Dexamethasone Uses, Dosage, Side Effects & Warnings | DrugsAtlas
Authoritative Clinical Reference
Therapeutic Class
Corticosteroid
Subclass
Glucocorticoid (Long-acting, High Potency)
Speciality
Endocrinology
Schedule (India)
Schedule H
Routes
Oral, Intravenous (IV), Intramuscular (IM), Topical, Ophthalmic, Intra-articular
Formulations
- Tablets: 0.5 mg, 0.75 mg, 4 mg
- Injection: 4 mg/mL (1 mL, 2 mL ampoules), 8 mg/2 mL
- Eye drops: 0.1% (5 mL, 10 mL)
- Eye ointment: 0.1%
- Topical cream/ointment: 0.05%, 0.1%
- Inhalation solution/Respules: Limited availability in India
Fixed-Dose Combinations (FDCs) Available:
- Dexamethasone + Neomycin + Polymyxin B (ophthalmic)
- Dexamethasone + Chloramphenicol (ophthalmic)
- Dexamethasone + Ciprofloxacin (ophthalmic/otic)
- Dexamethasone + Clotrimazole (topical)
Adult indications
INDICATIONS + DOSING ā FOR CLINICIAN USE ONLY
Primary Indications (Approved / Standard in India)
1. COVID-19 (Hospitalised Patients Requiring Supplemental Oxygen)
Per ICMR/AIIMS COVID-19 Management Guidelines
| Parameter | Dose |
|---|---|
|
Starting dose
|
6 mg IV or oral once daily |
|
Titration
|
Not applicable ā fixed dose regimen |
|
Usual maintenance dose
|
6 mg once daily |
|
Maximum dose
|
6 mg/day |
Duration: 5ā10 days (up to 10 days or until discharge, whichever is earlier)
Clinical Notes:
- Proven mortality benefit in RECOVERY trial; endorsed by ICMR and AIIMS
- Use ONLY in patients requiring oxygen (SpO2 <94% on room air) or on ventilatory support
- Do NOT use in mild COVID-19 without hypoxia ā may worsen outcomes
- May be given IV initially, switching to oral when stable
- Monitor for secondary infections, hyperglycaemia
2. Cerebral Oedema (Associated with Brain Tumours, CNS Infections, Head Injury)
Loading Dose:
| Parameter | Dose |
|---|---|
|
Starting dose
|
10 mg IV stat (or 8ā12 mg) |
|
Titration
|
Not applicable for loading |
Maintenance:
| Parameter | Dose |
|---|---|
|
Starting dose
|
4 mg IV every 6 hours |
|
Titration
|
Taper based on clinical response once oedema controlled |
|
Usual maintenance dose
|
4 mg IV/oral every 6ā8 hours |
|
Maximum dose
|
24 mg/day (higher doses rarely needed) |
Duration: 5ā14 days depending on aetiology; taper over 5ā7 days once improvement noted
Clinical Notes:
- Effective for vasogenic oedema (tumours, infections); less effective for cytotoxic oedema (stroke)
- Begin taper as soon as clinically feasible to minimise steroid adverse effects
- Switch to oral route when patient able to take orally
- For bacterial meningitis: see specific dosing under indications
3. Acute Asthma Exacerbation / Severe COPD Exacerbation
| Parameter | Dose |
|---|---|
|
Starting dose
|
4ā8 mg IV/IM every 8ā12 hours |
|
Titration
|
Not applicable ā short-term use |
|
Usual maintenance dose
|
4ā8 mg IV/IM twice daily initially; then 4 mg oral once or twice daily |
|
Maximum dose
|
16 mg/day |
Duration: IV for 48ā72 hours; oral switch and taper over 5ā7 days
Clinical Notes:
- Prednisolone 40ā50 mg/day oral often preferred for asthma exacerbations (more evidence)
- Dexamethasone useful when IV route required or patient cannot swallow
- Equivalent anti-inflammatory dose: 6 mg dexamethasone ≈ 40 mg prednisolone
- No taper needed if course ≤5 days
4. Chemotherapy-Induced Nausea and Vomiting (CINV) ā Prophylaxis and Treatment
High Emetogenic Chemotherapy (HEC):
| Parameter | Dose |
|---|---|
|
Starting dose
|
12ā20 mg IV/oral before chemotherapy (Day 1) |
|
Titration
|
Not applicable |
|
Usual maintenance dose
|
8 mg oral once or twice daily (Days 2ā4) |
|
Maximum dose
|
20 mg on Day 1; 8 mg twice daily on subsequent days |
Moderate Emetogenic Chemotherapy (MEC):
| Parameter | Dose |
|---|---|
|
Starting dose
|
8ā12 mg IV/oral before chemotherapy |
|
Titration
|
Not applicable |
|
Usual maintenance dose
|
4ā8 mg oral once daily (Days 2ā3) |
|
Maximum dose
|
12 mg/day |
Clinical Notes:
