Dexamethasone, 4 mg/ml 1 ml 25 pcs

Dexamethasone is a synthetic glucocorticoid drug containing fluorine atom.
It has pronounced anti-inflammatory, anti-allergic and desensitizing effect, has immunosuppressive activity.

It slightly retains sodium and water in the body. These effects are associated with inhibition of release of inflammatory mediators by eosinophils; induction of lipocortin formation and reduction of the number of mast cells producing hyaluronic acid; reduction of capillary permeability and stabilization of cell membranes (especially lysosomal) and organelle membranes.

The immunosuppressive effect is due to inhibition of release of cytokinins (interleukin 1, 2, gamma interferon) from lymphocytes and macrophages. The main effect on metabolism is connected with protein catabolism, increased gluconeogenesis in liver and decreased utilization of glucose by peripheral tissues.

The drug inhibits vitamin D activity, which leads to decreased calcium absorption and increased calcium excretion. Dexamethasone suppresses the synthesis and secretion of ACTH and secondary to the synthesis of endogenous glucocorticoids.

The peculiarity of action of the drug is significant inhibition of pituitary function and complete absence of mineralocorticoid activity.

Indications

According to the indications and prescribed doses are recommended for the treatment of all those diseases which are amenable to systemic treatment with glucocorticoids (if necessary as additional treatment to the main treatment), if local treatment or oral administration is impossible or ineffective:

• shock of various genesis (anaphylactic, posttraumatic, postoperative, cardiogenic, hemotransfusion, etc.
• cerebral edema (with a brain tumor, brain injury, neurosurgery, brain hemorrhage, encephalitis, meningitis, radiation injury);
• asthmatic status;
• Severe allergic reactions (Quincke’s edema, bronchospasm, dermatosis, acute anaphylactic reaction to medications, serum transfusions, pyrogenic reactions);
• acute hemolytic anemia, thrombocytopenia, agranulocytosis;
• acute lymphoblastic leukemia;
• acute insufficiency of the adrenal cortex;
• acute croup;
• acute (or exacerbation) rheumatic diseases, systemic connective tissue diseases and joint diseases (scapular periarthritis, epicondylitis, styloiditis, bursitis, tendovaginitis, compression neuropathy, osteochondrosis, arthritis of various etiologies, osteoarthritis);
• diagnosis of adrenocortical insufficiency, pituitary stunting (in children), affective disorders, including.

Active ingredient

Dexamethasone

Composition

Active ingredient:

dexamethasone sodium phosphate 4 mg;

Associates:

Methylparaben, 1.5 mg;

Propylparaben, 0.2 mg;

Sodium metabisulfite, 2 mg;

dinatrium edetate – 1 mg;

sodium hydroxide – to pH 7-8.5;

water for injection – up to 1 ml.

How to take, the dosage

Dexamethasone is administered intravenously by trickle slowly or by drip and intramuscularly. The dose of Dexamethasone is set individually. Within a day, 4 to 20 mg can be administered 3 to 4 times. The maximum daily dose is 80 mg. In exceptional cases, higher. The duration of parenteral administration is usually 3-4 days, then switch to maintenance therapy with oral form of Dexamethasone.

In the acute period for various diseases and at the beginning of treatment, Dexamethasone is used in higher doses. When an effect is achieved, the dose of Dexamethasone is reduced at intervals of a few days until a maintenance dose is reached or until treatment is stopped.

In cases of shock (adults), v/v, 20 mg once, then 3 mg/kg for 24 h as a continuous infusion or v/v once 2-6 mg/kg, or v/v 40 mg every 2-6 (4-6) h.

In cerebral edema (adults), 10 mg v/v, then 4 mg every 6 hr v/m until symptoms subside; the dose is reduced after 2-4 days and gradually, over 5-7 days, discontinue treatment.

In adrenal cortex insufficiency (children), 0.0233 mg/kg (0.67 mg/m2) per day in 3 injections every third day, or daily 0.00776-0.01165 mg/kg (0.233-0.335 mg/m2) per day.

