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Dexamethasone (Dexamethasone) - Indications and Dosage



By intravenous or intramuscular injection when oral therapy is not feasible:

1. Endocrine Disorders

     Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids

     where applicable; in infancy, mineralocorticoid supplementation is of particular importance).

     Acute adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; mineralocorticoid supplementation may be necessary, particularly when synthetic analogs

     are used).

     Preoperatively, and in the event of serious trauma or illness, in patients with known adrenal insufficiency or when adrenocortical reserve is doubtful.

     Shock unresponsive to conventional therapy if adrenocortical insufficiency exists or is suspected.

     Congenital adrenal hyperplasia

     Nonsuppurative thyroiditis

     Hypercalcemia associated with cancer

2. Rheumatic Disorders

     As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in:

     Post-traumatic osteoarthritis

     Synovitis of osteoarthritis

     Rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy).

     Acute and subacute bursitis


     Acute nonspecific tenosynovitis

     Acute gouty arthritis

     Psoriatic arthritis

     Ankylosing spondylitis

3. Collagen Diseases

     During an exacerbation or as maintenance therapy in selected cases of:

     Systemic lupus erythematosus

     Acute rheumatic carditis

4. Dermatologic Diseases


     Severe erythema multiforme (Stevens-Johnson syndrome)

     Exfoliative dermatitis

     Bullous dermatitis herpetiformis

     Severe seborrheic dermatitis

     Severe psoriasis

     Mycosis fungoides

5. Allergic States

     Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in:

     Bronchial asthma

     Contact dermatitis

     Atopic dermatitis

     Serum sickness

     Seasonal or perennial allergic rhinitis

     Drug hypersensitivity reactions

     Urticarial transfusion reactions

     Acute noninfectious laryngeal edema (epinephrine is the drug of first choice).

6. Ophthalmic Diseases

     Severe acute and chronic allergic and inflammatory processes involving the eye, such as:

     Herpes zoster ophthalmicus

     Iritis, iridocyclitis


     Diffuse posterior uveitis and choroiditis

     Optic neuritis

     Sympathetic ophthalmia

     Anterior segment inflammation

     Allergic conjunctivitis


     Allergic corneal marginal ulcers

7. Gastrointestinal Diseases

     To tide the patient over a critical period of the disease in:

     Ulcerative colitis (systemic therapy)

     Regional enteritis (systemic therapy)

8. Respiratory Diseases

     Symptomatic sarcoidosis


     Fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy.

     Loeffler’s syndrome not manageable by other means.

     Aspiration pneumonitis

9. Hematologic Disorders

     Acquired (autoimmune) hemolytic anemia.

     Idiopathic thrombocytopenic purpura in adults

     (IV only; IM administration is contraindicated).

     Secondary thrombocytopenia in adults

     Erythroblastopenia (RBC anemia)

     Congenital (erythroid) hypoplastic anemia

10. Neoplastic Diseases

     For palliative management of:

     Leukemias and lymphomas in adults

     Acute leukemia of childhood

11. Edematous States

     To induce diuresis or remission of proteinuria in the nephrotic syndrome, without uremia, of the idiopathic type or that due to lupus erythematosus.

12. Miscellaneous

     Tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy.

     Trichinosis with neurologic or myocardial involvement.

13. Diagnostic testing of adrenocortical hyperfunction.

14. Cerebral Edema associated with primary or metastatic brain tumor, craniotomy, or head injury.  Use in cerebral edema is not a substitute for careful neurosurgical evaluation

     and definitive management such as neurosurgery or other specific therapy.  


Dexamethasone sodium phosphate injection, 10 mg/mL– For intravenous and intramuscular injection only.

Dexamethasone sodium phosphate injection can be given directly from the vial, or it can be added to Sodium Chloride Injection or Dextrose Injection and administered by intravenous drip.

Solutions used for intravenous administration or further dilution of this product should be preservative free when used in the neonate, especially the premature infant.

When it is mixed with an infusion solution, sterile precautions should be observed.  Since infusion solutions generally do not contain preservatives, mixtures should be used within 24 hours.


