Normal operation the human body largely depends on the condition hormonal system. Even minor malfunctions in its operation lead to illness varying degrees gravity. Currently, pharmacists have developed a huge number of synthetic hormonal drugs that make it possible to correct the lack of a particular hormone, and also make it possible to have a systemic effect on the body. One of these hormone analogues is the substance dexamethasone.

What is dexamethasone?

Dexamethasone is a fluorinated derivative of a glucocorticosteroid hormone that is usually produced by the adrenal cortex.

Systemic drugs based on this hormone have an anti-inflammatory, antiallergic effect, and can reduce immune reactions. Doctors, using dexamethasone in their medical practice, leave reviews about its effectiveness in eliminating acute attacks of allergies.

The mechanisms for reducing inflammatory and allergic reactions have a chain nature. Dexamethasone reacts with receptor formations in the cytoplasm, creating a complex compound that penetrates the nuclear membrane and increases the formation of messenger RNA. As a result of translation into mRNA, lipocortin protein is synthesized. This protein mediates the effect of dexamethasone. Thus, under the influence of lipocortins, the action of phospholipases A2 slows down, the production of eicosatetraenoic acid, prostaglandin endoperoxides, and leukotriene, the main effects of which are inflammatory and allergic reactions, decreases. The production of prostanoids also decreases due to a decrease in the synthesis of cyclooxygenase.

With the participation of dexamethasone, the production of adrenocorticotropic, β-lipotropic and follicle-stimulating hormones by areas of the pituitary gland is slowed down, the secretory function of the thyroid gland decreases during production thyroid-stimulating hormone, however, the content of polypeptide endorphins in the blood does not decrease.

This synthetic substance takes part in the metabolism of proteins, fats and in the synthesis of glucose without carbohydrate components. Under the influence of dexamethasone, gluconeogenic enzymes are activated, then in the cells of the liver and kidneys from the mammary and pyruvic acid glucose is synthesized. The liver begins to store more glycogen, which in turn activates glycogen synthetase and the production of glucose from amino acid residues. There is an increase in plasma glucose concentration, which leads to the synthesis of insulin by the pancreas.

Treatment with dexamethasone:

• Leads to an enhanced process of fat breakdown in cells due to a decrease in the flow of glucose into them. But this process is reversible, since dexamethasone stimulates the production of insulin, which activates the synthesis of fats from glucose and their accumulation.
• Strengthens the process of dissimilation of complex substances into simpler ones in tissues such as connective, bone, muscle, fat and lymphoid.
• Disturbs the activity of all leukocyte cells, including monocytes, in tissues.
• Reduces the entry of these cells into the area with foreign agents and their phagocytic activity, the production of interleukin mediators. By strengthening the membrane shell of cell lysosomes, the number of enzymes that break down peptide bonds in proteins that cause inflammatory foci is reduced.
• Reduces the number of T-lymphocytes and B-lymphocytes, monocytic cells, basophilic and eosinophilic leukocytes in the vascular bed due to their passage into the lymphatic fluid, reduces the production of immunoglobulins, collagen fibers, and the penetrating ability of capillary walls.

Variety of dosage forms of dexamethasone

The substance dexamethasone is part of glucocorticoid drugs, which are produced in various dosage forms. This may be in tablet form. There is also the drug "Dexamethasone" in ampoules in the form of solutions for injection, in the form eye drops and ointments. Each dosage form has its own purpose for certain diseases, instructions for use and dosage, a list adverse reactions. Depending on the nature of the disease and the duration of treatment, doctors prescribe a specific form of the drug.

There is an opinion among doctors that injectable forms have a number of advantages over tablets. Thus, solutions of the drug after their administration are able to almost instantly have a therapeutic effect due to the rapid entry of the active substance into the bloodstream, and from it to the receptors. In liquid form, the drug is absorbed completely, and when using tablets, part active component destroyed by the contents of the digestive tract.

The drug "Dexamethasone", patient reviews

The drug "Dexamethasone" has many indications for use. Its main directions are anti-inflammatory, antiallergic, immunosuppressive effects.

After a course of therapy with the drug "Dexamethasone", reviews of some patients indicate its effectiveness in the treatment of acute allergic reactions, inflammatory processes in the joints or attacks of bronchial asthma, while others remain dissatisfied with the large number of side effects this drug.

Therapy with hormonal drugs has always been accompanied by a risk of undesirable consequences. Therefore, the attending physician must weigh the benefits of treating the disease against the risk of adverse reactions before prescribing Dexamethasone. Reviews from patients taking this medicine indicate that they experience adverse reactions that affect certain systems of the body.

These may be reactions associated with endocrine disorders, such as the development of various types of diabetes mellitus, a decrease in the body's resistance to glucose molecules, and an increase in the production of ACTH hormones by the adrenal glands. As a result, Cushing's disease develops with symptoms such as obesity, excess body hair, rounded facial features with a pronounced double chin, hypertension, menstrual cycle disorders in women, and excessive fatigue of striated muscles.

Changes also occur in the functioning of the heart and blood vessels; they are characterized by disruption heart rate in the direction of its reduction, as well as a deterioration in the pumping function of the heart to supply the body with blood, hypertension, increased blood clotting, and the formation of blood clots. The digestive system can also be negatively affected by the drug "Dexamethasone", which is manifested by impaired digestion of food, gag reflexes, nausea, gastritis and pancreatitis, ulcers or bleeding of the stomach and intestines, bloating, hiccup reflexes.

Side effects may also occur in the nervous system. These may be hallucinations, a state of euphoria, delirium, nervousness, paranoid disorders accompanied by headaches, convulsions, and sleep disturbances.

Sometimes patients complain of fluid retention in the body due to the accumulation of sodium ions and the excretion of potassium, excess weight, increased sweating, fragility bone tissue and tendons, long-term non-healing skin lesions, the appearance of red spots on the skin due to hemorrhages, impaired pigment content in the skin, acne.

Ampoule form of dexamethasone

The drug "Dexamethasone" in ampoules (injection forms) is used for emergency therapy, as well as when the drug can only be administered in the form of intravenous or intramuscular injections. This is a colorless or yellowish solution of the substance dexamethasone sodium phosphate at a concentration of 4 mg of dexamethasone phosphate per 1 ml of water for injection.

The ampoule drug "Dexamethasone" is widely used, the indications for use of which are based on its anti-inflammatory, antiallergic, and immunosuppressive effects.

Diseases requiring the administration of dexamethasone in the form of injections include acute and chronic adrenal insufficiency, hereditary proliferation of the adrenal cortex; destruction of thyrocytes of the thyroid gland; a state of shock of various origins, when other drugs do not work. Treated with a drug excess accumulation fluid in the brain due to tumors, injuries, surgical procedures, meningoencephalitis; asthmatic attack, bronchospasm in acute bronchitis, acute allergy attacks. Indications include rheumatoid arthritis; pathologies of bone, cartilage tissue, skin rashes and various dermatitis; malignant leukemias, leukemia, tumors; destruction of red blood cells, lack of granulocytes, diathesis with hemorrhagic decrease in the number of platelet cells; various infections.

This drug is used both separately and in combination with other drugs.

Instructions for use for dexamethasone in ampoules

The instructions for use recommend injecting the drug "Dexamethasone" in several ways. Injections are given intravenously using the jet or drip method. At drip administration prepare a solution from a five percent isotonic or dextrose sodium chloride solution. You can give injections intramuscularly or inject the drug locally into the site of the disease, for example, inside a joint.

The doctor prescribes the dosage and number of doses to the patient in accordance with the nature and severity of the disease, as well as the person’s ability to tolerate this drug. In acute conditions, treatment begins with high doses of the drug "Dexamethasone" in ampoules. The instructions for administering this medication during the first day prescribe a dosage of about 4-20 mg of the drug, which is divided into 3 or 4 doses, with the first dose always being larger than subsequent doses. So, the first dosage for removal cerebral edema is 10 mg, to eliminate shock, 20 mg is used, for an allergic reaction - about 8 mg. After the condition improves, the dosage is reduced. The duration of injection treatment is about 3-5 days.

