DEXAMETHASONE

Posology Dosage depends on the nature and severity of the disease and the individual response of the patient to treatment. In general, relatively high initial doses are administered, and they should be significantly higher in acute severe forms than in chronic diseases.

, followed by 16–24 mg (up to 48 mg)/day orally, divided into 3–4 (up to 6) individual doses for 4–8 days. A longer-term, lower-dose administration of Dexamethasone may be required during irradiation and in the conservative treatment of inoperable brain tumours.

4 mg/kg body weight every 12 hours for 2 days, starting before the first antibiotics. – Severe acute asthma attack: Adults: 8–20 mg, then, if necessary, 8 mg every 4 hours. 3 mg/kg body weight. – Acute skin diseases: Depending on the nature and extent of the disease, daily doses of 8–40 mg.

Followed by treatment with decreasing doses. – Active phases of rheumatic systemic diseases: systemic lupus erythematosus 6–16 mg/day. g. tuberculosis, typhoid): 4–20 mg for a few days, only with concomitant anti-infective therapy. – Palliative treatment of malignant tumours: initially 8–16 mg/day, in prolonged treatment 4–12 mg/day.

75 mg/day as a single dose. If necessary, addition of a mineralcorticoid (fludrocortisone). g. g. birth) a 10-fold increase. – The tablets should not be split to adjust doses. 5mg, other appropriate formulations should be used. Method of administration The tablets should be taken during or after a meal.

They should be swallowed whole, with a sufficient amount of liquid. The daily dose should be administered as a single dose in the morning, if possible (circadian therapy). In patients who require a high- dose therapy because of their disease, multiple daily dosing is often required to achieve maximum effect.

Depending on the underlying disease, clinical symptoms and response to therapy, the dose can be reduced at a faster or slower rate and the therapy stopped, or the patient is stabilised on a maintenance dose as low as possible and, if necessary, adrenal axis monitored.

Basically, the dose and duration of treatment should be kept as high and long as necessary, but as low and short as possible. In principle, the dose should be reduced gradually. In long-term therapy which is deemed necessary following initial treatment, patients should be switched to prednisone/prednisolone, because this leads to lower adrenal suppression.

– Very common (≥ 1/10) – Common (≥ 1/100 to < 1/10) – Uncommon (≥ 1/1,000 to < 1/100) – Rare (≥ 1/10,000 to < 1/1,000) – Very rare (< 1/10,000) – Not known (cannot be estimated from the available data) Hormone replacement therapy: Low risk of undesirable effects with the use of recommended doses.

Pharmacotherapy:

The following undesirable effects may occur; they are highly dependent on the dose and duration of treatment, so their frequency cannot be specified: Infections and infestations Masking of infections, manifestation and exacerbation of viral infections, fungal infections, bacterial, parasitic and opportunistic infections, activation of strongyloidiasis.

Blood and lymphatic system disorders Moderate leukocytosis, lymphocytopenia, eosinopenia, polycythemia. g. drug eruption), severe anaphylactic reactions, such as arrhythmias, bronchospasm, hypo- or hypertension, circulatory collapse, cardiac arrest, weakening of the immune system.

Endocrine disorders Adrenal suppression and induction of Cushing’s syndrome (typical symptoms: moon face, central obesity and plethora). Metabolism and nutrition disorders Sodium retention with oedema, increased potassium excretion (risk of arrhythmias), weight gain, reduced glucose tolerance, diabetes mellitus, hypercholesterolemia and hypertriglyceridemia, increased appetite.

Psychiatric disorders Depression, irritability, euphoria, increased drive, psychoses, mania, hallucinations, emotional lability, anxiety, sleep disorders, suicidality. Nervous system disorders Pseudotumor cerebri, manifestation of latent epilepsy, increase in seizure susceptibility in manifest epilepsy.

4). Vascular disorders Hypertension, increased risk of atherosclerosis and thrombosis, vasculitis (also as withdrawal syndrome after long-term therapy), increased capillary fragility. Gastrointestinal disorders Gastrointestinal ulcers, gastrointestinal bleeding, pancreatitis, stomach discomfort, hiccups.

In post-marketing experience tumour lysis syndrome (TLS) has been reported in patients with haematological malignancies following the use of dexamethasone alone or in combination with other chemotherapeutic agents. Patients at high risk of TLS such as patients with high proliferative rate, high tumour burden, and high sensitivity to cytotoxic agents, should be monitored closely and appropriate precaution taken.

Adrenocortical insufficiency An adrenocortical insufficiency, which is caused by glucocorticoid treatment, can, depending on the dose and length of treatment, remain for many months, and in some cases more than a year, after discontinuation of treatment.

), a temporary increase in dose may be required. Because of the possible risk in stressful conditions, a steroid emergency card should be made for patients undergoing long-term treatment. Even in cases of prolonged adrenocortical insufficiency after discontinuation of treatment, the administration of glucocorticoids can be necessary in physically stressful situations.

An acute therapy-induced adrenocortical insufficiency can be minimized by slow dose reduction until a planned discontinuation time. g. nematodes) – In patients with suspected or confirmed strongyloidiasis (infection with threadworms), glucocorticoids can lead to activation and mass proliferation of these parasites – Poliomyelitis – Lymphadenitis after BCG vaccination – Acute and chronic bacterial infections – In a history of tuberculosis (reactivation risk), use only under tuberculostatic protection – Known or suspected Strongyloidiasis (threadworm infestation).

Treatment with glucocorticoids may lead to lead to Strongyloides hyperinfection and dissemination with widespread larval migration. In addition, treatment with Dexamethasone should only be implemented under strong indications and, if necessary, additional specific treatment must be implemented for: – Gastrointestinal ulcers – Osteoporosis – Severe cardiac insufficiency – High blood pressure that is difficult to regulate – Diabetes mellitus that is difficult to regulate – Psychiatric disorders (also in the past), including suicidality: neurological or psychiatric monitoring is recommended – Narrow- and wide-angle glaucoma, ophthalmic monitoring and adjunctive therapy are recommended – Corneal ulcerations and corneal injuries, ophthalmic monitoring and adjunctive therapy are recommended Anaphylactic reaction Serious anaphylactic reactions may occur.

1. Systemic infection unless specific anti-infective therapy is employed. Stomach ulcer or duodenal ulcer. Avoid live vaccines in patients receiving immuno suppressive doses (serum antibody response diminished). In general no contraindications apply in conditions where the use of glucocorticoids may be life saving.