Dexamethasone Dosage

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Dosage of Dexamethasone in details

infoThe dose of a drug and dosage of the drug are two different terminologies. Dose is defined as the quantity or amount of medicine given by the doctor or taken by the patient at a given period. Dosage is the regimen prescribed by the doctor about how many days and how many times per day the drug is to be taken in specified dose by the patient. The dose is expressed in mg for tablets or gm, micro gm sometimes, ml for syrups or drops for kids syrups. The dose is not fixed for a drug for all conditions, and it changes according to the condition or a disease. It also changes on the age of the patient.
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Dosing Information

Dexamethasone should be administered as a single dose, intraocularly in the posterior chamber at the end of surgery. The dose is 0.005 mL of Dexamethasone 9% (equivalent to 517 micrograms).

Preparation and Administration

Each kit of Dexamethasone is for a single administration. After preparation, 0.005 mL will be administered.

The Dexamethasone administration kit contains the following items:

  1. One glass vial: 0.5 mL of Dexamethasone
  2. One sterile 1-mL syringe
  3. One sterile syringe guide
  4. One sterile syringe ring
  5. One sterile 18-gauge needle (1½ inches long), plastic cap attached
  6. One sterile 25-gauge bent cannula (8 mm long), plastic cap attached
Step 1.

Prepare a sterile field.

Remove the components of the administration kit from their respective pouches:

  • syringe
  • syringe guide
  • syringe ring
  • needle
  • cannula
Place onto the sterile field.
Step 2.

Withdraw the syringe plunger approximately 1 inch.

Place the syringe ring on the plunger (slit facing the plunger).

Apply slight downward pressure until the syringe ring "snaps" into place.

Step 3.

Place the 18-gauge needle firmly on the syringe.

Remove the cap from the needle.

Depress the plunger completely and then withdraw the plunger to fill the syringe with air.

Step 4.

Vigorously shake the vial of Dexamethasone sideways for a minimum of 30 seconds.

The suspended drug material must be used immediately after shaking.

Step 5.

Remove the blue plastic flip-cap from the vial and wipe the top of rubber stopper with an alcohol pad.

Invert the vial.

Step 6.

Insert the needle into the vial and inject the air into the vial.

Making sure the needle tip is immersed in the drug material pooled in the neck of the inverted vial, fill the syringe by slowly withdrawing the plunger approximately 0.2 mL.

Remove the needle from the vial and discard the unused portion in the vial.

Step 7.

Remove the needle from the syringe.

Firmly place the cannula on the syringe and remove the plastic cap.

Hold the syringe vertically with the cannula pointing up.

Depress the plunger to expel air bubbles from syringe.

Step 8.

Affix the syringe guide over the syringe ring on the plunger.

Step 9.

Depress the plunger until the syringe guide/ring mechanism comes gently into contact with the flange of the syringe.

Lightly tap/flick the barrel of the syringe to remove any excess drug from the tip of the cannula.

Do not wipe or touch the tip of the cannula to remove excess drug.

Step 10.

Remove the syringe guide, leaving the syringe ring in place.

Caution to not move the plunger. The space between the syringe ring and the top of the plunger is the medication injection volume that will be applied to the patient's eye.

The syringe is now ready for injection.

Step 11.

In a single slow motion, inject 0.005 mL of the drug material behind the iris in the inferior portion of the posterior chamber. If the sphere of administered drug after intraocular injection appears to be larger than 2 mm in diameter, excess drug material may be removed by irrigation and aspiration in the sterile surgical setting

PLEASE NOTE: Some drug material will remain in the syringe after the injection—this is necessary for accurate dosing. Discard unused portion remaining in the syringe after administration.

What other drugs will affect Dexamethasone?

Many drugs can interact with Dexamethasone. Below is just a partial list. Tell your doctor if you are using:

  • aspirin (taken on a daily basis or at high doses);

  • a diuretic (water pill);

  • a blood thinner such as warfarin (Coumadin);

  • cyclosporine (Gengraf, Neoral, Sandimmune);

  • insulin or diabetes medications you take by mouth;

  • ketoconazole (Nizoral);

  • rifampin (Rifadin, Rifater, Rifamate, Rimactane); or

  • seizure medications such as phenytoin (Dilantin) or phenobarbital (Luminal, Solfoton).

This list is not complete and other drugs may interact with Dexamethasone. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Dexamethasone interactions

infoInteractions are the effects that happen when the drug is taken along with the food or when taken with other medications. Suppose if you are taking a drug Dexamethasone, it may have interactions with specific foods and specific medications. It will not interact with all foods and medications. The interactions vary from drug to drug. You need to be aware of interactions of the medicine you take. Most medications may interact with alcohol, tobacco, so be cautious.
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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, pheny-toin, 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 corti-costeroids. Dexamethasone is a moderate inducer of CYP 3A4. Co-adminstration with other drugs that are metabolized by CYP 3A4 (e. g., indinavir, eryth-romycin) 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 corti-costeroid side effects. In addition, ketoconazole alone can inhibit adrenal corticosteroid synthesis and may cause adrenal insufficiency during corticos-teroid 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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References

  1. 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).
  2. 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).
  3. MeSH. "Antineoplastic Agents, Hormonal". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Dexamethasone are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Dexamethasone. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

User reports

1 consumer reported frequency of use

How frequently do I need to take Dexamethasone?
It was reported by ndrugs.com website users that Dexamethasone should ideally be taken Twice in a day as the most common frequency of the Dexamethasone. You should you adhere strictly to the instructions and guidelines provided by your doctor on how frequently this Dexamethasone should be taken. Get another patient's view on how frequent the capsule should be used by clicking here.
Users%
Twice in a day1
100.0%


2 consumers reported doses

What doses of Dexamethasone drug you have used?
The drug can be in various doses. Most anti-diabetic, anti-hypertensive drugs, pain killers, or antibiotics are in different low and high doses and prescribed by the doctors depending on the severity and demand of the condition suffered by the patient. In our reports, ndrugs.com website users used these doses of Dexamethasone drug in following percentages. Very few drugs come in a fixed dose or a single dose. Common conditions, like fever, have almost the same doses, e.g., [acetaminophen, 500mg] of drug used by the patient, even though it is available in various doses.
Users%
6-10mg1
50.0%
1-5mg1
50.0%


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Information checked by Dr. Sachin Kumar, MD Pharmacology

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