Dexamethasone withdrawal reaction. "Dexamethasone": reviews. "Dexamethasone": indications for use and instructions. Dexamethasone: side effects

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

It is widely used in medicine, in its various fields. It is produced in the form of a solution that is used for intravenous injection, intramuscular injection and for instillation into the conjunctiva of the eyes.

On this page you will find all the information about Dexamethasone: full 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. Want to leave your opinion? Please write in the comments.

Clinical and pharmacological group

GCS for injection.

Terms of dispensing from pharmacies

Dispensed by prescription.

Prices

How much does Dexamethasone cost? The average price in pharmacies is at the level of 100 rubles.

Release form and composition

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

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 looks like 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 the exchange of sodium, potassium, water balance and glucose homeostasis. It stimulates the production of enzyme proteins in the liver, acts on the synthesis of inflammatory and allergy mediators, and inhibits their formation. As a result, the product provides anti-inflammatory, anti-allergic, immunosuppressive, 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 intravenous administration. Dexamethasone has a strong anti-inflammatory and anti-allergic effect. It is 35 times more effective than cortisone.

What is Dexamethasone prescribed for?

1. In diseases of the gastrointestinal tract: and ulcerative colitis.
2. With systemic diseases of the connective tissue: acute rheumatic heart disease; ...
3. With endocrine disorders: insufficiency of the adrenal cortex and their congenital hyperplasia; subacute form of thyroid inflammation.
4. In rheumatic diseases: bursitis; ; psoriatic and gouty arthritis; osteoarthritis; synovitis; nonspecific tendosynovitis; ankylosing spondylitis; accompanying osteoarthritis epicondylitis.
5. For allergic diseases: contact and atopic; asthmatic status; serum sickness; allergies to food and certain medications; angioneurotic edema; (seasonal or chronic); ; associated with blood transfusion.
6. For skin diseases: severe erythema multiforme; pemphigus; exfoliative, bullous herpetiformis 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 tract diseases: Leffler's syndrome; ; sarcoidosis of the 2nd-3rd degree; aspiration pneumonia; beryllium disease.
9. With kidney disease: impaired renal function associated with systemic lupus erythematosus; idiopathic nephrotic syndrome.
10. In malignant diseases: leukemia (acute) in children; lymphoma and leukemia in adults.
11. In case of shock: shock that does not respond to classical methods; anaphylactic shock; shock in patients with adrenal insufficiency.
12. In hematological diseases: idiopathic thrombocytopenic purpura; erythroblastopenia; congenital hypoplastic anemia; autoimmune hemolytic anemia; secondary thrombocytopenia.
13. For other indications: myocardial trichinosis; trichinosis with neurological signs; tuberculous meningitis.

Contraindications

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

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

Application during pregnancy and lactation

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

Dexamethasone injections during pregnancy are done only for health reasons. For example, a drug can 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 injected into / in a slow stream or drip (in acute and urgent conditions); i / m; local (in pathological education) introduction is also possible. In order to prepare a solution for intravenous drip infusion, an isotonic sodium chloride solution or 5% dextrose solution should be used.
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 enter 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 (in case of adrenal cortex 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 of body weight or 0.833 to 5 mg / m2 of body surface area every 12-24 hours.
• When the effect is achieved, the dose is reduced to maintenance or until treatment is discontinued. The duration of parenteral administration 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 insufficiency of the adrenal cortex.

Side effects

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

1. From the skin and mucous membranes: delayed wound healing, petechiae, ecchymosis, thinning of the skin, hyper- or hypopigmentation, steroid acne, striae, a tendency to develop pyoderma and candidiasis;
2. 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, turbinates, scalp possible deposition of crystals of the drug in the vessels of the eye);
3. From the side of metabolism: increased calcium excretion, hypocalcemia, increased body weight, negative nitrogen balance (increased protein breakdown), increased sweating. Due to mineralocorticoid activity - fluid and sodium retention (peripheral edema), hypsrnatrinemia, hypokalemic 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, inhibition of adrenal function, Itsenko-Cushing's syndrome (moon face, pituitary obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, muscle weakness, genital development) in children;
5. From the 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 the focus of necrosis, slowing down the formation of scar tissue, which can lead to rupture of the heart muscle;
6. From the musculoskeletal system: growth retardation and ossification processes in children (premature closure of the epiphyseal growth zones), osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the humerus and femur head), muscle tendon rupture, 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, cerebellar pseudotumor, headache, convulsions.
8. From the digestive system: nausea, vomiting, pancreatitis, steroid stomach and duodenal ulcer, erosive esophagitis, gastrointestinal bleeding and perforation of the gastrointestinal tract wall, increased or decreased appetite, indigestion, flatulence, hiccups. In rare cases - increased activity of hepatic transaminases and alkaline phosphatase;

Overdose

With too active use of Dexamethasone for several weeks, an overdose is possible, which manifests itself by the symptoms listed among the side effects.

Treatment is performed according to the factors manifested, it consists in reducing the dose or temporarily discontinuing the drug. In case of an overdose, there is no particular antidote; hemodialysis is not effective.

special instructions

1. Patients with abnormalities in the liver are prescribed Dexamethasone with extreme caution.
2. In order to reduce the risk of side effects, the patient should follow a diet high in potassium. The food should be rich in protein, the intake of carbohydrates and salt should be slightly reduced.
3. During the period of treatment with Dexamethasone, patients should constantly monitor blood pressure indicators, the state of the organs of vision, water and electrolyte balance and the clinical picture of blood.
4. Treatment with the drug should not be stopped abruptly, since in this case the risk of developing a 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 high doses can lead to inhibition of the patient's growth.

Drug interactions

Instructions for the 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. Taking with other glucocorticosteroids increases the risk of hypokalemia;
4. When used with oral contraceptives, the half-life of Dexamethasone increases;
5. Ritodrinum should not be used concomitantly with the drug in question due to the risk of death;
6. Dexamethasone reduces the effectiveness of hypoglycemic, anticoagulant, antihypertensive medicines;
7. for the prevention of nausea and vomiting after chemotherapy, it is recommended to use simultaneously Dexamteazone and Metoclopramide, Diphenhydramine, Prochlorperazine, Ondansetron, Granisetron.

