dexamethasone: clinical use

Prescribing considerations

• Clarify the formulation and indication because systemic tablets and ophthalmic suspension have distinct administration and risks.
• Assess infection and vaccination status, psychiatric history, diabetes, gastrointestinal disease, osteoporosis and glaucoma.
• Ensure patients at risk of adrenal insufficiency understand sick-day and steroid-card requirements.
• For ocular use, exclude contraindicated infection and consider benzalkonium chloride and contact lenses.

Contraindications and cautions

• Hypersensitivity to dexamethasone or formulation excipients.
• Systemic infection without appropriate anti-infective treatment for the oral product.
• For Maxidex: herpes simplex keratitis and specified viral, fungal, mycobacterial, parasitic or acute untreated bacterial eye infections.

Monitoring

• Clinical response and infection.
• Blood glucose, blood pressure, weight, electrolytes and psychiatric effects when relevant.
• Adrenal suppression and withdrawal risk during systemic treatment.
• Bone health, growth in children and ocular complications with longer systemic exposure.
• Intraocular pressure, lens and corneal integrity during extended ophthalmic treatment.

Clinical pharmacology

A synthetic, long-acting glucocorticoid with anti-inflammatory, anti-allergic and immunosuppressive activity and minimal mineralocorticoid action. It is mainly metabolised in the liver, participates in CYP3A-mediated interactions and crosses the placenta.

Formulation and product differences

• The selected standard oral tablet contains lactose.
• Maxidex is a suspension containing benzalkonium chloride; it must be shaken and may temporarily blur vision.
• Eye administration usually produces lower systemic exposure, but systemic corticosteroid effects can occur with intensive or prolonged use.

Tablet

Route: Oral

Strengths: 500 micrograms, 0.5 mg, 1 mg, 2 mg, 4 mg