In this article you can find instructions for use medicinal product Dexamethasone. Feedback from site visitors - consumers - is presented of this medicine, as well as the opinions of specialist doctors on the use of Dexamethasone in their practice. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Dexamethasone analogues in the presence of existing structural analogues. Use for the treatment of inflammatory and systemic diseases, including the eyes, in adults, children, as well as during pregnancy and lactation.

Dexamethasone- synthetic glucocorticosteroid (GCS), a methylated derivative of fluoroprednisolone. It has anti-inflammatory, antiallergic, immunosuppressive effects, increases the sensitivity of beta-adrenergic receptors to endogenous catecholamines.

Interacts with specific cytoplasmic receptors (receptors for GCS are present in all tissues, especially in the liver) to form a complex that induces the formation of proteins (including enzymes that regulate vital processes in cells.)

Protein metabolism: reduces the amount of globulins in plasma, increases albumin synthesis in the liver and kidneys (with an increase in the albumin/globulin ratio), reduces synthesis and increases protein catabolism in muscle tissue.

Lipid metabolism: increases the synthesis of higher fatty acids and triglycerides, redistributes fat (fat accumulation occurs mainly in the shoulder girdle, face, abdomen), leads to the development of hypercholesterolemia.

Carbohydrate metabolism: increases the absorption of carbohydrates from the gastrointestinal tract; increases the activity of glucose-6-phosphatase (increasing the flow of glucose from the liver into the blood); increases the activity of phosphoenolpyruvate carboxylase and the synthesis of aminotransferases (activation of gluconeogenesis); promotes the development of hyperglycemia.

Water-electrolyte metabolism: retains Na+ and water in the body, stimulates the excretion of K+ (mineralocorticoid activity), reduces the absorption of Ca+ from the gastrointestinal tract, reduces bone mineralization.

The anti-inflammatory effect is associated with inhibition of the release of inflammatory mediators by eosinophils and mast cells; inducing the formation of lipocortins and reducing the number of mast cells producing hyaluronic acid; with a decrease in capillary permeability; stabilization of cell membranes (especially lysosomal) and organelle membranes. Acts on all stages of the inflammatory process: inhibits the synthesis of prostaglandins (Pg) at the level of arachidonic acid (lipocortin inhibits phospholipase A2, suppresses the liberation of arachidonic acid and inhibits the biosynthesis of endoperoxides, leukotrienes, which contribute to inflammation, allergies, etc.), the synthesis of “proinflammatory cytokines” ( interleukin 1, tumor necrosis factor alpha, etc.); increases the resistance of the cell membrane to the action of various damaging factors.

The immunosuppressive effect is caused by the involution of lymphoid tissue, inhibition of the proliferation of lymphocytes (especially T-lymphocytes), suppression of the migration of B cells and the interaction of T and B lymphocytes, inhibition of the release of cytokines (interleukin-1, 2; interferon gamma) from lymphocytes and macrophages and decreased antibody formation.

The antiallergic effect develops as a result of a decrease in the synthesis and secretion of allergy mediators, inhibition of the release of histamine and other biologically active substances from sensitized mast cells and basophils, a decrease in the number of circulating basophils, T- and B-lymphocytes, mast cells; suppressing the development of lymphoid and connective tissue, reducing the sensitivity of effector cells to allergy mediators, inhibiting antibody formation, changing the body's immune response.

For obstructive diseases respiratory tract the effect is due mainly to inhibition of inflammatory processes, prevention or reduction of the severity of edema of the mucous membranes, reduction of eosinophilic infiltration of the submucosal layer of the bronchial epithelium and deposition of circulating substances in the bronchial mucosa immune complexes, as well as inhibition of erosion and desquamation of the mucosa. Increases the sensitivity of beta-adrenergic receptors of small and medium-sized bronchi to endogenous catecholamines and exogenous sympathomimetics, reduces the viscosity of mucus by reducing its production.

Suppresses the synthesis and secretion of ACTH and, secondarily, the synthesis of endogenous corticosteroids.

Inhibits connective tissue reactions during the inflammatory process and reduces the possibility of scar tissue formation.

The peculiarity of the action is significant inhibition of pituitary function and the almost complete absence of mineralocorticosteroid activity.

Doses of 1-1.5 mg per day inhibit the function of the adrenal cortex; biological half-life - 32-72 hours (duration of inhibition of the hypothalamus-pituitary-adrenal cortex system).

In terms of the strength of glucocorticoid activity, 0.5 mg of dexamethasone corresponds to approximately 3.5 mg of prednisone (or prednisolone), 15 mg of hydrocortisone or 17.5 mg of cortisone.

Pharmacokinetics

Easily passes through histohematic barriers (including blood-brain and placental). Metabolized in the liver (mainly by conjugation with glucuronic and sulfuric acids) to inactive metabolites. Excreted by the kidneys (a small part by the lactating glands).

Indications

Diseases requiring the administration of fast-acting corticosteroids, as well as cases when oral administration of the drug is impossible:

• endocrine diseases: acute adrenal insufficiency, primary or secondary adrenal insufficiency, congenital adrenal hyperplasia, subacute thyroiditis;
• shock (burn, traumatic, surgical, toxic) - if vasoconstrictors, plasma replacement drugs and other symptomatic therapy are ineffective;
• cerebral edema (with a brain tumor, traumatic brain injury, neurosurgical intervention, cerebral hemorrhage, encephalitis, meningitis, radiation injury);
• status asthmaticus; severe bronchospasm (exacerbation bronchial asthma, chronic obstructive bronchitis);
• severe allergic reactions, anaphylactic shock;
• rheumatic diseases;
• systemic connective tissue diseases;
• acute severe dermatoses;
• malignant diseases: palliative treatment of leukemia and lymphoma in adult patients; acute leukemia in children; hypercalcemia in patients suffering from malignant tumors, if oral treatment is not possible;
• blood diseases: acute hemolytic anemia, agranulocytosis, idiopathic thrombocytopenic purpura in adults;
• severe infectious diseases (in combination with antibiotics);
• in ophthalmological practice (subconjunctival, retrobulbar or parabulbar administration): allergic conjunctivitis, keratitis, keratoconjunctivitis without damage to the epithelium, iritis, iridocyclitis, blepharitis, blepharoconjunctivitis, scleritis, episcleritis, inflammatory process after eye injuries and surgical interventions, sympathetic ophthalmia, immunosuppressive treatment after transplantation and cornea;
• local application (in the area of ​​pathological formation): keloids, discoid lupus erythematosus, granuloma annulare.

Release forms

Tablets 0.5 mg.

Solution in ampoules for intravenous and intramuscular administration (injections for injections) 4 mg/ml.

Oftan eye drops 0.1%.

Ophthalmic suspension 0.1%.

Instructions for use and dosage

The dosage regimen is individual and depends on the indications, the patient’s condition and his response to therapy. The drug is administered intravenously slowly in a stream or drip (for acute and emergency conditions); intramuscularly; local (into the pathological formation) administration is also possible. To prepare a solution for intravenous drip infusion (dropper), you should use an isotonic sodium chloride solution or a 5% dextrose solution.

In the acute period with various diseases and at the beginning of therapy, Dexamethasone is used in higher doses. During the day, you can administer from 4 to 20 mg of Dexamethasone 3-4 times.

Doses of the drug for children (intramuscular):

The dose of the drug during replacement therapy (for adrenal insufficiency) is 0.0233 mg/kg body weight or 0.67 mg/m2 body surface area, divided into 3 doses, every 3rd day or 0.00776 - 0.01165 mg/kg body weight or 0.233 - 0.335 mg/m2 body surface area daily. For other indications, the recommended dose is from 0.02776 to 0.16665 mg/kg body weight or 0.833 to 5 mg/m2 body surface area every 12-24 hours.

When the effect is achieved, the dose is reduced to maintenance or until treatment is stopped. The duration of parenteral use is usually 3-4 days, then they switch to maintenance therapy with dexamethasone tablets.

Long-term use of high doses of the drug requires a gradual dose reduction in order to prevent the development of acute adrenal insufficiency.

Drops

Conjunctivally, adults and children over 12 years of age in acute inflammatory conditions: 1-2 drops 4-5 times a day for 2 days, then 3-4 times a day for 4-6 days.

Chronic conditions: 1-2 drops 2 times a day for a maximum of 4 weeks (no more).

In post-operative and post-traumatic cases: starting from the 8th day after surgery for strabismus, retinal detachment, cataract extraction and from the moment of injury - 1-2 drops 2-4 times a day for 2-4 weeks; for antiglaucoma filtering surgery - on the day of surgery or the day after it.

Children from 6 to 12 years old with allergic inflammatory conditions: 1 drop 2-3 times a day for 7-10 days, if necessary, treatment is continued after monitoring the condition of the cornea on the 10th day.