Synthetic fluorinated corticosteroids with pronounced anti-inflammatory, anti-allergic, immunosuppressive action. It inhibits the release of ACTH, slightly affects the level of blood pressure and water-salt metabolism. 35 times more active than cortisone and 7 times more active than prednisolone. It induces the synthesis and secretion of lipomodulin, which inhibits phospholipase A2, inhibits the formation of metabolites of arachidonic acid, prevents the interaction of IgE with receptors of mast cells and basophilic granulocytes and activates the complement system, reduces exudation and capillary permeability. The immunosuppressive effect is due to inhibition of the release of lymphocytic and macrophage cytokines. Affects protein catabolism, stimulates gluconeogenesis in the liver and reduces glucose utilization in peripheral tissues, suppresses the activity of vitamin D, which leads to impaired calcium absorption and more active excretion. Suppresses the synthesis and secretion of ACTH and, secondarily, the synthesis of endogenous GCS. Unlike prednisolone, it does not have mineralocorticoid activity; inhibits the function of the pituitary gland.
After oral administration, it is rapidly and completely absorbed in the digestive tract. The maximum concentration in blood plasma is reached after 1-2 hours. About 60% of the active substance binds to blood plasma albumin. The half-life is more than 5 hours. It is actively metabolized in many tissues, especially in the liver, under the influence of cytochrome-containing enzymes CYP 2C, and is excreted in the form of metabolites in feces and urine. The half-life is on average 3 hours. In severe liver disease, during pregnancy, while taking oral contraceptives, the half-life of dexamethasone increases.
After instillation into the conjunctival sac, dexamethasone penetrates well into the epithelium of the cornea and conjunctiva; therapeutic concentrations are achieved in the aqueous humor of the eye. The duration of the anti-inflammatory action after instilling 1 drop of 0.1% solution or suspension into the eye is 4-8 hours.

Indications for the use of the drug Dexamethasone

Edema of the brain caused by a tumor resulting from traumatic brain injury, neurosurgical intervention, brain abscess, encephalitis or meningitis; progressive rheumatoid arthritis during an exacerbation; BA; acute erythroderma, pemphigus, initial treatment of acute eczema; sarcoidosis; nonspecific ulcerative colitis; severe infectious diseases (in combination with antibiotics or other chemotherapeutic agents); palliative therapy of a malignant tumor. They are also used for replacement therapy with severe adrenogenital syndrome.
Periarticular infiltration therapy is performed for periarthritis, epicondylitis, bursitis, tendovaginitis, intra-articular administration - for arthritis of non-microbial etiology; in ophthalmology - in the form of subconjunctival injections for inflammatory diseases of the eyes (after injuries and surgical interventions).
Eye drops - scleritis, episcleritis, iritis, optic neuritis, sympathetic ophthalmitis, conditions after trauma and ophthalmic operations.

Application of the drug Dexamethasone

Inside, injected intravenously and intramuscularly, intra- and periarticular, subconjunctivally, used in the form of eye drops.
In case of cerebral edema with a severe course, treatment usually begins with intravenous administration of dexamethasone, with improvement of the condition, they switch to oral administration of 4-16 mg / day. With a milder course, it is prescribed orally, usually 2-8 mg of dexamethasone per day.
In rheumatoid arthritis during an exacerbation, asthma, in acute skin diseases, sarcoidosis and acute ulcerative colitis, treatment begins with a dose of 4-16 mg / day. With the planned long-term therapy after the elimination of acute symptoms of the disease, dexamethasone should be replaced with prednisone or prednisolone.
In severe infectious diseases (in combination with antibiotics and other chemotherapeutic agents), 8-16 mg of dexamethasone is prescribed per day for 2-3 days with a rapid dose reduction.
For palliative therapy of a malignant tumor, the initial dose of dexamethasone is 8-16 mg / day; with long-term treatment - 4-12 mg / day.
Adolescents and adults with congenital adrenogenital syndrome are prescribed 1 mg / day, if necessary, additional mineralocorticoids are prescribed.
Dexamethasone is administered orally after meals, preferably after breakfast, with a small amount of liquid. The daily dose should be taken once in the morning (circadian therapy regimen). In the treatment of cerebral edema, as well as during palliative therapy, it may be necessary to divide the daily dose into 2-4 doses. After achieving a satisfactory therapeutic effect, the dose must be reduced to the lowest effective maintenance dose. To complete the course of treatment, this dose continues to be gradually reduced to restore the function of the adrenal cortex.
With local infiltration, 4-8 mg is prescribed, with intra-articular injection into small joints - 2 mg; with subconjunctival - 2-4 mg.
Eye drops (0.1%) are used in a dose of 1-2 drops at the beginning of treatment every 1-2 hours, then, with a decrease in the severity of inflammatory phenomena, every 4-6 hours.The duration of treatment is from 1-2 days to several weeks depending on the effect obtained.

Contraindications to the use of the drug Dexamethasone

For long-term use of dexamethasone, in addition to emergency and replacement therapy, contraindications are peptic ulcers of the stomach and duodenum, severe forms of osteoporosis, a history of mental illness, shingles, rosacea, chickenpox, a period of 8 weeks before and 2 weeks after vaccination, lymphadenitis after prophylactic vaccination against tuberculosis, amoebic infection, systemic mycoses, poliomyelitis (except for the bulbar-encephalitis form), angle-closure and open-angle glaucoma. For the use of eye drops, contraindications are treelike herpetic keratitis, acute phases of vaccination, chickenpox and other infectious lesions of the cornea and conjunctiva, tuberculous lesions of the eyes and fungal infections.

Side effects of the drug Dexamethasone

With prolonged (more than 2 weeks) treatment, the development of functional insufficiency of the adrenal cortex is possible, sometimes obesity, muscle weakness, increased blood pressure, osteoporosis, hyperglycemia (decreased glucose tolerance), diabetes mellitus, impaired secretion of sex hormones (amenorrhea, hirsutism, impotence) are noted, moon-shaped face, the appearance of striae, petechiae, ecchymosis, steroid acne; sodium retention with the formation of edema, increased potassium excretion, atrophy of the adrenal cortex, vasculitis (including as a manifestation of withdrawal syndrome after prolonged therapy), epigastric pain, peptic ulcer of the stomach, immunosuppression, increases the risk of infection, thrombosis; wound healing, growth in children slows down, aseptic necrosis of bones (femoral head and humerus), glaucoma, cataracts, mental disorders, pancreatitis develops. When using eye drops - glaucoma with damage to the optic nerve, impaired visual acuity and visual fields, the formation of subcapsular cataracts, secondary eye infections, including herpes simplex, impaired corneal integrity, rarely - acute pain or burning sensation after instillation.

Special instructions for the use of the drug Dexamethasone

Application for severe infections is possible only in combination with etiological therapy. If you indicate a history of tuberculosis, dexamethasone should be used only with the simultaneous prophylactic administration of anti-tuberculosis drugs to the patient.
During pregnancy, it is prescribed exclusively for strict indications; with prolonged therapy, a violation of the intrauterine development of the fetus is possible. In the case of the use of dexamethasone at the end of pregnancy, there is a danger of atrophy of the adrenal cortex in the fetus, which may necessitate replacement therapy with a gradual decrease in the dose of dexamethasone.
GCS pass into breast milk. If long-term treatment is necessary or the use of dexamethasone in high doses, it is recommended to stop breastfeeding.
Viral diseases in patients receiving dexamethasone can be especially difficult, primarily in children with immunodeficiency states, as well as in people who have not previously had measles or chickenpox. If these persons come into contact with patients with measles or chickenpox during treatment with dexamethasone, they should be prescribed preventive treatment.
Special situations that arise during treatment with dexamethasone (fever, trauma and surgery) may require an increase in its dose.