- Use in combination with 5-HT3 antagonists (ondansetron) ± NK1 antagonists (aprepitant)
- Single-dose regimens may be sufficient for some protocols
- Pre-medication typically given 30ā60 minutes before chemotherapy
5. Allergic and Inflammatory Conditions (Severe Acute Reactions)
| Parameter | Dose |
|---|---|
|
Starting dose
|
4ā8 mg IV/IM/oral |
|
Titration
|
Reduce dose as symptoms improve |
|
Usual maintenance dose
|
0.5ā4 mg/day oral (if maintenance needed) |
|
Maximum dose
|
16 mg/day for acute phase |
Clinical Notes:
- For anaphylaxis: dexamethasone is adjunctive (NOT a substitute for adrenaline)
- For severe allergic reactions not requiring adrenaline: useful for preventing biphasic reactions
- Short courses (3ā5 days) generally do not require taper
6. Adrenal Insufficiency (Replacement Therapy ā Alternative to Hydrocortisone)
| Parameter | Dose |
|---|---|
|
Starting dose
|
0.5ā0.75 mg orally once daily (morning) |
|
Titration
|
Adjust based on symptoms and clinical response |
|
Usual maintenance dose
|
0.5ā0.75 mg once daily |
|
Maximum dose
|
1.5 mg/day (equivalent to physiological replacement) |
Clinical Notes:
- Hydrocortisone (15ā25 mg/day in divided doses) is preferred for physiological replacement
- Dexamethasone lacks significant mineralocorticoid activity ā add fludrocortisone if salt-wasting form
- Long half-life allows once-daily dosing
- Monitor for Cushingoid features if dose excessive
7. Bacterial Meningitis (Adjunctive Therapy)
| Parameter | Dose |
|---|---|
|
Starting dose
|
0.15 mg/kg IV every 6 hours (adult equivalent: ~10 mg IV every 6 hours) |
|
Titration
|
Not applicable |
|
Usual maintenance dose
|
0.15 mg/kg IV every 6 hours |
|
Maximum dose
|
10 mg IV every 6 hours |
Duration: 4 days (start before or with first dose of antibiotics)
Clinical Notes:
- Best evidence for Streptococcus pneumoniae meningitis
- Must be given BEFORE or WITH first antibiotic dose for maximum benefit (reduces mortality and neurological sequelae)
- Benefit uncertain if given after antibiotics already started
- Per AIIMS and ICMR meningitis protocols
Secondary Indications ā Adults (Off-label)
| Indication | Dose | Duration | Supervision | Evidence Basis |
|---|---|---|---|---|
|
Acute Spinal Cord Compression (Malignant) (OFF-LABEL)
|
Loading: 10ā16 mg IV; Maintenance: 4ā8 mg IV/oral every 6 hours | Until definitive treatment (surgery/radiotherapy); then taper | Specialist only (Oncology/Neurosurgery) | Indian oncology practice; reduces oedema and may improve neurological function temporarily |
|
ARDS (Non-COVID) (OFF-LABEL)
|
20 mg IV on Day 1, then 10 mg IV daily for Days 2ā5, then taper | 10ā14 days total with taper | Specialist only (Critical Care) | DEXA-ARDS trial; reduces mortality and ventilator days; Indian ICU practice |
|
Immune Thrombocytopenia (ITP) ā First-line (OFF-LABEL)
|
40 mg oral once daily for 4 days; cycles may be repeated | 4-day pulses; repeat PRN | Specialist only (Haematology) | High response rate; alternative to prednisolone; Indian haematology practice |
|
Autoimmune Haemolytic Anaemia (AIHA) (OFF-LABEL)
|
0.5ā1 mg/kg/day oral (equivalent prednisolone dose often used) | Weeks to months; taper based on response | Specialist only (Haematology) | Indian haematology practice |
|
Multiple Myeloma (as part of chemotherapy regimen) (OFF-LABEL)
|
20ā40 mg oral weekly or per protocol (e.g., VRd, Rd) | Per chemotherapy protocol | Specialist only (Oncology) | Standard component of myeloma regimens |
|
Antenatal Corticosteroid for Fetal Lung Maturation (OFF-LABEL)
|
6 mg IM every 12 hours × 4 doses (total 24 mg) | Single course (4 doses over 48 hours) | Specialist only (Obstetrics) | RCOG/WHO recommendations; used when betamethasone unavailable; Indian obstetric practice |
Paediatric indications
PAEDIATRIC DOSING (Specialist Only)
ā ļø Steroid use in neonates should be under specialist supervision only due to risks of neurodevelopmental effects, infections, and adrenal suppression.
