Decason 0.5 mg

Description

Indications

Dexamethasone is indicated for the management of various medical conditions:

• Allergic Disorders: It is used for the treatment of severe or incapacitating allergic reactions that do not respond adequately to conventional treatments. These include conditions such as asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, both perennial and seasonal allergic rhinitis, and serum sickness.
• Collagen Vascular Diseases: It is effective in conditions such as lupus erythematosus and rheumatoid arthritis.
• Dermatologic Disorders: Dexamethasone can be prescribed for severe skin diseases including bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, and severe erythema multiforme (such as Stevens-Johnson syndrome).
• Endocrine Disorders: It treats primary or secondary adrenal insufficiency, congenital adrenal hyperplasia, hypercalcemia associated with cancer, and nonsuppurative thyroiditis.
• Gastrointestinal Diseases: It is used in the management of regional enteritis and ulcerative colitis.
• Hematologic Disorders: It is prescribed for acquired (autoimmune) hemolytic anemia, congenital hypoplastic anemia (Diamond-Blackfan anemia), idiopathic thrombocytopenic purpura in adults, and selected cases of secondary thrombocytopenia.
• Neoplastic Diseases: Dexamethasone is used in the treatment of leukemia and lymphoma.
• Neurological Conditions: It is used in acute exacerbations of multiple sclerosis, cerebral edema associated with primary or metastatic brain tumors, and post-craniotomy or head injury recovery.
• Ophthalmic Conditions: It is used to treat temporal arteritis, uveitis, and other ocular inflammatory conditions that do not respond to topical corticosteroids.
• Renal Disorders: Dexamethasone is indicated to induce diuresis or to help remit proteinuria in idiopathic nephrotic syndrome or lupus-related nephropathy.
• Respiratory Disorders: It is used to manage berylliosis, fulminating pulmonary tuberculosis (when combined with antituberculous therapy), idiopathic eosinophilic pneumonias, and symptomatic sarcoidosis.
• Rheumatic Diseases: It is recommended as adjunctive therapy for short-term management of acute episodes or exacerbations of conditions such as acute gouty arthritis, acute rheumatic carditis, ankylosing spondylitis, psoriatic arthritis, and rheumatoid arthritis (including juvenile rheumatoid arthritis). It may also be used for dermatomyositis, polymyositis, and systemic lupus erythematosus.
• Miscellaneous Uses: It can be used in diagnostic testing for adrenocortical hyperfunction, trichinosis with neurologic or myocardial involvement, and tuberculous meningitis with subarachnoid block or impending block when used alongside appropriate antituberculous therapy.

Note: Always follow the advice of a registered medical professional when using this medication.

Pharmacology

Dexamethasone is a synthetic glucocorticoid that works by reducing inflammation. It inhibits the migration of white blood cells (leukocytes) and reduces increased capillary permeability, thus decreasing inflammation. Additionally, it suppresses the normal immune response.

Dosage & Administration

• Tablets: The dosage for adults generally ranges from 1 mg to 10 mg daily, depending on the severity of the condition. For children, the dosage typically ranges from 0.03 to 0.20 mg per kilogram of body weight. In some cases, higher doses may be required temporarily to control the disease, but the dosage should be reduced as soon as possible.

  For a short dexamethasone suppression test, 1 mg of dexamethasone is administered at 11:00 p.m., and the plasma cortisol level is measured the following morning. For patients who do not show a decrease in cortisol, a longer test may be conducted involving doses every 6 hours for up to 48 hours.

• Injection: Dexamethasone can be administered intravenously (IV), intramuscularly (IM), or via local injection. When given intravenously in large doses, it should be administered slowly over several minutes. For intramuscular injection, deep intramuscular injections are recommended to avoid subcutaneous tissue atrophy. Intra-articular injections must be given under sterile conditions to avoid infection risks.

  For systemic therapy: The typical dose for adults is 0.05-0.20 mg per kg of body weight daily. In emergency situations (e.g., anaphylaxis, acute asthma, cerebral edema), higher doses are required, starting with an IV dose of 10-20 mg followed by 6 mg IV or IM every 6 hours until a satisfactory response is observed.

  For local therapy:

  • Intra-articular: 2-4 mg for large joints and 0.8-1 mg for smaller joints.
  • Intrabursal: 2-4 mg; in tendon sheaths: 0.4-1 mg.

  The frequency of injections can vary from every 3-5 days to every 2-3 weeks, depending on the patient’s condition.

Note: Always follow the guidance of a registered medical professional when using this medication.

Interactions

• Diuretics/Cardiac Glycosides: There is an increased risk of potassium loss when used together, especially in patients taking cardiac glycosides, as hypokalemia can increase the toxicity of these drugs.
• Antidiabetics: Glucocorticoids may impair glucose tolerance, which may require adjustments in antidiabetic medications.
• Non-steroidal Anti-inflammatory Drugs (NSAIDs): Concurrent use may increase the risk of gastrointestinal ulceration.
• Oral Anticoagulants: Glucocorticoids may alter the effectiveness of anticoagulants.
• Liver Enzyme Inducers: Drugs like rifampicin, phenytoin, and barbiturates may reduce the effectiveness of glucocorticoids.
• Salicylates: Caution is needed if glucocorticoids are used with salicylates due to a reported risk of salicylate toxicity when glucocorticoid dosage is reduced.

Contraindications

• Gastric and duodenal ulcers
• Systemic and ophthalmic fungal infections
• Viral infections such as varicella and herpes genitalis
• Glaucoma
• Hypersensitivity to corticosteroids

Side Effects

Prolonged use of glucocorticoids may lead to several adverse effects:

• Endocrine/Metabolic: Cushing’s syndrome, hirsutism, menstrual irregularities, impaired glucose tolerance, osteoporosis, and others.
• Fluid/Electrolyte Imbalance: Sodium and fluid retention, hypertension, hypokalemia, and alkalosis.
• Musculoskeletal: Myopathy, osteoporosis, and joint necrosis.
• Gastrointestinal: Ulcers, perforations, and gastrointestinal bleeding.
• Dermatological: Skin thinning, bruising, and impaired wound healing.
• Psychiatric/CNS Effects: Euphoria, insomnia, mood swings, depression, and psychosis.
• Ophthalmic Effects: Glaucoma and cataracts.
• Immunosuppressive Effects: Increased susceptibility to infections.

Pregnancy & Lactation

Dexamethasone is classified under Pregnancy Category C. There are no well-controlled studies in pregnant women, so it should only be used if the potential benefits outweigh the risks to the fetus. Dexamethasone is excreted in breast milk, and high doses should be avoided during breastfeeding.

Precautions & Warnings

• General: Use the lowest possible dose to minimize the risks associated with long-term corticosteroid therapy.
• Cardiovascular & Renal: Caution is advised for patients with heart failure, hypertension, or kidney issues.
• Gastrointestinal: Steroids should be used cautiously in patients with active ulcers or inflammatory bowel disease.
• Neuropsychiatric: Be aware of potential psychological effects, including mood swings and psychosis, especially with high doses.
• Musculoskeletal: Long-term use may lead to osteoporosis, especially in postmenopausal women.

Use in Special Populations

For pediatric patients, the dose should be adjusted to the lowest effective dose to minimize potential growth effects.

Overdose Effects

While overdose is unlikely, treatment should be supportive and symptomatic.

Storage Conditions

• Tablets: Store in a cool, dry place, away from light and moisture.
• Injection: Store below 30°C, protected from light. Do not freeze. Keep out of reach of children.