When the drug is administered into a diseased joint, the dose ranges from 0.2 to 6 mg, injections are given every three days.

When treating children as a result of insufficient production of adrenal hormones, the dosage of the drug is set at 0.023 mg per kilogram of body weight, which is administered in three injections intramuscularly every three days. For the treatment of other diseases, a maximum dose of 0.1667 mg per kilogram of body weight is prescribed.

With the simultaneous use of dexamethasone injections with other drugs, incompatibility of their actions may be observed, for example, when it is combined with a heparin solution, a precipitate may occur, which is unacceptable. Therefore, pharmacists recommend using intravenous dexamethasone alone, without other drugs.

Dexamethasone tablets

There are several dosages of the tablet form of the drug "Dexamethasone". The tablets of this drug are white and contain 0.5 mg and 1.5 mg of the active ingredient - dexamethasone.

On pharmaceutical market a wide range of the drug "Dexamethasone" is presented. What are these tablets prescribed for? Doctors usually prescribe this form after injection therapy, when an acute attack of the disease has been eliminated, as a maintenance treatment.

The drug is indicated for replacement therapy of insufficient functioning of the adrenal cortex, thyroiditis of various forms.

When using a drug such as Dexamethasone, the indications for use are the treatment of rheumatoid joint diseases, edema of the head or spinal cord, defeats connective tissue for vasculitis, lupus erythematosus, sclerosis, amyloidosis, various dermatitis and erythema, psoriasis and lichen, allergic diseases, systemic immune diseases.

The drug is also prescribed for endocrine diseases of the organs of vision, various changes in the structure of the eye, to reduce immune reactions during lens or cornea transplantation.

Treatment based on the drug "Dexamethasone" is effective; indications for its use include diseases digestive system, such as colitis, granulomatous enteritis, liver diseases; diseases of the respiratory system: tuberculosis lesions lung tissue, fibrosis and sarcoidosis of the lungs; diseases of the circulatory system: various anemias, erythroblast aplasia, platelet deficiency, leukemia and lymphoma.

Rules for taking dexamethasone tablets

The drug "Dexamethasone", tablets of 0.5 mg or 1.5 mg, is prescribed to each patient individually. The dosage depends on the type of disease, severity, duration of treatment, and the body’s ability to tolerate the drug. Usually the medicine is taken with food, and antacids are taken after the meal.

At the beginning of treatment, the dosage per day ranges from 0.70 to 9 mg. The maximum dose that can be used per day should not exceed 15 mg, and the minimum - 1 mg. When the patient's stable condition is established, the amount of dexamethasone is reduced to 3 mg per day. The drug "Dexamethasone" is used for children in a daily dosage of 83.3 to 333.3 mcg per kilogram of weight.

The duration of treatment can be several days, or it can drag on for months, it all depends on the therapeutic effect. After finishing taking the drug, corticotropin is administered for several days.

Dexamethasone eye drops

Another type of dexamethasone is “Oftan Dexamethasone” eye drops for local action. They are a colorless transparent solution of the substance dexamethasone sodium phosphate in the amount of 1.32 mg per 1 ml of water for injection; the most active component of dexamethasone in solution is 1 mg per 1 ml. This drug is used in ophthalmic practice as an anti-inflammatory, anti-allergic and anti-exudative agent.

The active ingredient dexamethasone affects protein synthesis, reduces the production of substances responsible for inflammatory processes, such as histamine, kinin, lysosome enzymes, reduces the flow of macrophages to the site of inflammation, reduces the penetrating ability of the vascular walls. Due to the action of the hormone, the production of immunoglobulins, interleukins, and mediators of inflammatory reactions is disrupted, which prevents the development of the inflammatory process in various disorders. The duration of this effect after administration of one drop is about eight hours.

Use of dexamethasone drops

For the treatment of eye diseases, the drug "Dexamethasone" is used - drops. The instructions describe the treatment of acute or chronic. This may be a non-purulent inflammatory process in the membrane of the eye, its cornea, chronic inflammation edges of the eyelid, acute inflammatory process of the white membrane of the eye, episcleral tissue, inflammation between the sclera and conjunctiva, in the iris, as well as in it and in the ciliary body eyeball. They treat the cornea with dexamethasone drops for various injuries, inflammation in the posterior ocular segment, postoperative or post-traumatic swelling and inflammatory processes, sympathetic ophthalmia, allergic conjunctivitis or keratoconjunctivitis, as well as ear diseases, for example, otitis media.

The method of using 0.1% drops is to instill the eyes into the area of ​​the conjunctival sac, one or two drops every two hours. After the inflammatory process has reduced, the number of instillations is reduced to five per day. The duration of treatment is determined by the doctor by examining the patient and measuring the pressure inside the eye. The period of use of the drug should be no more than three weeks.

When treating ear diseases, drop 3 or 4 drops into sore ear 2-3 times a day.

It should be borne in mind that during treatment with dexamethasone, concomitant fungal or infectious diseases may not be noticed, and if such are detected, hormonal drops are combined with antimicrobial drugs.

Oftan dexamethasone eye drops contain the preservative benzalkonium chloride, which is harmful to the eyes and can be absorbed by the surface of contact lenses.

Cost of drugs

All dosage forms of dexamethasone differ in price. The highest cost is injection solutions drug "Dexamethasone", which is different for each manufacturer. You can buy ampoule solutions at the pharmacy, ampoules of 25 pieces per package, the content of dexamethasone in 1 ml is 4 mg. Ampoules can contain 2 ml and 1 ml of solution. The box of the drug "Dexamethasone" must contain instructions for use. The price for such a drug starts from 200 rubles for 25 ampoules of 1 ml and from 226 rubles for 25 ampoules of 2 ml.

Dexamethasone tablets with a dosage of 0.5 mg, 50 pieces in a pack, can be bought for 28 rubles.

0.1% Dexamethasone eye drops cost a little more; their price varies from 40 rubles per pack. They are sold in dropper bottles of 5 ml and 10 ml, in a pack with instructions for use.

Dexamethasone - what is it prescribed for? This is a hormonal drug, which in modern medicine is considered as one of the vital pharmaceuticals belonging to the group of synthetic glucocorticosteroids. Dexamethasone is able to penetrate the tissues of all organs and systems, including the brain and nervous system, and affect the entire body. In severe conditions - shock, acute systemic allergies, severe inflammation, pathological immune reactions, the medicine can save lives.

Composition of the release form

For treatment different types diseases Dexamethasone is produced in 4 dosage forms, therapeutic basis which is dexamethasone sodium phosphate.

This substance is a synthetic analogue of a natural steroid hormone that is produced in the body by the adrenal glands.

Basic forms:

1. Tablets of 0.5 mg (0.5 mg of active ingredient) in a pack of 10 units.
2. Injection solution (0.4%) in 1 ml ampoules containing 4 mg of active substance (5 or 25 units per package). It is used for injection into a muscle, vein (stream or drip), inside a joint, into the soft tissue surrounding it, into the tissue of the eyeball.
3. Dexamethasone eye drops (ear) 10 ml with an active substance concentration of 0.1% (1 mg per 1 ml).
4. Eye ointment – ​​tube 2.5 g.

All forms of the drug contain, as auxiliary components, substances that are necessary for stabilization, shaping and transport of dexamethasone to the painful site, as well as preservatives and additives that facilitate the absorption of the drug.

Each medicinal form has its own purposefulness in application, certain indications and contraindications, so you should not engage in treatment yourself - only a specialist is able to develop the necessary treatment regimen, calculate doses and frequency of use.

The medicine is available by prescription, where the name of the drug in Latin is Dexamethasoni.