Primary Indications
1. Croup (Laryngotracheobronchitis)
| Parameter | Dose |
|---|---|
|
Starting dose
|
0.15ā0.6 mg/kg oral/IM as single dose |
|
Titration
|
Not applicable ā single dose usually sufficient |
|
Usual maintenance dose
|
Not applicable |
|
Maximum dose
|
12 mg (single dose) |
Clinical Notes:
- Single dose highly effective; repeat dosing rarely needed
- 0.6 mg/kg is standard dose in most IAP/Indian protocols
- If unable to tolerate oral: give IM or use nebulised budesonide as alternative
- Onset of action: 1ā2 hours; may use nebulised adrenaline for immediate relief in severe cases
2. Acute Severe Asthma / Bronchospasm
| Parameter | Dose |
|---|---|
|
Starting dose
|
0.15ā0.3 mg/kg IV/IM/oral |
|
Titration
|
Not applicable for acute use |
|
Usual maintenance dose
|
0.15ā0.3 mg/kg/day in 1ā2 divided doses |
|
Maximum dose
|
6 mg/dose; 12 mg/day |
Duration: 3ā5 days; no taper needed for short course
Clinical Notes:
- Prednisolone 1ā2 mg/kg/day oral often preferred (more paediatric data)
- Dexamethasone useful when IV required or if vomiting
- Single-dose or 2-day dexamethasone regimens increasingly used for acute asthma
3. Bacterial Meningitis (Adjunctive)
| Parameter | Dose |
|---|---|
|
Starting dose
|
0.15 mg/kg IV |
|
Titration
|
Not applicable |
|
Usual maintenance dose
|
0.15 mg/kg IV every 6 hours |
|
Maximum dose
|
10 mg every 6 hours (adult equivalent) |
Duration: 4 days; give before or with first antibiotic dose
Clinical Notes:
- Start BEFORE or WITH first antibiotic dose ā delayed administration reduces benefit
- Best evidence for S. pneumoniae and H. influenzae type b meningitis
- Per IAP and ICMR guidelines
4. Congenital Adrenal Hyperplasia (CAH) ā Replacement Therapy
| Parameter | Dose |
|---|---|
|
Starting dose
|
0.25ā0.5 mg/m²/day oral in 1ā2 divided doses |
|
Titration
|
Adjust based on 17-OHP levels, growth, bone age |
|
Usual maintenance dose
|
0.25ā0.5 mg/m²/day |
|
Maximum dose
|
Individualised; avoid over-replacement |
Clinical Notes:
- Hydrocortisone preferred in growing children (less growth-suppressive)
- Dexamethasone may be used in post-pubertal patients or those with poor compliance (once-daily dosing)
- Add fludrocortisone if salt-wasting form
- Specialist (Paediatric Endocrinology) supervision mandatory
5. Chemotherapy Protocols (Leukaemia, Lymphoma)
| Parameter | Dose |
|---|---|
|
Starting dose
|
Protocol-specific (typically 6ā10 mg/m²/day) |
|
Titration
|
Per protocol |
|
Usual maintenance dose
|
Protocol-specific |
|
Maximum dose
|
Protocol-specific (may exceed usual limits) |
Clinical Notes:
- Used in induction, consolidation phases of ALL protocols
- Specialist (Paediatric Oncology) supervision mandatory
- Monitor for hyperglycaemia, infections, mood changes, myopathy
Age-Based Dosing Reference (Croup/Asthma):
| Age/Weight | Single Dose (Croup) | Asthma Dose (Daily) |
|---|---|---|
| 6ā12 months | 1ā2 mg | 1ā1.5 mg/day |
| 1ā2 years | 2ā3 mg | 1.5ā2 mg/day |
| 2ā5 years | 3ā4 mg | 2ā3 mg/day |
| 6ā12 years | 4ā8 mg | 3ā6 mg/day |
| >12 years | 8ā12 mg | 6 mg/day |
Secondary Indications ā Paediatrics (Off-label)
| Indication | Age | Dose | Duration | Supervision | Evidence Basis |
|---|---|---|---|---|---|
|
Antiemetic for Chemotherapy (OFF-LABEL)
|
≥1 year | 4ā8 mg/m² IV before chemotherapy; 2ā4 mg/m² oral for 2ā3 days | Per chemotherapy cycle | Specialist only (Paediatric Oncology) | Standard paediatric oncology practice |
|
Acute Lymphoblastic Leukaemia (ALL) ā Induction (OFF-LABEL)
