dexamethasone: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
dexamethasone: clinical details
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.
dexamethasone preparations and strengths
Tablet
Route: Oral
Strengths: 500 micrograms, 0.5 mg, 1 mg, 2 mg, 4 mg
dexamethasone interactions
Tell the prescriber or pharmacist about all medicines, vaccines and supplements. Important examples include:
Ritonavir, cobicistat and other strong CYP3A inhibitors
May increase dexamethasone exposure and systemic corticosteroid effects.
Rifampicin, rifabutin and enzyme-inducing antiseizure medicines
May reduce dexamethasone’s clinical effect.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.