Drug interactions Dexamethasone

Dexamethasone enhances the effects of cardiac glycosides due to potassium deficiency. Simultaneous use with saluretics leads to increased excretion of potassium. Dexamethasone weakens the hypoglycemic effect of antidiabetic agents and the anticoagulant effect of coumarin derivatives. Rifampicin, phenytoin, barbiturates weaken the effect of GCS. With the simultaneous use of GCS with NSAIDs, the risk of gastropathy increases. Estrogen-containing oral contraceptives enhance the effects of GCS. With simultaneous administration with praziquantel, a decrease in the concentration of the latter in the blood is possible. ACE inhibitors, when used simultaneously with dexamethasone, sometimes change the composition of peripheral blood. Chloroquine, hydroxychloroquine, mefloquine in combination with dexamethasone may increase the risk of myopathy and cardiomyopathy. Dexamethasone reduces the effectiveness of somatropin with prolonged use. When combined with protirelin, the level of TSH in the blood decreases.

Overdose of the drug Dexamethasone, symptoms and treatment

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

List of pharmacies where you can buy Dexamethasone:

• St. Petersburg

Dexamethasone refers to synthetic drugs that are analogs of the hormones of the adrenal cortex - glucocorticosteroids. The action of the drug is similar to another hormonal drug -. Dexamethasone is obtained by fluoridation and methylation of Prednisolone.

So, let's talk about dexamethasone (in ampoules for injections, tablets, drop, etc.), its instructions for use, price, reviews and analogues.

Features of the drug

Dexamethasone composition

The main substance of the drug Dexamethasone is dexamethasone sodium phosphate, the amount of which is 4 mg per 1 ml of solution. Ampoules made of dark glass contain 2 ml of solution packed in cardboard boxes of 5 or 10 pieces (plastic boxes of 5 pieces).

Excipients of the injection solution are methyl and propyl derivatives of paraben, distilled water for injection, sodium salts of edetate and metabisulfite, sodium hydroxide.

Forms of release of dexamethasone

Dexamethasone is registered in the following dosage forms:

1. Ampoules with injection solution for intramuscular and intravenous infusion, 2 ml.
2. Dexamethasone tablets 0.5 mg.
3. In ophthalmology - Oftan - 0.1% solution (eye drops).
4. Eye drops Dexamethasone with an active ingredient concentration of 0.1%.

pharmachologic effect

Dexamethasone is a powerful immunosuppressant, has anti-inflammatory and anti-allergic effects. In the presence of an active substance, the receptor sensitivity of β-adrenergic receptors to adrenaline and norepinephrine, produced by the adrenal medulla, is enhanced.

• The drug activates interaction with receptors of the cell membrane, leading to the synthesis of proteins and enhancing enzymatic activity. The largest number of Dexamethasone-dependent β-adrenergic receptors is found in the liver tissues.
• Protein metabolism. In muscle tissue, the breakdown of proteins increases against the background of a decrease in their synthesis. In the liver and kidneys, the ratio of albumin and globulins shifts towards the formation of albumin. In the blood plasma, an increase in albumin synthesis and inhibition of the formation of globulins are also found.
• Lipid metabolism. Stimulates the synthesis of lipids from glycerol and higher fatty acids, promotes the development of hyperlipidemia. There is a redistribution of fat mass with its displacement in the body from the lower parts of the body (thighs, buttocks, pelvis) to the upper (face, chest and abdomen).
• Carbohydrate metabolism. Stimulates the active absorption of glucose in the intestinal villi and gastric mucosa, removes glycogen from the liver and muscles into the blood, causing hyperglycemia. It activates the enzymatic activity of glucose-6-phosphatase, aminotransferases and phosphoenolpyruvate carboxylase.
• Metabolism of water and mineral elements. Promotes active retention of water and sodium ions in the body, increased renal excretion of potassium and calcium salts. Calcium ions are absorbed in the parts of the digestive system weaker, the process of mineralization of bone plates begins.
• Relieves inflammatory processes by reducing the synthesis of eosinophils and mast cells that produce inflammatory mediators. Stimulates the synthesis of arachidonic acid, interleukin 1, prostaglandins. Increases the resistance of the cell membrane to chemical damage.
• The antiallergic and immunosuppressive effect of Dexamethasone is to reduce the differentiation of T-lymphocytes into suppressors, helpers and killers, decrease the reactions of interaction between T and B lymphocytes, inhibition of the activity of interleukin 2 and γ-interferon, and a decrease in antibody secretion. There is an involution of lymphoid tissue, a decrease in the synthesis of mast cells and inhibition of the secretion of mediators of allergy, histamine, etc. by basophils. The result of the effect of Dexamethasone is the transformation of the immune response.

There is a decrease in the production and release of adrenocorticotropic hormone and glucocorticoids by the pituitary gland by the adrenal cortex.

The following video talks in some detail about the action of Dexamethasone:

Pharmacodynamics

One ampoule of Dexamethasone causes inhibition of the hypothalamic-pituitary-glucocortical system for 3 days. In an equivalent ratio, 0.5 mg of Dexamethasone corresponds to the action of 3.5 mg of Prednisolone, 15 mg of Hydrocortisone or 17.5 mg of Cortisone.

Pharmacokinetics

In the blood plasma, Dexamethasone binds to the transport protein - transcortin. The blood-brain and hematoplacental barriers are not delayed. The disintegration of the medicinal substance is carried out by the liver to a complex compound of glucuronic and sulfuric acids.

The half-life of the hormonal drug is 5 hours. Excretion of the inactive metabolite is carried out through the mammary glands (during feeding) and the excretory system.

Now let's find out what dexamethasone is prescribed for.

Indications

Intramuscular injection of a hormonal drug is performed in conditions of impossibility of oral administration or hormone replacement therapy with an acute shortage of glucocorticosteroids. This happens in cases:

• hormonal abnormalities with a deficiency of the adrenal cortex, inflammation in the thyroid gland - subacute thyroiditis;
• shock therapy with an ineffective effect of antispasmodics and other drugs that relieve shock symptoms;
• neurological operations, brain injuries, other types of brain lesions with a symptom of edema;
• attacks of bronchial asthma and acute obstructive bronchitis;
• severe course of allergies with the threat of anaphylactic shock;
• acute course of dermatoses;
• rheumatism of various organs;
• pathologies of connective tissue development;
• agranulocytosis and other hematological pathologies;
• , in children - with malignant systemic;
• severe course of congestion in the lungs and infectious processes;
• local use during lupus erythematosus, etc.;
• in the practice of ophthalmologists in the treatment of inflammation of many structures of the eyeball and mucous membranes.