|
Any age | 6ā10 mg/m²/day in divided doses as per protocol | 28-day induction cycle | Specialist only (Paediatric Oncology) | Standard ALL protocols (BFM, COG) |
Safety Monitoring (All Paediatric Use):
- Growth velocity and height percentile (long-term use)
- Blood glucose (especially during acute illness or high-dose therapy)
- Blood pressure
- Signs of infection (fever may be masked)
- Behavioural changes, mood disturbance
- Bone density (if prolonged use)
- Ophthalmologic examination (cataracts, glaucoma with chronic use)
- Adrenal function before discontinuation if >2 weeks use
Age Restrictions:
- Neonates: Avoid unless under neonatology/endocrinology specialist supervision
- Use in infants <6 months should be carefully justified
Renal Adjustments
No dose adjustment required in renal impairment.
| Renal Function | Recommendation |
|---|---|
|
All eGFR levels
|
No dose adjustment required |
|
Haemodialysis
|
No supplemental dose required; not significantly dialysed |
|
Peritoneal Dialysis
|
No dose adjustment required |
Note: Monitor for fluid retention and electrolyte disturbances (hypokalaemia) in patients with renal impairment on long-term therapy.
Hepatic adjustment
Contraindications
- Known hypersensitivity to dexamethasone or any corticosteroid
- Systemic fungal infections (unless being treated with specific antifungals)
- Cerebral malaria (may worsen outcome)
- Administration of live or live-attenuated vaccines during immunosuppressive doses
- Untreated systemic bacterial, viral, or parasitic infections (unless corticosteroid is part of treatment protocol)
- Idiopathic thrombocytopenic purpura (IM injection contraindicated)
- Herpes simplex keratitis (for ophthalmic use)
Cautions
- Diabetes mellitus ā may significantly worsen glycaemic control; monitor blood glucose
- Hypertension ā may exacerbate; monitor BP
- Heart failure ā fluid retention may worsen symptoms
- Osteoporosis or risk factors for bone loss ā consider bone protection if prolonged use
- Peptic ulcer disease or history of GI bleeding ā increased risk of GI complications
- Psychiatric disorders (depression, psychosis, mania) ā may precipitate or exacerbate
- Glaucoma ā may increase intraocular pressure
- Myasthenia gravis ā initial worsening possible before improvement
- Thyroid disorders ā may alter thyroid function tests
- Active or latent tuberculosis ā may reactivate; screen before prolonged use
- Strongyloides infection risk (endemic areas/immigrants) ā screen before high-dose steroids
- Concurrent anticoagulant therapy ā increased bleeding risk
- Recent myocardial infarction ā myocardial rupture reported
- Immunocompromised patients ā increased infection risk
- Children ā growth suppression with prolonged use
- Abrupt withdrawal after prolonged use ā risk of adrenal crisis
Pregnancy
| Parameter | Information |
|---|---|
|
Overall Safety
|
Use only if benefit outweighs risk; crosses placenta |
|
Risk
|
First trimester: possible slight increase in orofacial cleft risk (data inconclusive); later pregnancy: generally well-tolerated short courses |
|
Preferred Alternatives
|
Prednisolone or prednisone preferred for long-term use (greater placental metabolism, less fetal exposure) |
|
Specific Indication
|
Fetal lung maturation (24ā34 weeks): 6 mg IM every 12 hours × 4 doses; alternative to betamethasone |
|
When Use May Be Justified
|
Severe maternal illness (asthma, ARDS, COVID-19); fetal lung maturation; obstetric specialist supervision |