Intravenous and Intramuscular Injection

The initial dosage of dexamethasone sodium phosphate injection varies from 0.5 to 9 mg a day depending on the disease being treated.  In less severe diseases doses lower than 0.5 mg may suffice, while in severe diseases doses higher than 9 mg may be required.

The initial dosage should be maintained or adjusted until the patient’s response is satisfactory.  If a satisfactory clinical response does not occur after a reasonable period of time, discontinue dexamethasone sodium phosphate injection and transfer the patient to other therapy.

After a favorable initial response, the proper maintenance dosage should be determined by decreasing the initial dosage in small amounts to the lowest dosage that maintains an adequate clinical response.

Patients should be observed closely for signs that might require dosage adjustment, including changes in clinical status resulting from remissions or exacerbations of the disease, individual drug responsiveness, and the effect of stress (e.g., surgery, infection, trauma).  During stress it may be necessary to increase dosage temporarily.  If the drug is to be stopped after more than a few days of treatment, it usually should be withdrawn gradually.

When the intravenous route of administration is used, dosage usually should be the same as the oral dosage.  In certain overwhelming, acute, life-threatening situations, however, administration in dosages exceeding the usual dosages may be justified and may be in multiples of the oral dosages.  The slower rate of absorption by intramuscular administration should be recognized.


There is a tendency in current medical practice to use high (pharmacologic) doses of corticosteroids for the treatment of unresponsive shock.  The following dosages of dexamethasone sodium phosphate injection have been suggested by various authors:




3 mg/kg of body weight per 24 hours by constant intravenous infusion after an initial intravenous injection of 20 mg


2 to 6 mg/kg of body weight as a single intravenous injection


40 mg initially followed by repeat intravenous injection every 4 to 6 hours while shock persists


40 mg initially followed by repeat intravenous injection every 2 to 6 hours while shock persists


1 mg/kg of body weight as a single intravenous injection

Administration of high dose corticosteroid therapy should be continued only until the patient’s condition has stabilized and usually not longer than 48 to 72 hours.

Although adverse reactions associated with high dose, short term corticosteroid therapy are uncommon, peptic ulceration may occur.

Cerebral Edema

Dexamethasone sodium phosphate injection is generally administered initially in a dosage of 10 mg intravenously followed by four mg every six hours intramuscularly until the symptoms of cerebral edema subside.  Response is usually noted within 12 to 24 hours and dosage may be reduced after two to four days and gradually discontinued over a period of five to seven days. For palliative management of patients with recurrent or inoperable brain tumors, maintenance therapy with 2 mg two or three times a day may be effective.

Acute Allergic Disorders

In acute, self-limited allergic disorders or acute exacerbations of chronic allergic disorders, the following dosage schedule combining parenteral and oral therapy is suggested:

Dexamethasone sodium phosphate injection, first day , 4 or 8 mg intramuscularly.

Dexamethasone tablets, 0.75 mg: second and third days, 4 tablets in two divided doses each day; fourth day , 2 tablets in two divided doses; fifth and sixth days, 1 tablet each day; seventh day, no treatment; eighth day, follow-up visit.

This schedule is designed to ensure adequate therapy during acute episodes, while minimizing the risk of overdosage in chronic cases.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever the solution and container permit.


Dexamethasone Sodium Phosphate Injection, USP (Preservative Free) equivalent to 10 mg dexamethasone phosphate, is supplied in a single dose vial as follows:






Vial Size



10 mg/mL

1 mL

Packaged in twenty-fives.

Dexamethasone Sodium Phosphate Injection, USP (Preserved) equivalent to 10 mg dexamethasone phosphate, is supplied in a multiple dose vial as follows:






Vial Size



10 mg/mL

10 mL

Packaged in tens.

Vial stoppers do not contain natural rubber latex.


Store at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature].  Sensitive to heat. Do not autoclave.

Protect from freezing.

Protect from light.

Single dose vials–Store in container until time of use.  Discard unused portion.

Multiple dose vials–Store in container until contents are used.

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