Pregnant women can receive Dexamethasone if:

• threats of premature birth;
• a rare hereditary disease of the fetus - underdevelopment of the adrenal cortex;
• anaphylactic shock and other conditions of each person falling into life-threatening conditions.

Instructions for use

The drug is administered by intramuscular or intravenous infusion. In the case of drip administration, Dexamethasone is mixed in a dextrose solution or isotonic sodium chloride solution.

Local application is possible. The maximum daily dose of the hormonal drug is 20 mg per day. The daily dose is divided by 3-4 times. In the initial period of treatment, the dosage of dexamethasone is increased until the desired effect is achieved, then the dose is reduced. The possibility of long-term use is limited due to the threat of atrophy of the adrenal cortex.

For children, the amount of the drug is calculated based on the child's body weight. Per 1 kg of the child's body weight per day, it is allowed to inject not more than 0.00233 mg intramuscularly.

The video below provides instructions for using Dexamethasone in the form of eye drops:

Contraindications

The drug is contraindicated in case of individual intolerance and severe liver failure. With extreme caution and vigilant supervision of the attending physician, the drug dexamethasone is administered to women during pregnancy, children and adults with:

• pathologies of the digestive system of an ulcerative nature;
• infectious diseases;
• HIV-infected and AIDS patients;
• chronic liver and kidney disease;
• cardiovascular pathologies, especially during the acute period;
• disorders of hormonal secretion;
• the period before and after vaccination of lymphadenitis and brucellosis;
• osteoporosis, glaucoma.

Side effects

Usually, side effects from dexamethasone from the somatic systems of the body are not observed.

• In some cases, exacerbations of diabetes mellitus, delayed sexual development were noted.
• On the part of the gastrointestinal tract, disorders and perforation of the mucous membranes of the digestive organs are sometimes noted.
• A local allergic reaction, slow wound healing, excessive sweating, increased excretion of calcium, and increased fatigue are not excluded.

special instructions

High doses of Dexamethasone are prescribed under close supervision of the attending physician. After discontinuation of the drug, it is imperative to monitor the patient's well-being in a clinical setting.

During the use of the drug, one should adhere to a diet and monitor the enrichment of the diet with calcium, potassium and proteins.

Dosage form

Solution for injection, 4 mg / ml, 1 ml

Composition

1 ml of the drug contains

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

inauxiliary substances: creatinine, sodium citrate, disodium edetate dihydrate, 1 M sodium hydroxide solution, water for injection.

Description

Transparent colorless or slightly brown solution

Pharmacotherapeutic group

Corticosteroids for systemic use. Glucocorticosteroids.

Dexamethasone.

ATX code H02AB02

Pharmacological properties

Pharmacokinetics

Dexamethasone phosphate is a long-acting glucocorticosteroid. After intramuscular injection, it is rapidly absorbed from the injection site and is distributed in the tissues with the blood stream. About 80% of the drug binds to blood plasma proteins. It penetrates well through the blood-brain and other histohematogenous barriers. The maximum concentration of dexamethasone in the cerebrospinal fluid is observed 4 hours after intravenous administration and is 15-20% of the concentration in blood plasma. After intravenous administration, the specific effect manifests itself after 2 hours and lasts for 6-24 hours. Dexamethasone is metabolized in the liver much more slowly than cortisone. The half-life (T1 \\\\ 2) from blood plasma is about 3-4.5 hours. About 80% of the administered dexamethasone is eliminated by the kidneys in the form of glucuronide within 24 hours.

Pharmacodynamics

Synthetic glucocorticoid drug. It has a pronounced anti-inflammatory, anti-allergic and desensitizing effect, has immunosuppressive activity. Slightly retains sodium and water in the body. These effects are associated with inhibition of the release of inflammatory mediators by eosinophils; inducing the formation of lipocortins and decreasing the number of mast cells that produce hyaluronic acid; with a decrease in capillary permeability; inhibition of the activity of cyclooxygenase (mainly COX-2) and the synthesis of prostaglandins; stabilization of cell membranes (especially lysosomal). The immunosuppressive effect is due to inhibition of the release of cytokines (interleukin-I, II, interferon gamma) from lymphocytes and macrophages. The main effect on metabolism is associated with protein catabolism, an increase in gluconeogenesis in the liver and a decrease in glucose utilization by peripheral tissues. The drug suppresses the activity of vitamin D, which leads to a decrease in calcium absorption and an increase in its excretion from the body. Dexamethasone suppresses the synthesis and secretion of adrenocorticotropic hormone and, secondarily, the synthesis of endogenous glucocorticoids. A feature of the drug is a significant inhibition of the function of the pituitary gland and the complete absence of mineralocorticoid activity.

Indications for use

Shock of various origins (anaphylactic, post-traumatic, postoperative, cardiogenic, blood transfusion, etc.)

Edema of the brain (with brain tumors, traumatic brain injury, neurosurgical operations, cerebral hemorrhage, meningitis, encephalitis, radiation damage)

Asthmatic status

Severe allergic reactions (Quincke's edema, bronchospasm, dermatosis, acute anaphylactic reaction to drugs, serum transfusion, pyrogenic reactions)

Acute hemolytic anemia

Thrombocytopenia

Agranulocytosis

Acute lymphoblastic leukemia

Severe infectious diseases (in combination with antibiotics)

Acute adrenal insufficiency

Joint diseases (periarthritis, epicondylitis, bursitis, tendovaginitis, osteochondrosis, arthritis of various etiologies, osteoarthritis)

Rheumatoid diseases

Collagenoses

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

Method of administration and dosage

The dosage regimen is individual and depends on the indications, the severity of the disease and the patient's response to therapy. The drug is administered intramuscularly, intravenously, slowly, jet or drip, periarticular or intraarticular injection is also possible. In order to prepare a solution for intravenous drip infusion, isotonic sodium chloride solution, 5% glucose solution or Ringer's solution should be used.

Adults intravenously, intramuscularly injected from 4 to 20 mg 3-4 times / day. The maximum daily dose is 80 mg. In acute life-threatening situations, high dosages may be necessary. The duration of parenteral administration is 3-4 days, then they switch to maintenance therapy with the oral form of the drug. When the effect is achieved, the dose is reduced over several days until a maintenance dose is reached (on average, 3-6 mg / day, depending on the severity of the disease) or until treatment is discontinued with continuous monitoring of the patient. Rapid intravenous administration of massive doses of glucocorticoids can cause cardiovascular collapse: the injection is performed slowly, over several minutes.

