Dexamethasone Flashcards
Dexamethasone
What is the dose for Airway edema or extubation (off-label use)?
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).
Why do we given Dexamethasone for PONV?
Dexamethasone may be beneficial because of a direct antiemetic effect and by reducing postoperative pain and the need for postoperative opioids.
Should you give low dose Dexamethasone or high dose dexamethasone for PONV?
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
When should you give Decadron for PONV during the surgery?
Because of its slow onset, dexamethasone is more effective if administered after induction rather than at the end of surgery [71].
Decadron PONV Dose Adults
Dexamethasone dose – Adults 4 mg IV after induction
Decadron PONV Dose Pediatrics
0.25 mg/kg, maximum 4 mg
Dexamethasone
Onset of Action
Rapid
Dexamethasone
Duration
Short acting
Dexamethasone
Absorption
Oral: 61% to 86%
Dexamethasone
Metabolism
Hepatic
Dexamethasone
Half Life Elimination Adults
Oral: 4 ± 0.9 hours (Czock 2005);
IV: ~1 to 5 hours
Dexamethasone
Half Life Elimination
Children 4 months to 16 years
- 34 ± 4.14 hours
range: 2.33 to 9.54 hours) (Richter 1983
Dexamethasone
Half Life Elimination
Extremely Low Birth Weight Infants
- 26 ± 3.34 hours
range: 5.85 to 16.1 hours) (Charles 1993
Dexamethasone
Time to Peak
Oral: 1 to 2 hours (Czock 2005);
IM: ~30 to 120 minutes (Egerman 1997; Hochhaus 2001)
IV: 5 to 10 minutes (free dexamethasone)
Dexamethasone
Excretion
Urine 10%
Dexamethasone MOA
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.
Is decadron present in breast milk?
Corticosteroids are present in breast milk;
Is decadron safe in pregnancy>
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
Decadron Pregnancy Class
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.
What side effect is seen with IV Decadron?
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
Decadron
Hepatic Impairment Adjustments or Considerations?
There are no dosage adjustments provided in the manufacturer’s labeling.
Decadron
Renal Impairment Adjustments or Considerations?
There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.
Dialysis (HD and peritoneal): Supplemental dose not necessary
