Dexamethasone

Question 1

Dexamethasone

What is the dose for Airway edema or extubation (off-label use)?

Answer 1

IV: 0.5 mg/kg/dose (maximum dose: 10 mg/dose) 6 to 12 hours prior to extubation then every 6 hours for 5 doses (Khemani 2009)

OR

5 mg every 6 hours for 4 doses with extubation performed 24 hours after last injection (Lee 2007).

Question 2

Why do we given Dexamethasone for PONV?

Answer 2

Dexamethasone may be beneficial because of a direct antiemetic effect and by reducing postoperative pain and the need for postoperative opioids.

Question 3

Should you give low dose Dexamethasone or high dose dexamethasone for PONV?

Answer 3

A meta-analysis of 60 randomized trials with 6700 patients found that a dose of 4 to 5 mg IV dexamethasone was as effective as 8 to 10 mg IV for reduction of PONV

In contrast, two meta-analyses of studies comparing lower-dose (<0.1 mg/kg IV) dexamethasone with higher doses (>0.1 mg/kg) found that higher doses were required for reduced opioid requirement

A subsequent multicenter randomized trial including 1350 patients who underwent bowel surgery reported that a single postinduction dose of dexamethasone 8 mg IV reduced the incidence of PONV at 24 hours and the need for rescue antiemetic for up to 72 hours

Question 4

When should you give Decadron for PONV during the surgery?

Answer 4

Because of its slow onset, dexamethasone is more effective if administered after induction rather than at the end of surgery [71].

Question 5

Decadron PONV Dose Adults

Answer 5

Dexamethasone dose – Adults 4 mg IV after induction

Question 6

Decadron PONV Dose Pediatrics

Answer 6

0.25 mg/kg, maximum 4 mg

Question 7

Dexamethasone

Onset of Action

Answer 7

Rapid

Question 8

Dexamethasone

Duration

Answer 8

Short acting

Question 9

Dexamethasone

Absorption

Answer 9

Oral: 61% to 86%

Question 10

Dexamethasone

Metabolism

Answer 10

Hepatic

Question 11

Dexamethasone

Half Life Elimination Adults

Answer 11

Oral: 4 ± 0.9 hours (Czock 2005);

IV: ~1 to 5 hours

Question 12

Dexamethasone

Half Life Elimination

Children 4 months to 16 years

Answer 12

4. 34 ± 4.14 hours

range: 2.33 to 9.54 hours) (Richter 1983

Question 13

Dexamethasone

Half Life Elimination

Extremely Low Birth Weight Infants

Answer 13

9. 26 ± 3.34 hours

range: 5.85 to 16.1 hours) (Charles 1993

Question 14

Dexamethasone

Time to Peak

Answer 14

Oral: 1 to 2 hours (Czock 2005);

IM: ~30 to 120 minutes (Egerman 1997; Hochhaus 2001)

IV: 5 to 10 minutes (free dexamethasone)

Question 15

Dexamethasone

Excretion

Answer 15

Urine 10%

Question 16

Dexamethasone MOA

Answer 16

Dexamethasone’s mechanism of antiemetic activity is unknown.

Dexamethasone is a long acting corticosteroid with minimal sodium-retaining potential. It decreases inflammation by suppression of neutrophil migration, decreased production of inflammatory mediators, and reversal of increased capillary permeability; suppresses normal immune response.

Question 17

Is decadron present in breast milk?

Answer 17

Corticosteroids are present in breast milk;

Question 18

Is decadron safe in pregnancy>

Answer 18

No

corticosteroids have the potential to cause adverse events in a breastfeeding infant (eg, growth suppression, interfere with endogenous corticosteroid production). Due to the potential for serious adverse reactions in the breastfeeding infant, the manufacturer recommends a decision be made whether to discontinue breastfeeding or to discontinue the drug, taking into account the importance of treatment to the mother. Single doses of dexamethasone are considered compatible with breastfeeding; information related to prolonged use is not available (WHO 2002). If there is concern about exposure to the infant, some guidelines recommend waiting 4 hours after the maternal dose of an oral systemic corticosteroid before breastfeeding in order to decrease potential exposure to the breastfed infant

Question 19

Decadron Pregnancy Class

Answer 19

C

Risk cannot be ruled out

Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal effects or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefits justify the potential risk to the fetus.

Question 20

What side effect is seen with IV Decadron?

Answer 20

Rapid administration may be associated with perineal irritation (especially with higher doses)

Consider further dilution and administration by IV intermittent infusion over 5 to 15 minutes

Question 21

Decadron

Hepatic Impairment Adjustments or Considerations?

Answer 21

There are no dosage adjustments provided in the manufacturer’s labeling.

Question 22

Decadron

Renal Impairment Adjustments or Considerations?

Answer 22

There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.

Dialysis (HD and peritoneal): Supplemental dose not necessary