Cerebral edema (adults): the initial dose is 8-16 mg intravenously, followed by 5 mg intravenously or intramuscularly every 6 hours until a satisfactory result is achieved. In brain surgery, these dosages may be necessary for several days after surgery. Thereafter, the dosage should be gradually reduced. Continuous treatment can counteract the increase in intracranial pressure associated with a brain tumor.

For children appoint intramuscularly. The dose of the drug usually ranges from 0.2 mg / kg to 0.4 mg / kg per day. Treatment should be kept to the lowest dose as soon as possible.
When intra-articular administration the dose depends on the degree of inflammation and the size and location of the affected area. The drug is administered once every 3-5 days (for the bursa) and once every 2-3 weeks (for the joint).

In the same joint, inject no more than 3-4 times and no more than 2 joints at the same time. More frequent administration of dexamethasone can damage the articular cartilage. Intra-articular injections must be carried out under strictly sterile conditions.

Side effects

Usually Dexamethasone is well tolerated. It has a low mineralocorticoid activity: 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, increased potassium excretion.

With a single administration

Nausea, vomiting

Arrhythmias, bradycardia, up to cardiac arrest

Arterial hypotension, collapse (especially with the rapid introduction of large doses of the drug)

Decreased glucose tolerance

Decreased immunity

With prolonged therapy

- steroid diabetes mellitus or manifestation of latent diabetes mellitus, inhibition of adrenal function, Itsenko-Cushing's syndrome, delayed sexual development in children, dysfunction of sex hormones (menstrual irregularities, amenorrhea, hirsutism, impotence)

- pancreatitis, steroid stomach and duodenal ulcers, erosive esophagitis, gastrointestinal bleeding and perforation of the gastrointestinal tract wall, increased or decreased appetite, indigestion, flatulence, hiccups, in rare cases - increased activity of liver transaminases and alkaline phosphatase,

- myocardial dystrophy, development or increase in the 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 the focus of necrosis, slowing down the formation of scar tissue, which can lead to rupture of the heart muscle

- delirium, disorientation, hallucinations, manic-depressive psychosis, depression, paranoia, increased intracranial pressure with edema of the optic nerve head (pseudotumor of the brain - more often in children, usually after reducing the dose too quickly, symptoms - headache, deterioration of visual acuity or double vision ), exacerbation of epilepsy, mental dependence, anxiety, sleep disturbances, dizziness, headache, convulsions, amnesia, cognitive impairment

- increased intraocular pressure, glaucoma, edema of the optic nerve head, posterior subcapsular cataract, thinning of the cornea or sclera, exacerbation of bacterial, fungal or viral eye diseases, exophthalmos, sudden loss of vision (with parenteral administration, the deposition of crystals of the drug in the vessels of the eye is possible)

- increased excretion of calcium, hypocalcemia, weight gain, negative nitrogen balance, increased sweating

Fluid and sodium retention (peripheral edema), hypernatremia, hypokalemic alkalosis

- growth retardation and ossification processes in children (premature closure of the epiphyseal growth zones), osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the humerus and femur head), rupture of muscle tendons, proximal myopathy, decreased muscle mass (atrophy). Increased joint pain, joint swelling, painless joint destruction, Charcot arthropathy (with intra-articular injection)

- delayed wound healing, petechiae, ecchymosis, thinning of the skin, hyper- or hypopigmentation, steroid acne, striae, tendency to develop pyoderma and candidiasis

- hypersensitivity, including anaphylactic shock, local allergic reactions - skin rash, itching. Transient burning or tingling sensation in the perineum after high dose intravenous injection of phosphate corticosteroids

mnatural for parenteral administration: burning, numbness, pain, tingling at the injection site, infections 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)

- the development or exacerbation of infections (promoted by jointly used immunosuppressants and vaccinations), leukocytosis, leukocyturia, flushing, withdrawal syndrome, risk of thrombus formation and infections.

Contraindications

Hypersensitivity to dexamethasone or ancillary components of the drug

Systemic infection, unless specific antibiotic therapy is used

- dlaperiarticular or intraarticular injection: previous arthroplasty, pathological bleeding (endogenous or caused by the use of anticoagulants), intra-articular bone fracture, infectious (septic) inflammatory process in the joint and periarticular infections (including history), as well as a general infectious disease, bacteremia, systemic fungal infection, severe periarticular osteoporosis, absence of signs of inflammation in the joint ("dry" joint, for example, in osteoarthritis without synovitis), pronounced bone destruction and joint deformation (sharp narrowing of the joint space, ankylosis), joint instability as an outcome of arthritis, aseptic necrosis of the epiphyses forming the joint, infection at the injection site (eg, septic arthritis due to gonorrhea, tuberculosis).

In children, during the growth period, glucocorticosteroids should be used only according to absolute indications and under the close supervision of a physician.

Carefully

Particular attention is required when considering the use of systemic corticosteroids in patients with the following diseases and conditions, while frequent monitoring of the patient's condition is necessary:

Arterial hypertension, congestive heart failure

Cushing's syndrome

Acute psychosis or cases of severe mood disorders (especially previous steroid psychoses)

Renal failure

Peptic ulcer of the stomach and duodenum

Liver failure

Active and latent tuberculosis, as glucocorticoids can cause reactivation

Osteoporosis

Diabetes mellitus (or hereditary burden of diabetes)

Systemic mycoses

Joint infections

Obesity III-IV Art.

Glaucoma (or hereditary burden of glaucoma)

Previous corticosteroid-induced myopathy

Epilepsy

Migraine

Immunodeficiency states

Drug interactions

Possible pharmaceutical incompatibility of dexamethasone with other intravenous injected drugs - it is recommended to administer it separately from other drugs (intravenously bolus, or through another dropper, as a second solution). When mixing a solution of dexamethasone with heparin, a precipitate is formed.

Simultaneous administration of dexamethasone from:

- inducers of hepatic microsomal enzymes (barbiturates, carbamazepine, primidone, rifabutin, rifampicin, phenytoin, phenylbutazone, theophylline, ephedrine, barbiturates) the effects of dexamethasone may be weakened due to an increase in its excretion from the body

- diuretics (especially thiazide and carbonic anhydrase inhibitors) and amphotericin B - can lead to increased excretion of potassium from the body and an increased risk of developing heart failure

- sodium-containing preparations - to the development of edema and increased blood pressure

- cardiac glycosides - their tolerance worsens and the likelihood of developing ventricular extrasitolia increases (due to induced hypokalemia)

- indirect anticoagulants- weakens (less often enhances) their effect (dose adjustment is required)

- anticoagulants and thrombolytics - the risk of bleeding from ulcers in the gastrointestinal tract increases

- ethanol and NSAIDs - the risk of erosive and ulcerative lesions in the gastrointestinal tract and the development of bleeding increases (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). Indomethacin, displacing dexamethasone from its association with albumin, increases the risk of its side effects

- paracetamol- the risk of developing hepatotoxicity increases (induction of liver enzymes and the formation of a toxic metabolite of paracetamol)

- >acetylsalicylic acid/ a\u003e - accelerates its excretion and reduces the concentration in the blood. When taking corticosteroids, the renal clearance of salicylates increases, so withdrawal of corticosteroids can lead to intoxication of the body with salicylates

- insulin and oral hypoglycemic drugs, antihypertensive drugs - their effectiveness decreases

- vitamin D -its effect on the absorption of Ca2 + in the intestine decreases

- growth hormone - reduces the effectiveness of the latter

- M-anticholinergics (including antihistamines and tricyclic antidepressants) and nitrates - helps to 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.