Pharmacological properties and pharmacokinetics

Medicinal properties

The mechanism of the therapeutic effect of the drug is based on its ability to create a high concentration in the blood and foci of inflammation, penetrate into all tissues and have an effect at the cellular level.

This allows the active substance to work in the brain and nerve tissues, relieve swelling of the brain and lungs in case of hemorrhage, poisoning, injuries, tumors, removing the patient from a life-threatening state of shock, slowing down the course of cancer processes, eliminating manifestations of acute allergies.

The glucocorticosteroid activates a series of processes that lead to a decrease in the permeability of vascular walls, strengthening the protection of cell membranes and blocking inflammation at any stage of development.

By suppressing the acute reaction of the immune system to allergens, the drug stops the development of an allergic reaction, including anaphylactic shock, reduces the degree of swelling of the mucous membrane of the respiratory organs and bronchi, restoring the flow of air during swelling of the larynx or an asthmatic attack.

At the same time, the medicine inhibits the production of histamine, stopping pathological manifestations allergies.

Slows down the formation of scar changes in the tissues of various organs.

Absorption and excretion from the body

The corticosteroid is actively and almost completely absorbed not only after injection, but also after internal administration. Bioavailability or the amount of medicinal substance reaching the site of action is 77 - 79%, due to which the therapeutic effect of the drug is maximum.

In the blood, 65–70% of dexamethasone binds to the transport protein transcortin, which provides a high concentration medicinal substance in blood. With the bloodstream, the protein delivers dexamethasone throughout the body, penetrating into the intracellular spaces of tissues.

The largest amount of active substance in the blood, which provides the maximum therapeutic effect, is observed within the range from 40 to 90 minutes, depending on the method of application.

The active substance is processed by liver enzymes to inactive intermediates. It is removed from the body along with urine and is excreted in small quantities (about 10%) by the intestines. A small amount of dexamethasone penetrates into human milk, which should be taken into account when prescribing the drug to a nursing mother.

Why is the drug prescribed?

The effect of the medicine is used for many diseases internal organs, systemic, autoimmune pathologies, for diseases of the joints, eyes, skin and in many other areas of medicine.

The list of pathological conditions that require Dexamethasone injections or tablets includes:

• life-threatening shock conditions of all forms, including painful shock, toxic, cardiogenic, allergic, postoperative, blood transfusion (after blood transfusions);
• swelling of brain tissue (with hemorrhage, meningitis, tumor, encephalitis, trauma, surgery);
• an attack of bronchial asthma or long-term status asthmaticus;
• lung pathologies: berylliosis, tuberculosis, alveolitis, pneumonia, Loeffler's syndrome (resistant to other medications);
• allergic reactions: urticaria, Quincke's edema, hay fever, allergies to medications and products, serum sickness;
• endocrine disorders - adrenal insufficiency, thyroid disease, thyrotoxic crisis, thyroiditis, adrenogenital syndrome;
• autoimmune diseases – rheumatic carditis, multiple sclerosis, systemic lupus erythematosus, pemphigus, scleroderma, systemic vasculitis;
• pain due to inflammation reproductive organs, including prostatitis; different kinds myositis;
• intractable skin diseases - eczema, various types of dermatitis, psoriasis, toxicerma, Lyell and Stevens-Johnson syndromes, discoid lupus erythematosus, keloid scars (topical application);
• allergic and eye damage inflammatory in nature: scleritis, corneal ulcer, various types of conjunctivitis (except purulent), uveitis, keratitis, blepharitis, inflammation of the optic nerve, ophthalmopathy due to diabetes mellitus;
• swelling of the larynx and glottis in acute croup;
• inflammation of joints of various types: arthritis of various forms, osteoarthritis, polyarthritis, ankylosing spondylitis, bursitis, tenosynovitis and others;
• hematopoietic disorders: Addison's disease, lymphoma, agranulocytosis, anemia of different origins, thrombocytopenia;
• critical conditions when affected gastrointestinal system: enteritis, including granulomatous, hepatitis and hepatic coma, ulcerative colitis;
• allergic-toxic reaction with massive helminthic aggression;
• damage to the esophagus and stomach due to poisoning with alkalis, acids to suppress inflammation and prevent scarring;
• acute renal pathologies - glomerulonephritis, nephrotic syndrome;
• malignant processes in the lungs, leukemia, lymphocytic leukemia, myeloma;
• nausea and vomiting while taking cytostatics.

Dexamethasone is one of the vital medications. It is included in the list of similar pharmaceuticals by the World Health Organization. Dexamethasone can penetrate the brain, nervous system, and have central action on the body. This property and its therapeutic effects (immunosuppressive, anti-inflammatory) make the drug indispensable in some situations.

Pharmacological group

Medicinal group of the drug: glucocorticosteroid. Synthetic hormone, a derivative of 9-fluoro-prednisolone.

Pharmacokinetics and pharmacodynamics

Once in the blood, dexamethasone bypasses the protective blood-brain, placental and other barriers of organs and tissues (histohematic barriers). This ability to penetrate everywhere allows dexamethasone to act even on the brain: to relieve cerebral edema. Swelling occurs in extreme situations: with hemorrhages, injuries, tumors.

The high concentration of the drug in the blood is ensured by the connection of the active substance with the blood protein – transcortin. It is a transport protein for corticosteroids. Transcortin delivers remedy everywhere, carrying him along with the bloodstream.
The drug is metabolized in the liver and excreted by the kidneys. A small part is excreted by the intestines (10%). When breastfeeding, a small amount of output comes with milk.

It has a targeted effect on the adrenal cortex: it inhibits their function. The adrenal glands are under the influence of dexamethasone for a long time: its half-life lasts up to 72 hours. During this time, the adrenal glands function endocrine organ oppressed. Need this for therapeutic effect: excessive production of secretion of hormones that cause pathological reactions is stopped.
Dexamethasone also affects the functions of the pituitary gland, inhibiting (slowing down) the production of hormones (the result of this action is reversible).

The medicine controls almost everything metabolic processes by changing them.

Protein metabolism. Protein catabolism (breakdown into simple components) accelerates. This causes the accumulation of glucose in the “depot” - liver, lymph. The glucose level in the blood drops, sometimes critically – to the point of hypoglycemia.

When the liver releases glucose into the blood, the pancreas is stimulated. It intensively produces insulin and utilizes glucose. There are “jumps” in the content of the latter in the blood.

It is necessary to monitor blood glucose levels. It is especially important for those suffering from diabetes, their sugar curve often peaks up or down.

Lipid metabolism. It changes not for the better for the body. The synthesis of fatty substances is organized so that fat moves to the abdominal area. Obesity of the “apple” type occurs, a dangerous increase in the likelihood of vascular accidents (heart attacks, strokes). The amount of cholesterol in the blood is significantly higher than normal.

Mechanism of therapeutic action

The medicine has no best influence on metabolic processes. Why then is dexamethasone prescribed? Even with some negative effects, dexamethasone is a powerful anti-inflammatory drug. It initiates a number of complex chemical processes leading to increased protection of cell membranes and works at the cellular level. Reduces capillary permeability. Blocks the inflammatory process at any stage.

By suppressing the immune response, the drug stops allergic reactions. Stops swelling of the mucous membranes, slows down the formation of connective tissues. As a result, impaired breathing is restored and the formation of scar changes in organs is prevented.

Blocking histamine also stops pathological allergic reactions.

Release form

The drug is available in four forms:

1. Tablets containing the active substance – dexamethasone – 0.5 mg;
2. Eye drops – 1 mg of the drug per milliliter;
3. Eye ointment – ​​2.5 g tubes;
4. Injection ampoules – 4 mg of dexamethasone per milliliter of ampoule contents.

All forms of the drug contain additives that stabilize and facilitate transportation to the site of pathology and absorption of the drug, and preservatives for preservation. Packaging from different manufacturers looks different (photo).

