Indications: suppression of inflammatory and allergic disorders; shock; diagnosis of Cushing's syndrome; congenital adrenal hyperplasia; cerebral oedema; inflammation associated with malignancy; croup; nausea and vomiting with chemotherapy; rheumatic disease; eye.

Cautions: pregnancy and breast-feeding. adrenal suppression and infection, children and adolescents (growth retardation possibly irreversible), elderly (use with supervision particularly on long-term treatment); if history of tuberculosis (or X-ray changes) use with frequent monitoring, hypertension, recent myocardial infarction (rupture reported), congestive heart failure, liver failure, renal impairment, diabetes mellitus including family history, osteoporosis (post-menopausal women at special risk), glaucoma (including family history), corneal perforation, severe affective disorders (particularly if history of steroid-induced psychosis), epilepsy, peptic ulcer, hypothyroidism, history of steroid myopathy; pregnancy; breast feeding.

Contra-indications: systemic infection; avoid live virus vaccines in those receiving immunosuppressive doses (serum antibody response diminished).

Side Effects: use lowest effective dose for minimum period possible to minimise side effects; gastro-intestinal effects include dyspepsia, peptic ulceration (with perforation), abdominal distension, acute pancreatitis, oesophageal ulceration and candidiasis; musculoskeletal effects include proximal myopathy, osteoporosis, vertebral and long bone fractures, avascular osteonecrosis, tendon rupture; endocrine effects include adrenal suppression, menstrual irregularities and amenorrhoea, Cushing's syndrome if used in high doses, usually reversible on withdrawal, hirsutism, weight gain, negative nitrogen and calcium balance, increased appetite; increased susceptibility to and severity of infection; neuropsychiatric effects include euphoria, psychological dependence, depression, insomnia, increased intracranial pressure with papilloedema in children (usually after withdrawal), psychosis and aggravation of schizophrenia, aggravation of epilepsy; ophthalmic effects include glaucoma, papilloedema, posterior subcapsular cataracts, corneal or scleral thinning and exacerbation of ophthalmic viral or fungal disease; other side effects: include impaired healing, skin atrophy, bruising, striae, telangiectasia, acne, myocardial rupture following recent myocardial infarction, fluid and electrolyte disturbance, leucocytosis, hypersensitivity reactions (including anaphylaxis), thromboembolism, nausea, malaise, hiccups; perineal irritation may follow intravenous administration of the phosphate ester.

Drug Interactions: with Aspirin, NSAI drugs, anticoagulant, diuretics estrogen phenytoin, rifampicin, sulphonyleurea resulting in side effects or altered effectiveness of the medication.

Dose: By mouth, usual range 0.5–10 mg daily; CHILD 10–100 mcg/kg daily; By intramuscular injection or slow intravenous injection or infusion (as dexamethasone phosphate), initially 0.5–24 mg; CHILD 200–400 mcg/kg daily.

Cerebral oedema associated with malignancy (as dexamethasone phosphate), by intravenous injection, 10 mg initially, then 4 mg by intramuscular injection every 6 hours as required for 2–4 days then gradually reduced and stopped over 5–7 days.

Adjunctive treatment of bacterial meningitis, (starting before or with first dose of antibacterial treatment, as dexamethasone phosphate), by intravenous injection, 10 mg every 6 hours for 4 days; CHILD 150 mcg/kg every 6 hours for 4 days.

Dexamethasone 1 mg ≡ dexamethasone phosphate 1.2 mg ≡ dexamethasone sodium phosphate 1.3 mg