ACTH enhances the effect of dexamethasone.

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

Cyclosporine and ketoconazole, slowing down the metabolism of dexamethasone, can in some cases increase its toxicity, increasing the risk of seizures in children.

The simultaneous administration of androgens and steroid anabolic drugs with dexamethasone contributes to the development of peripheral edema, hirsutism, and the appearance of acne.

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

Mitotan and other inhibitors of adrenal cortex function may necessitate an increase in the dose of dexamethasone.

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

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

With simultaneous use with antithyroid drugs, it decreases, and with thyroid hormones, the clearance of dexamethasone increases.

With simultaneous use with drugs that increase the metabolic clearance of glucocorticoids (ephedrine and aminoglutethimide), it is possible to decrease or suppress the effects of dexamethasone; with carbamazepine - it is possible to reduce the effect of dexamethasone; with imatinib - a decrease in the concentration of imatinib in the blood plasma is possible due to the induction of its metabolism and increased excretion from the body.

With simultaneous use with antipsychotics, bukarban, azathioprine, there is a risk of developing cataracts.

With simultaneous use with methotrexate - it is possible to increase hepatotoxicity; with praziquantel - a decrease in the concentration of praziquantel in the blood is possible.

Immunosuppressants and cytostatics enhance the effect of dexamethasone.

special instructions

Postmarketing studies have reported very rare cases of tumor lysis syndrome in patients with hematological malignancies after using dexamethasone alone or in combination with other chemotherapeutic agents. Patients at high risk of developing tumor lysis syndrome should be monitored closely and appropriate precautions should be taken.

Patients and / or caregivers should be warned of the possibility of serious psychiatric side effects. Symptoms usually appear within days or weeks after starting treatment. The risk of these side effects is higher with high doses / systemic exposure, although the dose level does not predict the onset, severity or duration of the reaction. Most reactions disappear after dose reduction or drug withdrawal, although specific treatment is sometimes necessary. Patients and / or caregivers should see a doctor if they experience psychological symptoms such as depression, suicidal thoughts, although such reactions

are not often registered. Special attention should be paid to the issue of the use of systemic corticosteroids in patients with existing or a history of severe affective disorders, which include depressive, manic-depressive psychosis, previous steroid psychosis - treatment is carried out only for health reasons.

After parenteral administration of glucocorticoids, serious anaphylactic reactions may occur, such as laryngeal edema, urticaria, bronchospasm, more often in patients with a history of allergies. If anaphylactic reactions occur, the following measures must be taken: urgently intravenous slow administration of 0.1-0.5 ml of adrenaline
(solution 1: 1000: 0.1 - 0.5 mg of epinephrine, depending on body weight), intravenous administration of aminophylline and, if necessary, artificial respiration.

Side effects can be reduced by prescribing the minimum effective dose in a short time and by administering the daily dose once in the morning. It is necessary to titrate the dose more often depending on the activity of the disease.

Patients with traumatic brain injury or stroke should not be given glucocorticoids, as this will not be beneficial and may even be harmful.

With diabetes mellitus, tuberculosis, bacterial and amoebic dysentery, arterial hypertension, thromboembolism, heart and renal failure, ulcerative colitis, diverticulitis, newly formed intestinal anastomosis, Dexamethasone should be used very carefully and with adequate treatment of the underlying disease.

With a sudden withdrawal of the drug, especially in the case of high doses, there is a withdrawal syndrome of glucocorticosteroids: anorexia, nausea, lethargy, generalized musculoskeletal pain, general weakness. Too rapid dose reduction after long-term treatment can lead to acute adrenal insufficiency, arterial hypotension, death. After discontinuation of the drug for several months, the relative insufficiency of the adrenal cortex may persist. 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, with a reduced fat content,

carbohydrates and sodium.

Dexamethasone suppresses the inflammatory response and immune function, increasing susceptibility to infection. If the patient has intercurrent infections, a septic condition, treatment with Dexamethasone should be combined with antibiotic therapy.

Chickenpox can be fatal in immunosuppressed patients. Patients who have not had chickenpox should avoid close personal contact with people with chickenpox or herpes zoster, and in case of contact, seek urgent medical attention.

Measles: Patients should be careful to avoid contact with patients with measles and seek immediate medical attention if contact occurs.

Live vaccines should not be given to people with a weakened immune response. The immune response to other vaccines may be reduced.

If treatment with Dexamethasone is carried out 8 weeks before or within 2 weeks after active immunization (vaccination), then a decrease or loss of the effect of immunization (suppresses antibody formation) may be observed.

Use in pediatrics

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

Preterm infants: Available evidence suggests that long-term nervous system side effects develop after early treatment (<96 часов) недоношенных детей с хроническими заболеваниями легких в начальной дозе 0.25 мг/кг два раза в день.

Recent studies have suggested a link between dexamethasone use in premature infants and the development of infantile cerebral palsy. In this regard, an individual approach to prescribing the drug is required, taking into account the risk / benefit assessment.

Use in the elderly

Common side effects of systemic corticosteroids may be associated with more serious consequences in old age, especially osteoporosis, hypertension, hypokalemia, diabetes mellitus, susceptibility to infection, and skin thinning.

Pregnancy and lactation

During pregnancy (especially in the first trimester) and during lactation, the drug is prescribed only if the expected therapeutic effect exceeds the potential risk to the fetus and child. With prolonged treatment during pregnancy, the possibility of a violation of fetal growth processes is not excluded. If used in the last months of pregnancy, there is a risk of atrophy of the adrenal cortex in the fetus, which in the future may require replacement therapy in the newborn.

Dexamethasone is a widespread drug from the class of glucocorticosteroids (GCS). It is difficult to point out a field of medicine in which it would not be applied. Its main purpose is to combat shock conditions of the body, edema, inflammation, etc.

Description

This artificially synthesized GCS was first obtained in 1957. Nowadays it is one of the essential medicines.

