Dexamet Dosage/Direction for Use

Dexamethasone Phosphate (Dexamet) solution for injection can be given without mixing or dilution, but if preferred, can be added without loss of potency to sodium chloride or dextrose injection and given by intravenous drip. The infusion mixture must be used within 24 hours and the usual aseptic techniques for injections should be observed. Solutions used for intravenous administration or further dilution of this product should be preservative-free when used in the neonate, especially the premature infant.
All dosage recommendations are given in units of Dexamethasone Phosphate.
Intravenous and intramuscular injection: General considerations: Dosage must be individualized on the basis of the disease and the response of the patient. In order to minimize side effects, the lowest possible dosage adequate to control the disease process should be used. Usually, the parenteral dosage ranges are one-third to one-half the oral dose given every 12 hours.
The usual initial dosage is 0.5 mg-20 mg (0.125 mL-5 mL) a day. In situations of less severity, lower doses will generally suffice. However, in certain overwhelming, acute, life-threatening situations, administration in dosages exceeding the usual dosages may be justified. In these circumstances, the slower rate of absorption by intramuscular administration should be recognized.
Both the dose in the evening, which is useful in alleviating morning stiffness, and the divided dosage regimen are associated with greater suppression of the hypothalamic-pituitary-adrenal axis. After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial dosage by small amounts at appropriate intervals to the lowest dosage which will maintain an adequate clinical response. Chronic dosage should preferably not exceed 500 micrograms of Dexamethasone daily. Close monitoring of the drug dosage is needed.
To avoid hypoadrenalism and/or a relapse of the underlying disease, it may be necessary to withdraw the drug gradually.
Whenever possible, the intravenous route should be used for the initial dose and for as many subsequent doses as are given while the patient is in shock (because of the irregular rate of absorption of any drug administered by any other route in such patients). When the blood pressure responds, use the intramuscular route until oral therapy can be substituted. For the comfort of the patient, not more than 2 mL should be injected intramuscularly at any one site.
In emergencies, the usual dose of Dexamethasone Phosphate (Dexamet) Injection by intravenous or intramuscular injection is 4 mg-20 mg (1 mL-5 mL) (in shock use only the I.V. route). This dose may be repeated until adequate response is noted.
After initial improvement, single doses of 2 mg-4 mg (0.5 mg-1 mL), repeated as necessary, should be sufficient. The total daily dosage usually need not exceed 80 mg (20 mL), even in severe conditions.
When constant maximal effect is desired, dosage must be repeated at three hour or four-hour intervals or maintained by slow intravenous drip.
Intravenous and intramuscular injections are advised in acute illness. When the acute stage has passed, oral steroid therapy should be substituted as soon as feasible.
Frequency of injection, once every three to five days to once every two to three weeks, depending on response.
Use in children: Dosage should be limited to a single dose on alternate days to lessen retardation of growth and minimize suppression of the hypothalamic-pituitary-adrenal axis.
Use in the Elderly: Treatment of elderly patients, particularly if long term, should be planned bearing in mind the more serious consequences of the common side effects of corticosteroid in old age, especially osteoporosis, diabetes, hypertension, hypokalemia, susceptibility to infection and thinning of the skin.
Close clinical supervision is required to avoid life threatening reactions.