DECADRON W/ XYLOCAINE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DECADRON W/ XYLOCAINE (DECADRON W/ XYLOCAINE).
Dexamethasone is a corticosteroid that binds to glucocorticoid receptors, modulating gene expression to reduce inflammation and immune response. Lidocaine is a sodium channel blocker that stabilizes neuronal membranes, inhibiting nerve impulse initiation and conduction, producing local anesthesia.
| Metabolism | Dexamethasone is primarily metabolized by CYP3A4. Lidocaine is extensively metabolized by CYP1A2 and CYP3A4 to active metabolites (MEGX, GX). |
| Excretion | Dexamethasone: Renal (~65% as metabolites, <10% unchanged); Biliary/Fecal (<35%). Lidocaine: Hepatic metabolism to MEGX; Renal (<10% unchanged). |
| Half-life | Dexamethasone: 3-4 hours (short-acting steroid). Lidocaine: 1.5-2 hours (prolonged in heart failure/hepatic disease). |
| Protein binding | Dexamethasone: 77%, primarily albumin. Lidocaine: 60-80%, alpha-1-acid glycoprotein. |
| Volume of Distribution | Dexamethasone: 0.8-1.0 L/kg (distributes widely). Lidocaine: 1.1-1.6 L/kg (increased in hepatic disease). |
| Bioavailability | Dexamethasone: Oral: 80-90%; IM: 100%. Lidocaine: Oral: <35% (first-pass); Epidural: 100%. |
| Onset of Action | Dexamethasone: IV: rapid (hours); IM: 1-2 hours. Lidocaine: Epidural: 5-15 min; Subcutaneous: 3-5 min. |
| Duration of Action | Dexamethasone: 24-72 hours (suppression of adrenal axis). Lidocaine: Epidural: 60-90 min; Subcutaneous: 30-60 min. |
| Molecular Weight | Dexamethasone: 392.46 Da; Lidocaine: 234.34 Da |
Not a standard pre-mixed combination; individual components dosed separately. Dexamethasone: 0.5-9 mg/day oral/IV divided every 6-12h. Lidocaine: 1-5 mg/kg IV bolus (max 300 mg), then 1-4 mg/min IV infusion; or local infiltration up to 4.5 mg/kg (max 300 mg) with epinephrine.
| Dosage form | INJECTABLE |
| Renal impairment | Dexamethasone: No adjustment. Lidocaine: GFR <10 mL/min: reduce dose by 25-50% or avoid continuous infusion; monitor for toxicity. |
| Liver impairment | Dexamethasone: No adjustment. Lidocaine: Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: contraindicated or use with extreme caution, reduce dose by 75%. |
| Pediatric use | Dexamethasone: 0.08-0.3 mg/kg/day oral/IV divided every 6-12h (max 16 mg/day). Lidocaine: 1-1.5 mg/kg IV bolus (max 100 mg), then 20-50 mcg/kg/min IV infusion; or local infiltration 4.5 mg/kg (max 300 mg) with epinephrine. |
| Geriatric use | Dexamethasone: Start at lowest adult dose; monitor for fluid retention and hyperglycemia. Lidocaine: Reduce bolus dose (e.g., 0.5-1 mg/kg) and infusion rate (e.g., 1-2 mg/min); monitor for neurotoxicity and cardiac depression. |
| 1st trimester | Avoid in first trimester unless essential; corticosteroid and lidocaine combination may be associated with increased risk of oral clefts and other malformations based on animal and limited human data; consider alternative agents if possible. |
| 2nd trimester | Use only if clearly needed; corticosteroids may increase risk of growth restriction and adrenal suppression; lidocaine is generally considered safe in obstetric procedures but systemic exposure should be minimized. |
| 3rd trimester | Use with caution near term; corticosteroids can cause fetal adrenal suppression and growth retardation; lidocaine may cause CNS depression in neonate if used in high doses or near delivery. |
Clinical note
Comprehensive clinical and safety monograph for DECADRON W/ XYLOCAINE (DECADRON W/ XYLOCAINE).
