Dexamethasone (Rheumatology)

The SPC states these dosing recommendations are given for guidance only and that the initial and daily doses should always be determined by individual patient response and disease severity; the lowest effective dose should be used. Other SPC indications, listed for reference and NOT the rheumatology regimen: cerebral oedema 6-16 mg (up to 24 mg)/day orally in 3-4 divided doses; acute asthma (adults) 16 mg/day for two days; acute skin diseases 8-40 mg/day, in some cases up to 100 mg, followed by down-titration; idiopathic thrombocytopenic purpura 40 mg for 4 days in cycles; palliative treatment of neoplastic disease 3-20 mg/day (very high doses up to 96 mg may also be used); prophylaxis and treatment of emesis induced by emetogenic chemotherapy 8-20 mg before chemotherapy then 4-16 mg/day on days 2 and 3; prevention and treatment of postoperative vomiting single dose of 8 mg before surgery; symptomatic multiple myeloma, acute lymphocytic/lymphoblastic leukaemia, Hodgkin's and non-Hodgkin's lymphoma in combination with other medicinal products, usually 40 mg or 20 mg once per day varying with the therapeutic protocol. Tuberculous meningitis regimens in the SPC are intravenous then oral and weight-based (grade II or III: IV 0.4 mg/kg/day week 1, 0.3 mg/kg/day week 2, 0.2 mg/kg/day week 3, 0.1 mg/kg/day week 4, then oral for four weeks starting at 4 mg/day total and decreasing by 1 mg each week; grade I: IV 0.3 mg/kg/day week 1 and 0.2 mg/kg/day week 2, then oral 0.1 mg/kg/day week 3 and then 3 mg/day total decreasing by 1 mg each week). Long-term treatment: after initial therapy, glucocorticoid treatment should be switched from dexamethasone to prednisone/prednisolone to reduce suppression of adrenal cortex function. Discontinuation: acute adrenocortical failure may occur after abrupt discontinuation of long-term high-dose treatment, so doses should be reduced gradually. During specific physical stress (trauma, surgery, childbirth) a temporary dose increase may be required. Hepatic impairment: dose adjustment may be necessary in severe liver disease. Elderly: plasma concentrations may be higher and excretion slower than in younger patients, so the dose should be reduced accordingly, bearing in mind the more serious consequences of common corticosteroid side effects in old age. The 10 mg soluble tablet is not suitable for subdivision of the dose (as tablet or as solution) - select another available strength, and a lower strength or formulation may be needed during tapered dose reduction. PAEDIATRIC: the SPC gives NO paediatric rheumatology dose. It states only that excretion of dexamethasone is approximately equal in children and adults if dosage is adjusted to their body area, and that dosage should be planned bearing in mind possible effects on growth and development and signs of adrenal suppression. The only paediatric mg/kg figures in the SPC are for other indications (acute asthma 0.6 mg/kg body weight for one or two days; croup 0.15 mg/kg to 0.6 mg/kg in a single dose) and must not be carried across to rheumatology. Verify all under-18 dosing against a children's formulary. Source: eMC SPC for Dexamethasone 10mg Soluble Tablets.