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Active ingredient: Dexamethasone - Brands, Medical Use, Clinical Data

Brands, Medical Use, Clinical Data

Drug Category

  • Antineoplastic Agents, Hormonal
  • Glucocorticoids
  • Antiemetics
  • Anti-inflammatory Agents
  • Adrenergic Agents

Dosage Forms

  • Drops
  • Elixir
  • Implant
  • Liquid
  • Ointment
  • Powder
  • Solution
  • Tablet

Brands / Synonyms

Adexone; Aeroseb-D; Aeroseb-Dex; Anaflogistico; Aphtasolon; Aphthasolone; Auxiron; Azium; Bisu Ds; Calonat; Ciprodex; Corson; Corsone; Cortisumman; Decacort; Decacortin; Decaderm; Decadron; Decadron Tablets, Elixir; Decadron-La; Decagel; Decalix; Decasone; Decaspray; Dectancyl; Dekacort; Deltafluorene; Dergramin; Deronil; Desadrene; Desametasone; Desametasone [Dcit]; Desamethasone; Desameton; Deseronil; DEX; Dex-Ide; Dexa; Dexa Mamallet; Dexa-Cortidelt; Dexa-Cortisyl; Dexa-Mamallet; Dexa-Scheroson; Dexa-Sine; Dexacen-4; Dexacidin; Dexacort; Dexacortal; Dexacortin; Dexadeltone; Dexafarma; Dexair; Dexalona; Dexaltin; Dexametasona [Inn-Spanish]; Dexameth; Dexamethasone; Dexamethasone Acetate; Dexamethasone Alcohol; Dexamethasone Base; Dexamethasone Intensol; Dexamethasone Sodium Phosphate; Dexamethasone [Ban:Inn:Jan]; Dexamethasonum [Inn-Latin]; Dexamethazone; Dexamonozon; Dexapolcort; Dexapos; Dexaprol; Dexason; Dexasone; Dexinolon; Dexinoral; Dexone; Dexone 0.5; Dexone 0.75; Dexone 1.5; Dexone 4; Dexonium; Dextelan; Dezone; Dinormon; DXM; Dxms; Fluormethylprednisolone; Fluormone; Fluorocort; Fortecortin; Gammacorten; Hexadecadrol; Hexadrol; Hexadrol Elixir; Hexadrol Tablets; Hl-Dex; Isopto-Dex; Lokalison F; Loverine; Luxazone; Maxidex; Maxitrol; Mediamethasone; Mexidex; Millicorten; Mymethasone; Neomycin and Polymyxin B Sulfates and Dexamethasone; Ocu-Trol; Oradexon; Pet Derm Iii; Pet-Derm Iii; Policort; Prednisolon F; Prednisolone F; Sk-Dexamethasone; Spoloven; Sunia Sol D; Superprednol; Tobradex; Turbinaire; Visumetazone

Indications

Injection: for the treatment of endocrine disorders, rheumatic D=disorders, collagen diseases, dermatologic diseases, allergic statesc, ophthalmic diseases, gastrointestinal diseases, respiratory diseases, hematologic disorders, neoplastic diseases, edematous states, cerebral edema.
Ophthalmic ointment and solution: for the treatment of steroid responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe.
Ophthalmic solution only: for the treatment of steroid responsive inflammatory conditions of the external auditory meatus
Topic cream: for relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses
Oral aerosol: for the treatment of bronchial asthma and related corticosteroid responsive bronchospastic states intractable to adequate trial of conventional therapy
Intranasal aerosol: for the treatment of allergic ot inflammatory nasal conditions, and nasal polyps

Pharmacology

Dexamethasone and its derivatives, dexamethasone sodium phosphate and dexamethasone acetate, are synthetic glucocorticoids. Used for its antiinflammatory or immunosuppressive properties and ability to penetrate the CNS, dexamethasone is used alone to manage cerebral edema and with tobramycin to treat corticosteroid-responsive inflammatory ocular conditions.