Side effect

Dexamethasone is usually well tolerated. It has low mineralocorticoid activity, i.e. its effect on water-electrolyte metabolism is small. As a rule, low and medium doses of Dexamethasone do not cause sodium and water retention in the body or increased potassium excretion. The following side effects are described:

• decreased glucose tolerance;
• steroid diabetes mellitus or manifestation of latent diabetes mellitus;
• suppression of adrenal function;
• Itsenko-Cushing syndrome (moon face, pituitary obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, muscle weakness, stretch marks);
• delayed sexual development in children;
• nausea, vomiting;
• pancreatitis;
• steroid ulcer of the stomach and duodenum;
• erosive esophagitis;
• gastrointestinal bleeding and perforation of the wall of the gastrointestinal tract;
• increased or decreased appetite;
• indigestion;
• flatulence;
• arrhythmias;
• bradycardia (up to cardiac arrest);
• increased blood pressure;
• hypercoagulability;
• thrombosis;
• euphoria;
• hallucinations;
• affective insanity;
• depression;
• paranoia;
• increased intracranial pressure;
• nervousness or anxiety;
• insomnia;
• dizziness;
• headache;
• convulsions;
• increased intraocular pressure with possible damage to the optic nerve;
• tendency to develop secondary bacterial, fungal or viral infections eye;
• trophic changes in the cornea;
• exophthalmos;
• sudden loss of vision (with parenteral administration in the head, neck, nasal turbinates, scalp, deposition of drug crystals in the vessels of the eye is possible);
• hypocalcemia;
• weight gain;
• negative nitrogen balance (increased protein breakdown);
• increased sweating;
• fluid and sodium retention (peripheral edema);
• slower growth and ossification processes in children (premature closure of epiphyseal growth zones);
• osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the head of the humerus and femur);
• muscle tendon rupture;
• delayed wound healing;
• steroid acne;
• striae;
• tendency to develop pyoderma and candidiasis;
• skin rash;
• anaphylactic shock;
• local allergic reactions.

Local for parenteral administration: burning, numbness, pain, tingling at the injection site, infection at the injection site, rarely - necrosis of surrounding tissues, scarring at the injection site; skin atrophy and subcutaneous tissue with intramuscular injection (injection into the deltoid muscle is especially dangerous).

Contraindications

For short-term use for health reasons, the only contraindication is hypersensitivity to dexamethasone or the components of the drug.

In children during the growth period, GCS should be used only for absolute indications and under the careful supervision of the attending physician.

The drug should be prescribed with caution for the following diseases and conditions:

Use during pregnancy and breastfeeding

During pregnancy (especially in the 1st trimester), the drug can be used only when the expected therapeutic effect outweighs the potential risk to the fetus. With long-term therapy during pregnancy, the possibility of impaired fetal growth cannot be excluded. If used at the end of pregnancy, there is a risk of atrophy of the adrenal cortex in the fetus, which may require replacement therapy in the newborn.

If it is necessary to carry out treatment with the drug during breastfeeding, then breastfeeding should be stopped.

special instructions

During treatment with Dexamethasone (especially long-term), observation by an ophthalmologist, monitoring of blood pressure and water-electrolyte balance, as well as peripheral blood patterns and blood glucose levels are necessary.

In order to reduce side effects Antacids can be prescribed, and the intake of K+ into the body should be increased (diet, potassium supplements). Food should be rich in proteins, vitamins, and limit the content of fats, carbohydrates and table salt.

The effect of the drug is enhanced in patients with hypothyroidism and liver cirrhosis. The drug may enhance existing emotional instability or psychotic disorders. If a history of psychosis is indicated, Dexamethasone in high doses is prescribed under the strict supervision of a physician.

It should be used with caution in acute and subacute myocardial infarction - the necrosis may spread, the formation of scar tissue may slow down, and the heart muscle may rupture.

In stressful situations during maintenance treatment (eg, surgical operations, trauma or infectious diseases), the dose of the drug should be adjusted due to the increased need for glucocorticosteroids. Patients should be carefully monitored for a year after the end of long-term therapy with Dexamethasone due to the possible development of relative insufficiency of the adrenal cortex in stressful situations.

With sudden withdrawal, especially in the case of previous use of high doses, the development of withdrawal syndrome (anorexia, nausea, lethargy, generalized musculoskeletal pain, general weakness) is possible, as well as an exacerbation of the disease for which Dexamethasone was prescribed.

During treatment with Dexamethasone, vaccination should not be carried out due to a decrease in its effectiveness (immune response).

When prescribing Dexamethasone for intercurrent infections, septic conditions and tuberculosis, it is necessary to simultaneously treat with bactericidal antibiotics.

In children during long-term treatment with Dexamethasone, careful monitoring of the dynamics of growth and development is necessary. Children who, during the treatment period, were in contact with patients with measles or chicken pox, specific immunoglobulins are prescribed prophylactically.

Due to the weak mineralocorticoid effect, Dexamethasone is used in combination with mineralocorticoids for replacement therapy for adrenal insufficiency.

In patients diabetes mellitus Blood glucose levels should be monitored and therapy adjusted if necessary.

X-ray monitoring of the osteoarticular system (images of the spine, hand) is indicated.

In patients with latent infectious diseases kidneys and urinary tract Dexamethasone can cause leukocyturia, which may have diagnostic value.

Drug interactions

There may be pharmaceutical incompatibility of dexamethasone with other IV drugs - it is recommended to administer it separately from other drugs (IV bolus, or through another dropper, as a second solution). When mixing a solution of dexamethasone with heparin, a precipitate forms.

Simultaneous administration of dexamethasone with:

• inducers of hepatic microsomal enzymes (phenobarbital, rifampicin, phenytoin, theophylline, ephedrine) leads to a decrease in its concentration;
• diuretics (especially thiazide and carbonic anhydrase inhibitors) and amphotericin B - can lead to increased excretion of K+ from the body and an increased risk of developing heart failure;
• with sodium-containing drugs - to the development of edema and increased blood pressure;
• cardiac glycosides - their tolerability worsens and the likelihood of developing ventricular extrasytolia increases (due to caused hypokalemia);
• indirect anticoagulants - weakens (less often enhances) their effect (dose adjustment required);
• anticoagulants and thrombolytics - the risk of bleeding from ulcers in the gastrointestinal tract increases;
• ethanol (alcohol) and non-steroidal anti-inflammatory drugs - increases the risk of erosive and ulcerative lesions in gastrointestinal tract and the development of bleeding (in combination with NSAIDs in the treatment of arthritis, it is possible to reduce the dose of glucocorticosteroids due to the summation therapeutic effect);
• paracetamol - the risk of developing hepatotoxicity increases (induction of liver enzymes and the formation of a toxic metabolite of paracetamol);
• acetylsalicylic acid - accelerates its elimination and reduces its concentration in the blood (when dexamethasone is discontinued, the level of salicylates in the blood increases and the risk of side effects increases);
• insulin and oral hypoglycemic drugs, antihypertensive drugs- their effectiveness decreases;
• vitamin D - its effect on the absorption of Ca2+ in the intestine is reduced;
• growth hormone - reduces the effectiveness of the latter, and with praziquantel - its concentration;
• M-anticholinergics (including antihistamines and tricyclic antidepressants) and nitrates - increases intraocular pressure;
• isoniazid and mexiletine - increases their metabolism (especially in “slow” acetylators), which leads to a decrease in their plasma concentrations.

Carbonic anhydrase inhibitors and loop diuretics may increase the risk of osteoporosis.

Indomethacin, displacing dexamethasone from its connection with albumin, increases the risk of developing it side effects.

ACTH enhances the effect of dexamethasone.

Ergocalciferol and parathyroid hormone prevent the development of osteopathy caused by dexamethasone.

Cyclosporine and ketoconazole, by slowing down the metabolism of dexamethasone, can in some cases increase its toxicity.

Simultaneous administration of androgens and steroids anabolic drugs with dexamethasone promotes the development of peripheral edema and hirsutism, the appearance of acne.

Estrogens and oral contraceptives containing estrogen reduce the clearance of dexamethasone, which may be accompanied by an increase in the severity of its action.

When used simultaneously with live antiviral vaccines and against the background of other types of immunization, it increases the risk of viral activation and the development of infections.

Antipsychotics (neuroleptics) and azathioprine increase the risk of developing cataracts when dexamethasone is prescribed.

When used simultaneously with antithyroid drugs, the clearance of dexamethasone decreases and with thyroid hormones increases.

Analogs of the drug Dexamethasone

Structural analogues of the active substance:

• Decadron;
• Dexaven;
• Dexazone;
• Dexamed;
• Dexamethasone Bufus;
• Dexamethasone Nycomed;
• Dexamethasone-Betalek;
• Dexamethasone Vial;
• Dexamethasone-LENS;
• Dexamethasone-Ferein;
• Dexamethasone sodium phosphate;
• Dexamethasone phosphate;
• Dexamethasonelong;
• Dexapos;
• Dexafar;
• Dexon;
• Maxidex;
• Oftan Dexamethasone;
• Fortecortin.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.

Dexamethasone is a drug that belongs to the group of corticosteroids. There are quite a lot of pathologies that require the use of this medicine.

It is sometimes used to treat even infants, but only in cases where it is necessary to take urgent measures that will save the child’s life (for example, with, or when other medications have not had the desired therapeutic effect. In this case, it is necessary to constantly be under the supervision of a doctor.

Features of the drug

The medicine is available in several dosage forms: in the form of injections, tablets and drops. For children, Dexamethasone is usually prescribed in injection or tablet form.

The active ingredient is dexamethasone phosphate. With regard to additional ingredients of the drug, it must be said that the composition of the drug depends on its form:

1. The composition of the injection form contains 4 mg of active substance per 1 ml of solution, and a small amount of glycerin, propylene glycol, phosphate buffer solution, and water are observed as accompanying components.
2. In tablet form is 0.5 mg active substance, as well as lactose, silicon and residual amounts of magnesium stearate.
3. IN eye drops contains the main active ingredient weighing 1 mg per milliliter of solution, as well as small amounts boric acid, sodium tetraborate, water and preservatives.

