The dosage regimen is individual and depends on the indications, the patient's condition and his response to therapy. The drug is injected into / in a slow stream or drip (in acute and urgent conditions); i / m; local (in pathological education) introduction is also possible. In order to prepare a solution for intravenous drip infusion, an isotonic sodium chloride solution or 5% dextrose solution should be used.

In the acute period for various diseases and at the beginning of therapy, Dexamethasone is used in higher doses. During the day, you can enter from 4 to 20 mg of Dexamethasone 3-4 times.

Doses of the drug for children (i / m):

The dose of the drug during replacement therapy (in case of adrenal cortex insufficiency) is 0.0233 mg / kg body weight or 0.67 mg / m2 body surface area, divided into 3 doses, every 3rd day or 0.00776 - 0.01165 mg / kg body weight or 0.233 - 0.335 mg / m2 body surface area daily. For other indications, the recommended dose ranges from 0.02776 to 0.16665 mg / kg body weight or 0.833 to 5 mg / m2 body surface area every 12-24 hours.

When the effect is achieved, the dose is reduced to maintenance or until treatment is discontinued. The duration of parenteral administration is usually 3-4 days, then they switch to maintenance therapy with dexamethasone tablets.

Long-term use of high doses of the drug requires a gradual dose reduction in order to prevent the development of acute insufficiency of the adrenal cortex.

For short-term use for health reasons, the only contraindication is hypersensitivity to dexamethasone or drug components. In children, during the period of growth, GCS should be used only for absolute indications and under the particularly careful supervision of the attending physician. With caution, the drug should be prescribed for the following diseases and conditions: gastrointestinal diseases - gastric ulcer and duodenal ulcer, esophagitis, gastritis, acute or latent peptic ulcer, recently created intestinal anastomosis, ulcerative colitis with the threat of perforation or abscess formation, diverticulitis; parasitic and infectious diseases of a viral, fungal or bacterial nature (currently or recently transferred, including recent contact with a patient) - herpes simplex, herpes zoster (viremic phase), chickenpox, measles; amebiasis, strongyloidosis; systemic mycosis; active and latent tuberculosis. Application for severe infectious diseases is permissible only against the background of specific therapy. pre- and post-vaccination period (8 weeks before and 2 weeks after vaccination), lymphadenitis after BCG vaccination; immunodeficiency states (including AIDS or HIV infection); diseases of the cardiovascular system (including recent myocardial infarction - in patients with acute and subacute myocardial infarction, the spread of the necrosis focus, slowing down the formation of scar tissue and, as a result, rupture of the heart muscle is possible), severe chronic heart failure, arterial hypertension, hyperlipidemia); endocrine diseases - diabetes mellitus (including impaired carbohydrate tolerance), thyrotoxicosis, hypothyroidism, Itsenko-Cushing's disease, obesity (III-IV century) severe chronic renal and / or hepatic failure, nephrourolithiasis; hypoalbuminemia and conditions that predispose to its occurrence; systemic osteoporosis, myasthenia gravis, acute psychosis, poliomyelitis (except for the form of bulbar encephalitis), open and closed angle glaucoma; pregnancy.

Application during pregnancy and lactation:

During pregnancy (especially in the first trimester), the drug can be used only when the expected therapeutic effect outweighs the potential risk to the fetus. With prolonged therapy during pregnancy, the possibility of impaired fetal growth is not excluded. If used at the end of pregnancy, there is a risk of atrophy of the adrenal cortex in the fetus, which may require replacement therapy in the newborn. If it is necessary to treat with the drug during breastfeeding, then breastfeeding should be discontinued.

Application for violations of liver function:

Contraindication: severe chronic liver failure. Application for impaired renal function

Contraindication: severe chronic renal failure, nephrourolithiasis. Application in children In children, during the period of growth, GCS should be used only for absolute indications and under the particularly careful supervision of the attending physician.

