dexamethasone

Adult Dosing .

Dosage forms:  TAB: 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg; SOL: 0.5 mg per 5 mL, 1 mg per mL

adrenal insufficiency

[0.03-0.15 mg/kg/day PO divided q6-12h]

Info: give w/ food; taper dose gradually to D/C

congenital adrenal hyperplasia, maintenance tx

[0.25-0.5 mg PO qd]

Info: individualize dose based on dz severity and tx response; give w/ food; taper dose gradually to D/C

corticosteroid-responsive conditions

[0.75-9 mg/day PO divided q6-12h]

Info: dose, frequency varies by condition; give w/ food; taper dose gradually to D/C if high-dose or long-term use

dexamethasone suppression test

[single dose test]

Dose: 1 mg PO at 11pm; Info: draw cortisol at 8am next day

[multiple-dose test]

Dose: 0.5 mg PO q6h x48h; Info: check 24h urinary 17-OHCS

multiple myeloma

[20-40 mg PO x1 on specific days of cycle per regimen]

Info: part of multi-drug chemo regimen

COVID-19 (off-label)

[6 mg PO qd for up to 10 days]

Info: for hospitalized pts w/ suspected or confirmed severe COVID-19 requiring supplemental oxygen or mechanical ventilation; may use alternative glucocorticoids such as methylprednisolone 32 mg/day, prednisone 40 mg/day, hydrocortisone 160 mg/day

nausea/vomiting prevention, chemo-related (off-label)

[highly-emetogenic parenteral chemo]

Dose: 12 mg PO x1 on day 1 before chemo, then may give 8 mg PO qd on days 2-4; Info: part of multi-drug regimen; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool

[moderately-emetogenic parenteral chemo]

Dose: 12 mg PO x1 on day 1 before chemo, then may give 8 mg PO qd on days 2-3; Info: part of multi-drug regimen; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool

[low-emetogenic parenteral chemo]

Dose: 8-12 mg PO x1 before chemo; Info: may repeat 8-12 mg PO qd for multi-day chemo; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool

refractory nausea/vomiting, chemo-related (off-label)

[12 mg PO qd]

Info: search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool

nausea/vomiting prevention, XRT-related (off-label)

[4 mg PO qd]

Info: part of multi-drug regimen; give dose before each XRT

altitude sickness prevention (off-label)

[2 mg PO q6h]

Start: day of ascent; Max: x10 days; Alt: 4 mg PO q12h; Info: give w/ food; may consider 4 mg PO q6h in very high risk situations; D/C 2-3 days after peak arrival or upon descent

altitude sickness tx (off-label)

[4 mg PO q6h]

Info: give w/ food; for high altitude cerebral edema, give loading dose 8 mg PO x1

malignant spinal cord compression (off-label)

[16 mg/day PO divided q6h]

Start: 10 mg IV x1; begin when neurological sx present; Info: IV form avail. as dexamethasone sodium phosphate; taper dose gradually to D/C if high-dose or long-term use

renal dosing

[no adjustment]

renal impairment: no adjustment

HD/PD: no adjustment; no supplement

hepatic dosing

[not defined]

Peds Dosing .

Dosage forms:  TAB: 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg; SOL: 0.5 mg per 5 mL, 1 mg per mL

adrenal insufficiency

[0.02-0.3 mg/kg/day PO divided q6-12h]

Info: give w/ food; taper dose gradually to D/C

corticosteroid-responsive conditions

[0.08-0.3 mg/kg/day PO divided q6-12h]

Info: dose, frequency varies by condition; give w/ food; taper dose gradually to D/C if high-dose or long-term use

dexamethasone suppression test

[single dose test]

Dose: 1 mg PO at 11pm; Info: draw cortisol at 8am next day

[multiple-dose test]

Dose: 0.5 mg PO q6h x48h; Info: check 24h urinary 17-OHCS

COVID-19 (off-label)

[0.15 mg/kg/dose PO qd for up to 10 days]

Max: 6 mg/dose; Info: for hospitalized pts w/ suspected or confirmed severe COVID-19 requiring supplemental oxygen or mechanical ventilation; may use alternative glucocorticoids such as methylprednisolone 0.8 mg/kg/dose up to 32 mg/dose, prednisone 1 mg/kg/dose up to 40 mg/dose, or hydrocortisone 4 mg/kg/dose up to 160 mg/dose

croup (off-label)

[0.6 mg/kg/dose PO x1]

Max: 20 mg/dose; Info: may use 0.15-0.3 mg/kg/dose PO x1 for mild-moderate croup; give w/ food

altitude sickness (off-label)

[0.15 mg/kg/dose PO q6h]

Max: 4 mg/dose; Info: give w/ food

nausea/vomiting prevention, chemo-related (off-label)

[highly-emetogenic parenteral chemo]

Dose: 6 mg/m^2/dose PO q6h; Info: part of multi-drug regimen

[moderately-emetogenic parenteral chemo, BSA <0.6 m^2]

Dose: 2 mg PO q12h; Info: part of multi-drug regimen

[moderately-emetogenic parenteral chemo, BSA >0.6 m^2]

Dose: 4 mg PO q12h; Info: part of multi-drug regimen

renal dosing

[no adjustment]

renal impairment: no adjustment

HD/PD: no adjustment; no supplement

hepatic dosing

[not defined]