Dexamethasone is a corticosteroid. It is designed for use in certain endocrine and non-endocrine disorders, in certain cases of cerebral oedema and for diagnostic testing of adrenocortical hyperfunction.
Dexamethasone may be used in the treatment of non-endocrine corticosteroid responsive conditions including:. Haemolytic anaemia also auto immune buy liquid dexamethasone, leukaemia, myeloma, idiopathic thrombocytopenic purpura in adults, reticulolymphoproliferative buy liquid dexamethasone see also buy liquid dexamethasone oncological disorders.
For treatment during the critical stage in: Raised intra-cranial pressure secondary to cerebral tumours, acute exacerbations of multiple sclerosis.
Anterior and posterior uveitis, optic neuritis, chorioretinitis, iridocyclitis, temporal arteritis, orbital pseudotumour. Pemphigus vulgaris, bullous pemphigoid, erythrodermas, serious forms of erythema multiforme Stevens-Johnson syndromemycosis fungoides, bullous dermatitis herpetiformis.
In general, glucocorticoid dosage depends on the severity of the condition and response of the patient. Under certain circumstances, for instance in stress and changed clinical picture, extra dosage adjustments may be necessary.
The prescribed amount of solution should be withdrawn from the bottle using the oral dosing syringe supplied. The dosage should be titrated to the individual response and the buy liquid dexamethasone of the disease. In order buy liquid dexamethasone minimise side effects, the lowest effective possible dosage should be used see section 4. Usually, daily oral dosages of 0. In buy liquid dexamethasone patients higher dosages may be temporarily required to control the disease.
Once the disease is under control the dosage should be reduced or tapered off to the lowest suitable level under continuous monitoring and observation of the patient see section 4. The initial dosage should be maintained or adjusted until the patient's response is satisfactory. Both the dose in the evening, which buy liquid dexamethasone useful in alleviating morning stiffness, and the divided dosage regimen are associated with greater suppression of the hypothalamo-pituitary-adrenal buy liquid dexamethasone.
If the initial response is favourable, the buy liquid dexamethasone dosage should be determined by lowering the dose gradually to the lowest dose required to maintain an adequate clinical response. Chronic dosage should preferably not exceed 1. If no favourable response is noted within a couple of days, glucocorticoid therapy should be discontinued. Patients should be monitored for signs that dosage adjustment is required. These may arise from a change in clinical status e. During periods of stress it may be necessary to increase the dose temporarily.
If the drug is to be discontinued after more than a few days of treatment, it should be withdrawn gradually. Milligram for milligram, dexamethasone is approximately equivalent to betamethasone, 4 to 6 times more potent than methylprednisolone and triamcinolone, 6 to 8 times more potent than prednisone and buy liquid dexamethasone, 25 to 30 times more potent than hydrocortisone, and about 35 times more potent than cortisone. Acute, self-limiting allergic disorders or acute exacerbations of chronic allergic disorders.
This schedule is designed to ensure adequate therapy during acute episodes whilst minimising the risk of overdosage in chronic cases. Initial therapy is usually by injection. When maintenance therapy is required, this should be changed to dexamethasone oral solution as soon as possible.
For the palliative management of patients buy liquid dexamethasone recurrent or inoperable brain tumours, maintenance dosage should be calculated individually. A dosage of buy liquid dexamethasone two or three times a day may be effective.
The smallest dosage necessary to control symptoms should always be buy liquid dexamethasone. Lower strength oral formulations may buy liquid dexamethasone the administration of lower daily doses in the initial stages of treatment. Blood samples are then taken at 8am the next morning for plasma cortisol determination.
If greater accuracy is required, micrograms 0. Blood should be drawn at 8am for plasma cortisol determination on the third morning. Test to distinguish Cushing's syndrome caused by pituitary ACTH excess from the syndrome induced by other causes: For a short dexamethasone suppression test, the use of lower strength oral formulations may facilitate the administration of lower doses.
Buy liquid dexamethasone elderly may be more susceptible to the side-effects of corticosteroids particularly during long-term therapy. Suitable for administration via nasogastric NG or percutaneous endoscopic gastrostomy PEG tubes only. For further information see section 6. Avoid live vaccines in patients receiving immuno suppressive doses serum antibody response diminished.
In general buy liquid dexamethasone contraindications apply in conditions where the use of glucocorticoids may be life saving. Patients should carry 'Steroid treatment' cards which give clear guidance on the precautions to be taken to minimise risk and which provide details of prescriber, drug, dosage and the duration of treatment. Undesirable effects may be minimised by using the lowest effective dose for the minimum period, and by administering the daily requirement as a single morning dose or whenever possible as a single morning dose on alternative days.
Frequent patient review is required to appropriately titrate the dose against disease activity. When reduction in dosage is possible, the reduction should be gradual Refer to 'Posology and Administration'. Corticosteroids may exacerbate systemic fungal infections and should not be used unless they are needed to control drug reactions due to amphotericin. There have also been reports in which concomitant use of amphotericin and hydrocortisone was buy liquid dexamethasone by cardiac enlargement and heart failure.
If inactivated viral or bacterial vaccines are administered to individuals receiving immunosuppressive doses of corticosteroids, the expected serum antibody response may not be obtained. Suppression of the inflammatory response and immune function increases the susceptibility to infections and their severity. The clinical presentation may often buy liquid dexamethasone atypical, and serious infections such as septicaemia and tuberculosis may be masked and may reach an advanced stage before being recognised.