The price of dexamethasone in pharmacies across the country varies:

1. Tablets – 16 – 38 rub. for 10 pcs. dosage 0.5 mg;
2. Injection solutions – 141 – 209 rub. for 25 ampoules, dosage 4 ml;
3. Eye drops – 46 – 70 rub. per dropper bottle, 10 ml;
4. Eye ointment – ​​100–140 rubles. tube.

The medicine is valuable in its action, the cost of dexamethasone itself is low. Sale by prescription. In the Latin prescription, the drug dexamethasone is called: Dexamethasone.

The drug dexamethasone is listed in the RLS - the official register of medicines.

Indications for use

The nervous system is the regulator of the entire body, and dexamethasone acts through it

The systemic effect of the drug caused wide range use of this medicine. It is used for many diseases.

Add to list painful conditions conditions that require Dexamethasone include:

• Endocrine disorders - problems of the adrenal glands, thyroid gland, androgenital syndrome;
• Autoimmune dysfunctions;
• Respiratory dysfunction;
• Shock life-threatening conditions;
• Blood diseases;
• Nonspecific ulcerative colitis;
• Acute phase of eczema;
• Serum sickness;
• Connective tissue defects;
• Agranulocytosis;
• Addison-Beermer disease;
• Pemphigus;
• Hypoplasia of hematopoiesis;
• Ophthalmic diseases;
• Deforming joint diseases– bursitis, arthrosis, osteochondrosis;
• Myositis;
• Tuberculosis;
• Helminthiasis with organ damage;
• Exacerbation of bronchial asthma;
• Meningitis;
• Traumatic brain injury;
• Malignant tumors;
• Severe infections.

Methods of application

Internal use. Integral route of drug intake: orally – through the gastrointestinal tract. Tablet forms are taken orally. Usually prescribed after withdrawal acute conditions, in which dexamethasone is administered intramuscularly or intravenously - from 8 mg of the active substance in an injection solution. In the future, the doctor prescribes taking pills.

Average daily dose oral administration is usually 15 mg. The attending physician is responsible for adjusting doses.

Injections

Dexamethasone injections are administered intramuscularly or intravenously.

Intravenous injections of dexamethasone solution are divided into jet injections (slowly from a syringe into a vein) and drip injections - in droppers. In critical situations, when there is a high risk to the patient's life, it is preferable intravenous administration dexamethasone. The drug immediately appears in the blood, ensuring rapid action.

If the drug's tolerability is known and the person knows the symptoms of an impending dangerous condition, from which this particular drug removes him, the doctor prescribes dexamethasone in ampoules. The patient is trained in administering intramuscular injections and has the drug with him. This way you can save your own life if the doctor is far away, and the time countdown is on minutes.
For this, at a minimum, you need to know how to inject dexamethasone into yourself or a person who needs an injection.

If the situation is difficult and ambulance necessary: ​​requires intravenous administration. But you still need to get an injection before the arrival of a specialized team - inaction is dangerous!

You will need:

• Syringe;
• Dexamethasone ampoule (or several);
• Sterile wipes (you can use cotton wool and an alcohol-containing solution to disinfect the injection site).

It is more convenient to inject yourself into the femoral muscle. Algorithm:

1. A person lies down, or better yet sits, if his condition allows.
2. Opens (breaks off) top part ampoules.
3. Opens the syringe package, assembles it or, if it is initially assembled, removes the cap from the needle.
4. Having inserted the needle into the ampoule, he draws its contents into the syringe, pulling the syringe rod towards himself.
5. By lifting it vertically, it removes air bubbles: it “drives” the air by pressing the rod up.
6. Grasping the thigh muscle with your left hand, inserts a needle into it. The depth depends on the size of the needle; if the needle is small, it is inserted right up to the cannula.
7. Slowly injects the medicine into the muscle.
8. Removes the needle with a quick movement (this way pain is felt less).
9. Wipe the injection site with a disinfectant wipe or cotton swab soaked in alcohol.
10. Knowing how to inject life-saving dexamethasone intramuscularly, a person receives additional opportunity survive, help yourself immediately when needed.

Only healthcare workers administer the solution by drip. If necessary, in a hospital setting. Injection application medication is usually limited to three days. Then the patient is transferred to maintenance treatment with tablet forms with a gradual reduction in dosage until complete withdrawal.

Dexamethasone is also used for inhalation, be sure to follow the instructions for use. Respiratory diseases sometimes require just such an emergency approach. By inhalation, the drug is delivered locally - namely to the respiratory tract, to the “destination”.

For inhalation, take the same solution that is intended for injection.

The procedure is indicated for swelling of the bronchial mucosa, allergic inflammation and severe inflammatory processes of another nature.

Inhaled dexamethasone is used to treat:

• Pulmonary tuberculosis;
• Laryngitis;
• Allergic cough and accompanying other respiratory diseases;
• Pharyngitis;
• Residual manifestations of pneumonia;
• Bronchial asthma;
• Diseases of the respiratory system of fungal etiology;
• Bronchiectasis;
• Cystic fibrosis;
• Choking from swelling of the larynx (false croup).

There are contraindications. Inhalations are not carried out if:

Pregnant and breastfeeding women should avoid inhaling dexamethasone.

Carrying out inhalation:

1. The dosage is important: adults – one ampoule per procedure, children – half (1 and 0.5 ml, respectively). IN severe cases the doctor can increase the dose and perform inhalation personally, monitoring the patient’s condition. If the ampoules contain 2 ml of medication, it is convenient to measure the required amount with a sterile syringe.
2. The hormone is a potent drug; a diluted substance is administered by inhalation. This is insurance against side effects and ease of use. Administering 0.5 ml of any substance by inhalation is almost impossible.
3. The medicine is diluted six times with saline solution.
4. The amount of liquid in diluted form is small, but modern nebulizers can spray even negligible amounts.
5. Inhalation should be carried out according to the instructions of the nebulizer. Breathe calmly and shallowly: deep breathing increases the likelihood of side effects.
6. Do not physically burden the body before and after inhalation with dexamethasone. Even eating food is considered a load.

The procedure itself will only take ten minutes or less.
It is important to follow the rules, then there is almost no risk of trouble. But it is not excluded.

Possible side effects from inhalation:

• Bronchospasm;
• Drying of the mucous membranes, their irritation, resulting in coughing;
• Overdose or hyperventilation (deep breathing) can cause swelling of the mucous membranes, dizziness, tachycardia, redness of the face, blurred vision, clouded consciousness.

All of these reactions are very rare. You just have to not panic. Usually the inhalation is successful.
The course of treatment is from three days to a week.

What is Dexamethasone used for?

The list of diseases in the indications shows how strong and varied the effect of the drug is.

Joint diseases

Inflammatory diseases of the joints that occur with acute pain are treated short course dexamethasone, injecting it directly into the joint. The properties of the drug allow you to quickly relieve pain and relieve inflammation.

If the inflammatory process has entered a stage where conventional NSAIDs cannot stop it, the pain is unbearably painful, hormones are added to the treatment of prostatitis.

Powerful and effective dexamethasone in three days will have an effect sufficient to mitigate the disease.

For a longer period of time with prostatitis, prescribe a drug such strong action– inappropriate. It suppresses immune reactions, and to heal from prostatitis, immunomodulators and immune stimulation are needed. A conflict of opposition arises. It cannot be prolonged. The risk of side effects increases with long-term use of dexamethasone. Failure of metabolic processes is especially dangerous.

But a short, three-day reception hormonal medication will help relieve inflammation and pain. This is important both psychologically and for successful treatment prostatitis.

Asthmatic status

The positive effect of the hormone dexamethasone on the bronchial mucosa, preventing or eliminating edema is guaranteed to improve the patient’s condition, help cope with asthma, and relieve exacerbations in a short time. The danger of suffocation disappears, attacks are reduced and weakened. The mucus that clogs the bronchi stops accumulating.