|
Monitoring
|
Maternal: blood glucose, BP, signs of infection; Fetal: growth if chronic exposure; Neonatal: glucose, adrenal function after maternal exposure |
Lactation
| Parameter | Information |
|---|---|
|
Compatibility
|
Generally compatible with breastfeeding for short courses |
|
Expected Drug Level in Milk
|
Low (corticosteroids present in small amounts) |
|
Risk to Infant
|
Minimal with short-term maternal use; theoretical risk of adrenal suppression with high-dose prolonged exposure |
|
Preferred Alternatives
|
Prednisolone may be preferred (more data; greater maternal metabolism) |
|
Infant Monitoring
|
Growth, feeding, signs of adrenal insufficiency (rare) with prolonged high-dose maternal therapy |
|
Recommendation
|
Short courses acceptable; for prolonged high-dose use, consider alternatives or monitor infant |
Elderly
| Parameter | Recommendation |
|---|---|
|
Starting dose
|
Use lowest effective dose (typically lower end of dose range) |
|
Titration
|
Slower titration and taper; elderly more susceptible to adverse effects |
|
Increased Risks
|
Osteoporosis and fractures; hyperglycaemia and new-onset diabetes; hypertension; fluid retention and heart failure exacerbation; infections (including reactivation TB); delirium and psychiatric disturbance; GI bleeding (especially with NSAIDs); myopathy; cataracts; skin fragility |
|
Additional Precautions
|
Consider bone protection (calcium, vitamin D, bisphosphonate) for courses >3 months; monitor glucose; use PPI if GI risk factors; avoid NSAIDs if possible |
Major drug interactions
| Interacting Drug | Mechanism | Effect | Management |
|---|---|---|---|
|
Rifampicin, Rifabutin
|
Strong CYP3A4 induction | Significantly reduced dexamethasone levels and efficacy (may need 2ā3× dose) | Increase dexamethasone dose; monitor clinical response; consider alternative steroid |
|
Phenytoin, Carbamazepine, Phenobarbital
|
CYP3A4 induction | Reduced dexamethasone efficacy | May need dose increase; monitor response |
|
Ketoconazole, Itraconazole
|
CYP3A4 inhibition | Increased dexamethasone levels and toxicity | Use with caution; monitor for steroid adverse effects; reduce dose if necessary |
|
Ritonavir, Cobicistat
|
Strong CYP3A4 inhibition | Markedly increased dexamethasone exposure; Cushing syndrome risk | Avoid if possible; if essential, reduce dexamethasone dose significantly; monitor closely |
|
Live Vaccines (BCG, OPV, MMR, Varicella, Yellow Fever)
|
Immunosuppression | Risk of disseminated vaccine infection |
Avoid live vaccines during high-dose immunosuppressive therapy and for 3 months after
|
|
NSAIDs
|
Additive GI toxicity | Significantly increased risk of peptic ulceration and GI bleeding | Avoid combination if possible; if essential, co-prescribe PPI; monitor for GI symptoms |
|
Warfarin and other Vitamin K Antagonists
|
Unclear mechanism; variable effect on INR | May increase or decrease anticoagulant effect | Monitor INR closely when starting, stopping, or changing dexamethasone dose |
Moderate drug interactions
| Interacting Drug | Effect | Management |
|---|---|---|
|
Insulin, Oral Antidiabetics
|
Corticosteroids antagonise glucose-lowering effect | Monitor blood glucose frequently; adjust antidiabetic doses as needed |
|
Antihypertensives
|
Corticosteroids may reduce efficacy (fluid retention, vasoconstriction) | Monitor BP; may need antihypertensive dose adjustment |
|
Diuretics (Thiazides, Loop)
|