In structure, the drug is similar to the natural hormone of the human adrenal glands - hydrocortisone, but it has a more pronounced effect. Compared to another widespread synthetic glucocorticoid - prednisolone, Dexamethasone has 7 times more activity, and compared to hydrocortisone - 30 times more activity. However, the mineralocorticoid activity of Dexamethasone, in contrast to prednisolone and hydrocortisone, is very low.

When the drug enters the body, it binds to special glucocorticosteroid receptors present in all tissues. The antishock effect of the drug is mainly due to its ability to stimulate beta-adrenergic receptors. As a result, the pathological drop in pressure is replaced by its increase, and the physiological parameters of the body return to normal.

Also, the compound is able to reduce vascular permeability, suppress the production of inflammatory mediators - histamines and prostaglandins, inhibit the release of cytokines, reduce the activity of cells of the immune system - lymphocytes, macrophages and mast cells, reduce the sensitivity of effector cells to inflammatory mediators, prevent the appearance of connective tissue.

These properties of the drug allow you to fight severe allergic reactions, such as anaphylactic shock and Quincke's edema, reduce pain and inflammation in rheumatic diseases. The drug acts on all stages of the inflammatory process, increases the resistance of cell membranes to external influences. The drug increases the sensitivity of beta-receptors located in the lower respiratory tract to sympathomimetics, which explains its therapeutic effect in obstructive respiratory diseases.

The drug has a significant effect on the metabolic processes of proteins, lipids and minerals. In particular, the drug promotes the formation of adipose tissue on the body, improves the absorption of carbohydrates from the gastrointestinal tract, and helps to increase the synthesis of higher fatty acids and triglycerides. Retains sodium ions and water in the body, stimulates the removal of potassium ions. The compound also alters the metabolism in bone and cartilage tissue, in particular, promotes the leaching of calcium from bones. Able to penetrate the central nervous system.

The tool can be used not only for the treatment of adults, but also in pediatric practice. Moreover, it is allowed even for babies.

When administered intravenously, the drug acts almost instantly. With the intramuscular route, it takes several hours for the drug to start working.
Most of the drug (60-70%) binds in the blood with a special transport protein - transcortin. The drug can pass through the blood-brain and placental barriers.

Varieties of the pharmacological action of dexamethasone:

• anti-inflammatory,
• antiallergic,
• immunosuppressive,
• anti-shock,
• glucocorticoid.

Application

Dexamethasone is an inseparable companion of the therapist and the surgeon, since the number of diseases for which the drug is prescribed is very large. But, as a rule, these are inflammatory diseases of the connective tissue, in particular, joints, edema (including cerebral edema), systemic allergic reactions (angioedema, bronchial asthma, urticaria, anaphylactic shock), autoimmune diseases, shock conditions, inflammatory pathologies skin (psoriasis, eczema, dermatitis), traumatic brain injury, bowel disease of unknown etiology.

The drug is irreplaceable in case of shock conditions resulting from:

• injuries,
• surgical operations,

In these cases, GCS is used with the ineffectiveness of vasoconstrictors, plasma-substituting drugs, and other symptomatic therapy.

For articular diseases, the remedy is used if non-steroidal therapy has shown its ineffectiveness. Diagnosis in which a doctor may prescribe a drug include:

• rheumatoid arthritis;
• ankylosing spondylitis;
• lupus and scleroderma, combined with joint damage;
• osteoarthritis;
• osteochondrosis.

In allergic conditions, the drug is used in cases where therapy with antihistamines is ineffective, or a violent allergic reaction threatens the patient's life, for example, with anaphylactic shock.

The remedy is also used for many diseases of the blood system:

• hemolytic anemia,
• thrombocytopenia,
• agranulocytosis.

The drug is also used in case of insufficient functionality of the adrenal glands, congenital hyperplasia of the adrenal cortex, subacute thyroiditis.

In addition, a glucocorticosteroid is prescribed for:

• addison-Birmer disease;
• hypothyroidism;
• ophthalmopathy associated with thyrotoxicosis;
• ulcerative colitis;
• congenital adrenogenital syndrome;
• multiple myeloma;
• bone marrow transplant;

In chemotherapy with cytostatics, the drug can be used as a means of suppressing the gag reflex.

Parenteral administration is most effective in shock conditions, cerebral edema, severe allergic reactions, acute hemolytic anemias.

Also, the drug is often used in ophthalmic practice, in the treatment of pathologies such as conjunctivitis, keratitis, blepharitis, iritis, scleritis, episcleritis, as well as in the treatment of inflammatory processes that have arisen after eye surgery.

Release form

The drug is mainly intended for parenteral administration (intravenous stream or drip, or intramuscularly). For this purpose, ampoules with a solution of Dexamethasone with a capacity of 1 and 2 ml are produced. The concentration of the active substance in ampoules is 4 mg / ml.
There is also a tablet form of the drug. The dosage of one tablet is 0.5 mg.

Another form designed to treat a number of eye diseases is drops. They have a dosage of 1 mg / ml.

Instructions for the use of Dexamethasone

In most cases, the duration of ingestion or administration of the drug is short and is only a few days, usually 3-4. Only in rare cases can the doctor prescribe a longer course of treatment. If initially the drug is administered parenterally, then at the earliest opportunity the patient is transferred to taking pills.

The therapeutic dosage depends on the type of disease and its severity, and in most cases ranges from 5-20 mg per day. Although in some cases, higher doses are used. The daily dosage is usually divided into several doses or injections.

In the treatment of allergic diseases, 4-8 mg of the drug is usually prescribed intravenously on the first day, then they switch to taking tablets. The duration of therapy is usually a week.

In severe diseases, the initial dose may be 10-15 mg, the maintenance dose is 2-4.5 mg.

Children are usually given intramuscular injections. The dosage is 0.2-0.4 mg per day.

For joint diseases, intra-articular administration of the drug can be practiced. These procedures are rarely performed - 3-4 times a year. The dosage for such injections is from 0.5 to 5 mg. The exact dosage value depends on the age of the patient and the course of the disease.

With exacerbations of ophthalmic diseases, 1-2 drops are instilled into each eye every 1-2 hours. With a decrease in inflammation, the interval between procedures increases to 4-6 hours. The duration of treatment can vary from 1-2 days to several weeks.

Withdrawal syndrome

With prolonged therapy, the drug can cause drug dependence, and abrupt discontinuation of drug treatment is sometimes fraught with serious health consequences. In addition, the drug inhibits the synthesis of steroid hormones by the human adrenal glands. Usually, after you stop using dexamethasone, adrenal function returns to normal. However, this does not always happen. If the function of the adrenal glands remains in a depressed state, then the patient develops adrenal insufficiency, which in severe cases leads to death.

To avoid worsening of the condition after discontinuation of admission, the drug must be withdrawn gradually.

