Several theories on the mechanism of dexamethasone in infertility exist. One theory is that dexamethasone enhances folliculogenesis by suppressing adrenal androgen hypersecretion, which should augment the actions of clomiphene. Dexamethasone may increase FSH concentrations thereby facilitating folliculogenesis. If PONV prophylaxis was either inadequate or not initially given, dexamethasone is an appropriate rescue treatment option if not initially used for PONV prophylaxis.
Of note, the 5-HT3 antagonists are the only class of drugs that have been adequately studied for the treatment of established PONV. Some studies suggest that 8 mg IV is associated with a dose-dependent increase in quality of recovery, including reduced fatigue, postoperative pain, and need for opioid analgesia; however, further confirmation is necessary before larger doses are universally recommend.
For patients with labile glucose control, dexamethasone use is relatively contraindicated. A lower dose of 0. Due to the lack of consistent efficacy data and the high risk of adverse effects, the American Academy of Pediatrics does not recommend systemic corticosteroids for the management of bronchiolitis in any setting.
However, other authors state corticosteroids may be beneficial in severely ill or mechanically ventilated patients. Dexamethasone in combination with nebulized epinephrine was effective in reducing hospital admissions by day 7 of illness compared to treatment with dexamethasone alone, epinephrine alone, or placebo.
In a study of infants median age 3. In infants receiving dexamethasone with salbutamol, the time to readiness for discharge was Bortezomib was given as follows: 1. All patients received premedication with acetaminophen 1, mg PO and diphenhydramine 50 mg IV prior to rituximab and herpes zoster prophylaxis with valacyclovir or acyclovir. Dexamethasone in combination with lenalidomide 15 mg PO daily on days 1 to 21 and cyclophosphamide repeated every 28 days has been evaluated in nonrandomized, phase II studies.
Patients with cardiac stage III had an upfront dose modification of dexamethasone. In one study, melphalan 0. Patients were evaluated for response after 3 and 6 cycles of therapy; patients with a partial response PR or better after cycle 3 received an additional 3 cycles of therapy. Patients with a complete response CR or a PR and organ response stopped treatment after cycle 6. The dose of dexamethasone was reduced to 20 mg in patients older than 70 years or who had a body mass index less than Daratumumab; hyaluronidase was administered as follows: 1, mg daratumumab and 30, units hyaluronidase subcutaneously weekly on weeks 1 to 8 8 doses , 1, mg daratumumab and 30, units hyaluronidase every 2 weeks on weeks 9 to 24 8 doses , and then 1, mg daratumumab and 30, units hyaluronidase every 4 weeks starting on week 25 until disease progression or for a maximum of 2 years.
Dosage must be individualized and is highly variable depending on the nature and severity of the disease, route of dexamethasone treatment, and on patient response. Systemic dosage may need adjustment depending on the degree of hepatic insufficiency, but quantitative recommendations are not available. Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. Administer with food to minimize GI upset.
If given once daily, give in the morning to coincide with the body's normal cortisol secretion. Measure the appropriate dose, using only the calibrated dropper provided with product. Mix the dose with liquid or semi-solid food such as water, juice, soda, applesauce, or pudding and stir the preparation for a few seconds. Consume the entire mixture immediately; do not store for future use.
Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. Some injectable formulations contain benzyl alcohol; avoid the use of these formulations in premature neonates, and use with caution in neonates. Use diluted solutions within 24 hours, as infusion solutions generally do not contain preservatives. Only clinicians familiar with these methods of administration and with management of potential complications should administer dexamethasone by these routes.
Frequent intra-articular injections may result in damage to joint tissues. Dexamethasone sodium phosphate injection is particularly recommended for use in conjunction with one of the less soluble, longer-acting steroids for intra-articular and soft tissue injection. Ophthalmic solution or suspension: Apply ophthalmic solution or suspension topically to the eye.
For ophthalmic suspensions, shake well prior to each administration. Instruct patient on appropriate instillation technique. Do not to touch the tip of the dropper or tube to the eye, fingertips, or other surfaces. To prevent contamination, each dropper is for one individual, do not share among patients. Dexycu Intraocular Suspension Preparation of intraocular suspension: Prepare a sterile field.
Remove the components of the administration kit from their respective pouches and place onto the sterile field. 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. Place the 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. Mix using a vortex mixer or vigorously shake the vial sideways for a minimum of 30 seconds; the suspended drug material must be used immediately after shaking.
Remove the blue plastic flip-cap from the vial and wipe the top of the rubber stopper with an alcohol pad. Invert the vial. 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.
Remove the needle from the vial and discard the unused portion in the vial. 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 the syringe. Affix the syringe guide over the syringe ring on the plunger. Do not wipe or touch the tip of the cannula to remove excess drug.