Appropriate anti-microbial therapy should accompany glucocorticoid therapy when necessary e. There may be decreased resistance and inability to localise buy liquid dexamethasone in patients on corticosteroids. Chickenpox is of particular concern since this normally minor illness may be fatal in immunosuppressed patients. Patients or parents of children without a definite history of chickenpox should be advised to avoid close personal contact with chickenpox or herpes zoster and if exposed they should seek urgent medical attention.
Passive immunisation with varicella zoster immunoglobulin VZIG is needed by exposed non-immune patients who are receiving systemic corticosteroids or who have used them within the previous 3 months; this should be given within 10 days of exposure to chickenpox. If a diagnosis of chickenpox is confirmed, the illness warrants specialist care and urgent treatment. Corticosteroids should not be stopped buy liquid dexamethasone the dose may need to be increased.
Measles can have a more serious or buy liquid dexamethasone fatal course in immunosuppressed patients. In such children or adults particular care should be taken to avoid exposure to measles.
If exposed, prophylaxis with intramuscular pooled immunoglobulin IG may be indicated. Exposed patients should be advised to seek medical advice without delay. Corticosteroids may buy liquid dexamethasone latent amoebiasis or strongyloidiasis or exacerbate active disease.
Latent disease may be activated or there buy liquid dexamethasone be an exacerbation of intercurrent infections due to pathogens, including those caused by Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis or Toxoplasma.
It is recommended that these are ruled out before initiating corticosteroid therapy particularly in those patients who have spent time in the tropics or those with unexplained diarrhoea.
A report shows that the use of corticosteroids in cerebral malaria is associated with a prolonged coma and an increased incidence of pneumonia and gastro-intestinal bleeding and therefore corticosteroids should not be used in cerebral malaria. Prolonged use of corticosteroids may produce subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to fungi or viruses.
Particular care is needed when treating patients with glaucoma buy liquid dexamethasone family history of glaucoma as well as when treating patients with ocular herpes simplex, because of possible corneal perforation.
Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, retention of salt and water, and increased excretion of potassium, but these effects are less likely to occur with synthetic derivatives, except when used in large doses.
Dietary salt restriction and potassium supplementation may be necessary with corticosteroid therapy. All corticosteroids increase calcium excretion. Particular care is needed when treating patients with renal impairment, hypertention and congestive heart failure.
Adrenal cortical atrophy develops during prolonged therapy and may persist for years after stopping treatment. Withdrawal of corticosteroids after prolonged therapy must therefore always be gradual to avoid acute adrenal insufficiency, being tapered off over weeks or months according to the dose and duration of treatment. In patients who have received more than physiological doses of systemic corticosteroids approximately 1 mg dexamethasone for greater than 3 weeks, withdrawal should not be abrupt.
How dose reduction should be carried buy liquid dexamethasone depends largely on whether the disease is likely to relapse as the dose of systemic corticosteroids is reduced. Clinical assessment of disease activity may be needed during withdrawal. If the disease is unlikely to relapse on withdrawal of systemic corticosteroids but there is uncertainty about HPA suppression, the dose of systemic corticosteroid may be reduced rapidly to physiological doses.
Once a daily dose of 1mg dexamethasone is reached, dose reduction should be slower to allow buy liquid dexamethasone HPA-axis to recover. Abrupt withdrawal of systemic corticosteroid treatment, which has continued up to 3 weeks, is appropriate if it is considered that the disease is unlikely to relapse. Abrupt withdrawal of doses of up to 6mg daily of dexamethasone for 3 weeks is unlikely to lead to clinically relevant HPA-axis suppression in the majority of patients.
In the following patient groups, gradual withdrawal of systemic corticosteroid therapy should be considered even after courses lasting 3 weeks or less:. During prolonged therapy any intercurrent illness, trauma or surgical procedure will require a temporary increase in dosage; if corticosteroids have been stopped following prolonged therapy they may need to be temporarily re-introduced.
Patients under stress may require increased doses of corticosteroids prior, during and after the period of stressful situation. Stopping corticosteroids after prolonged therapy may cause withdrawal symptoms including fever, myalgia, arthralgia and malaise.
This may occur in patients even without evidence of adrenal insufficiency. In addition to the information given under the other headings, particular care is required when considering the use of systemic corticosteroids in patients with the following conditions and frequent patient monitoring is necessary:.
There is an enhanced effect of corticosteroids in patients with hypothyroidism and in those with cirrhosis. Reports in the literature suggest an apparent association between use of corticosteroids and left-ventricular free-wall rupture after a recent myocardial infarction; therefore, corticosteroids should be used with great caution in these patients.
In rare cases, decrease or withdrawal of orally administered corticosteroids could reveal underlying disease that is accompanied by eosinophilia e. Churg Strauss Syndrome in patients with asthma. The results of a randomised, placebo-controlled study suggest an increase in mortality if methylprednisolone therapy starts more than two weeks after the onset of Acute Respiratory Distress Syndrome ARDS.
Rare cases of anaphylactoid or hypersensitivity reactions such as glottis oedema, urticaria and bronchospasm have been reported especially with parenteral administration of corticosteroids and in patients with a history of allergy. Prophylactic measures should be taken especially if the patient has a history of allergic reactions to medicines.
If such an anaphylactoid reaction occurs, the following measures are recommended: Symptoms typically emerge within a few days or weeks of starting the treatment.
Most reactions recover after either dose reduction or withdrawal, although specific treatment may be necessary.
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