The active substance is able to pass into cells and increase the synthesis of ribonucleic acid. Due to the inhibition of phospholipase, the production of arachidonic acids is increased, as well as the biosynthesis of endoperoxide, mediators of the inflammatory allergic reaction and pain syndrome.

As a result of the action of the drug, there is a decrease in the amount of protease, hyaluronidase and collagenase in small quantities or with complete absence, which leads to the following:

1. Improving the functioning of bone and cartilage tissues.
2. Reduced permeability of the capillary bed.
3. Correcting the stabilization of cell membranes.
4. Retention of water and sodium in the body.
5. Increased protein catabolism, glucose utilization, and increased glycogen release from the liver.

When taking the tablet form of Dexamethasone for children, almost complete absorption of the drug into the blood from the stomach is observed. At the same time, the percentage of binding to blood proteins is not too high, it reaches on average no more than 80%, and bioavailability is no more than 70%. The active substance can act inside cells.

The effect may appear within a few minutes from the moment of administration, but the maximum effect is achieved on average after 2 hours. The duration of the therapeutic effect of the drug can be 3 days.

When using the injection form, the effect of the drug can occur much faster. This is largely due to the lack of time required for the drug to be absorbed. The medicine penetrates the blood-brain barrier, thereby affecting the central organs nervous system.
The drug is excreted in the urine through the urinary system.

Dexamethasone is incompatible with other medications.

Indications and contraindications

Dexamethasone can be used for various pathologies, but due to possible side effects, as well as the presence large quantity contraindications, including children's, it is not used so often. Basically, its use is justified only in cases where there is a threat to life. AND childhood This is no exception.

Among the indications in which there is an acute threat to life are:

1. Anaphylactic shock, manifested by a sharp drop in blood pressure, disruption of the heart and other vital organs.
2. Heavy allergic reaction as .
3. Brain swelling as a result of a traumatic brain injury, infectious process, the presence of a tumor process in the skull area.
4. Toxic condition associated with a massive burn, a consequence of painful or traumatic shock, acute blood loss.
5. Acute failure adrenal apparatus.

Dexamethasone in children is also used for the following: chronic diseases:

• severe course, clinical manifestations of severe bronchospasm;
• severe autoimmune pathologies such as rheumatoid arthritis or systemic lupus erythematosus;
• expressed;
• Crohn's disease or ulcerative colitis with severe dysfunction digestive tract;
• hemolytic anemia or other pathologies of the blood system;
• glomerulonephritis;
• severe infectious processes;
• malignant lesions.

Among the contraindications, in which even acute processes will not be an indication for the use of this drug, the following should be highlighted:

• increased sensitivity of the body to the components of the drug;
• allergy to dexamethasone;
• acute diseases that can be caused by bacterial, viral, and fungal infections;
• condition associated with direct vaccination, especially after BCG vaccination;
• pathologies of the cornea, accompanied by a violation of its integrity;
• Itsenko-Cushing syndrome;
• inflammatory diseases of the digestive tract, especially associated with the presence of erosive and ulcerative defects (gastritis, gastric or duodenal ulcers);
• tuberculosis and other chronic infectious processes;
• pathologies of the nervous system, accompanied by seizures, epilepsy;
• diseases of the endocrine system, especially the thyroid gland (hypothyroidism or thyroiditis).

Dexamethasone should be taken with caution in case of liver dysfunction.

To treat severe nasal congestion and difficulty breathing due to allergies in children, Dexamethasone drops are sometimes prescribed for instillation into the nose. This unusual use of the drug effectively relieves swelling, eliminates inflammation, and facilitates the baby’s breathing.

Possible side effects

Side effects are a common problem when using Dexamethasone in children. Among the most common reactions are:

1. Allergic reaction in response to the administration of the drug, which most often takes the form of urticaria, eczema or rashes of various types.
2. Nervous system dysfunction, such as headache, dizziness, neuropathy, etc.
3. Damage to the digestive tract. May manifest as the appearance or complication of pancreatitis, gastritis, as well as peptic ulcer stomach and duodenum.
4. In children, improper or prolonged use of Dexamethasone can lead to slowing down the growth of both the whole organism and individual systems. This is why children taking Dexamethasone develop acquired heart defects and serious dysfunction internal organs, underdevelopment or lag in the development of the gonads and organs of the reproductive system.
5. The appearance of a specific appearance associated with increased body weight, water retention in the body, and muscle atrophy.
6. Mental disorders.
7. Skin changes with their depletion and the appearance of stretch marks and cicatricial changes.
8. Development of cataracts and glaucoma.

Instructions for the use of Dexamethasone for children in the form of injections, tablets and drops

The dosage of the drug in children and not only should be calculated only by a specialist, based on pathological condition the patient, the severity of the process, as well as the patient’s age and body weight.
The method of administration and dose of Dexamethasone for children depends on the form of the drug and indications.

Using injection form The doctor’s prescription for the drug may be as follows: in the event of an acute condition that is urgent, the calculation is based on 0.02 mg per 1 kg of body weight. In some cases, the dosage can be increased to 0.16 mg per 1 kg. In this case, it is necessary to take into account the dosage regimen and frequency of administration. The minimum duration between administrations is 12 hours. In some cases, a single injection of Dexamethasone is used intramuscularly or intravenously. In case of acute adrenal insufficiency, it is permissible to increase the dosage to 0.2-0.3 mg per kilogram of body weight until the condition stabilizes.

In tablet form for inflammatory, allergic or other chronic pathologies, Dexamethasone, dosage 0.25 mg, is divided into three or four doses per day. The maximum daily dosage can reach 2 mg.

In the form of eye drops Dexamethasone is allowed to be taken in one drop up to 3 times a day. The duration of therapy can be up to a week. In the case of a severe or chronic process, an individual increase in the duration of use of this drug is possible.

The drug in liquid form in ampoules is often used for inhalation in children with inflammation of the respiratory tract (for example, bronchitis, laryngitis, bronchial obstruction). For children, the following dosage is used: 0.5 ml of the drug is mixed with 2-3 ml of saline solution. Inhalations are done 3 times a day for 3-7 days.

How much does it cost and how to store it

The price of Dexamethasone depends not only on the type of pharmacy and manufacturer, but also dosage form. The average cost of the tablet form is about 50 rubles. The injection form can cost about 200 rubles. The cost of eye drops is about 70 rubles. The drug is dispensed from the pharmacy only with a doctor's prescription.

The drug can be stored in the form of tablets and injections for five years from the date of manufacture, and the shelf life for drops is three years, but only if the bottle is sealed. Once opened, the drops must be used within 3 weeks.
The optimal temperature should not exceed 25 degrees Celsius. It is necessary to protect the drug from exposure to sunlight.

• Instructions for use Dexamethasone
• Composition of the drug Dexamethasone
• Indications for the drug Dexamethasone
• Storage conditions for the drug Dexamethasone
• Shelf life of Dexamethasone

ATX Code: Hormones for systemic use (excluding sex hormones and insulins) (H) > Corticosteroids for systemic use (H02) > Corticosteroids for systemic use (H02A) > Glucocorticoids (H02AB) > Dexamethasone (H02AB02)

Release form, composition and packaging

solution for injection 4 mg/ml: 1 ml amp. 25 pcs.
Reg. No.: 402/94/2000/05/10/15/16 dated 06/24/2015 - Valid

Injection transparent, colorless or slightly yellowish.

Excipients: glycerol, disodium edetate, disodium hydrogen phosphate dihydrate, d/i water.

1 ml - ampoules (25) - cardboard boxes.

Description of the drug DEXAMETHASONE solution created in 2010 on the basis of instructions posted on the official website of the Ministry of Health of the Republic of Belarus. Update date: 06/08/2011

pharmachologic effect

Dexamethasone is a synthetic adrenal hormone (corticosteroid) with glucocorticoid activity. It has anti-inflammatory and immunosuppressive effects, and also affects energy metabolism, glucose homeostasis, and (through a negative feedback effect) the secretion of hypothalamic releasing hormone and trophic hormone of the adenohypophysis.

Pharmacokinetics

After intravenous administration, dexamethasone phosphate reaches Cmax in plasma within 5 minutes and one hour after intramuscular injection. After topical application as an injection into a joint or soft fabrics(wounds), absorption is slightly lower than after intramuscular administration. After IV application, the onset of action occurs quickly; after IM application, the clinical effect is achieved after 8 hours. The effect lasts for a long time: 17-28 days after IM application, and 3 days - 3 weeks after topical application. The biological half-life of dexamethasone is 24-72 hours. In plasma and synovial fluid, dexamethasone phosphate is quickly converted into dexamethasone. The drug is primarily metabolized in the liver, but is also metabolized in the kidneys and other tissues. Mainly excreted in urine.

Indications for use

Dexamethasone is prescribed IV or IM in case of emergency, or when internal use is not possible.

Endocrine disorders: replacement therapy for primary and secondary (pituitary) adrenocortical insufficiency (except for acute insufficiency, where it is better to use cortisone and hydrocortisone, due to their stronger mineralocorticoid effect);

congenital adrenal hyperplasia;

subacute thyroiditis and severe radiation thyroiditis.

