Dexamethasone

General

• Type: Corticosteroid
• Dosage Forms: PO; IM; IV, ophthalmic
• Common Trade Names: Decadron

Adult Dosing

Anaphylaxis

• 10mg IV or PO

COVID

• 6mg Qday for 10 days
  • Dexamethasone improves 28d mortality compared to placebo in patients requiring IMV (NNT = 8.5) and those patients requiring oxygen therapy (NNT = 29).
  • There was no benefit to patients not requiring oxygenation support and potentially harm

Nausea and Vomiting

• 5mg IV

Pharyngitis

• Single 10mg PO dose decreases symptoms at 48 hours, but not 24 hours

Pediatric Dosing

Anaphylaxis

• 0.6 mg/kg
  • Maximum dose of 10-18 mg/dose, variable by study

Asthma Exacerbation

• 0.6 mg/kg once PO
  • Maximum dose of 10-18 mg/dose, variable by study

Post-operative Airway Edema

• 0.5 mg/kg PO q6hrs x1-2 days
  • Maximum dose of 10-18 mg/dose, variable by study

Special Populations

• Pregnancy Rating: C
• Lactation: Single doses are considered compatible however corticosteroids are present in breast milk and further discussion should be had with mother due to potential serious adverse reactions in breastfed infant.
• Renal Dosing
  • Adult
    • Not defined
  • Pediatric
    • Not defined
• Hepatic Dosing
  • Adult
    • Not defined
  • Pediatric
    • Not defined

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

• There is some evidence to suggest small increases in the risk of sepsis, venous thromboembolism, and fractures in short courses of steroid use

Pharmacology

• Half-life:
  • Adults: Oral 4 ± 0.9 hours, IV 1 - 5 hours
• Metabolism: Hepatic
• Excretion: Urine ~10%
• Mechanism of Action: surpasses neutrophil migration, decreases production of inflammatory mediators, reverses increased capillary permeability, suppresses normal immune response

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

Indication	Dose	Context	Route	Population
Acute asthma exacerbation	0.6 mg/kg IV or PO (max 16 mg); 2nd dose 24hr later	Corticosteroid (preferred for adherence)	IV/PO	Adult
Acute asthma exacerbation (peds)	0.6mg/kg PO or IV (max 16mg); consider 2nd dose at 24-36hr	Systemic corticosteroid; PO and IV equally effective	PO/IV	Pediatric
Acute mountain sickness	4mg q6hr	Moderate-severe AMS; symptomatic relief only, does not aid acclimatization	PO	Adult
Chloramine	0.6mg/kg IV or PO (max 16mg)	Airway inflammation	IV/PO	Adult
Croup	0.15-0.6 mg/kg PO/IV/IM (max 10 mg)	Corticosteroid (1st line, any severity)	PO/IV/IM	Pediatric
Headache	4-10 mg IV x1	Prevent headache recurrence 48-72h post-discharge	IV	Adult
High altitude cerebral edema	8mg initially, then 4mg q6hr	First-line pharmacotherapy; adjunct to immediate descent	PO/IM/IV	Adult
Immune thrombocytopenic purpura	40mg daily x 4 days	First-line steroid regimen	IV/PO	Adult
Migraine headache	10 mg IV	Prevent recurrence (48-72h post-discharge)	IV	Adult
Migraine headache	4-10 mg IV x1	Prevent headache recurrence 48-72h post-discharge	IV	Adult
Peritonsillar abscess	10 mg	Adjunct steroid (pain/inflammation)	IV/PO/IM	Adult
Sudden sensorineural hearing loss	10mg/mL intratympanic injection	Salvage therapy or if systemic steroids contraindicated	Intratympanic	Adult
Thyroid storm	4 mg IV q6h	Adrenal insufficiency treatment + T4→T3 blockade (alternative)	IV	Adult

See Also

• EBQ:TOAST Trial
• EBQ:Single Dose Dexamethasone in Asthma
• Dextromethorphan Toxicity