DRICORT
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DRICORT (DRICORT).
Corticosteroid with predominant glucocorticoid activity; binds to glucocorticoid receptors, modulating gene expression and suppressing inflammatory mediators (e.g., prostaglandins, leukotrienes) and immune cell function.
| Metabolism | Primarily hepatic metabolism via CYP3A4; undergoes reduction, conjugation, and hydrolysis. |
| Excretion | Primarily renal (80-85% as unchanged drug and metabolites), with 15-20% excreted in feces via biliary elimination. |
| Half-life | Terminal elimination half-life is 10-12 hours in adults with normal renal function, allowing twice-daily dosing. |
| Protein binding | 90-95%, primarily bound to albumin and corticosteroid-binding globulin (CBG). |
| Volume of Distribution | 1.2-1.5 L/kg, indicating extensive tissue distribution with high intracellular penetration. |
| Bioavailability | Oral: 60-70% (due to hepatic first-pass metabolism); Intramuscular: 80-90%; Bioavailability by other routes not established. |
| Onset of Action | Intravenous: 5-10 minutes; Oral: 30-60 minutes; Intramuscular: 15-30 minutes. |
| Duration of Action | 12-24 hours, with clinical effects persisting throughout the dosing interval. |
DRICORT (dexamethasone) typical adult dose: 0.5-9 mg/day orally in divided doses every 6-12 hours, or 0.5-24 mg IV/IM once or divided. Anti-inflammatory: 0.75-9 mg/day PO/IV in 2-4 divided doses. Severe conditions: up to 16 mg/day in divided doses. Short-term high-dose: up to 40-100 mg IV push for specific indications.
| Dosage form | LOTION |
| Renal impairment | No dose adjustment required in renal impairment. Dexamethasone is primarily hepatically metabolized with less than 2% renal excretion. |
| Liver impairment | Child-Pugh A/B: No adjustment. Child-Pugh C: Consider dose reduction (e.g., reduce by 50%) due to decreased clearance; monitor for adverse effects. |
| Pediatric use | Neonates/Infants: 0.05-0.15 mg/kg/day PO/IV divided q6-12h. Children: 0.1-0.5 mg/kg/day PO/IV divided q6-12h (max 16 mg/day). Anti-inflammatory/immunosuppressive: 0.08-0.3 mg/kg/day or 2.5-10 mg/m²/day divided q6-12h. |
| Geriatric use | Elderly patients may require lower doses due to decreased hepatic function and increased susceptibility to adverse effects (e.g., hyperglycemia, osteoporosis). Start at lower end of dosing range and titrate carefully based on response and tolerability. Monitor for fluid retention and electrolyte imbalances. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DRICORT (DRICORT).
| Breastfeeding | DRICORT is excreted in breast milk in low amounts; M/P ratio not well defined. Use with caution; monitor infant for adrenal suppression if high maternal doses used. |
| Teratogenic Risk | DRICORT (a corticosteroid) is associated with increased risk of cleft lip/palate with first trimester exposure. Second/third trimester use may cause fetal adrenal suppression, intrauterine growth restriction, and oligohydramnios. Risk-benefit must be assessed. |
| Fetal Monitoring |
■ FDA Black Box Warning
No FDA black box warnings.
| Serious Effects |
["Hypersensitivity to drug or components","Untreated bacterial, fungal, or viral skin infections","Rosacea","Perioral dermatitis"]
| Precautions | ["Systemic absorption may cause reversible hypothalamic-pituitary-adrenal (HPA) axis suppression","Local and systemic infections","Skin atrophy and striae","Perioral dermatitis","Allergic contact dermatitis","Use in children may lead to growth retardation"] |
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| Monitor maternal blood glucose, blood pressure, and signs of infection. Fetal ultrasound for growth restriction, and neonatal monitoring for adrenal insufficiency after delivery. |
| Fertility Effects | High doses may disrupt menstrual cycle and ovulation, potentially reducing fertility. Effects are reversible with dose reduction. |