Rheumatic diseases: rheumatoid arthritis, including adolescence chronic arthritis, and extra-articular manifestations of rheumatoid arthritis (rheumatic lungs, cardiac changes, ocular changes, cutaneous vasculitis), Systemic connective tissue diseases, vasculitic syndromes.

Skin diseases: pemphigus, severe form of exudative erythema multiforme(Stevens-Johnson syndrome), exfoliative dermatitis, bullous dermatitis herpetiformis, exudative erythema (severe), erythema nodosum, seborrheic dermatitis (severe), psoriasis (severe), urticaria (not responding to standard treatment), mycosis fungoides, dermatomyositis , scleroderma, Quincke's edema.

Allergic diseases (not responding to conventional treatment): asthma, contact dermatitis, atopic dermatitis, serum sickness, allergic rhinitis, drug allergy, urticaria after blood transfusion.

Eye diseases: diseases that threaten vision (acute central chorioretinitis, retrobulbar neuritis), allergic diseases(conjunctivitis, uveitis, scleritis, keratitis, inflammation of the iris), systemic immune diseases (sarcoidosis, temporal arteritis), proliferative changes in the orbit (endocrine ophthalmopathy, false tumor), sympathetic ophthalmia, immunosuppressive therapy for corneal transplantation.

The drug is applied systemically or locally (subconjunctival, retrobulbar or parabulbar application)

Gastrointestinal diseases: ulcerative colitis (severe exacerbation), Crohn's disease (severe exacerbation), chronic autoimmune hepatitis, rejection reaction after liver transplantation.

Respiratory diseases: sarcoidosis (symptomatic), acute toxic bronchiolitis, chronic bronchitis and asthma ( acute attack diseases), pulmonary tuberculosis, accompanied by severe general weakness (in combination with appropriate anti-tuberculosis therapy), berylliosis (granulomatous inflammation), radiation or aspiration pneumonitis.

Hematological diseases: congenital or acquired chronic pure aplastic anemia, autoimmune hemolytic anemia, secondary thrombocytopenia in adults, erythroblastopenia, acute lymphoblastic leukemia (induction therapy), idiopathic thrombocytopenic purpura (intravenous use only;

intramuscular injections are contraindicated).

Kidney diseases: immunosuppressive therapy for kidney transplantation, induction of diuresis or reduction of proteinuria in idiopathic nephrotic syndrome (without uremia) and renal disorders in systemic lupus erythematosus.

Malignant diseases: palliative treatment of leukemia and lymphoma in adults, acute leukemia in children, hypercalcemia in patients suffering from malignant diseases.

Brain edema: cerebral edema caused by primary or metastatic brain tumors, neurosurgery, or traumatic brain injury.

Shock: shock unresponsive classical therapy, shock in patients with adrenal insufficiency, anaphylactic shock (intravenously after the use of adrenaline), before surgery to prevent shock in cases of adrenal insufficiency or suspected adrenal insufficiency.

Other indications: tuberculous meningitis with subarachnoid block (in combination with appropriate anti-tuberculosis therapy), trichinosis with neurological symptoms and myocardial damage, cystic tumor of the aponeurosis or tendon (ganglion).

Indications for intra-articular injection of dexamethasone or injection into soft tissues: rheumatoid arthritis (severe inflammation of a single joint), ankylosing spondylitis (if the inflamed joints do not respond to conventional therapy), psoriatic arthritis (oligoarticular injury or tenosynovitis), monoarthritis (after pumping out fluid from the joint), osteoarthritis of the joints (only in the case of synovitis and exudate) , extra-articular rheumatism (epicondylitis, tenosynovitis, bursitis).

Local application (introduction into the wound): keloids, hypertrophic, inflamed wounds with infiltration in lichen, psoriasis, granuloma annulare, sclerosing folliculitis, discoid lupus erythematosus and cutaneous sarcoidosis, localized alopecia.

Dosage regimen

The dose is set individually depending on the disease, the expected duration of treatment, corticoid tolerance and the body's response. The injection solution can be prescribed intravenously (in the form of injections or infusions with glucose or saline), intramuscularly or locally (into a joint, into a wound, into soft tissues).

Parenteral use. Dexamethasone is used parenterally in emergency cases, in cases where oral therapy is not possible and for conditions indicated in the indications. The injection solution is prescribed intravenously or intramuscularly, or in the form of intravenous infusion (with glucose or saline solution).

Recommended average initial daily doses for IV or IM administration are 0.5 mg–0.9 mg or more as needed. Initially, the dosage of dexamethasone is taken until a clinical response is achieved, then the dosage is gradually reduced until low level, at which the dose remains clinically effective. If treatment with high doses continues for more than a few days, the dose should be reduced over several consecutive days or even over a longer period of time.

Local application. The recommended single dose of dexamethasone for intra-articular administration is 0.4 mg-4 mg. The dosage depends on the size of the affected joint. The usual dosage of dexamethasone for large joints is 2 mg-4 mg and 0.8 mg-1 mg for small joints. Intra-articular administration can be repeated after 3-4 months. The usual dosage of dexamethasone for administration into the bursa is 2 mg-3 mg, into the tendon sheath - 0.4 mg-1 mg and for the tendons - 1 mg-2 mg.

For injection into the wound, the same dosage of dexamethasone is used as for intra-articular injection. Dexamethasone can be administered into no more than two wounds at a time. Recommended doses for infiltration into soft tissues (periarticular) are 2-6 mg of dexamethasone.

Dosage for children. The recommended dose for intramuscular administration during replacement therapy is 0.02 mg/kg body weight or 0.67 mg/m2 body surface, divided into three doses, every third day, or 0.008 mg–0.01 mg/kg body weight, or 0.2 mg - 0.3 mg/m2 body surface daily.

Side effects

Like all drugs, Dexamethasone can cause side effects, although these may not occur in every patient taking the drug.

Side effects that may occur during treatment with dexamethasone phosphate are classified into groups depending on the frequency of occurrence:

• very common (≥1/10), frequent (≥1/100 to< 1/10), нечастые (≥ 1/1000 до < 1/100), редкие (≥ 1/10000 до < 1/1000), очень редкие (<1/10000), неизвестные (не могут быть оценены по доступным данным).

Side effects associated with short-term dexamethasone treatment include:

Side effects associated with long-term dexamethasone treatment include:

The following side effects associated with dexamethasone may also occur:

Frequent:	adrenal insufficiency and atrophy (weakened response to stress), Cushing's syndrome, irregular menstruation, excessive hair growth (hirsutism), transition from latent to clinical diabetes, sodium and water retention, increased potassium loss, muscle weakness, steroid myopathy ( muscle weakness due to muscle catabolism), slow wound healing, stretch marks, pinpoint or large skin hemorrhages, increased sweating, acne, suppressed response to skin tests.
Uncommon:	Swelling of the brain due to very high blood pressure (hypertensive encephalopathy), papilledema, increased intracranial pressure (benign intracranial hypertension), dizziness, headache, personality and behavior changes, insomnia, irritability, abnormal increase in muscle activity (hyperkinesia ), depression, nausea, hiccups, stomach and duodenal ulcers, increased intraocular pressure.
Rare:	Blockage of blood vessels by a clot, changes in the blood picture, rash, spasm of the bronchial muscles (bronchospasm), hypersensitivity reactions, psychosis, impotence.
Very rare:	Heart rhythm disturbances, heart failure, rupture of the heart muscle in patients after a recent heart attack (myocardial infarction), seizures, hypokalemic alkalosis (renal response to high potassium deficiency or loss), negative nitrogen balance due to protein breakdown, inflammation of the esophagus (esophagitis), perforation of a gastrointestinal ulcer and gastrointestinal bleeding (hematemesis, melena), perforation of the gallbladder, intestinal perforation in patients with chronic inflammatory bowel disease, swelling of the face, lips, throat and/or tongue that leads to difficulty breathing or swallowing (angioedema), allergic dermatitis, vertebral compression fracture, tendon ruptures (especially with concomitant use of quinolones), articular cartilage damage and necrosis bones (associated with frequent intra-articular injections), urticaria, protrusion of the eyeballs (exophthalmos), edema, hyper- or hypopigmentation skin, atrophy of the skin or subcutaneous tissue, sterile local inflammation (abscess), redness of the skin.

Contraindications for use

Hypersensitivity to the active substance or other ingredients of the drug.

Acute viral, bacterial and systemic fungal infections (without appropriate treatment). Cushing's syndrome.

Vaccination using live vaccine.

Breastfeeding period (except in emergency cases).

IM use is contraindicated in patients with severe hemostatic disorders.

special instructions

Allergic reactions may occur (although rarely) during parenteral use of corticoids. Appropriate measures should be taken before starting treatment, taking into account this possibility (especially in patients with a history of allergic reactions to any drugs).

Patients undergoing long-term treatment with dexamethasone may experience corticoid withdrawal syndrome. Therefore, the dosage of dexamethasone should be gradually reduced.

If during therapy or when discontinuing a drug the patient is exposed to unexpected stress (trauma, surgery or serious illness), then the dose of dexamethasone should be increased or hydrocortisone or cortisone prescribed. In patients who have experienced severe stress after discontinuation of long-term dexamethasone, dexamethasone should be restarted as induced adrenal insufficiency may persist for several months after discontinuation of treatment.

Treatment with dexamethasone or natural glucocorticoids may mask signs of existing or new infection and signs of interstitial perforation.