Additive hypokalaemia | Monitor potassium; supplement if needed |
|
Digoxin
|
Steroid-induced hypokalaemia may increase digoxin toxicity | Monitor potassium and digoxin levels |
|
Amphotericin B
|
Additive hypokalaemia | Monitor potassium closely; supplement as needed |
|
Fluoroquinolones (Ciprofloxacin, Levofloxacin)
|
Increased risk of tendon rupture | Use with caution; advise patient to report tendon pain |
|
Cyclosporine, Tacrolimus
|
Mutual inhibition of metabolism; possible additive immunosuppression | Monitor drug levels; watch for toxicity of both agents |
|
Aspirin (Anti-inflammatory doses)
|
Additive GI bleeding risk; steroids may increase aspirin clearance | Co-prescribe PPI; monitor for GI symptoms; may need aspirin dose adjustment |
|
Oestrogens / Oral Contraceptives
|
May increase corticosteroid effect (reduced clearance) | Monitor for steroid adverse effects |
|
Neuromuscular Blocking Agents (Pancuronium, Vecuronium)
|
May enhance or prolong neuromuscular blockade | Use with caution in ICU setting |
Common Adverse effects
Short-term Use (<2 weeks):
- Hyperglycaemia
- Insomnia
- Increased appetite, weight gain
- Mood changes (euphoria, irritability, anxiety)
- Dyspepsia, gastritis
- Fluid retention, facial flushing
- Increased energy/restlessness
Long-term Use:
- Cushingoid features (moon face, buffalo hump, central obesity)
- Skin thinning, easy bruising, striae
- Muscle weakness (proximal myopathy)
- Hypertension
- Hypokalaemia
- Immunosuppression, increased infection risk
- Acne
- Hirsutism
- Menstrual irregularities
Serious Adverse effects
| Adverse Effect | Clinical Action |
|---|---|
|
Adrenal Suppression / Adrenal Crisis (on abrupt withdrawal after prolonged use)
|
Never stop abruptly after >7ā10 days use; taper gradually; stress-dose steroids during illness/surgery |
|
Peptic Ulcer with Haemorrhage/Perforation
|
Consider PPI prophylaxis in high-risk patients; discontinue if severe GI symptoms; endoscopy if bleeding |
|
Avascular Necrosis (Osteonecrosis) (especially femoral head)
|
High-dose/prolonged use; investigate hip pain; MRI for diagnosis; orthopaedic referral |
|
Severe Infections / TB Reactivation / Opportunistic Infections
|
Screen for latent TB before prolonged use; maintain high suspicion for infection (fever may be masked) |
|
Hyperglycaemia / New-Onset Diabetes / DKA
|
Monitor glucose; treat with insulin if needed; may require admission in severe cases |
|
Severe Psychiatric Reactions (psychosis, severe depression, mania, suicidal ideation)
|
May require dose reduction or discontinuation; psychiatric consultation |
|
Posterior Subcapsular Cataract / Glaucoma
|
Ophthalmologic evaluation for chronic use; may need treatment |
|
Osteoporotic Fractures
|
Bone protection for prolonged use; DEXA scan; treat osteoporosis |
|
Growth Suppression in Children
|
Use lowest effective dose; alternate-day therapy if possible; monitor growth |
|
Myopathy (Steroid Myopathy)
|
Proximal weakness; CK usually normal; reduce dose; physiotherapy |
|
SJS/TEN (rare)
|
Discontinue immediately; dermatology consultation; hospitalisation |
|
Anaphylaxis (rare, especially with IV)
|
Discontinue; emergency management |
Monitoring requirements
| Timing | Parameters |
|---|---|
|
Baseline (before starting, especially for prolonged use)
|
Blood glucose (FBG, HbA1c); blood pressure; weight; serum electrolytes (potassium); complete blood count; chest X-ray or Mantoux/IGRA for latent TB (if >2 weeks planned use); bone density (DEXA) if osteoporosis risk; ophthalmologic examination (baseline) |
