DEXAMETHASONE

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A Drug Study Presented to the

Faculty of the Nursing Department of
San Pedro College, Davao City
Bella Shary G. Fuentes, RN, MN

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In Partial Fulfillment of
The Requirements in NCM 209-RLE
Delivery Room Nursing Rotation

Submitted by:
Sophia Elyssa D. Ibuyan, St.N

March 23, 2021

Generic Name

Dexamethasone

Brand Name Decadron, Dexamethasone Intensol, Dexasone, Solurex,

Baycadron

Drug Classification Pharmacologic: Adrenal Corticosteroids, Glucocorticoid

Therapeutic: Adrenocortical Steroid, Anti-Inflammatory

Suggested Dose Anti-Inflammatory

PO, IV, IM: Adults, Elderly: 0.5–9 mg/day in divided doses
q6–12h.
Children: 0.08–0.3 mg/kg/day in divided doses q6–12h.
Intra-Articular: Adults, Elderly: 0.4–6 mg/day.

Adrenal Insufficiency
PO: Adults: 0.5 mg q6h for 48 hours
PO: Children: 0.024-0.34 mg/kg daily in four divided doses

Cerebral Edema
IV: Adults, Elderly: Initially, 10 mg, then 4 mg (IV or IM)
q6h.
PO, IV, IM: Children: Loading dose of 1–2 mg/kg, then 1–
1.5 mg/kg/day in divided doses q4–6h.

Nausea/Vomiting in Chemotherapy Pts

Note: Refer to individual protocols and emetogenic
potential.
IV: Adults, Elderly: 8–20 mg 15–30 min before treatment.
Children: 6 mg/m2/dose on days of chemotherapy.

Cushing’s Syndrome
PO: Adults: 2 mg q6h x 48h

Physiologic Replacement
 PO, IV, IM: Adults, Elderly, Children: 0.03–0.15 mg/kg/day
in divided doses q6–12h.

Prevention of Hyaline Membrane Disease in Premature

Infants
IM: Adults: 5 mg (phosphate) t.i.d. to mother for 2 days
before delivery

Usual Ophthalmic Dosage, Ocular Inflammatory

Conditions
Adults, Elderly, Children: (Solution): Initially, 2 drops q1h
while awake and q2h at night for 1 day, then reduce to 3–4
times/day. (Suspension): 1–2 drops up to 4–6 times/day.

Mode of Action Dexamethasone is a long-acting corticosteroid with minimal

sodium-retaining potential. It decreases inflammation by
suppression of neutrophil migration, decreased production of
inflammatory mediators, and reversal of increased capillary
permeability; suppresses normal immune response.
Dexamethasone induces apoptosis in multiple myeloma
cells. Dexamethasone accelerates maturation of fetal lungs,
and improves fetal lung surfactant production, decrease
number of neonates with respiratory distress syndrome and
improves survival in preterm delivered neonates.

Indications • Preterm pregnancy to accelerate surfactant

production
• Bronchopulmonary dysplasia
• Cushing’s Syndrome
• Adrenal Insufficiency
• Croup
• Acute lymphoblastic leukemia
• Raised intracranial pressure
• Brain tumor induced cerebral edema
• Airway edema
• Inflammation
• Meningitis
• Spinal cord compression
• Adrenocortical Hyperfunction test
• Respiratory Distress Syndrome in Premature Infants

Contraindications Contraindicated in patients hypersensitive to drug or its

components and in those with systemic fungal infections,
cerebral edema, acute infections, active or resting
tuberculosis, vaccinia, varicella, administration of live virus
vaccines (to patient, family members), latent or active
 amebiasis; Cushing’s syndrome; neonates or infants
weighing less than 1300 g; lactation.

Side Effects Frequent

Inhalation: Cough, dry mouth, hoarseness, throat irritation.
Intranasal: Burning, mucosal dryness.
Ophthalmic: Blurred vision.
Systemic: Insomnia, facial edema (cushingoid appearance
["moon face"]), moderate
abdominal distention, indigestion, increased appetite,
nervousness, facial
flushing, diaphoresis.
Occasional
Inhalation: Localized fungal infection (thrush)

Intranasal: Crusting inside nose, epistaxis, sore throat,

ulceration of nasal mucosa

Ophthalmic: Decreased vision; lacrimation; eye pain;

burning, stinging, redness of eyes; nausea; vomiting

Systemic: Dizziness, decreased/blurred vision

Rare

Inhalation: Increased bronchospasm,

esophageal candidiasis.

Intranasal: Nasal/pharyngeal candidiasis, eye pain.

Systemic: Generalized allergic reaction (rash, urticaria);

pain, redness, swelling at injection site; psychological
changes; false sense of well-being; hallucinations;
depression.

Adverse Effects Aerosol Therapy: Nasal irritation, dryness, epistaxis,

rebound congestion, bronchial asthma, anosmia, perforation
of nasal septum.

Systemic Absorption – CNS: Euphoria, insomnia,

convulsions, increased ICP, vertigo, headache, psychic
disturbances.
 CV: CHF, hypertension, edema.