The immunosuppressive and anti-inflammatory properties of the drug have found application in the treatment of eye ailments of allergic etiology. Eye drops treat keratoconjunctivitis, keratitis, inflammatory processes of the conjunctiva, iritis caused by allergies. At the same time, inflammation is relieved and its cause is eliminated.

One drop continues to act after instillation - 8 hours. All this time, the solution treats the inflamed eye and normalizes metabolic processes at the site of pathology.

Traumatic brain injury

In such a situation, cerebral edema is possible; stopping and eliminating it is vitally important. A glucocorticosteroid can do this.

Infectious diseases

If antibiotics are unable to cope, the body loses strength. Medicine uses the “heavy artillery” – hormones. Not for long, but the effect will have time to appear. With such support, the body will cope with the infection.

Anaphylactic shock

The same allergic reaction, but life-threatening, occurring violently, quickly, requiring immediate help. The antiallergic effect of the drug is life-saving in this situation.

The adrenal cortex normally produces glucocorticosteroids, which regulate many processes in the body. When hormone production is disrupted, a person gets sick.

Dexamethasone – synthetic hormone, identical to what the adrenal glands should produce.

Its introduction in case of impaired functioning of the latter stabilizes the patient’s well-being.

Thyroid diseases

The drug acts on the pituitary gland, and through it - indirectly - on thyroid gland. It reduces the increased secretion of thyroid-stimulating hormone.

Dexamethasone or Prednisolone

When choosing Dexamethasone or, it is worth considering the difference in dosage. In terms of glucocorticoid activity, prednisolone lags behind, and by much: seven times. A single dose of the former in injections is 4 mg, and prednisolone is up to 80 mg. It is up to the doctor to decide which medication is better: prednisolone or dexamethasone in each specific situation. Patients are different, and tolerance and concomitant diseases may be different.

Dexamethasone has a stronger effect; the course of treatment with it is only possible for a short period. Then the therapeutic effect of dexamethasone will have time to manifest itself, and the risk of side effects will be minimal.

Prednisolone can be used longer, but it has a weaker effect.

Test with Dexamethasone

What does the dexamethasone test do? In the use of the drug there is such a concept: test. The study is carried out if pathological abnormalities in the functioning of the adrenal cortex are suspected. It is an important endocrine organ that produces hormones. When failures occur, human health suffers greatly.

In the human body of any gender, the endocrine system secretes male (androgens) and female (estrogens) hormones. Normal homeostasis requires a certain ratio of both. For men, the predominance of androgens is important for health, for women - estrogen.

Balance is ensured by the endocrine organs of the reproductive system in each sex separately. But these same hormones are controlled by the adrenal cortex. To check the functioning and health of this important endocrine organ, a test with dexamethasone is performed.

Normally, this hormone is secreted by the adrenal cortex. Homeostasis is the controller of a strictly defined amount of secretion.
The purpose of the test is to determine the amount of cortisol produced by the adrenal glands.

Initially, the patient detects problems in health, painful symptoms and abnormalities. The following are likely:

• Formation in women external signs, characteristic of men (male hair growth, deepening of the voice, sharp facial features, even the character becomes tougher);
• Delayed or atypical signs of puberty, reproductive problems;
• Symptoms of neoplasms of the reproductive system.

Having contacted a specialist, a person receives an appointment to take tests. The need for a test with dexamethasone is determined by urine analysis. If the analysis showed that the content of 17-ketosteroids in daily urine is increased, pathology of the adrenal glands and more is likely.

An additional study of 24-hour urine hormones may include checking the content of oxycorticosteroids or 17-OX analysis. It will show the amount of all metabolites steroid hormones, not just cortisol. The goal is the same - to check the function of the adrenal glands.

If these tests reveal abnormalities, it is advisable to test with dexamethasone. This manipulation is informative regarding:

• Etiology of hyperandrogenism (increased secretion of androgens);
• Diagnosis of tumors of the adrenal cortex that affect the secretion of hormones;
• Detection of hyperplasia (growth like neoplasms) of the adrenal glands;
• Diagnosis of hypercortisolism - a long-term pathological effect of an excess of adrenal hormones on the body (Itsenko-Cushing disease).

The test also reveals: tumor processes pituitary gland, ovaries, cysts of the reproductive organs.

Other violations are also diagnosed: the readings are interpreted by a trained doctor

How is the test carried out?

The procedure is performed permanently. It is simple and not very stressful for the body. But accuracy of compliance and medical control are important. Repeated blood sampling is also carried out, which the patient cannot do on his own at home.

The hospitalization is short, there is no need to worry. Calmness is also important for correct diagnosis: stressful conditions change hormonal levels.

On the eve of the examination, stop taking painkillers: they can affect these tests. The attending physician needs to know all the medications the patient is taking. To take into account their influence on the data obtained, if these drugs are capable of distorting the result.

Doctors will monitor both the dose of the drug and the time between subsequent doses of the drug. Violations must not be allowed in order for the result to be reliable.

There are small and large diagnostic tests with dexamethasone.

1. In the morning on an empty stomach, venous blood is collected. It will determine the initial level of cortisol. Blood is drawn at 8 o'clock.
2. Then dexamethasone is started. Every six hours - a tablet. And so - for two days.
3. Third morning – another blood draw. The time, as on the previous, first day, is 8 am.
4. The cortisol levels in both samples are compared.

Large sample:

1. The beginning is similar - blood sampling in the morning.
2. Only two tablets are taken, but once, at 23:00 on the same day.
3. In the morning at 8 – blood donation.

The first method is reliable up to 100%, the second – up to 95%. If cortisol decreases by half, the test result is positive. The absence of changes is interpreted as a negative test. It is up to the doctor to decide what to do next.

The test is based on the ability of dexamethasone to inhibit the secretion of corticotropin. The adrenal cortex reduces the production of hormones: the function is dependent on corticotropin. But if the tumor secretes hormones, it continues to secrete them: the pituitary gland does not control the activity of the tumor.

If an injected drug is urgently administered to save a life, all likely side effects are ignored. Only one thing is taken into account absolute contraindication: drug intolerance. When the situation is not so dramatic, and the drug is prescribed in a course, other contraindications should be taken into account:

• Open form of tuberculosis;
• Obesity;
• Diabetes mellitus, including hidden (latent) course;
• Decompensated heart failure;
• Hypercholesterolemia;
• Shingles;
• AIDS;
• Ulcerations of any part of the gastrointestinal tract;
• Itsenko-Cushing's disease;
• Thyroid diseases;
• Severe failure of any organ.

There are contraindications for injections into joints:

• Excessive bleeding;
• Fracture of bone tissue in a joint;
• Infections in the joint;
• Operated joints.

Side effects

Hormones should always be used with caution. Even synthetic, they are deeply embedded in the systems that control the body. They take control of it themselves. It is necessary to master the technique of hormonal treatment in order to minimize the likelihood and severity of side effects. Dexamethasone, and if the instructions for use are followed, has many side effects after injections, tablets, even after inhalation:

1. Metabolic disorders - hypokalemia, protein breakdown, bulimia, excess weight gain.
2. Cardiovascular system - arrhythmia, thrombosis, hypertension, myocardial dystrophy, heart failure, bradycardia, asystole (sudden cardiac arrest).
3. Digestive system - gastritis, pancreatitis, ulcerative colitis, intestinal bleeding, vomiting, nausea.
4. Musculoskeletal system – myasthenia gravis, myopathy, muscle dystrophy, osteoporosis, weakness spinal column, susceptibility to fractures.
5. Endocrine system - diabetes mellitus, including latent form, abdominal obesity, adrenal insufficiency, hypertension, disorder menstrual cycle.
6. Visual organs – increased eye pressure, cataracts.
7. Nervous system – headache, psychosis, dizziness, convulsions, high intracranial pressure, fatigue.
8. Immune suppression is a common infectious disease.



Drug interactions

Some medications increase or decrease the effect of dexamethasone.

