DECADRON
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DECADRON (DECADRON).
Dexamethasone is a glucocorticoid receptor agonist, binding to the glucocorticoid receptor and modulating gene expression to produce anti-inflammatory and immunosuppressive effects. It also suppresses adrenal function by inhibiting ACTH secretion.
| Metabolism | Primarily hepatic via cytochrome P450 3A4 (CYP3A4) to inactive metabolites. Minimal renal excretion of unchanged drug. |
| Excretion | Renal (65-80% as 17-hydroxycorticosteroids and 20-hydroxycorticosteroids after hepatic metabolism); biliary/fecal (minor, <10%) |
| Half-life | Terminal half-life: 3-4 hours (plasma); biological half-life: 36-54 hours (due to intracellular receptor binding); clinical context: duration of HPA axis suppression longer than plasma half-life |
| Protein binding | 70-80% bound; primarily to corticosteroid-binding globulin (CBG) and albumin |
| Volume of Distribution | 0.5-1.0 L/kg; clinical meaning: distributes widely into tissues, including CNS (crosses blood-brain barrier) |
| Bioavailability | Oral: 60-70%; IM: 100%; IV: 100% |
| Onset of Action | Oral: 1-2 hours; IV: rapid (minutes); IM: 1-2 hours; topical: variable (hours to days) |
| Duration of Action | Single dose: 1-3 days (biological effects); clinical notes: duration depends on dose, route, and underlying condition; HPA axis suppression may persist for weeks after chronic therapy |
| Action Class | Glucocorticoids |
| Brand Substitutes | DEXAMETHASONE Tablet, Methasone Tablet, Decakem Tablet, Dexomet Tablet |
0.75-9 mg/day orally in divided doses every 6-12 hours; or 0.5-9 mg/day IM/IV in divided doses every 12 hours for acute conditions; for cerebral edema, IV loading dose of 10 mg followed by 4 mg IM/IV every 6 hours.
| Dosage form | TABLET |
| Renal impairment | No dose adjustment required for GFR <15-90 mL/min; no specific guideline for dialysis; use with caution in severe renal impairment. |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: reduce by 50%; Child-Pugh C: reduce by 75% or consider alternative. |
| Pediatric use | 0.02-0.3 mg/kg/day or 0.6-9 mg/m²/day orally in divided doses every 6-12 hours; for cerebral edema, IV 0.1-0.5 mg/kg/day divided every 6 hours. |
| Geriatric use | Start at lowest effective dose due to increased risk of osteoporosis and hyperglycemia; monitor for fluid retention and delirium; dose based on severity of condition and renal/hepatic function. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DECADRON (DECADRON).
| Breastfeeding | Enters breast milk; M/P ratio approximately 0.8. Doses up to 20 mg/day considered compatible with breastfeeding, but monitor infant for adrenal suppression (e.g., poor weight gain, lethargy). Avoid high-dose or prolonged therapy; delay feeding 3-4 hours after dose. |
| Teratogenic Risk | First trimester: Increased risk of cleft palate (OR 3.4) with systemic use; avoid unless life-threatening. Second/third trimesters: Risk of fetal adrenal suppression, intrauterine growth restriction (IUGR), and preterm delivery; use lowest effective dose. Category C (no adequate studies); favors risk of orofacial clefts and oligohydramnios. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Systemic fungal infections","Hypersensitivity to dexamethasone or any component","Administration of live or live-attenuated vaccines (relative)","Idiopathic thrombocytopenic purpura (IM administration)"]
| Precautions | ["Increased risk of infections due to immunosuppression","Adrenal suppression with prolonged use; taper dose to avoid withdrawal","Osteoporosis with long-term use","Gastrointestinal perforation or bleeding","Hyperglycemia and diabetes mellitus exacerbation","Psychiatric disturbances (e.g., euphoria, psychosis)","Kaposi sarcoma (rare)","Ocular effects (cataracts, glaucoma)"] |
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| Fetal Monitoring | Monitor maternal blood glucose (steroid-induced hyperglycemia), blood pressure (hypertension), and signs of infection. Fetal: serial ultrasound for growth restriction (IUGR) and amniotic fluid volume; fetal heart rate monitoring if preterm labor risk. Neonatal: assess for adrenal insufficiency if prolonged maternal use. |
| Fertility Effects | May suppress endogenous gonadotropins and hypothalamic-pituitary-adrenal axis, potentially delaying ovulation or spermatogenesis. High doses can cause menstrual irregularities; impact reversible upon discontinuation. |