Dexamethasone is usually well tolerated. It has low mineralocorticoid activity, i.e. its effect on water-electrolyte metabolism is small. As a rule, low and medium doses of Dexamethasone do not cause sodium and water retention in the body, increased potassium excretion. The following side effects have been described: From the endocrine system: decreased glucose tolerance, steroid diabetes mellitus or manifestation of latent diabetes mellitus, suppression of adrenal function, Itsenko-Cushing syndrome (moon face, pituitary obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, muscular) , delayed sexual development in children. From the digestive system: nausea, vomiting, pancreatitis, steroid stomach and duodenal ulcers, erosive esophagitis, gastrointestinal bleeding and perforation of the gastrointestinal tract wall, increased or decreased appetite, indigestion, flatulence, hiccups. In rare cases, an increase in the activity of hepatic transaminases and alkaline phosphatase. From the side of the cardiovascular system: arrhythmias, bradycardia (up to cardiac arrest); development (in predisposed patients) or increased severity of heart failure, changes in the electrocardiogram, characteristic of hypokalemia, increased blood pressure, hypercoagulation, thrombosis. In patients with acute and subacute myocardial infarction - the spread of the focus of necrosis, slowing down the formation of scar tissue, which can lead to rupture of the heart muscle. From the nervous system: delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increased intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, cerebellar pseudotumor, headache, convulsions. From the sensory organs: posterior subcapsular cataract, increased intraocular pressure with possible damage to the optic nerve, a tendency to develop secondary bacterial, fungal or viral eye infections, trophic changes in the cornea, exophthalmos, sudden loss of vision (with parenteral administration in the head, neck, nasal shells, scalp, possible deposition of crystals of the drug in the vessels of the eye). From the side of metabolism: increased excretion of calcium, hypocalcemia, increased body weight, negative nitrogen balance (increased protein breakdown), increased sweating. Due to mineralocorticoid activity - fluid and sodium retention (peripheral edema), hypersnatrinemia, hypokalemic syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue). On the part of the musculoskeletal system: slowing growth and ossification processes in children (premature closure of the epiphyseal growth zones), osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the humerus and femur head), rupture of muscle tendons, steroid myopathy, decreased muscle mass (atrophy). On the part of the skin and mucous membranes: delayed wound healing, petechiae, ecchymosis, thinning of the skin, hyper- or hypopigmentation, steroid acne, striae, a tendency to develop pyoderma and candidiasis. Allergic reactions: skin rash, itching, anaphylactic shock, local allergic reactions. Local for parenteral administration: burning, numbness, pain, tingling at the injection site, infection at the injection site, rarely - necrosis of surrounding tissues, scarring at the injection site; atrophy of the skin and subcutaneous tissue with intramuscular injection (injection into the deltoid muscle is especially dangerous). Others: the development or exacerbation of infections (the appearance of this side effect is promoted by jointly used immunosuppressants and vaccinations), leukocyturia, "hot flushes" of blood to the face, "withdrawal" syndrome.

Possible pharmaceutical incompatibility of dexamethasone with other intravenous injected drugs - it is recommended to administer it separately from other drugs (intravenous bolus, or through another dropper, as a second solution). When a solution of dexamethasone is mixed with heparin, a precipitate is formed.

Simultaneous administration of dexamethasone with:

inducers of hepatic microsomal enzymes (phenobarbital, rifampicin, phenytoin, theophylline, ephedrine) leads to a decrease in its concentration;

diuretics (especially thiazide and carbonic anhydrase inhibitors) and amphotericin B - can lead to increased excretion of K + from the body and an increase in the risk of developing heart failure;

with sodium-containing drugs - to the development of edema and increased blood pressure;

cardiac glycosides - their tolerance worsens and the likelihood of developing ventricular extrasitolia increases (due to hypokalemia caused);

indirect anticoagupants - weakens (less often enhances) their effect (dose adjustment is required);

anticoagulants and thrombolytics - the risk of bleeding from ulcers in the gastrointestinal tract increases;

ethanol and NSAIDs - the risk of erosive and ulcerative lesions in the gastrointestinal tract and the development of bleeding increases (in combination with NSAIDs in the treatment of arthritis, it is possible to reduce the dose of glucocorticosteroids due to the summation of the therapeutic effect);

paracetamol - the risk of hepatotoxicity increases (induction of liver enzymes and the formation of a toxic metabolite of paracetamol);

acetylsalicylic acid - accelerates its excretion and reduces the concentration in the blood (when dexamethasone is canceled, the level of salicylates in the blood increases and the risk of side effects increases);

insulin and oral hypoglycemic drugs, antihypertensive drugs - their effectiveness decreases;

vitamin D - its effect on the absorption of Ca2 + in the intestine decreases;

growth hormone - reduces the effectiveness of the latter, and with praziquantel - its concentration;

M-anticholinergics (including antihistamines and tricyclic antidepressants) and nitrates - promotes an increase in intraocular pressure;

isoniazid and mexiletine - increases their metabolism (especially in "slow" acetylators), which leads to a decrease in their plasma concentrations.

Carbonic anhydrase inhibitors and loop diuretics may increase the risk of osteoporosis.

Indomethacin, displacing dexamethasone from its association with albumin, increases the risk of developing its side effects.

ACTH enhances the effect of dexamethasone.

Ergocalciferol and parathyroid hormone prevent the development of osteopathy caused by dexamethasone.

Cyclosporine and ketoconazole, slowing down the metabolism of dexamethasone, can in some cases increase its toxicity.

The simultaneous administration of androgens and steroid anabolic drugs with dexamethasone contributes to the development of peripheral edema and hirsutism, the appearance of acne.

Estrogens and oral estrogen-containing contraceptives reduce the clearance of dexamethasone, which may be accompanied by an increase in the severity of its action.

Mitotan and other inhibitors of adrenal cortex function may necessitate an increase in the dose of dexamethasone.

When used simultaneously with live antiviral vaccines and against the background of other types of immunization, it increases the risk of virus activation and the development of infections.

Antipsychotics (neuroleptics) and azathioprine increase the risk of developing cataracts when dexamethasone is given.

With simultaneous use with antithyroid drugs, it decreases, and with thyroid hormones, the clearance of dexamethasone increases.

Storage conditions of the drug Dexamethasone

List B. Store at a temperature not exceeding 25 ° C, out of reach of children. Do not freeze.

An increase in the side effects described above is possible. It is necessary to reduce the dose of Dexamethasone.Treatment is symptomatic.