Weaken:

• Ephedrine;
• Phenobarbital;
• Phenytoin;
• Rifampicin;
• Antacids.

Hormones act in different ways. Contraceptives (hormonal) have an additive effect: the effect of dexamethasone is enhanced.
Cardiac glycosides in the presence of the drug can provoke arrhythmia.

Diuretics taken simultaneously remove potassium from more Potassium deficiency is possible. It weakens the heart.

Coumarins behave unpredictably: they can act stronger, they can weaken.

Diacarb and other carbonic anhydrase inhibitors (affecting the kidneys, diuretics) can lead to increased excretion of potassium from the body, retaining sodium. Result: edema, potassium deficiency.

Paracetamol by itself is a blow to the liver, and when paired with dexamethasone it is a double blow.

NSAIDs in this tandem do not spare the gastrointestinal tract, damaging its parts to the point of bleeding. Their therapeutic effect is simultaneously reduced.

During treatment, it is advisable to exclude anabolic steroids: the combination will cause swelling and may cause excess hair growth (hirsutism).

Neuroleptics promote the formation of cataracts.

Amphotericin B – its combination with dexamethasone is fraught with heart failure.

Live vaccines - the suppressed immune system will not cope, the incidence of infections will increase.

Sodium preparations – edema, increased blood pressure.

special instructions

The drug may cause developmental disorders of the developing fetus in pregnant women. It is not advisable to use it; the risk is great. Sometimes pregnant women are prescribed dexamethasone for health reasons. The newborn will subsequently require intensive treatment.

Do not use during breastfeeding. If this is necessary for the mother, the child should be switched to feeding with adapted formulas.

Taking the drug often affects concentration. Work that requires increased concentration should not be carried out during the treatment period.

If a person taking dexamethasone has been in contact with a patient with a herpetic disease (chickenpox, shingles), he needs immunoglobulins. Immunity suppressed by the drug must be supported.

Dexamethasone should not be used before or after vaccinations: it neutralizes their effect. It might even provoke viral infections against the background of suppressed immunity.

Passing serious hormonal treatment a person understands that health problems are not a joke. Sometimes this understanding is so depressing that he wants to take some alcohol as an “antidepressant”. The question naturally arises: is it possible?

Each of these substances, taken separately, distorts the normal processes and internal reactions of the body. Combining them will give unpredictable, unplanned results.

Willingly or unwittingly, some patients experienced these unpredictabilities.

Not a single one pleased me. Cross-reactions give up to four dozen negative side effects. Among them:

• Uncontrollable diarrhea;
• Sudden loss or severe decrease in vision;
• “Acute abdomen” – pain in the abdomen, stomach, vomiting reflex, nausea;
• The injection site becomes intensely painful: two incompatible substances collide there - medicine and alcohol;
• Body skin, especially the area chest, reacts to the “explosive mixture” with a rash of large red spots;
• The digestive tract is affected by ulcers;
• The skin of the face becomes acne-greasy.

Organisms are individual, and all troubles cannot be predicted. Positive influence was not noticed.

If a person is dependent on alcohol, he cannot take dexamethasone; the prescription of the drugs must be adjusted. You can’t do this on your own; you need to admit it and tell your doctor about the problem.

Analogs

Dexamethasone has analogues - medications with the same active ingredient. There are also drugs that act similarly, but have a different composition. These concepts need to be distinguished simply because the second group will have other indications, contraindications, other side effects and other nuances of use are possible.

Absolute analogues of Dexamethasone:

• Dexamethasone sodium phosphate;
• Vero-Dexamethasone;
• Dexafar;
• Dexamethasone-Ferey;
• Decdan;

In addition to these, there are a dozen more analogues, differing in names and prices, but active substance everyone had dexamethasone. And the properties, accordingly, are indistinguishable from the original drug.

Preparations with similar active ingredients:

• Berlicourt;
• Budesoni;
• Hydrocortiso;
• Decortin Triamcinolo;
• Budesoni;
• Hydrocortiso;
• Prednisolone.

It interacts with specific cytoplasmic receptors and forms a complex that penetrates the cell nucleus and stimulates the synthesis of mRNA: the latter induces the formation of proteins, including lipocortin, that mediate cellular effects. Lipocortin inhibits phospholipase A 2, suppresses liberation arachidonic acid and inhibits the biosynthesis of endoperoxides, PGs, leukotrienes, which promote inflammation, allergies, etc. Prevents the release of inflammatory mediators from eosinophils and mast cells. Inhibits the activity of hyaluronidase, collagenase and proteases, normalizes the functions of the intercellular matrix of cartilage tissue and bone tissue. Reduces capillary permeability, stabilizes cell membranes, incl. lysosomal, inhibits the release of cytokines (interleukins and gamma-interferron) from lymphocytes and macrophages, causes involution lymphoid tissue. Restores the sensitivity of adrenergic receptors to catecholamines. Accelerates protein catabolism, reduces glucose utilization peripheral tissues and increases gluconeogenesis in the liver. Reduces absorption and increases excretion of calcium; inhibits sodium (and water) ACTH secretion.

Pharmacokinetics

When administered intravenously, it binds to a specific carrier protein – transcortin – by 70-80%; when high doses of the drug are administered, protein binding is reduced to 60-70% due to saturation of transcortin. Easily passes through histohematic barriers, including blood-brain and placental. Cmax is achieved within 1-2 hours. Biotransformed in the liver, mainly by conjugation with glucuronic and sulfuric acids, to inactive metabolites. The half-life from the blood T1/2 is 3-5 hours, the biological half-life is 36-54 hours. When administered parenterally, it is metabolized faster and, accordingly, pharmacological effects less long lasting. It is excreted mainly in the urine (a small part by the lactating glands) in the form of 17-ketosteroids, glucuroids, and sulfates. About 15% of Dexamethasone is excreted unchanged in the urine. When applied to the skin, absorption is determined by many factors (integrity skin, the presence of an occlusive dressing, dosage form, etc.) and varies greatly.

Indications for use

Diseases requiring the administration of a fast-acting glucocorticosteroid, as well as cases when oral administration drug is not possible.

Addison's disease, congenital adrenal hyperplasia, adrenal insufficiency (usually in combination with mineralocorticoids), adrenogenital syndrome, non-suppurative thyroiditis, hypothyroidism, tumor hypercalcemia, shock (anaphylactic, post-traumatic, postoperative, cardiogenic, blood transfusion, etc.), rheumatoid arthritis in the acute phase, acute rheumatic carditis, collagenosis (rheumatic diseases - as complementary therapy for short-term treatment of exacerbation of the disease, disseminated lupus erythematosus, etc.), joint diseases (post-traumatic osteoarthritis, acute gouty arthritis, psoriatic arthritis, synoveitis in osteoarthritis, acute nonspecific tenosynovitis, bursitis, epicondylitis, ankylosing spondylitis, etc.), bronchial asthma, status asthmaticus, anaphylactoid reactions, incl. caused by drugs; cerebral edema (due to tumors, traumatic brain injury, neurosurgical intervention, cerebral hemorrhage, encephalitis, meningitis); nonspecific ulcerative colitis, sarcoidosis, berylliosis, disseminated tuberculosis (only in combination with anti-tuberculosis drugs), Loeffler's disease and other severe respiratory diseases; anemia (autoimmune, hemolytic, congenital, hypoplastic, idiopathic, erythroblastopenia), idiopathic thrombocytopenic purpura (in adults), secondary thrombocytopenia, lymphoma (Hodgkin and non-Hodgkin), leukemia, lymphocytic leukemia (acute, chronic), serum sickness, allergic reactions to blood transfusion , spicy infectious edema larynx (adrenaline is the drug of first choice), trichinosis with damage to the nervous system or involvement of the myocardium, nephrotic syndrome, severe inflammatory processes after eye injuries and operations, skin diseases: pemphigus, Stevens-Johnson syndrome, exfoliative dermatitis, bullous dermatitis herpetiformis, severe seborrheic dermatitis , severe psoriasis, atopic dermatitis.

