convulsions (with intravenous administration), collapse (with rapid administration of large doses)

Contraindications

hypersensitivity to the active substance or auxiliary components of the drug

peptic ulcer of the stomach and duodenum

osteoporosis

acute viral, bacterial and systemic fungal infections (when appropriate therapy is not used)

Cushing's syndrome

pregnancy and lactation

renal failure

liver cirrhosis or chronic hepatitis

acute psychoses

intramuscular administration is contraindicated in patients with severe hemostasis disorders (idiopathic thrombocytopenic

for use in ophthalmic practice: viral and fungal eye diseases

acute form of purulent eye infection in the absence of a specific

therapy, corneal diseases combined with epithelial defects, trachoma, glaucoma

active form of tuberculosis

Drug interactions

The effectiveness of dexamethasone is reduced when taken concomitantly rifampicin, carbamazepine, phenobarbitone, phenytoin (diphenylhydantoin), primidone, ephedrine or aminoglutethimide. Dexamethasone reduces the therapeutic effect hypoglycemic drugs, antihypertensive drugs, praziquantel and natriuretics; dexamethasone increases activity heparin, albendazole and kaliuretics. Dexamethasone may alter the effect coumarin anticoagulants.

Concomitant use of dexamethasone and high doses glucocorticoids or agonists 2-receptors increases the risk of developing hypokalemia. Higher arrhythmogenicity and toxicity of cardiac glycosides is observed in patients suffering from hypokalemia.

With simultaneous use of oral contraceptives, the half-life of glucocorticoids may increase, which leads to an increase in their effect and an increase in the number of side effects.

The simultaneous use of ritodrine and dexamethasone during labor is contraindicated, as this can lead to maternal death due to pulmonary edema.

Concomitant administration of dexamethasone and metoclopramide, diphenhydramine, prochlorperazine, or 5-HT3 receptor antagonists (serotonin or 5-hydroxytryptamine receptor type 3), such as ondansetron or granisetron, is effective in preventing nausea and vomiting caused by chemotherapy using cisplatin, cyclophosphamide, methotrexate, fluorouraci la .

special instructions

Use in pediatrics

In children, during long-term treatment it is necessary to carefully monitor the dynamics of growth and development. In children during the growth period, glucocorticosteroids should be used only for health reasons and under especially careful medical supervision. To prevent disruption of growth processes during long-term treatment of children under 14 years of age with the drug, it is advisable to take a 4-day break in treatment every 3 days.

During treatment, children who are in contact with patients with measles and chickenpox are prescribed specific immunoglobulins.

For diabetes mellitus, tuberculosis, bacterial and amoebic dysentery, arterial hypertension, thromboembolism, heart and kidney failure, ulcerative colitis, diverticulitis, newly formed intestinal anastomosis, Dexamethasone should be used very carefully and subject to the possibility of adequate treatment of the underlying disease. If the patient has a history of psychosis, then treatment with glucocorticosteroids is carried out only for health reasons.

When the drug is suddenly discontinued, especially in the case of high doses, glucocorticosteroid withdrawal syndrome occurs: anorexia, nausea, lethargy, generalized musculoskeletal pain, general weakness. After discontinuation of the drug, relative insufficiency of the adrenal cortex may persist for several months. If stressful situations arise during this period, glucocorticoids are temporarily prescribed, and, if necessary, mineralocorticoids.

Before starting to use the drug, it is advisable to examine the patient for the presence of ulcerative pathology of the gastrointestinal tract. Patients with a predisposition to the development of this pathology should be prescribed antacids for prophylactic purposes.

During treatment with the drug, the patient must adhere to a diet rich in potassium, proteins, vitamins, and low in fat, carbohydrates and sodium.

If the patient has intercurrent infections or a septic condition, treatment with Dexamethasone must be combined with antibacterial therapy.

If treatment with Dexamethasone is carried out for 8 weeks before and 2 weeks after active immunization (vaccination), then in this case the effect of immunization will be reduced or completely neutralized.

Patients with severe traumatic brain injuries and ischemic cerebrovascular accidents should be prescribed glucocorticoids with caution.

Features of influenceon the ability to drive a vehicle or potentially dangerous machinery

Since Dexamethasone can cause dizziness and headache, it is recommended to refrain from driving or operating other potentially dangerous mechanisms when driving a vehicle or operating other machinery.

Overdose

Symptoms: Possible worsening side effects.

Treatment: should be discontinued and symptomatic therapy prescribed. There is no specific antidote.

After the symptoms of overdose disappear, the drug is resumed.

Release formand packaging

1 ml in dark glass ampoules with a white dot and a green ring for opening the ampoules. A self-adhesive label is placed on the ampoule.