Contraindications

In the case when it comes to conditions so severe that an injection of a glucocorticosteroid can save a life, doctors do not pay attention to most of the contraindications. The only obstacle here may be the patient's individual intolerance to the drug.

If we are not talking about the life and death of the patient, then in such a case the drug may not always be suitable.

The main contraindications are:

• myocardial infarction (the drug prevents the formation of a scar on the heart muscle);
• severe heart failure;
• internal bleeding;
• itsenko-Cushing's syndrome;
• diabetes;
• pregnancy;
• obesity 3-4 degrees;
• immunodeficiency states, including AIDS or HIV carrier;
• severe forms of osteoporosis;
• esophagitis;
• mental disorders;
• ulcers of the stomach and duodenum;
• gastritis;
• ulcerative colitis with the threat of perforation;
• chronic renal failure.

The drug is prescribed with caution in old age. For children, the drug is prescribed only for absolute indications.

You should also be careful to prescribe the drug for bacterial and viral infections. This primarily applies to tuberculosis. Indeed, one of the effects of the drug is to reduce immunity. This means that during infections, the immune system can no longer work at full strength to fight viruses and bacteria. Therefore, the treatment of GCS in such cases must be combined with etiotropic therapy - using antibiotics or antiviral drugs.

Avoid using the drug for prophylactic vaccinations. The ban period lasts 8 weeks before and 2 weeks after vaccination. This is also due to the fact that GCS suppresses the immune system and, as a result, proper immunity to infections will not be developed during vaccination.

With long-term treatment with Dexamethasone, it is necessary to perform on a regular basis:

• checking the patient's condition by the ophthalmologist,
• blood pressure measurements,
• control of water and electrolyte balance,
• glucose control,
• control of the picture of peripheral blood.

Use of the drug during pregnancy and lactation

As mentioned above, doctors do not recommend using the drug during pregnancy. What is the reason for this approach? The fact is that studies have shown that the drug can affect the development of the fetus and the course of the pregnancy itself. But when it comes to treating conditions that threaten the life of the mother, then doctors can authorize the use of GCS. However, in such cases, the baby may develop adrenal insufficiency and may need appropriate therapy after birth.

Side effects

One of the negative aspects of the drug is a fairly large number of side effects. Side effects can affect various body systems:

• gastrointestinal tract,
• respiratory system,
• cardiovascular system,
• nervous system.

Also, reactions of intolerance to the drug are not excluded - Quincke's edema, skin allergic reactions, itching.

Side effects affecting the nervous system include:

• headache;
• dizziness;
• hearing and vision disorders;
• mental disorders, exacerbation of mental illness;
• convulsions;
• insomnia;
• hallucinations;
• glaucoma and cataracts;
• increased intracranial and intraocular pressure.

On the part of the digestive tract, when using the drug, the following reactions are possible:

• nausea,
• vomiting
• stomach pain
• stomach bleeding
• hiccups,
• pancreatitis.

Side effects associated with the cardiovascular system:

• arrhythmias,
• increased blood pressure,
• bradycardia,
• heart failure,
• changes in blood composition,
• hypercoagulation.

Disorders associated with the endocrine system and metabolism can also be observed:

• menstrual irregularities,
• adrenal atrophy,
• weight gain
• growth and sexual development disorders in children,
• hypocalcemia,
• decreased glucose tolerance,
• steroid diabetes mellitus,
• dysmenorrhea,
• peripheral edema,
• increased fatigue.

Side effects associated with the musculoskeletal system:

• osteoporosis,
• tendon ruptures
• muscle weakness.

Other side effects include increased sweating, delayed wound healing, and decreased potency.

Side effects are dose-dependent. Thus, the higher the dosage of the drug, the greater the likelihood of their occurrence.

The agent has a low mineralocorticoid activity. This means that medium or low doses of the drug, used for a short period of time, do not cause water and sodium retention and an increase in potassium excretion.

However, with long-term therapy, the patient should adhere to a diet with a high potassium content, as well as a low content of table salt and carbohydrates.

Interaction with other medicinal products

This glucocorticosteroid enhances the action of some drugs, while the action of others, on the contrary, blocks. Therefore, it is necessary to know about negative drug interactions so that treatment with GCS itself and other drugs would be more effective.

Barbiturates, phenytoin, rifampicin, antacids reduce the effectiveness of the drug, and estrogen-containing oral contraceptives increase. Cardiac glycosides and diuretics increase the risk of arrhythmias and hypokalemia; drugs containing sodium increase the risk of edema and hypertension.

Glucocorticosteroid weakens the hypoglycemic activity of insulin and other antidiabetic agents. Also, the drug weakens the effect of coumarin and diuretics. The drug is incompatible with antiviral vaccines, since it interferes with the development of antiviral immunity, and when using live vaccines, there is a high risk of developing a viral infection.

Some drugs should not be taken with Dexamethasone at all. This category, in particular, includes NSAIDs. When they are taken, side effects may increase, especially the risk of gastrointestinal bleeding.

Overdose

In case of an overdose, side effects may increase, an increase in blood pressure. Overdose treatment is symptomatic. If the drug was taken orally, then it is recommended to drink enterosorbents. Hemodialysis is ineffective due to the high degree of connection of the drug with blood proteins.

Precautions

Dexamethasone is a serious drug that affects many biological processes in the body, and its improper use, without taking into account the specifics of the patient's condition, can lead to negative consequences.

Hypothyroidism and cirrhosis of the liver enhance the effect of glucocorticosteroids. This must be taken into account when prescribing a drug for these diseases. If supportive therapy is carried out, then it should be borne in mind that with injuries, diseases, surgical operations, the need for glucocorticosteroids increases.

For parenteral administration, the likelihood of an anaphylactic reaction must be taken into account and all necessary precautions must be taken. Also, during therapy, it is necessary to avoid alcohol consumption, vaccinations.

If therapy is prescribed to children for a long time, then it is necessary to regularly monitor their growth and development dynamics, the state of the hypothalamus, pituitary and adrenal glands, and blood glucose levels.

Also, the drug is able to mask some symptoms of infection. If the drug is discontinued, adrenal insufficiency may persist for a long time (up to a year).

When using the ophthalmic forms of the drug, the patient must remove the contact lenses and install them back no earlier than 15 minutes after instillation.

The drug is capable of affecting the speed of psychomotor reactions and concentration of attention, which should be taken into account by drivers of vehicles and people driving complex mechanisms.

Trade names

Dexamethasone, as an active ingredient, is included in many medicines that can be purchased at pharmacies. The most famous drugs containing this glucocorticosteroid are:

• Dexazon,
• Dexon,
• Maxidex,
• Dexamed,
• Fortecortin,
• Decadron,
• Dexapos,
• Megadexane,
• Dexaven,
• Ozurdeks.