dexamethasone sodium phosphate

Adult Dosing .

Dosage forms:  INJ: 4 mg per mL, 10 mg per mL

Special Note

[prescribing info]

Info: 10 mg per mL vial for IM or IV use only

corticosteroid-responsive conditions

[IM/IV route]

Dose: 0.5-9 mg/day IM/IV divided q6-12h; Info: dose, frequency varies by condition; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if high-dose or long-term use

[intra-articular route, small joints]

Dose: 0.8-1 mg intra-articularly x1; Info: use 4 mg per mL vial; dose, frequency varies by condition and injection site; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if high-dose or long-term use

[intra-articular route, large joints]

Dose: 2-4 mg intra-articularly x1; Info: use 4 mg per mL vial; dose, frequency varies by condition and injection site; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if high-dose or long-term use

[soft tissue injection]

Dose: 0.4-4 mg INJ into affected area x1; Info: use 4 mg per mL vial; dose, frequency varies by condition and injection site; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if high-dose or long-term use

[intralesional injection]

Dose: individualize dose intralesionally x1; Info: use 4 mg per mL vial; dose, frequency varies by condition and injection site; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if high-dose or long-term use

adrenal insufficiency

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

cerebral edema, acute

[4 mg IM/IV q6h]

Start: 10 mg IV x1; Info: cont. until sx subside, taper dose over 5-7 days to D/C; switch to PO when possible

COVID-19 (off-label)

[6 mg IV 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 IV x1 on day 1 before chemo, then may give 8 mg IV 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 IV x1 on day 1 before chemo, then may give 8 mg IV 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 IV x1 before chemo; Info: may repeat 8-12 mg IV 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 IV qd]

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

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

[4 mg IV qd]

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

shock, unresponsive (off-label)

[1-6 mg/kg/dose IV q2-6h prn]

Start: 40 mg IV x1; Alt: 20 mg IV x1 then 3 mg/kg/24h IV; Info: dosing regimens vary; taper dose over 5-7 days to D/C

altitude sickness (off-label)

[4 mg IM/IV q6h]

Info: for high altitude cerebral edema, give loading dose 8 mg IM/IV x1

fetal lung maturation (off-label)

[6 mg IM q12h x4 doses]

Info: for expectant mothers 24 wk,0 days-33 wk,6 days gestation at high risk of preterm delivery; may consider for mothers at least 23 wk,0 days gestation at high risk of preterm delivery w/in 7 days; may repeat x1 for mothers <34wk,0 days gestation at imminent risk of preterm birth w/in 7 days and no prior antenatal steroid use w/in 14 days

malignant spinal cord compression (off-label)

[16 mg/day IV divided q6h]

Start: 10 mg IV x1; begin when neurological sx present; Info: taper dose gradually to D/C

ARDS, early (off-label)

[20 mg IV qd x5 days, then 10 mg IV qd x5 days or until extubation]

Start: w/in 24h of onset

renal dosing

[no adjustment]

renal impairment: no adjustment

HD/PD: no adjustment; no supplement

hepatic dosing

[not defined]

Peds Dosing .

Dosage forms:  INJ: 4 mg per mL, 10 mg per mL

corticosteroid-responsive conditions

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

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

adrenal insufficiency

[0.03-0.3 mg/kg/day IM/IV divided q6-12h]

cerebral edema, acute

[1-1.5 mg/kg/day IM/IV divided q4-6h]

Start: 1-2 mg/kg/dose IM/IV x1; Max: 16 mg/day; Info: cont. until sx subside, taper dose over 5-7 days to D/C; switch to PO when possible

COVID-19 (off-label)

[0.15 mg/kg/dose IV 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 IM/IV x1]

Max: 20 mg/dose; Info: may use 0.15-0.3 mg/kg/dose IM/IV x1 for mild-moderate croup

chronic lung dz prevention (off-label)

[premature neonates, 8-27 days old]

Dose: 0.075 mg/kg/dose IV q12h x3 days, then 0.05 mg/kg/dose IV q12h x3 days, then 0.025 mg/kg/dose IV q12h x2 days, then 0.01 mg/kg/dose IV q12h x2 days; Info: for high-risk ventilator-dependent pts

airway edema (off-label)

[0.5-2 mg/kg/day IM/IV divided q6h x4-6 doses after extubation]

Start: 24h before extubation

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

[highly-emetogenic parenteral chemo]

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

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

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

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

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

meningitis, bacterial (off-label)

[>6 wk old]

Dose: 0.6 mg/kg/day IV divided q6h x2 days; Start: w/ 1st dose abx

malignant spinal cord compression (off-label)

[0.25-0.5 mg/kg/dose IV q6h]

Start: 1-2 mg/kg/dose IV x1; begin when neurological sx present; Max: 16 mg/dose; Info: taper dose gradually to D/C

altitude sickness (off-label)

[0.15 mg/kg/dose IM/IV q6h]

Max: 4 mg/dose

renal dosing

[no adjustment]

renal impairment: no adjustment

HD/PD: no adjustment; no supplement

hepatic dosing

[not defined]