Mechanism of Action

Dexamethasone is a glucocorticoid agonist. Unbound dexamethasone crosses cell membranes and binds with high affinity to specific cytoplasmic receptors. This results in a modification of transcription and, hence, protein synthesis in order to achieve inhibition of leukocyte infiltration at the site of inflammation, interference in the function of mediators of inflammatory response, suppression of humoral immune responses, and reduction in edema or scar tissue. The antiinflammatory actions of dexamethasone are thought to involve phospholipase A2 inhibitory proteins, lipocortins, which control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes.

Absorption

80-90%

Toxicity

Oral, rat LD50: >3 gm/kg. Signs of overdose include retinal toxicity, glaucoma, subcapsular cataract, gastrointestinal bleeding, pancreatitis, aseptic bone necrosis, osteoporosis, myopathies, obesity, edemas, hypertension, proteinuria, diabetes, sleep disturbances, psychiatric syndromes, delayed wound healing, atrophy and fragility of the skin, ecchymosis, and pseudotumor cerebri.

Biotrnasformation / Drug Metabolism

Hepatic.

Contraindications

Systemic fungal infections.

DECADRON tablets are contraindicated in patients who are hypersensitive to any components of this product.

Drug Interactions

Aminoglutethimide: Aminoglutethimide may diminish adrenal suppression by corticosteroids.

Amphotericin B injection and potassium-depleting agents: When corticosteroids are administered concomitantly with potassium-depleting agents (e.g., amphotericin B, diuretics), patients should be observed closely for development of hypokalemia. In addition, there have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure.

Antibiotics: Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance.

Anticholinesterases: Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy.

Anticoagulants, oral: Co-administration of corticosteroids and warfarin usually results in inhibition of response to warfarin, although there have been some conflicting reports. Therefore, coagulation indices should be monitored frequently to maintain the desired anticoagulant effect.

Antidiabetics: Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required.

Antitubercular drugs: Serum concentrations of isoniazid may be decreased. Cholestyramine: Cholestyramine may increase the clearance of corticosteroids. Cyclosporine: Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. Convulsions have been reported with this concurrent use.

Dexamethasone suppression test (DST): False-negative results in the dexamethasone suppression test (DST) in patients being treated with indomethacin have been reported. Thus, results of the DST should be interpreted with caution in these patients.

Digitalis glycosides: Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia.

Ephedrine: Ephedrine may enhance the metabolic clearance of corticosteroids, resulting in decreased blood levels and lessened physiologic activity, thus requiring an increase in corticosteroid dosage.

Estrogens, including oral contraceptives: Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their effect.

Hepatic Enzyme Inducers, Inhibitors and Substrates: Drugs which induce cytochrome P450 3A4 (CYP 3A4) enzyme activity (e.g., barbiturates, phenytoin, carbamazepine, rifampin) may enhance the metabolism of corticosteroids and require that the dosage of the corticosteroid be increased. Drugs which inhibit CYP 3A4 (e.g., ketoconazole, macrolide antibiotics such as erythromycin) have the potential to result in increased plasma concentrations of corticosteroids. Dexamethasone is a moderate inducer of CYP 3A4. Co-administration with other drugs that are metabolized by CYP 3A4 (e.g., indinavir, erythromycin) may increase their clearance, resulting in decreased plasma concentration.

Ketoconazole: Ketoconazole has been reported to decrease the metabolism of certain corticosteroids by up to 60%, leading to increased risk of corticosteroid side effects. In addition, ketoconazole alone can inhibit adrenal corticosteroid synthesis and may cause adrenal insufficiency during corticosteroid withdrawal.

Nonsteroidal anti-inflammatory agents (NSAIDS): Concomitant use of aspirin (or other nonsteroidal antiinflammatory agents) and corticosteroids increases the risk of gastrointestinal side effects. Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia. The clearance of salicylates may be increased with concurrent use of corticosteroids.

Phenytoin: In post-marketing experience, there have been reports of both increases and decreases in phenytoin levels with dexamethasone co-administration, leading to alterations in seizure control.

Skin tests: Corticosteroids may suppress reactions to skin tests.

Thalidomide: Co-administration with thalidomide should be employed cautiously, as toxic epidermal necrolysis has been reported with concomitant use.

Vaccines: Patients on corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines due to inhibition of antibody response. Corticosteroids may also potentiate the replication of some organisms contained in live attenuated vaccines. Routine administration of vaccines or toxoids should be deferred until corticosteroid therapy is discontinued if possible.

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