Interaction

Possible pharmacological incompatibility of dexamethasone with other IV drugs administered – it is recommended to administer it separately from other drugs (by IV bolus or through another IV, as a second solution). When mixing dexamethasone solution with heparin, a precipitate is formed.

The simultaneous administration of dexamethasone with:

• hepatic microsomal enzyme inducers (phenobarbital, rifampicin, phenytoin, theophylline, ephedrine) lead to a decrease in its concentration;
• with sodium-containing drugs – development of edema and increased arterial pressure;
• cardiac glycosides – worsens their tolerance and increases the risk of ventricular extrasittole (due to hypokalemia caused);
• indirect anticoagulants – weakens (rarely increases) their effect (requires dose adjustment);
• anticoagulants and thrombolytics – increases the risk of bleeding from ulcers in the stomach;
• paracetamol – increased risk of hepatotoxicity (induction of liver enzymes and formation of toxic metabolite of paracetamol);
• Insulin and oral hypoglycemic drugs, hypotensive agents – their effectiveness decreases;
• Insulin and oral hypoglycemic drugs – reduces their effectiveness
• vitamin D – its effect on absorption of Ca2+ in the intestine is reduced;
• somatotropic hormone – reduces the effectiveness of the latter, and spraziquantel – its concentration;
• isoniazid and mexiletine – increases their metabolism (especially in “slow” acetylators), which leads to a decrease in their plasma concentrations.

Carboanhydrase inhibitors and “loop” diuretics may increase the risk of osteoporosis.

Indomethacin, by displacing dexamethasone from binding to albumin, increases the risk of its side effects.

ACTH increases the effects of dexamethasone.

Ergocalciferol and parathormone prevent dexamethasone-induced osteopathy.

Cyclosporine and ketoconazole, while slowing the metabolism of dexamethasone, can increase its toxicity in some cases.

The concomitant administration of androgens and steroid anabolic drugs with dexamethasone promotes peripheral edema and hirsutism and the appearance of acne.

Estrogens and oral estrogen-containing contraceptives decrease dexamethasone clearance, which may be accompanied by increased potency.

Mitotan and other inhibitors of adrenal cortex function may necessitate increasing the dose of dexamethasone.

The concomitant use with live antiviral vaccines and other immunizations increases the risk of viral activation and infections.

Antipsychotics (neuroleptics) and azathioprine increase the risk of cataracts when dexamethasone is given.

Concomitant use with antithyroid drugs decreases and with thyroid hormones increases dexamethasone clearance.

Contraindications

• Arterial hypertension,
• Icenko-Cushing’s disease,
• psychosis,
• renal insufficiency,

osteoporosis,

peptic ulcerKidney failure,

• osteoporosis,
• Gastric and duodenal ulcer,
bacterial endocarditis,
• syphilis,
• tuberculosis,
• diabetes mellitus,
• systemic mycoses,
• infectious joint lesions,
• fat III-IV degree

.,

• high sensitivity to dexamethasone.
  

Side effects

In short-term therapy: nausea, vomiting, bradycardia, arrhythmias, ulceration of gastrointestinal mucosa, reduced immunity.
In long-term use: Icenko-Cushing’s syndrome, hyperglycemia, pancreatitis, myocardial dystrophy, headache, seizures, psychosis.

Local reactions: a brief burning sensation may occur immediately after injection of the drug.

Long-term use may cause increase in intraocular pressure (therefore, intraocular pressure should be measured regularly if corticosteriod-containing drugs are used for more than 10 days).

When used for more than 3 months a posterior capsular cataract may develop. The regeneration processes may be slowed down.

Overdose

The side effects described above may worsen.

The dose of Dexamethasone should be reduced. Treatment is symptomatic.

Similarities

Oftan Dexamethasone, Maxidex, Dexamethasone-Vial, Dexamethasone, Megadexan