Drenex

Cerebral edema associated w/ primary or metastatic brain tumor, craniotomy or head injury. Control of severe incapacitating allergic conditions intractable to adequate trials of conventional treatment in adult & childn w/ bronchial asthma, contact dermatitis, serum sickness, seasonal or perennial allergic rhinitis, atopic dermatitis, & drug hypersensitivity reactions. Adjunctive therapy for short-term administration of rheumatic disorders. During an exacerbation or as maintenance therapy for SLE, arteritis or acute rheumatic carditis. Severe acute & chronic allergic & inflammatory processes involving the eye & its adnexa. Induce diuresis or remission of proteinuria in nephrotic syndrome, w/o uremia, of the idiopathic type or that due to lupus erythematosus. Tide the patient over a critical period of the disease in ulcerative colitis & regional enteritis. Congenital adrenal hyperplasia, nonsuppurative thyroiditis, hypercalcemia associated w/ cancer, primary or secondary adrenocortical insufficiency; pemphigus, severe erythema multiforme, mycosis fungoides, severe psoriasis, bullous dermatitis herpetiformis, exfoliative dermatitis, severe seborrheic dermatitis; symptomatic sarcoidosis, fulminating or disseminated pulmonary TB, aspiration pneumonitis, berylliosis, idiopathic eosinophilic pneumonias, Loeffler's syndrome, prevention of neonatal resp distress syndrome; idiopathic thrombocytopenic purpura & secondary thrombocytopenia in adult, congenital hypoplastic anemia, pure red cell aplasia, acquired hemolytic anemia; palliative management of leukemias & lymphomas in adult, chemotherapy-induced nausea & vomiting, acute leukemia in childn; tuberculous meningitis w/ subarachnoid block or impending block, diagnostic testing of adrenocortical hyperfunction, acute exacerbations of multiple sclerosis, trichinosis w/ neurologic or myocardial involvement.

Individualized dosage. Adult Initially 0.75-9 mg/day. Childn Initially 0.02-0.3 mg/kg/day. Acute exacerbations of multiple sclerosis 30 mg daily for a wk then 4-12 mg every other day for 1 mth. Acute, self-limited allergic disorders or acute exacerbations of chronic disorders Day 1: 4-8 mg IM; day 2 & 3: 3 mg in 2 divided doses; day 4: 1.5 mg in 2 divided doses; day 5 & 6: 0.75 mg once daily. Cerebral edema 1-3 mg tid. Chemotherapy-induced nausea & vomiting Low emetic risk: 8 mg single dose before chemotherapy on day 1; moderate emetic risk: 8 mg single IV dose before chemotherapy on day 1 then 8 mg once daily on days 2 & 3 w/o aprepitant & 12 mg single dose before chemotherapy on day 1 w/ aprepitant; high emetic risk: 12 mg single dose before chemotherapy on day 1 then 8 mg once daily on days 2-4. Test for Cushing's syndrome 1 mg at 11 pm then blood is extracted for plasma cortisol determination at 8 am the following morning. Test for distinguishing Cushing's syndrome due to pituitary adrenocorticotropic hormone excess from Cushing's syndrome due to other causes 2 mg every 6 hr for 48 hr then 24 hr urine free cortisol & 17-hydrocorticosteroid excretion.

Should be taken with food.

Hypersensitivity. Systemic fungal infections, GI ulcer, osteoporosis, DM, HTN, immediately before prophylactic immunization, acute or chronic infections, history of psychotic illness. Renal insufficiency. Pregnancy.

Exaggerated effects in patients w/ hypothyroidism & cirrhosis. Kaposi's sarcoma in patients receiving treatment for chronic conditions. Altered metabolic clearance in hypothyroid or hyperthyroid patients. Increased susceptibility to or mask symptoms of infection. May exacerbate systemic fungal infections. Do not administer live or live attenuated vaccines (including smallpox vaccine). Activation of latent diseases or exacerbation of intercurrent infections. Do not use in cerebral malaria; active ocular herpes simplex. Use only in active TB in fulminating or disseminated cases. Monitor IOP if therapy is continued for >6 wk. HTN, CHF, renal insufficiency, recent MI; diverticulitis, recent intestinal anastomoses, nonspecific ulcerative colitis. Acute myopathy. May lead to mental disturbances & aggravate emotional instability or psychotic tendencies. Avoid abrupt w/drawal. Concomitant use w/ amphotericin B & hydrocortisone. False -ve result w/ nitroblue-tetrazolium test for bacterial infections. Closely monitor grown & development of infant & childn if prolonged therapy is necessary. Postmenopausal women. Lactation. Elderly.

Decreased carbohydrate tolerance, development of cushingoid state, glycosuria, hirsutism, hyperglycemia, increased requirements for insulin or oral hypoglycemic agents in diabetes, manifestations of latent DM, menstrual irregularities, secondary adrenocortical & pituitary unresponsiveness, suppression of growth in child, CHF, fluid retention, HTN, hypokalemic alkalosis, K loss, Na retention, bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, fat embolism, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent MI, edema, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis. Aseptic necrosis of femoral & humeral heads, loss of muscle mass, muscle weakness, osteoporosis, pathological fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures, convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure w/ papilledema, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychic disorders, vertigo. Abdominal distention, elevation of serum liver enzyme levels, hepatomegaly, increased appetite, nausea, pancreatitis, peptic ulcer w/ possible perforation & hemorrhage, perforation of the small & large bowel particularly in patients w/ inflammatory bowel disease, ulcerative esophagitis, acne, allergic dermatitis, dry scaly skin, erythema, increased sweating, impaired wound healing, petechia & ecchymoses, thin fragile skin, rash, striae, thinning scalp hair, urticaria, suppress reactions to skin tests. -ve nitrogen balance due to protein catabolism, exophthalmos, glaucoma, increased IOP, posterior subcapsular cataracts, abnormal fat deposits, decreased resistance to infection, hiccups, increased/decreased motility & number of spermatozoa, malaise, moon face, wt gain, allergic reactions including anaphylactoid reactions, anaphylaxis, angioedema.

May enhance metabolism, shorten plasma t½ & lead to less effect w/ barbiturates, phenytoin, ephedrine, carbamazepine, rifampicin & other drugs that stimulate hepatic metabolism. May increase plasma conc w/ ketoconazole & macrolides. May increase clearance of indinavir, erythromycin & other drugs metabolized by CYP3A4. Alterations in plasma protein binding & metabolism w/ OCs & estrogen. Increased risk of GI adverse effects w/ aspirin & NSAIDs. Decreased response to warfarin. Cardiac enlargement & CHF w/ amphotericin B & hydrocortisone. Severe weakness in patients w/ myasthenia gravis w/ anticholinesterase agents. Decreased absorption w/ antacids. May increase blood glucose conc. Decreased metabolism w/ ketoconazole. Toxic epidermal necrolysis w/ thalidomide. False -ve dexamethasone suppression test w/ indomethacin. May diminish adrenal suppression w/ aminoglutethimide. May increase clearance w/ cholestyramine. Increased activity w/ ciclosporin. Increased risk of arrhythmias due to hypokalemia w/ digitalis glycosides. May enhance metabolic clearance w/ ephedrine. Prolonged therapy may diminish response to toxoids & live or inactivated vaccines. May suppress reaction to skin tests.

Corticosteroid Hormones

H02AB02 - dexamethasone ; Belongs to the class of glucocorticoids. Used in systemic corticosteroid preparations.

Rx