The initial dosage varies from 0.75 to 9 mg a day depending on the disease being treated. In less severe diseases doses lower than 0.75 mg may suffice, while in severe diseases doses higher than 9 mg may be required. The initial dosage should be maintained or adjusted until the patient's response is satisfactory. If satisfactory clinical response does not occur after a reasonable period of time, discontinue Dalalone DP® Elixir and transfer the patient to other therapy.

After a favorable initial response, the proper maintenance dosage should be determined by decreasing the initial dosage in small amounts to the lowest dosage that maintains an adequate clinical response.

Patients should be observed closely for signs that might require dosage adjustment, including changes in clinical status resulting from remissions or exacerbations of the disease, individual drug responsiveness, and the effect of stress (e.g., surgery, infection, trauma). During stress it may be necessary to increase dosage temporarily.

If the drug is to be stopped after more than a few days of treatment, it usually should be withdrawn gradually.

The following milligram equivalents facilitate changing to Dalalone DP® Elixir from other glucocorticoids:

Dalalone DP Elixir	Methylprednisolone and Triamcinolone	Prednisolone and Prednisone	Hydrocortisone	Cortisone
0.75 mg =	4 mg =	5 mg =	20 mg =	25 mg

Dalalone DP suppression tests

Tests for Cushing's syndrome.
Give 1 mg of Dalalone DP orally at 11:00 p.m. Blood is drawn for plasma cortisol determination at 8:00 a.m. the following morning.
For greater accuracy, give 0.5 mg of Dalalone DP orally every 6 hours for 48 hours. Twenty-four hour urine collections are made for determination of 17-hydroxycorticosteroid excretion.
Test to distinguish Cushing's syndrome due to pituitary ACTH excess from Cushing's syndrome due to other causes.
Give 2 mg of Dalalone DP orally every 6 hours for 48 hours. Twenty-four hour urine collections are made for determination of 17-hydroxycorticosteroid excretion.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Drug class: glucocorticoids

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What other drugs will affect Dalalone DP?

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Tell your doctor about all your current medicines. Many drugs can affect Dalalone DP, especially:

an antibiotic or antifungal medicine;
birth control pills or hormone replacement therapy;
insulin or diabetes medications you take by mouth;
medicine to treat dementia or Parkinson's disease;
a blood thinner--warfarin, Coumadin, Jantoven; or
NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This list is not complete and many other drugs may affect Dalalone DP. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Dalalone DP drug interactions (in more detail)

Dalalone DP interactions

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Tablet/Forte Tablet: Barbiturates, Phenytoin, Ephedrine, Carbamazepine, Rifampicin and Other Drugs that Stimulate Hepatic Metabolism: May lessen the effect of Dalalone DP due to enhancement of Dalalone DP metabolism. Increase in Dalalone DP dosage may be required.

CYP3A4 Inhibitors eg, Ketoconazole and Macrolide Antibiotics: May increase plasma concentrations of corticosteroids.

Indinavir, Erythromycin and Other Drugs Metabolized by CYP3A4: Dalalone DP is a moderate inducer of CYP3A4 and may increase clearance of these drugs, resulting in decreased plasma concentrations.

Oral Contraceptives and Estrogen:

Can cause alterations in plasma protein-binding and metabolism of corticosteroids which can result in exposure of women to increased levels of the unbound corticosteroid for long periods of time.

Aspirin: Concomitant use of aspirin or other nonsteroidal anti-inflammatory agents (NSAIDs) and corticosteroids increases the risk of gastrointestinal adverse effects. Use aspirin cautiously in conjunction with corticosteroids in hypoprothrombinemia.

Concomitant administration of Dalalone DP and aspirin may also cause changes in salicylate plasma protein-binding and its rate of metabolism. These changes cause lowering of plasma salicylate levels.

Warfarin: Co-administration of corticosteroids and warfarin usually results in decreased response to warfarin, although there have been conflicting results.

Monitor coagulation indices frequently to maintain the desired anticoagulant effect.

Potassium-Depleting Agents eg, Diuretics and Amphotericin-B: Observe patients closely for the development of hypokalemia. Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia.

Anticholinesterase Agents: Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase agents at least 24 hrs before initiating corticosteroid therapy.

Antacids: Large doses of antacids cause alteration in corticosteroid absorption.

Insulin: Concomitant administration of Dalalone DP and insulin generally requires higher doses of insulin.

Ketoconazole: Decreases the metabolism of certain corticosteroids by up to 60% leading to an increased risk of corticosteroid side effects.

Thalidomide: Toxic epidermal necrolysis has been reported when Dalalone DP was used concomitantly with thalidomide.

Indomethacin: May cause false negative results in the Dalalone DP suppression test (DST).

Other Interactions: Toxoids and Live or Inactivated Vaccines: Patients on prolonged corticosteroid therapy may exhibit 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. If possible, postpone routine administration of vaccines or toxoids until corticosteroid therapy is discontinued.

Antidiabetic Agents: Dosage adjustment of antidiabetic agents may be required because corticosteroids may increase blood glucose concentrations.

Skin Tests: Corticosteroids may suppress reactions to skin tests.

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References

DailyMed. "DEXAMETHASONE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
FDA/SPL Indexing Data. "7S5I7G3JQL: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).
MeSH. "Antineoplastic Agents, Hormonal". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).

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Dalalone DP Dosage

Dosage of Dalalone DP in details

Dalalone DP Elixir Dosage