Remove the syringe guide, leaving the syringe ring in place. 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. If the sphere of the 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.
Some drug material will remain in the syringe after the injection; this is necessary for accurate dosing. Discard the unused portion remaining in the syringe after administration. Do not re-sterilize. Carefully remove foam carrier and transfer to a clean and dry area. If necessary, dilate the punctum with an ophthalmic dilator. Care should be taken not to perforate the canaliculus during dilation or placement of the insert.
If perforation occurs, do not place the insert in the eye. After drying the punctal area, using blunt non-toothed forceps, grasp the insert and place into the lower lacrimal canaliculus by pulling the lid temporally and inserting nasally. Ensure the insert is placed just below the punctal opening. Excessive squeezing of the insert with forceps may cause deformation.
To aid in the hydration of the insert, 1 to 2 drops of balanced salt solution can be instilled into the punctum. The insert hydrates quickly upon contact with moisture. If the insert begins to hydrate before fully inserted, discard the product and use a new insert.
The insert can be visualized when illuminated by a blue light source e. Insert is resorbable; removal not required. Otic Administration of Ophthalmic Solution: Clean the ear canal thoroughly and sponge dry prior to administration. Instill the solution directly into the ear canal. Alternatively, a gauze wick may be saturated with solution and packed into the ear canal. Keep the gauze wick moist with solution and remove from ear after 12 to 24 hours. Intravitreal Implant Administration Intravitreal implantation should be performed only by surgeons who have observed or assisted in surgical implantation of the implant.
Consult specialized instructions regarding insertion of the implant. Administer via intravitreal injection with the provided single-use plastic applicator. Use controlled aseptic conditions, which include the use of sterile gloves, a sterile drape, and a sterile eyelid speculum or equivalent. Use each applicator for a single treatment only. If the contralateral eye requires treatment, a new applicator must be used and the sterile field should be changed.
After the intravitreal injection, monitor patients for elevation in intraocular pressure and for endophthalmitis. Monitoring may consist of a check for reperfusion of the optic nerve head immediately after the injection, tonometry within 30 minutes after the injection, and biomicroscopy 2 to 7 days after the injection. Instruct patients to promptly report any symptoms suggestive of endophthalmitis. Do not store for later use. Epidural administration of corticosteroids should be used with great caution.
Rare, but serious adverse reactions, including cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been associated with epidural administration of injectable corticosteroids.
These events have been reported with and without the use of fluoroscopy. Many cases were temporally associated with the corticosteroid injection; reactions occurred within minutes to 48 hours after injection. Some cases of neurologic events were confirmed through magnetic resonance imaging MRI or computed tomography CT scan.
Many patients did not recover from the reported adverse effects. Discuss the benefits and risks of epidural corticosteroid injections with the patient before treatment. If a decision is made to proceed with corticosteroid epidural administration, counsel patients to seek emergency medical attention if they experience symptoms after injection such as vision changes, tingling in the arms or legs, dizziness, severe headache, seizures, or sudden weakness or numbness of face, arm, or leg.
Dexamethasone is contraindicated in patients with a hypersensitivity to the drug or any of its components. Although true corticosteroid hypersensitivity is rare, it is possible, though also rare, that such patients will display cross-hypersensitivity to other corticosteroids.
It is advisable that patients who have a hypersensitivity reaction to any corticosteroid undergo skin testing, which, although not a conclusive predictor, may help to determine if hypersensitivity to another corticosteroid exists. Such patients should be carefully monitored during and following the administration of any corticosteroid. Acute adrenal insufficiency and even death may occur following abrupt discontinuation of systemic therapy.
In addition, a withdrawal syndrome unrelated to adrenocortical insufficiency may occur following sudden discontinuation of corticosteroid therapy. These effects are thought to be due to the sudden change in glucocorticoid concentration rather than to low corticosteroid concentrations. Withdraw prolonged systemic corticosteroid therapy duration of treatment of more than 2 weeks gradually.
HPA suppression can last for up to 12 months following cessation of systemic therapy. Recovery of HPA axis function is generally prompt and complete upon discontinuation of the topical corticosteroid. HPA-suppressed patients may need supplemental corticosteroid treatment during periods of physiologic stress, such as post-surgical stress, acute blood loss, or infectious conditions, even after the corticosteroid has been discontinued.
Encourage patients currently receiving chronic corticosteroid therapy or who have had corticosteroids discontinued within the last 12 months to carry identification advising the need for administration of corticosteroids in situations of increased stress.
Potential adverse effects of chronic corticosteroid therapy should be weighed against the clinical benefits obtained and the availability of other treatment alternatives. Prolonged systemic corticosteroid therapy can lead to osteopenia, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, and pathologic fractures of long bones secondary to decreased bone formation, increased bone resorption, and protein catabolism in any patient.