Dexamethasone can aggravate the course of systemic fungal infections, latent amebiasis and pulmonary tuberculosis.

In patients with active pulmonary tuberculosis, dexamethasone should be prescribed (in combination with antituberculosis therapy) in cases of fulminant or severe disseminated pulmonary tuberculosis. Patients with inactive tuberculosis who are taking dexamethasone or patients with a positive tuberculin test should receive chemoprophylaxis.

Particular caution and close medical monitoring should be performed in patients with osteoporosis, hypertension, heart failure, tuberculosis, glaucoma, liver failure, renal failure, diabetes, active gastric and duodenal ulcers, recent intestinal anastomosis, ulcerative colitis and epilepsy. Particular attention should be paid to patients in the first weeks after myocardial infarction, as well as patients with thromboembolism, asthenic bulbar palsy, glaucoma, hypothyroidism, psychosis or psychoneurosis, and elderly patients.

During treatment with dexamethasone, an exacerbation of diabetes or a transition from a latent form to the form of clinical manifestations of diabetes may occur.

During long-term treatment, it is necessary to monitor serum potassium levels. Vaccination with live vaccines is contraindicated during treatment with dexamethasone. Immunization with killed viral or bacterial vaccines does not lead to the expected increase in antibodies and does not have the expected protective effect. Dexamethasone is usually not prescribed 8 weeks before and 2 weeks after vaccination. Patients receiving or taking high doses of dexamethasone for a long time should avoid contact with people with measles; In case of accidental contact, prophylactic treatment with immunoglobulin is recommended. Caution is advised in patients recovering from recent surgery and a bone fracture, as dexamethasone may delay the healing of wounds and fractures.

The effect of glucocorticoids is potentiated in patients with liver cirrhosis or hypothyroidism. Intra-articular administration of corticoids can cause local and systemic effects. Frequent use may cause damage to articular cartilage and bone necrosis.

Before intra-articular injection, synovial fluid should be evacuated from the joint and examined (for possible infection). Injecting corticosteroids into infected joints should be avoided. If septic inflammation of the joint develops after the injection, then appropriate antibacterial treatment must be started.

Patients should be informed that it is necessary to avoid putting stress on the joints into which the injection was performed until the inflammatory process has completely resolved.

Injections into unstable joints are not recommended. Corticosteroids may interfere with allergy skin test results. Dexamethasone is used in children and adolescents only under strict indications. During treatment with dexamethasone, the growth and development of children and adolescents should be carefully monitored.

Special information about some of the ingredients of the drug. This medicine contains less than 1 mmol (23 mg) sodium per dose, which is a negligible amount.

Pregnancy and lactation. Dexamethasone should be prescribed to pregnant women only in selected urgent cases when the expected benefit to the mother justifies the risk to the fetus.

Particular care should be taken in case of preeclampsia. According to general recommendations for glucocorticoid treatment during pregnancy, the lowest effective dose to control the underlying disease should be used.

Glucocorticoids are excreted in small quantities in breast milk. Therefore, breastfeeding is not recommended for mothers taking dexamethasone, especially when using high physiological doses (about 1 mg). This can lead to fetal growth retardation and decreased secretion of endogenous corticosteroids.

Impact on the ability to drive a car or use other machinery. Dexamethasone does not affect the ability to drive a car or operate machinery.

Overdose

Symptoms. Case reports of acute overdose or death due to acute overdose are rare. Overdose can, usually after only a few weeks of use, lead to most of the side effects mentioned, especially Cushing's syndrome.

Treatment. There is no known specific antidote. Treatment is supportive and symptomatic. Hemodialysis is not effective in accelerating the elimination of dexamethasone from the body.

Drug interactions

The simultaneous use of dexamethasone and nonsteroidal anti-inflammatory drugs increases the risk of gastrointestinal bleeding and ulcers. The effect of dexamethasone is reduced by the simultaneous administration of drugs that activate the CYP3A4 enzyme (for example, phenytoin, phenobarbitone, carbamazepine, primidone, rifabutin, rifampicin) or increase the clearance of glucocorticoids (ephedrine and aminoglutethimide); therefore, in these cases, an increase in the dose of dexamethasone is necessary.

Dexamethasone reduces the therapeutic effect of antidiabetic drugs, antihypertensive drugs, praziquantel and natriuretics (the dosage of these drugs should be increased), but potentiates the activity of heparin, albendazole and kaliuretics (if necessary, the dosage of these drugs should be decreased). Dexamethasone may alter the effect of coumarin anticoagulants; therefore, more frequent monitoring of prothrombin time is recommended during concomitant use.

Concomitant use of high doses of glucocorticoids and betag receptor agonists increases the risk of hypokalemia. Patients with hypokalemia have increased arrhythmogenicity and toxicity of cardiac glycosides.

Antacids reduce the absorption of dexamethasone in the stomach. The effect of combined use of dexamethasone with food and alcohol has not been studied; however, concomitant use with medications and foods high in sodium is not recommended. Smoking does not affect the pharmacokinetics of dexamethasone. Glucocorticoids accelerate the renal clearance of salicylates, so it is sometimes difficult to achieve therapeutic serum concentrations of salicylates. Caution should be exercised in patients who have had their dexamethasone dose tapered as increased serum salicylate concentrations and salicylate toxicity may occur.

When taken together with oral contraceptives, the half-life of glucocorticoids may increase, which enhances their biological effect and increases the incidence of side effects.

The combined use of ritodrine and dexamethasone during childbirth is contraindicated, as this may lead to maternal death due to pulmonary edema. Concomitant use of dexamethasone and thalidomide may cause toxicodermal necrolysis.

Interactions with possible beneficial therapeutic effects. Concomitant use of dexamethasone and metoclopromide, diphenhydramine, prochlorperazine, or 5-HT 3 receptor antagonists (serotonin or 5-hydroxytryptamine type 3 receptors, such as ondansetron or granisetron) is effective for the prevention of nausea and vomiting caused by chemotherapy (cisplatin, cyclophosphamide, methotrexate, fluorouracil ).

Dexamethasone is one of the vital medications. It is included in the list of similar pharmaceuticals by the World Health Organization. Dexamethasone can penetrate the brain, nervous system, and have a central effect on the body. This property and its therapeutic effects (immunosuppressive, anti-inflammatory) make the drug indispensable in some situations.

Pharmacological group

Medicinal group of the drug: glucocorticosteroid. Synthetic hormone, a derivative of 9-fluoro-prednisolone.

Pharmacokinetics and pharmacodynamics

Once in the blood, dexamethasone bypasses the protective blood-brain, placental and other barriers of organs and tissues (histohematic barriers). This ability to penetrate everywhere allows dexamethasone to act even on the brain: to relieve cerebral edema. Swelling occurs in extreme situations: with hemorrhages, injuries, tumors.

The high concentration of the drug in the blood is ensured by the connection of the active substance with the blood protein – transcortin. It is a transport protein for corticosteroids. Transcortin delivers the therapeutic agent everywhere, carrying it with the bloodstream.
The drug is metabolized in the liver and excreted by the kidneys. A small part is excreted by the intestines (10%). When breastfeeding, a small amount of output comes with milk.

It has a targeted effect on the adrenal cortex: it inhibits their function. The adrenal glands are under the influence of dexamethasone for a long time: its half-life lasts up to 72 hours. All this time, the function of the endocrine organ is suppressed. This is necessary for the therapeutic effect: the excessive production of hormone secretion that causes pathological reactions is stopped.
Dexamethasone also affects the functions of the pituitary gland, inhibiting (slowing down) the production of hormones (the result of this action is reversible).

The medicine controls almost all metabolic processes, changing them.

Protein metabolism. Protein catabolism (breakdown into simple components) accelerates. This causes the accumulation of glucose in the “depot” - liver, lymph. The glucose level in the blood drops, sometimes critically – to the point of hypoglycemia.

When the liver releases glucose into the blood, the pancreas is stimulated. It intensively produces insulin and utilizes glucose. There are “jumps” in the content of the latter in the blood.

It is necessary to monitor blood glucose levels. It is especially important for those suffering from diabetes, their sugar curve often peaks up or down.

Lipid metabolism. It changes not for the better for the body. The synthesis of fatty substances is organized so that fat moves to the abdominal area. Obesity of the “apple” type occurs, a dangerous increase in the likelihood of vascular accidents (heart attacks, strokes). The amount of cholesterol in the blood is significantly higher than normal.

Mechanism of therapeutic action

The medicine does not have the best effect on metabolic processes. Why then is dexamethasone prescribed? Even with some negative effects, dexamethasone is a powerful anti-inflammatory drug. It initiates a number of complex chemical processes leading to increased protection of cell membranes and works at the cellular level. Reduces capillary permeability. Blocks the inflammatory process at any stage.

By suppressing the immune response, the drug stops allergic reactions. Stops swelling of the mucous membranes, slows down the formation of connective tissues. As a result, impaired breathing is restored and the formation of scar changes in organs is prevented.

Blocking histamine also stops pathological allergic reactions.

Release form

The drug is available in four forms:

1. Tablets containing the active substance – dexamethasone – 0.5 mg;
2. Eye drops – 1 mg of the drug per milliliter;
3. Eye ointment – ​​2.5 g tubes;
4. Injection ampoules – 4 mg of dexamethasone per milliliter of ampoule contents.

