Dexamethasone (Dexamethasone)
Also sold as: Decadron, Dexona, Dexacort, Dexamethasone GSK
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Tablet (0.5mg, 4mg) +4
Indications
- Cerebral edema (tumour, abscess, trauma)
- Bacterial meningitis (adjunct to antibiotics)
- Severe COVID-19 requiring oxygen or ventilation
- Chemotherapy-induced nausea and vomiting (CINV) prevention
- Antenatal corticosteroid therapy for fetal lung maturity
- Croup (laryngotracheobronchitis) in children
- Acute adrenal insufficiency
- Allergic and anaphylactic reactions
- Spinal cord compression (malignant)
- Anti-inflammatory and immunosuppressive indications
- Dexamethasone suppression test (Cushing's diagnosis)
- Multiple myeloma (part of regimens: VRd, Rd, DPd)
Adult Dosing
Cerebral edema (peritumoral)
10mg IV stat, then 4mg IV/IM q6h
Until stabilised, then oral taper over 5–7 days
Reduces tumour-associated vasogenic edema; less effective for cytotoxic edema
Bacterial meningitis (adjunct)
0.15mg/kg IV q6h
4 days; start with or before first antibiotic dose
Greatest benefit in pneumococcal meningitis; reduces sensorineural hearing loss and neurological sequelae
Severe COVID-19 (O2-dependent/ventilated)
6mg OD oral or IV
10 days or until discharge
RECOVERY trial: NNT=8 for ventilated patients; no benefit in non-hypoxic COVID-19
Antiemetic (chemotherapy)
8–20mg IV
Before chemotherapy; may repeat q12–24h x1–2 days
Combined with ondansetron for highly emetogenic regimens
Antenatal corticosteroid (fetal lung maturity)
12mg IM q24h
2 doses (total 24mg)
For gestational age 24–34 weeks (consider up to 36+6 weeks); give at least 24h before anticipated delivery
Croup (adult/adolescent)
0.15–0.6mg/kg (or 6–10mg fixed dose)
Single dose oral/IM
Single dose equivalent to nebulised budesonide; oral as effective as IM
Anti-inflammatory (general)
0.5–9mg/day in 1–4 divided doses
Titrated to response; taper on discontinuation
1mg dexamethasone ≈ 7mg prednisolone (relative potency)
Pediatric Dosing
Croup: single dose 0.15–0.6mg/kg (max 10mg) oral/IM/IV; Meningitis: 0.15mg/kg q6h x4 days; Cerebral edema: 0.5mg/kg loading, then 0.25mg/kg q6h
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl <30 mL/min | No dose adjustment required; monitor for fluid retention and hypertension |
| Dialysis | Not significantly dialyzed; standard dosing |
Hepatic Adjustment
Use with caution in severe hepatic impairment; dexamethasone is hepatically metabolised (CYP3A4); monitor for enhanced effect
Pregnancy & Lactation
Pregnancy: Category C
Unlike betamethasone, dexamethasone crosses placenta — used deliberately for fetal lung maturity (antenatal). Repeated antenatal doses associated with lower birth weight. Avoid routine systemic use outside specific indications.
Lactation: Caution
Excreted in breast milk. Short courses for acute indications acceptable. For high doses (>6mg/day), consider discarding milk for 4–6 hours after dose.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Rifampicin | Potent CYP3A4 inducer; reduces dexamethasone AUC by up to 66%; significantly reduces efficacy; may need 3x dose increase | Major |
| Phenytoin / Carbamazepine | Strong CYP3A4 inducers reduce dexamethasone levels 3–5 fold; dexamethasone suppression test becomes unreliable; increase dexamethasone dose | Major |
| Live vaccines (MMR, varicella, BCG) | Risk of disseminated vaccine infection; contraindicated with immunosuppressive doses | Major |
| NSAIDs | Additive risk of GI ulceration and bleeding; avoid combination or add PPI | Major |
| Antidiabetics (insulin, oral agents) | Dexamethasone causes dose-dependent hyperglycemia; adjust antidiabetic therapy; monitor BG closely | Moderate |
| Ketoconazole / Itraconazole | CYP3A4 inhibitors increase dexamethasone levels; enhanced steroid toxicity risk | Moderate |
| Warfarin | Variable interaction; generally increases anticoagulant effect; INR monitoring required | Moderate |
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Side Effects
Common
- Hyperglycemia (especially with high doses)
- Insomnia and mood elevation/euphoria
- Increased appetite
- Facial flushing
- Hiccups (especially with IV dosing)
- Perineal burning/itching with rapid IV injection
- Weight gain with prolonged use
- Acne
Serious / Discontinue If
- Adrenal suppression and crisis on withdrawal (with prolonged use)
- Severe hyperglycemia — steroid-induced diabetes
- Avascular necrosis of femoral head
- Posterior subcapsular cataracts
- Osteoporosis with long-term use
- Serious opportunistic infections
- Psychiatric disturbances (psychosis, severe depression)
- Hypertensive crisis with high IV doses
- Kaposi's sarcoma reactivation (with immunosuppression)
Contraindications
- Systemic fungal infections (without concurrent antifungal cover)
- Live vaccine administration during immunosuppression
- Hypersensitivity to dexamethasone or any excipient
- Cerebral malaria (evidence of harm — increased coma duration)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Dexona 0.5mg | Zydus Cadila | ₹15/30 tab |
| Decadron 0.5mg | MSD (Merck) | ₹22/30 tab |
| Dexacort 4mg/mL injection | Pfizer | ₹12/vial |
Monitoring Required
- Blood glucose (fasting and post-prandial) — monitor daily during high-dose IV therapy
- Blood pressure
- Serum electrolytes (sodium, potassium)
- Weight
- Signs of infection (temperature, WBC)
- Intraocular pressure (with prolonged ophthalmic or systemic use)
- Bone density (DEXA) if >3 months therapy
- HbA1c — if prolonged use
Patient Counseling Points
- Do not stop dexamethasone suddenly if you have been taking it for more than 2–3 weeks; always taper as directed.
- Take oral tablets in the morning with food to reduce stomach discomfort.
- This medicine suppresses your immune system — avoid crowds and contact with people who have infections.
- Inform your doctor or any healthcare provider that you are taking dexamethasone before any procedure, surgery, or vaccination.
- Report blurred vision, eye pain, or rapid weight gain immediately.
- Blood sugar can rise significantly — check glucose regularly if you are diabetic or on high doses.
- Do not take antacids within 2 hours of dexamethasone — they may affect absorption.
- Inform your doctor if you experience severe mood swings, confusion, or thoughts of self-harm.
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Clinically reviewed by: Dr. Ramesh Iyer, MD (Medicine), DNB (Critical Care Medicine), PGIMER Chandigarh
Last reviewed: 2026-03-15
References
- RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19. NEJM 2021;384(8):693–704.
- van de Beek D et al. Dexamethasone in adults with bacterial meningitis. NEJM 2002;347(20):1549–1556.
- WHO Consolidated Guidelines on COVID-19 — Corticosteroids. 2021.
- BNF 86 (2024). Dexamethasone monograph. BMJ Group.
- Bjornsdottir US, Boe J. Corticosteroid treatment for croup in children. Cochrane Database Syst Rev 2018.
- CIMS India Drug Reference 2024. Dexamethasone monograph.