Contraindications

Hypersensitivity, systemic mycoses, amoebic infections, infectious lesions joints and periarticular soft tissues, active forms of tuberculosis, period before and after preventive vaccinations(especially antiviral), glaucoma, acute purulent eye infection(retrobulbar administration).

Pregnancy and lactation

Use during pregnancy is allowed if the expected effect of therapy outweighs the potential risk to the fetus. Treatment should be stopped during treatment breast-feeding. Infants born to mothers who received significant doses of corticosteroids during pregnancy should be closely monitored for signs of adrenal hypofunction.

Directions for use and doses

Intended for intravenous, intramuscular, intraarticular, periarticular and retrobulbar administration. The dosage regimen is individual and depends on the indications, the patient’s condition and his response to therapy.

To prepare a solution for intravenous drip infusion, you should use an isotonic sodium chloride solution or a 5% dextrose solution. Administration of high doses of dexamethasone can be continued only until the patient's condition has stabilized, which usually does not exceed 48 to 72 hours. Adults with acute and emergency conditions administered intravenously slowly, in a stream or drip, or intramuscularly at a dose of 4-20 mg 3-4 times a day. The maximum single dose is 80 mg. Maintenance dose – 0.2-9 mg per day. The course of treatment is 3-4 days, then switch to oral administration of Dexamethasone. Children - IM at a dose of 0.02776-0.16665 mg/kg every 12-24 hours. For local treatment, the following doses may be recommended:

Large joints (eg. knee-joint): from 2 to 4 mg;

Small joints (for example, interphalangeal, temporal joint): from 0.8 to 1 mg;

Joint capsules: from 2 to 3 mg;

Tendons: from 0.4 to 1 mg;

Soft tissue: 2 to 6 mg;

Nerve ganglia: 1 to 2 mg.

The drug is re-prescribed at intervals from 3 days to 3 weeks as needed; maximum dose for adults – 80 mg per day. For shock, adults - 20 mg intravenously once, then 3 mg/kg over 24 hours as a continuous infusion or intravenously 2-6 mg/kg once, or iv 40 mg every 2- 6 hours. For cerebral edema (adults) – 10 mg IV, then 4 mg every 6 hours IM until symptoms disappear; the dose is reduced after 2-4 days and gradually - over 5-7 days - treatment is stopped. For adrenal insufficiency (children), IM 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.

In case of an acute allergic reaction or exacerbation of a chronic allergic disease, dexamethasone should be prescribed according to the following schedule, taking into account the combination of parenteral and oral administration: dexamethasone injection 4 mg/ml: 1 day, 1 or 2 ml (4 or 8 mg) intramuscularly; dexamethasone tablets 0.75 mg: second and third days, 4 tablets in 2 divided doses per day, 4th day, 2 tablets in 2 divided doses, 5th and 6th days, 1 tablet every day, 7th day - without treatment, 8th day - observation.

Side effect

Sodium and fluid retention, loss of potassium and calcium, edema, hypokalemic alkalosis, erosive and ulcerative lesions of the gastrointestinal tract (with exacerbation of peptic ulcer up to perforation, bleeding), hemorrhagic pancreatitis, gastrointestinal atony, increased appetite, nausea and vomiting, weight gain, hiccups , hepatomegaly, bloating, ulcerative esophagitis, muscle weakness, myopathy, loss of muscle mass, osteoporosis, pathological fractures of long bones, compression fractures vertebrae, aseptic necrosis femoral head and humerus, tendon ruptures, arrhythmia, bradycardia, increased blood pressure, congestive heart failure, myocardial infarction and dystrophy, myocardial rupture in recent myocardial infarction, Itsenko-Cushing syndrome, HCM in low birth weight infants, hyperglycemia, hyperlipoproteinemia, negative nitrogen balance, dysmenorrhea , growth retardation in children, hirsutism, decreased immunity, suppression of regenerative and reparative processes, dizziness, headaches, mood disorders, psychoses, increased intracranial pressure with papilledema, vertigo, neuropathy, convulsions, polymorphonuclear leukocytosis, thinning and fragility of the skin, impaired wound healing, petechiae, ecchymosis, acne, stretch marks, erythema and changes in skin pigmentation, degeneration of the skin or subcutaneous tissue, sterile abscess, burning at the injection site (after intra-articular injection), false negative results during allergy skin tests, burning or tingling (especially in the perineum), angioedema, arthropathy resembling Charcot arthropathy, increased sweating, increased intraocular pressure, exophthalmos, glaucoma, cataracts, exophthalmos, rare cases of blindness, retinopathy of prematurity, secondary fungal or viral eye infections; thrombosis and thromboembolism, withdrawal symptoms after long-term therapy (with rapid withdrawal of corticosteroids): fever, myalgia, arthralgia, malaise. This can occur in patients even without signs of adrenal insufficiency; depression, secondary adrenal insufficiency, menstrual irregularities, development of Cushingoid conditions, growth suppression in children, decreased tolerance to carbohydrates, latent diabetes mellitus, the need to increase the dose of insulin and oral hypoglycemic agents in patients with diabetes, hirsutism; rarely - allergic reactions (rash, itching), urticaria, Quincke's edema.

Overdose

Reports of acute toxic poisoning and/or death due to glucocorticoid overdose are extremely rare. With the development of adverse events - treatment symptomatic, aimed at maintaining vital functions; Itsenko-Cushing syndrome - administration of aminoglutemide.

Interaction with other drugs

The therapeutic and toxic effects of Dexamethasone are reduced by barbiturates, phenytoin, rifabutin, carbamazepine, ephedrine and aminoglutethimide, rifampicin (accelerate metabolism); somatotropin; antacids (reduce absorption), enhance - estrogen-containing oral contraceptives. Concomitant use with cyclosporine increases the risk of developing seizures in children. The risk of arrhythmias and hypokalemia is increased by cardiac glycosides and diuretics, the likelihood of edema and arterial hypertension– sodium-containing drugs and nutritional supplements, severe hypokalemia, heart failure and osteoporosis – amphotericin B and carbonic anhydrase inhibitors; risk erosive and ulcerative lesions and bleeding from the gastrointestinal tract - non-steroidal anti-inflammatory drugs. When used simultaneously with live antiviral vaccines and against the background of other types of immunization, it increases the risk of viral activation and the development of infection. Concomitant use with thiazide diuretics, furosemide, ethacrynic acid, carbonic anhydrase inhibitors, amphotericin B can lead to severe hypokalemia, which can enhance the toxic effects of cardiac glycosides and non-depolarizing muscle relaxants. Weakens the hypoglycemic activity of insulin and oral antidiabetic agents; anticoagulant - coumarins; diuretic – diuretic diuretics; immunotropic – vaccination (suppresses antibody formation). Worsens the tolerance of cardiac glycosides (causes potassium deficiency), reduces the concentration of salicylates and praziquantel in the blood. It may increase the concentration of glucose in the blood, which requires dose adjustment of hypoglycemic drugs, sulfonylurea derivatives, and asparaginase. GCS increase the clearance of salicylates, therefore, after discontinuation of Dexamethasone, it is necessary to reduce the dose of salicylates. When used concomitantly with indomethacin, the Dexamethasone suppression test may give false negative results.

Features of application

Restricted for use when: peptic ulcers Gastrointestinal tract, gastric and duodenal ulcers, esophagitis, gastritis, intestinal anastomosis (in the immediate history); congestive heart failure, arterial hypertension, thrombosis, diabetes mellitus, osteoporosis, Itsenko-Cushing's disease, acute renal and/or liver failure, psychoses, convulsive states, myasthenia gravis, open-angle glaucoma, AIDS, pregnancy, breastfeeding. At long-term treatment(more than 3 weeks) in high doses(more than 1 mg of Dexamethasone per day) to prevent secondary adrenal insufficiency, discontinuation of Dexamethasone is carried out gradually. This condition can last for several months, so if stress occurs (including during general anesthesia, surgery or trauma), an increase in the dose or administration of Dexamethasone is necessary.
Topical use of Dexamethasone may lead to systemic effects. When administered intra-articularly, it is necessary to exclude local infectious processes (septic arthritis). Frequent intra-articular administration can lead to damage to joint tissue and osteonecrosis. Patients are not recommended to overload the joints (despite the reduction in symptoms, inflammatory processes in the joint continue).