All forms of the drug contain additives that stabilize and facilitate transportation to the site of pathology and absorption of the drug, and preservatives for preservation. Packaging from different manufacturers looks different (photo).

The price of dexamethasone in pharmacies across the country varies:

1. Tablets – 16 – 38 rub. for 10 pcs. dosage 0.5 mg;
2. Injection solutions – 141 – 209 rub. for 25 ampoules, dosage 4 ml;
3. Eye drops – 46 – 70 rub. per dropper bottle, 10 ml;
4. Eye ointment – ​​100–140 rubles. tube.

The medicine is valuable in its action, the cost of dexamethasone itself is low. Sale by prescription. In the Latin prescription, the drug dexamethasone is called: Dexamethasone.

The drug dexamethasone is listed in the RLS - the official register of medicines.

Indications for use

The nervous system is the regulator of the entire body, and dexamethasone acts through it

The systemic effect of the drug has led to a wide range of uses of this medicine. It is used for many diseases.

The list of painful conditions for which Dexamethasone is needed includes:

• Endocrine disorders - problems of the adrenal glands, thyroid gland, androgenital syndrome;
• Autoimmune dysfunctions;
• Respiratory dysfunction;
• Shock life-threatening conditions;
• Blood diseases;
• Nonspecific ulcerative colitis;
• Acute phase of eczema;
• Serum sickness;
• Connective tissue defects;
• Agranulocytosis;
• Addison-Beermer disease;
• Pemphigus;
• Hypoplasia of hematopoiesis;
• Ophthalmic diseases;
• Deforming joint diseases – bursitis, arthrosis, osteochondrosis;
• Myositis;
• Tuberculosis;
• Helminthiasis with organ damage;
• Exacerbation of bronchial asthma;
• Meningitis;
• Traumatic brain injury;
• Malignant tumors;
• Severe infections.

Methods of application

Internal use. Integral route of drug intake: orally – through the gastrointestinal tract. Tablet forms are taken orally. Usually prescribed after acute conditions have been relieved, in which dexamethasone is administered intramuscularly or intravenously - from 8 mg of the active substance in an injection solution. In the future, the doctor prescribes taking pills.

The average daily oral dose is usually 15 mg. The attending physician is responsible for adjusting doses.

Injections

Dexamethasone injections are administered intramuscularly or intravenously.

Intravenous injections of dexamethasone solution are divided into jet injections (slowly from a syringe into a vein) and drip injections - in droppers. In critical situations, when there is a high risk to the patient's life, intravenous dexamethasone is preferable. The drug immediately appears in the blood, ensuring rapid action.

If the tolerability of the drug is known, and the person knows the symptoms of an approaching dangerous condition from which this particular drug is removing him, the doctor prescribes dexamethasone in ampoules. The patient is trained in administering intramuscular injections and has the drug with him. This way you can save your own life if the doctor is far away, and the time countdown is on minutes.
For this, at a minimum, you need to know how to inject dexamethasone into yourself or a person who needs an injection.

If the situation is severe and emergency assistance is necessary: ​​intravenous administration is required. But you still need to get an injection before the arrival of a specialized team - inaction is dangerous!

You will need:

• Syringe;
• Dexamethasone ampoule (or several);
• Sterile wipes (you can use cotton wool and an alcohol-containing solution to disinfect the injection site).

It is more convenient to inject yourself into the femoral muscle. Algorithm:

1. A person lies down, or better yet sits, if his condition allows.
2. Opens (breaks off) the upper part of the ampoule.
3. Opens the syringe package, assembles it or, if it is initially assembled, removes the cap from the needle.
4. Having inserted the needle into the ampoule, he draws its contents into the syringe, pulling the syringe rod towards himself.
5. By lifting it vertically, it removes air bubbles: it “drives” the air by pressing the rod up.
6. Grasping the thigh muscle with your left hand, inserts a needle into it. The depth depends on the size of the needle; if the needle is small, it is inserted right up to the cannula.
7. Slowly injects the medicine into the muscle.
8. Removes the needle with a quick movement (this way pain is felt less).
9. Wipe the injection site with a disinfectant wipe or cotton swab soaked in alcohol.
10. Knowing how to inject life-saving dexamethasone intramuscularly, a person gets an additional opportunity to survive and help himself immediately when needed.

Only healthcare workers administer the solution by drip. If necessary, in a hospital setting. Injection use of the drug is usually limited to three days. Then the patient is transferred to maintenance treatment with tablet forms with a gradual reduction in dosage until complete withdrawal.

Dexamethasone is also used for inhalation, be sure to follow the instructions for use. Respiratory diseases sometimes require just such an emergency approach. By inhalation, the drug is delivered locally - namely to the respiratory tract, to the “destination”.

For inhalation, take the same solution that is intended for injection.

The procedure is indicated for swelling of the bronchial mucosa, allergic inflammation and severe inflammatory processes of another nature.

Inhaled dexamethasone is used to treat:

• Pulmonary tuberculosis;
• Laryngitis;
• Allergic cough and accompanying other respiratory diseases;
• Pharyngitis;
• Residual manifestations of pneumonia;
• Bronchial asthma;
• Diseases of the respiratory system of fungal etiology;
• Bronchiectasis;
• Cystic fibrosis;
• Choking from swelling of the larynx (false croup).

There are contraindications. Inhalations are not carried out if:

Pregnant and breastfeeding women should avoid inhaling dexamethasone.

Carrying out inhalation:

1. The dosage is important: adults – one ampoule per procedure, children – half (1 and 0.5 ml, respectively). In severe cases, the doctor can increase the dose and perform inhalation personally, monitoring the patient’s condition. If the ampoules contain 2 ml of medication, it is convenient to measure the required amount with a sterile syringe.
2. The hormone is a potent drug; a diluted substance is administered by inhalation. This is insurance against side effects and ease of use. Administering 0.5 ml of any substance by inhalation is almost impossible.
3. The medicine is diluted six times with saline solution.
4. The amount of liquid in diluted form is small, but modern nebulizers can spray even negligible amounts.
5. Inhalation should be carried out according to the instructions of the nebulizer. Breathe calmly and shallowly: deep breathing increases the likelihood of side effects.
6. Do not physically burden the body before and after inhalation with dexamethasone. Even eating food is considered a load.

The procedure itself will only take ten minutes or less.
It is important to follow the rules, then there is almost no risk of trouble. But it is not excluded.

Possible side effects from inhalations:

• Bronchospasm;
• Drying of the mucous membranes, their irritation, resulting in coughing;
• Overdose or hyperventilation (deep breathing) can cause swelling of the mucous membranes, dizziness, tachycardia, redness of the face, blurred vision, clouded consciousness.

All of these reactions are very rare. You just have to not panic. Usually the inhalation is successful.
The course of treatment is from three days to a week.

What is Dexamethasone used for?

The list of diseases in the indications shows how strong and varied the effect of the drug is.

Joint diseases

Inflammatory joint diseases that occur with acute pain are treated with a short course of dexamethasone, injected directly into the joint. The properties of the drug allow you to quickly relieve pain and relieve inflammation.

If the inflammatory process has entered a stage where conventional NSAIDs cannot stop it, the pain is unbearably painful, hormones are added to the treatment of prostatitis.

Powerful and effective dexamethasone in three days will have an effect sufficient to mitigate the disease.

For prostatitis, it is not advisable to prescribe a drug of such a strong effect for a longer period. It suppresses immune reactions, and to heal from prostatitis, immunomodulators and immune stimulation are needed. A conflict of opposition arises. It cannot be prolonged. The risk of side effects increases with long-term use of dexamethasone. Failure of metabolic processes is especially dangerous.

But a short, three-day, hormonal medication will help relieve inflammation and pain. This is important both psychologically and for the successful treatment of prostatitis.

Asthmatic status

The positive effect of the hormone dexamethasone on the bronchial mucosa, preventing or eliminating edema is guaranteed to improve the patient’s condition, help cope with asthma, and relieve exacerbations in a short time. The danger of suffocation disappears, attacks are reduced and weakened. The mucus that clogs the bronchi stops accumulating.

The immunosuppressive and anti-inflammatory properties of the drug have found application in the treatment of eye ailments of allergic etiology. Eye drops are used to treat keratoconjunctivitis, keratitis, inflammatory processes of the conjunctiva, and iritis caused by allergies. At the same time, inflammation is relieved and its cause is eliminated.

One drop continues to act after instillation - 8 hours. All this time, the solution treats the inflamed eye and normalizes metabolic processes at the site of pathology.

Traumatic brain injury

In such a situation, cerebral edema is possible; stopping and eliminating it is vitally important. A glucocorticosteroid can do this.

Infectious diseases

If antibiotics are unable to cope, the body loses strength. Medicine uses the “heavy artillery” – hormones. Not for long, but the effect will have time to appear. With such support, the body will cope with the infection.

Anaphylactic shock

The same allergic reaction, but life-threatening, occurring violently, quickly, requiring immediate help. The antiallergic effect of the drug is life-saving in this situation.

The adrenal cortex normally produces glucocorticosteroids, which regulate many processes in the body. When hormone production is disrupted, a person gets sick.

Dexamethasone is a synthetic hormone identical to what the adrenal glands are supposed to produce.

Its introduction in case of impaired functioning of the latter stabilizes the patient’s well-being.