|
Short-term use (<2 weeks)
|
Blood glucose (daily if diabetic or hospitalised); BP; clinical assessment for adverse effects |
|
After initiation of prolonged therapy (2ā4 weeks)
|
Blood glucose; electrolytes; BP; weight; signs of infection; mood/behaviour |
|
Long-term use (every 1ā3 months)
|
Blood glucose/HbA1c; BP; weight; potassium; signs of Cushing syndrome; infections; mood; growth (children); DEXA annually; ophthalmologic examination annually |
|
Before discontinuation
|
Assess HPA axis suppression (if >2 weeks use); plan taper; educate on stress dosing |
Brands in India
Tablets:
- Dexona⢠(Zydus Cadila) ā 0.5 mg, 4 mg
- Decadron⢠ā 0.5 mg
- Dexameth⢠(Cadila) ā 0.5 mg
- Wysolone-D⢠ā 0.5 mg
- Generic dexamethasone ā 0.5 mg, 4 mg
Injection:
- Dexona⢠Injection (Zydus) ā 4 mg/mL
- Decmax⢠(Mankind) ā 4 mg/mL
- Dexamethasone Injection⢠(Various) ā 4 mg/mL, 8 mg/2mL
Ophthalmic:
- MaxDex⢠Eye Drops ā 0.1%
- Dexacort⢠Eye Drops ā 0.1%
- Various FDCs (Dexamethasone + antibiotic)
Topical:
- Desowen⢠(though this is desonide, often confused)
- Various FDC topical preparations
Price range (INR)
| 0.5 mg tablet | ā¹0.80āā¹3.00 per tablet | ā |
|---|---|---|
| 4 mg tablet | ā¹2.00āā¹6.00 per tablet | ā |
| 4 mg/mL injection (2 mL) | ā¹8āā¹25 per ampoule | NLEM listed |
| 8 mg/2mL injection | ā¹15āā¹40 per ampoule | ā |
| 0.1% eye drops (5 mL) | ā¹25āā¹60 | ā |
Regulatory: Injectable formulation listed under NLEM 2022; NPPA price controlled for scheduled formulations; widely available in government supply
Clinical pearls
- COVID-19: oxygen-dependent only ā Dexamethasone 6 mg/day reduces mortality in hypoxic COVID-19 patients; do NOT use in mild cases without hypoxia ā may be harmful
- Tapering after prolonged use ā HPA axis suppression occurs after >7ā10 days of systemic steroids; taper gradually (reduce by 10ā20% every few days to weeks depending on duration/dose); abrupt withdrawal may precipitate adrenal crisis
- Meningitis timing critical ā Give dexamethasone BEFORE or WITH the first antibiotic dose; benefit lost if started after antibiotics
- Equivalent potency ā Dexamethasone is ~6ā7× more potent than prednisolone; 6 mg dexamethasone ≈ 40 mg prednisolone (anti-inflammatory equivalence)
- GI protection ā Co-prescribe PPI in patients on high-dose steroids, elderly, or those with history of peptic ulcer or concurrent NSAID/anticoagulant use
- Drug interactions with TB treatment ā Rifampicin significantly reduces dexamethasone efficacy; may need 2ā3× usual dose to achieve clinical effect in patients on anti-TB therapy
Version
RxIndia v1.1 ā 02 Apr 2025
Reference
- CDSCO Product Information
- Indian Pharmacopoeia (IP)
- National List of Essential Medicines (NLEM) 2022
- ICMR COVID-19 Management Guidelines
- AIIMS COVID-19 Treatment Protocol
- API Textbook of Medicine
- AIIMS and PGIMER Protocols for Cerebral Oedema
- Harrison's Principles of Internal Medicine
- Goodman & Gilman's The Pharmacological Basis of Therapeutics
- IAP Guidelines (Croup, Asthma, Meningitis)
- MoHFW National Asthma and COPD Treatment Modules
- RECOVERY Trial (NEJM 2020) ā COVID-19 evidence
- DEXA-ARDS Trial ā ARDS evidence (off-label)
- European Society of Medical Oncology (ESMO) Antiemetic Guidelines ā CINV evidence
āļø
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This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.
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