A high-protein diet may alleviate or prevent the adverse effects associated with protein catabolism. The elderly, post-menopausal, and pediatric patients may be more susceptible to the effects on bone.
Chronic systemic dexamethasone therapy may cause growth inhibition in pediatric patients due to hypothalamic-pituitary-adrenal axis suppression and inhibition of bone growth. Corticosteroids should be titrated to the lowest effective dose. Because bone development is critical in pediatric patients, monitoring is warranted in patients receiving high-dose or chronic corticosteroid treatment.
Use of the lowest effective dose is recommended to minimize the occurrence of systemic adverse effects. Monitor growth routinely. Patients receiving high-dose e. Treatment with topical or inhaled corticosteroids lessens the risk of immunosuppression; although localized effects may be seen in some patients. When given in combination with other immunosuppressive agents, there is a risk of over-immunosuppression.
Intra-articularly injected corticosteroids are systemically absorbed and may cause immunosuppression. Advise patients to contact their health care provider if they develop fever or other signs or symptoms of an infectious process.
Local injection of a corticosteroid into a previously infected joint is not usually recommended. Examine any joint fluid to exclude a septic process. Injection into unstable joints is generally not recommended. If surgery is required, patients should advise their physician that they received prolonged systemic corticosteroid therapy, such as dexamethasone, within the last 12 months and state the disease for which they were being treated.
For systemic therapy, identification cards that include disease state, type and dose of corticosteroid, and physician should always be carried with the patient. Long-acting dexamethasone injection preparations, which are no longer marketed in the U. To avoid drug-induced adrenal insufficiency, a supportive corticosteroid dosage may be required in times of stress such as trauma, surgery, or severe illness both during treatment with these injections and for a year afterward.
Corticosteroids may increase the risks related to infections with any pathogen, including viral, bacterial, fungal, protozoan, or helminth infection. The degree to which the dose, route, and duration of corticosteroid administration correlate with the specific risks of infection is not well characterized, however, with increasing doses of corticosteroids, the rate of occurrence of infectious complications increases. Corticosteroids may also mask some signs of current infection.
Although the FDA-approved product labeling states that corticosteroids are contraindicated in patients with systemic fungal infections, most clinicians believe that systemic corticosteroids can be administered to these patients as long as appropriate therapy is administered simultaneously. Avoid the use of dexamethasone in patients with a fungal infection or bacterial infection that is not adequately controlled with anti-infective agents.
This is to make sure the steroid is not affecting their growth. Talk to their doctor if you're worried. They will be able to explain the benefits and risks of giving your child dexamethasone. Do not stop taking dexamethasone suddenly, especially if you have been on a high dose for a long time. Your health condition may flare up again. You may also get extra side effects including:. Your doctor will probably want to reduce your dose gradually over several weeks to prevent these side effects.
Do not stop taking dexamethasone without talking to your doctor. You will need to reduce your dose gradually. Some vaccines are not suitable for you while you are taking dexamethasone.
Taking dexamethasone lowers your immune system. If you have a "live" vaccine, like the shingles vaccine, while you are taking dexamethasone your immune system might not be able to handle it. This may lead to an infection. If you take dexamethasone for longer than 3 weeks, or you take more than 6mg a day, your doctor or pharmacist will give you a blue steroid treatment card.
The card is the size of a credit card and fits in your wallet or purse. It tells you how you can reduce the risks of side effects. It also gives details of your doctor, how much dexamethasone you take and how long the treatment will last for. If you need any medical or dental treatment, show your blue steroid card to the doctor or dentist so they know that you are taking dexamethasone. However, more severe mood changes and mental health problems may be more likely if you take a higher dose 6mg or more.
Taking dexamethasone makes you more likely to catch infections such as flu , the common cold and chest infections. Keep away from people with an infectious disease, especially measles , chickenpox or shingles. If you get any of these illnesses they could make you very ill. There's no clear evidence to suggest that taking dexamethasone will reduce fertility in either men or women.
However, speak to a pharmacist or your doctor if you're trying to get pregnant. Dexamethasone will not affect contraception, including the combined pill or emergency contraception. Dexamethasone does not make you sleepy and so it's usually safe to drive or ride a bike while taking this medicine.
However, do not drive, cycle or operate machinery if your eyesight is affected. Page last reviewed: 4 August Next review due: 4 August Dexamethasone tablets and liquid - Brand names: Neofordex, Glensoludex, Martapan On this page About dexamethasone tablets and liquid Key facts Who can and cannot use dexamethasone tablets and liquid How and when to take dexamethasone Side effects How to cope with side effects of dexamethasone Pregnancy and breastfeeding Cautions with other medicines Common questions about dexamethasone.