Thyroid diseases

The drug acts on the pituitary gland, and through it, indirectly, on the thyroid gland. It reduces the increased secretion of thyroid-stimulating hormone.

Dexamethasone or Prednisolone

When choosing Dexamethasone or Prednisolone, it is worth considering the difference in dosage. In terms of glucocorticoid activity, prednisolone lags behind, and by much: seven times. A single dose of the former in injections is 4 mg, and prednisolone is up to 80 mg. It is up to the doctor to decide which medication is better: prednisolone or dexamethasone in each specific situation. Patients are different, and tolerance and concomitant diseases may be different.

Dexamethasone has a stronger effect; the course of treatment with it is only possible for a short period. Then the therapeutic effect of dexamethasone will have time to manifest itself, and the risk of side effects will be minimal.

Prednisolone can be used longer, but it has a weaker effect.

Test with Dexamethasone

What does the dexamethasone test do? In the use of the drug there is such a concept: test. The study is carried out if pathological abnormalities in the functioning of the adrenal cortex are suspected. It is an important endocrine organ that produces hormones. When failures occur, human health suffers greatly.

In the human body of any gender, the endocrine system secretes male (androgens) and female (estrogens) hormones. Normal homeostasis requires a certain ratio of both. For men, the predominance of androgens is important for health, for women - estrogen.

Balance is ensured by the endocrine organs of the reproductive system in each sex separately. But these same hormones are controlled by the adrenal cortex. To check the functioning and health of this important endocrine organ, a test with dexamethasone is performed.

Normally, this hormone is secreted by the adrenal cortex. Homeostasis is the controller of a strictly defined amount of secretion.
The purpose of the test is to determine the amount of cortisol produced by the adrenal glands.

Initially, the patient detects problems in health, painful symptoms and abnormalities. Likely ones are:

• The formation in women of external signs characteristic of men (male hair growth, deepening of the voice, sharp facial features, even the character becomes tougher);
• Delayed or atypical signs of puberty, reproductive problems;
• Symptoms of neoplasms of the reproductive system.

Having contacted a specialist, a person receives an appointment to take tests. The need for a test with dexamethasone is determined by urine analysis. If the analysis showed that the content of 17-ketosteroids in daily urine is increased, pathology of the adrenal glands and more is likely.

An additional study of 24-hour urine hormones may include checking the content of oxycorticosteroids or 17-OX analysis. It will show the amount of all steroid hormone metabolites, not just cortisol. The goal is the same - to check the function of the adrenal glands.

If these tests reveal abnormalities, it is advisable to test with dexamethasone. This manipulation is informative regarding:

• Etiology of hyperandrogenism (increased secretion of androgens);
• Diagnosis of tumors of the adrenal cortex that affect the secretion of hormones;
• Detection of hyperplasia (growth like neoplasms) of the adrenal glands;
• Diagnosis of hypercortisolism - a long-term pathological effect of an excess of adrenal hormones on the body (Itsenko-Cushing disease).

The test also detects: tumor processes of the pituitary gland, ovaries, cysts of the reproductive organs.

Other violations are also diagnosed: the readings are interpreted by a trained doctor

How is the test carried out?

The procedure is performed permanently. It is simple and not very stressful for the body. But accuracy of compliance and medical control are important. Repeated blood sampling is also carried out, which the patient cannot do on his own at home.

The hospitalization is short, there is no need to worry. Calmness is also important for correct diagnosis: stressful conditions change hormonal levels.

On the eve of the examination, stop taking painkillers: they can affect these tests. The attending physician needs to know all the medications the patient is taking. To take into account their influence on the data obtained, if these drugs are capable of distorting the result.

Doctors will monitor both the dose of the drug and the time between subsequent doses of the drug. Violations must not be allowed in order for the result to be reliable.

There are small and large diagnostic tests with dexamethasone.

1. In the morning on an empty stomach, venous blood is collected. It will determine the initial level of cortisol. Blood is drawn at 8 o'clock.
2. Then dexamethasone is started. Every six hours - a tablet. And so - for two days.
3. Third morning – another blood draw. The time, as on the previous, first day, is 8 am.
4. The cortisol levels in both samples are compared.

Large sample:

1. The beginning is similar - blood sampling in the morning.
2. Only two tablets are taken, but once, at 23:00 on the same day.
3. In the morning at 8 – blood donation.

The first method is reliable up to 100%, the second – up to 95%. If cortisol has decreased by half, the test result is positive. The absence of changes is interpreted as a negative test. It is up to the doctor to decide what to do next.

The test is based on the ability of dexamethasone to inhibit the secretion of corticotropin. The adrenal cortex reduces the production of hormones: the function is dependent on corticotropin. But if the tumor secretes hormones, it continues to secrete them: the pituitary gland does not control the activity of the tumor.

If an injected drug is urgently administered to save a life, all likely side effects are ignored. Only one absolute contraindication is taken into account: intolerance to the drug. When the situation is not so dramatic, and the drug is prescribed in a course, other contraindications should be taken into account:

• Open form of tuberculosis;
• Obesity;
• Diabetes mellitus, including hidden (latent) course;
• Decompensated heart failure;
• Hypercholesterolemia;
• Shingles;
• AIDS;
• Ulcerations of any part of the gastrointestinal tract;
• Itsenko-Cushing's disease;
• Thyroid diseases;
• Severe failure of any organ.

There are contraindications for injections into joints:

• Excessive bleeding;
• Fracture of bone tissue in a joint;
• Infections in the joint;
• Operated joints.

Side effects

Hormones should always be used with caution. Even synthetic, they are deeply embedded in the systems that control the body. They take control of it themselves. It is necessary to master the technique of hormonal treatment in order to minimize the likelihood and severity of side effects. Dexamethasone, and if the instructions for use are followed, has many side effects after injections, tablets, even after inhalation:

1. Metabolic disorders - hypokalemia, protein breakdown, bulimia, excess weight gain.
2. Cardiovascular system - arrhythmia, thrombosis, hypertension, myocardial dystrophy, heart failure, bradycardia, asystole (sudden cardiac arrest).
3. Digestive system - gastritis, pancreatitis, ulcerative colitis, intestinal bleeding, vomiting, nausea.
4. Musculoskeletal system - myasthenia gravis, myopathy, muscle dystrophy, osteoporosis, weakness of the spinal column, tendency to fractures.
5. Endocrine system – diabetes mellitus, including latent form, abdominal obesity, adrenal insufficiency, hypertension, menstrual irregularities.
6. Visual organs – increased eye pressure, cataracts.
7. Nervous system – headache, psychosis, dizziness, convulsions, high intracranial pressure, fatigue.
8. Immune suppression is a common infectious disease.



Drug interactions

Some medications increase or decrease the effect of dexamethasone.

Weaken:

• Ephedrine;
• Phenobarbital;
• Phenytoin;
• Rifampicin;
• Antacids.

Hormones act in different ways. Contraceptives (hormonal) have an additive effect: the effect of dexamethasone is enhanced.
Cardiac glycosides in the presence of the drug can provoke arrhythmia.

Diuretics taken at the same time remove potassium in larger quantities, and potassium deficiency is possible. It weakens the heart.

Coumarins behave unpredictably: they can act stronger, they can weaken.

Diacarb and other carbonic anhydrase inhibitors (affecting the kidneys, diuretics) can lead to increased excretion of potassium from the body, retaining sodium. Result: edema, potassium deficiency.

Paracetamol by itself is a blow to the liver, but when paired with dexamethasone it is a double blow.

NSAIDs in such a tandem do not spare the gastrointestinal tract, damaging its parts to the point of bleeding. Their therapeutic effect is simultaneously reduced.

During treatment, it is advisable to exclude anabolic steroids: the combination will cause swelling and may cause excess hair growth (hirsutism).

Neuroleptics promote the formation of cataracts.

Amphotericin B – its combination with dexamethasone is fraught with heart failure.

Live vaccines - the suppressed immune system will not cope, the incidence of infections will increase.

Sodium preparations – edema, increased blood pressure.

special instructions

The drug can cause developmental disorders of the developing fetus in pregnant women. It is undesirable to use it; the risk is great. Sometimes pregnant women are prescribed dexamethasone for health reasons. The newborn will subsequently require intensive treatment.

Do not use during breastfeeding. If this is necessary for the mother, the child should be switched to feeding with adapted formulas.

Taking the drug often affects concentration. Work that requires increased concentration should not be carried out during the treatment period.

If a person taking dexamethasone has been in contact with a patient with a herpetic disease (chickenpox, herpes zoster), he needs immunoglobulins. Immunity suppressed by the drug must be supported.

Dexamethasone should not be used before or after vaccinations: it neutralizes their effect. It can even provoke viral infections against the background of suppressed immunity.

A person undergoing serious hormonal treatment understands that health problems are not a joke. Sometimes this understanding is so depressing that he wants to take some alcohol as an “antidepressant”. The question naturally arises: is it possible?

Each of these substances, taken separately, distorts the normal processes and internal reactions of the body. Combining them will give unpredictable, unplanned results.

Willingly or unwittingly, some patients experienced these unpredictabilities.

Not a single one pleased me. Cross-reactions give up to four dozen negative side effects. Among them:

• Uncontrollable diarrhea;
• Sudden loss or severe decrease in vision;
• “Acute abdomen” – pain in the abdomen, stomach, gag reflex, nausea;
• The injection site becomes intensely painful: two incompatible substances collide there - medicine and alcohol;
• The skin of the body, especially the chest area, reacts to the “explosive mixture” with a rash of large red spots;
• The digestive tract is affected by ulcers;
• The skin of the face becomes acne-greasy.

