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Drug Details

DECADRON

• Drug Class Description
  Glucocorticoids (corticosteroids, steroids).
• Generic Name
  Dexamethasone
• Presentation
  Tablets, dexamethasone 0.5 mg .
• Description
  White scored tablets marked with MSD 41.
• Indications
  Endocrine and non-endocrine disorders, cerebral oedema, diagnostic test for adrenocortical hyperfunction.
• Adult Dosage
  

  Initial dosage varies from 0.5- 9mg daily depending on the 9mg daily depending on the disease being treated. Refer to summary of product characteristics for further information.

• Child Dosage
  Limit dosage to a single dose on alternate days to lessen retardation of growth and minimise suppression of the hypothalamo-pituitary-adrenal axis. See summary of product characteristics.
• Contra Indications
  Systemic infections unless specific anti-infective therapy is used. Administration of live vaccines.
• Special Precautions
  

  Tuberculosis, viral, fungal or active infections, latent or active amoebiasis, strongyloidiasis. Warn patients to avoid contact with chickenpox or herpes zoster while they are receiving steroids and for 3 months post-treatment. In the event of exposure to chickenpox, non-immunised patients should receive varicella-zoster immunoglobulin ideally within 3 days and not later than 10 days from the time of contact. Patients diagnosed with chickenpox should be referred for specialist care. Recent intestinal anastomoses, ulcerative colitis, diverticulitis, active or latent peptic ulcer, thrombophlebitis, psychoses, exanthematous disease, chronic nephritis, acute glomerulonephritis, renal insufficiency, liver failure, cirrhosis, metastatic carcinoma, osteoporosis, hypertension, congestive heart failure, recent MI, glaucoma, epilepsy, diabetes, hypothyroidism, ocular herpes simplex, myasthenia gravis, previous steroid myopathy, cerebral malaria. Limit use in children. Elderly. Pregnancy, lactation.

  Stress, intercurrent illness, trauma or surgical procedures; monitor patients to avoid life-threatening reactions, (including babies of women who have received large doses of steroids). Use for the shortest effective dose, review regularly. Administration in the morning or, if possible, on alternate days helps to reduce risk of adrenal suppression. Advise patient to carry "steroid treatment card". Withrawal: In patients who have received more than physiological doses of systemic corticosteroids (approximately 1 mg dexamethasone) for greater than three weeks, withdrawal should not be abrupt. How dose reduction should be carried out depends largely on whether the disease is likely to relapse as the dose of systemic corticosteroids is reduced. Clinical assessment of disease activity may be needed during withdrawal.

  If the disease is unlikely to relapse on withdrawal of systemic corticosteroids but there is uncertainty about hypothalamic-petuitary adrenal (HPA) suppression, the dose of systemic corticosteroids may be reduced rapidly to physiological doses. Once a daily dose of 1 mg dexamethasone is reached, dose reduction should be slower to allow the HPA-axis to recover. Abrupt withdrawal of systemic corticosteroid treatment, which has continued up to three weeks is appropriate if it is considered that the disease is unlikely to relapse. Abrupt withdrawal of doses of up to 6 mg daily of dexamethasone for three weeks is unlikely to lead to clinically relevant HPA-axis suppression, in the majority of patients. In the following patient groups, gradual withdrawal of systemic corticosteroid therapy should be considered even after courses lasting three weeks or less: patients who have had repeated courses of systemic corticosteroids, particularly if taken for greater than three weeks, when a short course has been prescribed within one year of cessation of long-term therapy (months or years), for adrenocortical insufficiency other than exogenous corticosteroid therapy, patients receiving doses of systemic corticosteroid greater than 6 mg daily of dexamethasone, patients repeatedly taking doses in the evening. Reinstate if stressed. Measles can have a more serious or even fatal course in immunosuppressed patients. In such children or adults particular care should be taken to avoid exposure to measles

  If exposed, prophylaxis with intramuscular pooled immunoglobulin (IG) may be indicated. Exposed patients should be advised to seek medical advice without delay.

• Interactions
  

  Salicylates, phenytoin, barbiturates, ephedrine, rifabutin, carbamazepine, rifampicin, aminoglutethimide, indometacin (indomethacin), coumarin anticoagulants, hypoglycaemic agents (including insulin).

• Adverse Drug Reactions
  

  Depending on steroid, dose and length of treatment, both glucocorticoid and mineralocorticoid adverse effects may be seen.

  These include suppression of growth in children, hypertension, fluid retention, potassium loss, muscle weakness, aseptic necrosis of femoral and humeral heads, cushingoid changes, hyperglycaemia, osteoporosis, depression, euphoria, peptic ulceration, posterior subcapsular cataracts, impaired wound healing, skin thinning.