Endocrine: Menstrual irregularities, hyperglycemia;

cushingoid state; growth suppression in children; hirsutism.

Special Senses: Posterior subcapsular cataract, increased

IOP, glaucoma, exophthalmos.

GI: Peptic ulcer with possible perforation, abdominal

distension, nausea, increased appetite, heartburn,
dyspepsia, pancreatitis, bowel perforation, oral candidiasis.

Musculoskeletal: Muscle weakness, loss of muscle mass,

vertebral compression fracture, pathologic fracture of long
bones, tendon rupture.

Skin: Acne, impaired wound healing, petechiae,

ecchymoses, diaphoresis, allergic dermatitis, hypo- or
hyperpigmentation, subcutaneous and cutaneous atrophy,
burning and tingling in perineal area (following IV injection).

Drug Interaction Drug-Drug:

Aminoglutethimide: May cause loss of dexamethasone-
induced adrenal suppression. Monitor patient for effect.

Amphotericin B, diuretics: Increases risk of

hypokalemia. Monitor serum potassium levels.

Antacids, cholestyramine, colestipol: Decreases

corticosteroid effect. Monitor patient closely, and adjust
dosage as needed.

Aspirin, NSAIDs: May increase risk of GI ulceration. Use

together cautiously.

Barbiturates, phenytoin, rifampin: May cause decreased

corticosteroid effects. Adjust dosage as needed.

Cardiac glycosides: Hypokalemia may increase risk of

toxicity. Adjust dosage as needed.
 Ephedrine: May cause decreased half-life and increased
clearance of dexamethasone. Monitor patient for effect.

Estrogens, oral contraceptives: May reduce

dexamethasone metabolism by increasing transcortin
levels. Monitor patient carefully.

Insulin, oral antidiabetics: Increases risk of

hyperglycemia. Adjust dosage as needed.

Isoniazid, salicylates: Increases metabolism of these

drugs. Monitor patient carefully.

Ketoconazole: May increase area under the curve and

decrease clearance of dexamethasone. Monitor patient for
increased adverse effects.

Oral anticoagulants: Decreases anticoagulant

effects. Monitor PT and INR closely.

Potassium-depleting diuretics: May cause

hypokalemia. Monitor serum potassium level.

Skin-test antigens: Decreases response. Defer skin testing

until therapy is completed.

Toxoids, vaccines: Decreases antibody response and

increases risk of neurologic complications. Avoid use
together.
Drug-Food: Interferes with calcium absorption.
Drug-Lifestyle: Alcohol use: Increases risk of gastric
irritation and GI ulceration. Discourage alcohol use.

Nursing 1. Question for hypersensitivity to any corticosteroids.

Responsibilities
2. Obtain baselines for height, weight, B/P, serum glucose,
electrolytes
3. Monitor I&O, daily weight, serum glucose.
4. Monitor neonates born to a mother who has been
receiving a corticosteroid during pregnancy for symptoms of
hypoadrenocorticism.

5. Monitor for S&S of a hypersensitivity reaction such as

urticaria, pruritis, wheezing, edema, redness, and
anaphylaxis.

6. Monitor and report S&S of Cushing’s syndrome such as

fatty swelling in the intrascapular and in facial area,
distention of the abdomen, ecchymoses, impotence,
amenorrhea, high blood pressure, general weakness, loss of
muscle mass, osteoporosis, psychosis

7. Check vital signs at least twice daily

8. Be alert to infection (sore throat, fever, vague symptoms)
9. Monitor serum electrolytes, esp. for hypercalcemia,
hypokalemia, paresthesia (esp. lower extremities,
nausea/vomiting, irritability), Hgb, occult blood loss.
10. Report lack of response to medication or malaise,
orthostatic hypotension, muscular weakness and pain,
nausea, vomiting, anorexia, hypoglycemic reactions, or
mental depression to prescriber.

11. Assess emotional status, ability to sleep.

12. Inform patient that abrupt withdrawal may cause adrenal
insufficiency; taper dose gradually.
13. Advice the patient not to change dose/schedule or stop
taking drug.
14. Inform patient to avoid alcohol and limit caffeine to
decrease the risk of stomach/intestinal bleeding.
15.Teach patient signs of early adrenal insufficiency: fatigue,
muscle weakness, joint pain, fever, anorexia, nausea,
dyspnea, dizziness, and fainting.
16. Inform patient that Dexamethasone dose regimen may
need to be altered during stress (e.g., surgery, infections,
emotional stress, illness, acute bronchial attacks, trauma)

17. Instruct patient to take drug with food or milk to minimize

GI problems.
Bibliography
Kizior, R., & Hodgson, K. (2019). Saunders Nursing Drug Handbook 2019. St. Louis,
Missouri: Elsevier.
Vallerand, A., & Sanoski, C. (2019). Davis's Drug Guide for Nurses Sixteenth Edition.
Philadelphia: F.A Davis Company
Wilson, Shannon, & Shields. (2015). Pearson Nurse's Drug Guide. Hoboken, New Jersey:
Pearson Education, Inc.