Organisms are individual, and all troubles cannot be predicted. No positive effect was noticed.

If a person is dependent on alcohol, he cannot take dexamethasone; the prescription of the drugs must be adjusted. You can’t do this on your own; you need to admit it and tell your doctor about the problem.

Analogs

Dexamethasone has analogues - medications with the same active ingredient. There are also drugs that act similarly, but have a different composition. These concepts need to be distinguished simply because the second group will have other indications, contraindications, other side effects and other nuances of use are possible.

Absolute analogues of Dexamethasone:

• Dexamethasone sodium phosphate;
• Vero-Dexamethasone;
• Dexafar;
• Dexamethasone-Ferey;
• Decdan;

In addition to these, there are a dozen more analogues, differing in names and prices, but the active ingredient in all of them is dexamethasone. And the properties, accordingly, are indistinguishable from the original drug.

Preparations with similar active ingredients:

• Berlicourt;
• Budesoni;
• Hydrocortiso;
• Decortin Triamcinolo;
• Budesoni;
• Hydrocortiso;
• Prednisolone.

Inflammatory processes in modern medicine are treated with the help of hormonal drugs, which are analogues of the hormone of the adrenal cortex. Such medications include Dexamethasone injections, which allows them to be used to treat joint diseases and relieve allergic reactions.

Properties of the drug and its use

The substance Dexamethasone is a synthetic analogue of the secretion of the adrenal cortex, which is normally produced in humans, and has the following effects on the body:

1. It reacts with the receptor protein, which allows the substance to penetrate directly into the nuclei of membrane cells.
2. Activates a number of metabolic processes by inhibiting the enzyme phospholipase.
3. Blocks mediators of inflammatory processes in the immune system.
4. Inhibits the production of enzymes that affect protein breakdown, thereby improving the metabolism of bone and cartilage tissue.
5. Reduces the production of leukocytes.
6. Reduces vascular permeability, thereby preventing the spread of inflammatory processes.

As a result of the listed properties, the substance Dexamethasone has a powerful antiallergic, anti-inflammatory, anti-shock, and immunosuppressive effect.

Important! A distinctive positive property of the drug is that when administered intravenously, it has an almost instantaneous effect (when administered intramuscularly, after 8 hours).

Dexamethasone in ampoules is used for the systemic treatment of pathologies, in cases where local therapy and internal medication have not produced any results, or their use is impossible.

Dexamethasone injections can be purchased for 35-60 rubles, or replaced with analogues, including Oftan Dexamethasone, Maxidex, Metazon, Dexasone

Most often, Dexamethasone injections are used to relieve allergic reactions, as well as to treat joint diseases. The description of the drug indicates the following conditions and diseases for which Dexamethasone is used:

• Development of acute adrenal insufficiency;
• Rheumatic pathologies;
• Intestinal diseases of unknown nature;
• Shock conditions;
• Acute forms of thrombocytopenia, hemolytic, severe types of diseases of an infectious nature;
• Skin pathologies: psoriasis, dermatitis;
• , humeroscapular periarthritis, osteoarthritis, ;
• Acute laryngotracheitis in children;
• Absentminded ;
• Swelling of the brain due to traumatic brain injuries, tumors, hemorrhages, radiation injuries, neurosurgical interventions,.

Note! Dexamethasone injections have a powerful anti-inflammatory and antiallergic effect, which is 35 times more effective than the use of cortisone.

Dexamethasone injections are used in the development of acute and emergency conditions, when human life depends on the effectiveness and speed of action of the medicine. The drug is usually used for a short course, taking into account vital indications.

How to use Dexamethasone injections

The instructions for Dexamethasone indicate that injections can be used starting from the first year of life, not only intramuscularly, but also intravenously. Determination of the dose depends on the form and severity of the disease, the presence and manifestations of side effects, and the age of the patient.

Dexamethasone injections intramuscularly for adults

For adults, Dexamethasone can be administered in amounts from 4 mg to 20 mg, while the maximum daily dose should not exceed 80 ml, i.e. The drug is administered three to four times a day. In the event of acute, dangerous situations, the daily dosage can be increased with the consent and under the supervision of a physician.

In the form of injections, Dexamethasone is usually used for no more than 3-4 days, and if it is necessary to continue therapy, they switch to taking the drug in tablet form.

When the expected effect occurs, the dosage of the drug begins to be gradually reduced to a maintenance dose, and discontinuation of the drug is prescribed by the attending physician.

Important! For intravenous and intramuscular use, rapid administration of Dexamethasone in a large dose should not be allowed, because this can lead to heart complications.

For cerebral edema, the dosage of the drug in the initial stage of treatment should be no more than 16 mg. After this, 5 mg of the drug is administered intramuscularly or intravenously every 6 hours until a positive effect occurs.

Dexamethasone injections intramuscularly for children

Dexamethasone is administered to children intramuscularly. The dosage is determined according to the child’s weight - 0.2-0.4 mg per day per kilogram of weight. When treating children, treatment with the drug should not be prolonged, and the dosage should be kept to a minimum depending on the nature and severity of the disease.

Dexamethasone injections during pregnancy

Dexamethasone should be used with extreme caution during pregnancy, because active forms of the drug are able to penetrate through any barriers. The medicine can have a negative effect on the fetus and cause complications both in the fetus and in the subsequently born child. Therefore, the doctor decides whether the drug can be used during pregnancy, because this is only advisable if there is a threat to the mother’s life.

Treatment of joint diseases

When therapy for joint diseases using non-steroidal drugs does not bring the expected effect, doctors are forced to use Dexamethasone injections.

The use of Dexamethasone in the treatment of joint diseases is permissible in the following conditions:

• Scleroderma with articular lesions;
• Still's disease;
• Joint syndrome with.

Note! To eliminate inflammatory processes in the joints of the arms and legs, Dexamethasone injections can in some cases be injected directly into the joint capsule. However, long-term use inside joints is unacceptable, because may cause tendon rupture.

The medicine can be administered to the joint area no more than once per course. The drug can be re-administered in this way only after 3-4 months, i.e. per year, the use of intra-articular Dexamethasone should not exceed three to four times. Exceeding this norm can cause destruction of cartilage tissue.

The intra-articular dosage can vary from 0.4 to 4 mg depending on the patient's age, weight, size of the shoulder or knee joint and the severity of the pathology.

Treatment of allergic diseases

If allergies are accompanied by severe inflammatory processes, then conventional medications will not be able to relieve this condition. In these cases, Dexamethasone is used, which is a derivative of prednisolone, which reduces the manifestation of allergic symptoms.

When to use Dexamethasone injections:

• , and other skin allergic manifestations;
• Inflammatory allergic reactions on the nasal mucosa;
• Angioneurotic and.

A description of the use of Dexamethasone injections indicates that for allergies it is advisable to use injections in conjunction with oral medications. Typically, injections are given only on the first day of therapy - 4-8 mg intravenously. Next, tablets are prescribed for 7-8 days.

Side effects and contraindications

If there are serious complications and the risk of developing severe conditions, the main contraindication to the use of Dexamethasone is the presence of individual intolerance of the patient to the components of the drug.

For chronic pathologies and the use of the drug as prophylaxis, the following contraindications for use are taken into account:

Development of immunodeficiency (acquired and congenital);

• Severe form;
• Joint fractures;
• Infectious diseases of viral, fungal and bacterial nature in the active phase;
• Internal bleeding;
• Mental disorders.

The advisability of using Dexamethasone in the presence of contraindications should be taken into account in each individual case separately. In some cases, the use of the drug for any contraindication may lead to the development of side effects.

The use of Dexamethasone during pregnancy is allowed if the expected effect of therapy outweighs the potential risk to the fetus. Breastfeeding should be stopped during treatment. Infants born to mothers who received significant doses of corticosteroids during pregnancy should be closely monitored for signs of adrenal hypofunction.

Dexamethasone has a certain effect on the body, which can cause side effects:

1. It has a depressing effect on the immune system, which increases the risk of tumors and the development of severe infectious diseases;
2. Prevents healthy bone formation because inhibits absorption;
3. Redistributes deposits of fat cells, which causes fat tissue to be deposited on the torso;
4. Retains sodium ions and water in the kidneys, which interferes with the removal of adrenocorticotropic hormone from the body.

Such properties of Dexamethasone can cause negative side reactions:

• Arterial hypertension;
• Decrease in the level of monocytes and lymphocytes;
• Insomnia, mental disorders, hallucinations, depression;
• , nausea, vomiting, internal bleeding, hiccups,
• Swelling of the optic disc;
• Weight gain, menstrual irregularities, growth problems in children;
• , muscle weakness, damage to articular cartilage, tendon rupture;
• , increased intraocular fluid, cataracts, exacerbations of infectious processes in the eyes.

At the injection site, pain and local symptoms may occur - scarring, atrophy of the skin.

Note! You can reduce the negative impact of the drug by reducing the dosage, but in some cases only stopping the drug helps. In any case, if you feel unwell, you should immediately inform your doctor.

Negative consequences can occur if the course of therapy is abruptly terminated without medical consent. In such cases, the development of arterial hypertension, adrenal insufficiency, and sometimes death was observed.