| Placental transfer | Both compounds cross the placenta. Dexamethasone is extensively metabolized by placental 11β-HSD2 to inactive metabolites, reducing fetal exposure but significant transfer still occurs (fetal:maternal ratio ~0.6-0.7). Lidocaine crosses readily with fetal:maternal ratio ~0.5-0.8, especially in acidotic conditions. |
■ FDA Black Box Warning
Not for intravenous or spinal administration. Lidocaine formulations containing preservatives (e.g., methylparaben) are contraindicated for epidural or intrathecal use due to risk of neurotoxicity.
| Serious Effects |
Systemic fungal infectionsKnown hypersensitivity to dexamethasone, lidocaine, or any component of the formulationAdministration in children under 2 years of age (due to lidocaine content and risk of toxicity)Severe hypertensionUncontrolled diabetes mellitusGlaucoma (especially primary open-angle)Active tuberculosis or other untreated infectionsPregnancy (first trimester unless essential) - relative but often listed as absolute for combination
| Precautions | Avoid inadvertent intravascular injection (may cause cardiac arrest). Use caution in patients with hepatic impairment, severe hypertension, or diabetes. Prolonged use may lead to adrenal suppression, Cushing's syndrome, or osteoporosis. |
| Food/Dietary | No significant food interactions. However, dexamethasone may increase appetite and cause fluid retention; patients with hypertension or heart failure should limit sodium intake. Grapefruit juice may increase dexamethasone levels slightly, but not clinically relevant with single injection. |
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| Breastfeeding | Both dexamethasone and lidocaine are excreted into breast milk in small amounts. Dexamethasone concentrations are low and considered compatible with breastfeeding. Lidocaine has low oral bioavailability, so infant exposure is minimal. However, due to the combination product, avoid use in breastfeeding unless clearly needed and monitor infant for signs of sedation or adrenal suppression. |
| Lactation Rating | L2 (Safer) |
| Teratogenic Risk | First trimester: Increased risk of orofacial clefts (odds ratio 1.3-3.3) with systemic corticosteroids. Second/third trimesters: Possible fetal adrenal suppression, intrauterine growth restriction, and premature rupture of membranes. Lidocaine crosses placenta but not teratogenic at clinical doses. |
| Fetal Monitoring | Maternal: Blood glucose, blood pressure, signs of infection, bone density with prolonged use. Fetal/neonatal: Serial ultrasound for growth restriction; monitor for neonatal hypoglycemia, adrenal insufficiency, and cardiac arrhythmias if lidocaine used near term. |
| Fertility Effects | Dexamethasone may suppress endogenous steroid production, potentially affecting menstrual regularity and ovulation. Lidocaine has no known effect on fertility. High-dose or chronic use may impair gamete function. |
| Clinical Pearls | Dexamethasone and lidocaine combination for injectable use. Dexamethasone is a potent, long-acting corticosteroid with minimal mineralocorticoid activity; lidocaine provides local anesthesia. Onset of analgesic effect from lidocaine is immediate (1-2 minutes), lasting 1-2 hours; anti-inflammatory effect from dexamethasone begins within hours and lasts days. Do not inject into infected or unstable joints. Avoid intra-articular injection if joint instability or septic arthritis is suspected. Use with caution in patients with bleeding diathesis or on anticoagulants. Maximum single dose of lidocaine with epinephrine is 7 mg/kg; without epinephrine, 4.5 mg/kg. Dexamethasone may cause tendon rupture with repeated injections. Not for intravenous or epidural use. Contraindicated in systemic fungal infections and in patients with known hypersensitivity to components. |
| Patient Advice | This medication is a combination of a corticosteroid and a local anesthetic, used to reduce inflammation and provide immediate pain relief when injected into a joint or soft tissue. · You may experience temporary pain or swelling at the injection site; apply ice if needed. · Avoid strenuous activity or overuse of the injected joint for at least 48 hours to allow the medication to work and prevent injury. · Contact your doctor if you have signs of infection: increasing pain, redness, warmth, or fever. · Do not receive live vaccines while on this treatment; report any infections or illness to your doctor. · Tell your doctor if you have diabetes, as dexamethasone may increase blood sugar levels. · This injection is for local use only; do not use it for self-medication or repeated injections without medical advice. |