About dexamethasone tablets and liquid Dexamethasone is a medicine used to treat a wide range of health conditions. These include: severe skin conditions severe allergies anaphylaxis sickness nausea and vomiting croup swelling inflammation in your eye autoimmune conditions, such as lupus It's used in hospitals as a treatment for severe cases of COVID coronavirus and other serious infections.
It also comes as drops and a spray to treat ear and eye infections. NHS coronavirus advice As long as you have no symptoms of coronavirus infection, carry on taking your prescribed steroid medicine as usual. Updated: 20 March Help us improve our website Can you answer a quick question about your visit today? You usually take dexamethasone tablets or liquid once a day. It's best to take it in the morning so it does not affect your sleep.
The most common side effects are sleep problems, mood changes, indigestion and weight gain. Tell your doctor if you come into contact with anyone who has measles , chickenpox or shingles while you're taking dexamethasone.
If you take dexamethasone for more than 3 weeks, or take more than 6mg a day, you'll get a blue steroid card. Keep this with you at all times. Most adults and children including babies can take dexamethasone. Tell your doctor before starting on this medicine if: you have ever had an allergic reaction to dexamethasone or any other medicine in the past you have recently been in contact with someone with shingles , chickenpox or measles you have an infection or any unhealed wounds you have liver or kidney problems you have ever had mental health problems or a close family member has you have ever had tuberculosis TB you have high blood pressure , heart failure or recently had a heart attack you have diabetes you have epilepsy you have glaucoma you have an underactive thyroid you have osteoporosis thinning bones you have a stomach ulcer you have myasthenia gravis , a rare condition that causes muscle weakness you have recently had vaccinations, or are due to have vaccinations you're pregnant, trying to get pregnant or breastfeeding.
Always follow your doctor's instructions when taking this medicine. Dosage Adults — you'll usually take between 0. For treating croup, your child will usually have a single one-off dose. How often to take it You'll usually take dexamethasone once a day. Will my dose go up or down? What if I forget to take it? Do not take a double dose to make up for a forgotten one.
What if I take too much? Why is this medication prescribed? How should this medicine be used? Other uses for this medicine What special precautions should I follow? What special dietary instructions should I follow? What side effects can this medication cause? What should I know about storage and disposal of this medication? Brand names. Other uses for this medicine. What special precautions should I follow? Before receiving dexamethasone injection, tell your doctor and pharmacist if you are allergic to dexamethasone, any other medications, benzyl alcohol, or any of the ingredients in dexamethasone injection.
Ask your pharmacist for a list of the ingredients. Be sure to mention any of the following: amphotericin B Abelcet, Ambisome, Amphotec ; anticoagulants 'blood thinners' such as warfarin Coumadin, Jantoven ; aspirin and other nonsteroidal anti-inflammatory drugs NSAIDs such as ibuprofen Advil, Motrin and naproxen Aleve, Naprosyn and selective COX-2 inhibitors such as celecoxib Celebrex ; medications for diabetes including insulin; diuretics 'water pills' ; ephedrine; phenobarbital; phenytoin Dilantin, Phenytek ; and rifampin Rifadin, Rimactane, in Rifamate, in Rifater.
Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Your doctor will probably tell you not to use dexamethasone injection. Also tell your doctor if you have any type of untreated bacterial, parasitic, or viral infection anywhere in your body or a herpes eye infection a type of infection that causes a sore on the eyelid or eye surface.
If you become pregnant while receiving dexamethasone injection, call your doctor. Stay away from people who are sick and wash your hands often while you are using this medication.
Be sure to avoid people who have chicken pox or measles. Consult your doctor before breast- feeding. Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Do not start, stop, or change the dosage of any medicines without your doctor's approval. This medication can speed up the removal of other medications from your body, which may affect how they work.
Examples of affected drugs include certain cancer drugs such as dasatinib, lapatinib, sunitinib , praziquantel, rilpivirine, among others. If your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention usually at dosages of milligrams a day , you should continue taking it unless your doctor instructs you otherwise.
Ask your doctor or pharmacist for more details. This medication may interfere with certain lab tests including skin tests , possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call Otherwise, call a poison control center right away. US residents can call their local poison control center at Canada residents can call a provincial poison control center.
Keep all medical and lab appointments. Consult your doctor for more details. This medication may cause bone problems osteoporosis when used for an extended time. Lifestyle changes that may help reduce the risk of bone problems include doing weight-bearing exercise, getting enough calcium and vitamin D, stopping smoking, and limiting alcohol. Discuss with your doctor lifestyle changes that might benefit you. If you miss a dose, use it as soon as you remember.
If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up. Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed.
Consult your pharmacist or local waste disposal company. Your condition can cause complications in a medical emergency.
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