dexamethasone sodium phosphate: clinical use

Prescribing considerations

• Confirm the indication, route and product because licences and excipients differ.
• Assess infection risk, vaccination status, psychiatric history, diabetes, hypertension, gastrointestinal disease, osteoporosis, glaucoma and previous steroid reactions.
• Provide appropriate steroid-card and sick-day information when systemic exposure creates adrenal-suppression risk.
• Do not use ophthalmic corticosteroids for an undiagnosed red eye; treatment should be under ophthalmic supervision.

Contraindications and cautions

• Hypersensitivity to dexamethasone sodium phosphate or product excipients.
• Systemic infection without appropriate anti-infective treatment; selected oral products also list systemic fungal, parasitic or tropical-worm infection and peptic ulceration.
• Local injection with bacteraemia, systemic fungal infection, an infected injection site or an unstable joint.
• Uncontrolled eye infection, incompletely healed corneal ulceration, perforation or injury, and known corticosteroid-induced ocular hypertension.

Monitoring

• Clinical response and signs of infection or impaired wound healing.
• Blood glucose, blood pressure, weight, fluid status and electrolytes where clinically relevant.
• Mood, behaviour, sleep and symptoms of adrenal suppression.
• Bone health and growth during prolonged systemic treatment.
• Eye pressure, lens and corneal integrity during ophthalmic treatment or if systemic treatment causes visual symptoms.
• Tumour-lysis risk in susceptible haematological malignancy.

Clinical pharmacology

A water-soluble phosphate ester rapidly hydrolysed to dexamethasone. The active glucocorticoid regulates glucocorticoid-responsive genes, producing prolonged anti-inflammatory and immunosuppressive effects with little mineralocorticoid activity.

Formulation and product differences

• Injection supports intravenous, intramuscular and selected local administration when oral treatment is unsuitable.
• Oral liquids differ in concentration, suitability for children or feeding tubes, measuring devices and excipients.
• Soluble tablets are dissolved in water and may contain clinically relevant sodium and colouring agents.
• Selected preservative-free eye drops come in single-dose containers or a multidose bottle. Both contain phosphate and require specialist supervision.

Eye drops

Route: Ophthalmic

Strengths: 1 mg/mL, 0.1% w/v

Oral solution

Route: Oral

Strengths: 2 mg/5 mL, 10 mg/5 mL, 20 mg/5 mL