Precautionary measures

Caution should be exercised when prescribing against the background of ulcerative colitis, intestinal diverticulitis, and hypoalbuminemia. Prescription in case of intercurrent infections, tuberculosis, septic conditions requires preliminary and then simultaneous antibacterial therapy. GCS may increase susceptibility or mask symptoms of infectious diseases. Chicken pox, measles and other infections can be more severe and even lead to fatal outcome in non-immunized individuals. Immunosuppression often develops with long-term use of GCS, but can also occur with short-term treatment. Against the background of concomitant tuberculosis, it is necessary to carry out adequate antimycobacterial chemotherapy. Concomitant use of dexamethasone in high doses with inactivated viral or bacterial vaccines may not produce the desired result. Immunization against the background of GCS replacement therapy is acceptable. It is necessary to take into account the increased effect in hypothyroidism and cirrhosis of the liver, aggravation of psychotic symptoms and emotional lability with their high baseline, masking of some symptoms of infection, the likelihood of relative adrenal insufficiency persisting for several months (up to 1 year) after discontinuation of Dexamethasone (especially in the case of long-term use). During a long course, carefully monitor the dynamics of growth and development of children, systematically carry out ophthalmological examination, monitor the state of the hypothalamic-pituitary-adrenal system, blood glucose levels. Stop therapy only gradually. It is recommended to be careful when performing any kind of surgery, the occurrence of infectious diseases, injuries, avoid immunization, and avoid drinking alcohol. In children, in order to avoid overdose, the dose is calculated based on the body surface area. In case of contact with people with measles, chicken pox and other infections, concomitant preventive therapy is prescribed.

IN in rare cases Anaphylactoid reactions may occur in patients receiving parenteral corticosteroids. Patients should take appropriate precautions prior to administration, especially if the patient has a history of allergy to any drug.

Corticosteroids may aggravate systemic fungal infections and therefore should not be used in the presence of such infections.

Corticosteroids can activate latent amoebiasis. Therefore, it is recommended to exclude latent or active amebiasis before starting corticosteroid therapy.

Moderate to high doses of cortisone or hydrocortisone can cause increased blood pressure, salt and water retention, and increased potassium excretion. In this case, it may be necessary to limit salt and potassium. All corticosteroids increase calcium excretion.

Use corticosteroids with great caution in patients with recent myocardial infarction due to the risk of ventricular wall rupture.

Corticosteroids should be used with caution in patients with eye infection due to herpes simplex due to the risk of corneal perforation.

Aspirin should be used with caution in combination with corticosteroids due to the risk of hypoprothrombinemia.

In some patients, steroids may increase or decrease sperm motility and count.

May be observed:

Loss of muscle mass;

Pathological fractures of long tubular bones;

Compression fractures of the vertebrae;

Aseptic necrosis of the head of the femur and humerus.

Impact on the ability to drive a car and other potentially dangerous mechanisms. During treatment should not be administered vehicles and engage in potentially hazardous activities that require increased attention and speed of psychomotor reactions.

Conditions for dispensing from pharmacies

By doctor's prescription.

Dexamethasone is a drug from the group of glucocorticosteroids intended for parenteral use. I will consider in detail its instructions for use.

What is the composition and release form of Dexamethasone?

The product is produced in solution, it is colorless and transparent, intended for injection. The active substance is in the amount of 4 and 8 milligrams, it is represented by dexamethasone sodium phosphate. Excipients Dexamethasone: methylparaben, propylparaben, sodium hydroxide and metabisulfite, in addition, disodium edetate and water for injection.

The medicine is sealed in dark ampoules and glass bottles. The medication should be stored out of the reach of children; the drug should not be frozen. Its shelf life is three years; after this period, the solution must be disposed of. Dexamethasone can be purchased with a prescription.

What is the effect of Dexamethasone?

Synthetic glucocorticoid Dexamethasone is a derivative of fluoroprednisolone. The medication has anti-inflammatory and immunosuppressive effects, and also has antiallergic properties. The active substance of the drug reduces globulins in the blood and increases the synthesis of albumin in the liver.

In addition, the product increases the synthesis of triglycerides and some higher fatty acids, redistributes lipids, which leads to the accumulation of a fatty layer in the face, as well as the shoulder girdle and abdomen.

The anti-inflammatory effect occurs as a result of inhibition of the production of inflammatory mediators. The immunosuppressive effect is due to the suppression of lymphocyte proliferation and B-cell migration, as well as inhibition of the release of certain cytokines from macrophages.

The antiallergic effect occurs due to a decrease in the secretion of some allergy mediators; in addition, antibody formation is inhibited. With obstructive diseases of the respiratory tract, inflammation is inhibited, swelling of the mucous membrane is reduced, and so on.

What are the indications for use of Dexamethasone?

There are quite a few conditions when Dexamethasone is indicated for use:

In the presence of certain endocrine diseases, such as acute adrenal insufficiency, subacute thyroiditis;
In case of shock (burn, toxic, traumatic, as well as surgical shock);
With cerebral edema;
For severe allergic reactions;
For status asthmaticus;
In the presence of severe bronchospasm;
For rheumatic diseases;
For severe dermatoses;
With systemic pathology of connective tissue;
Infectious diseases are severe;
A remedy is prescribed for malignant diseases;
The drug is effective for certain blood diseases;
The drug is used in ophthalmology ( allergic conjunctivitis, blepharitis, keratitis, keratoconjunctivitis and some other diseases of the organ of vision).

In addition, Dexamethasone is used locally directly on the affected area, for example, in the presence of discoid lupus erythematosus, as well as in granuloma annulare.

What are the contraindications for use of Dexamethasone?

The only contraindication is increased sensitivity to the drug. Prescribe with caution medicine for such diseases:

In immunodeficiency conditions;
For some gastrointestinal diseases, such as peptic ulcer, esophagitis, gastritis;
With recently transferred infectious diseases bacterial, viral, fungal nature;
The drug is not prescribed before or after vaccination;
With renal and also with liver failure;
For heart diseases, for example, with a recent myocardial infarction;
During pregnancy.

Do not use Dexamethasone for systemic osteoporosis, in acute psychosis, in addition, with poliomyelitis, as well as with glaucoma (increased intraocular pressure).

What are the uses and dosage of Dexamethasone?

The dosage regimen for Dexamethasone is individual; it directly depends on the patient’s condition. The medicine is administered intravenously by stream or drip; in addition, the intramuscular route of administration is possible. IN acute period Usually the medication is used in high doses. It is recommended to administer from four to twenty milligrams of the drug during the day.

What are the side effects of Dexamethasone?

Typically, the drug Dexamethasone is quite well tolerated by the patient. But in some situations, the following side effects may occur: suppression of adrenal function is noted, Itsenko-Cushing syndrome develops, children may experience delayed sexual development, nausea and vomiting, steroid stomach ulcers, erosive esophagitis, gastrointestinal bleeding, flatulence, hiccups, changes appetite, .

Other undesirable manifestations: arrhythmia, bradycardia, pathological changes in the electrocardiogram, increased pressure, thrombosis, disorientation, possible euphoria, hallucinations, in addition, manic-depressive psychosis, depression, nervousness, dizziness, as well as anxiety and convulsions.

In addition, undesirable manifestations are expressed in the form of increased intraocular pressure, sudden loss of vision, hypocalcemia, increased sweating, hyponatremia, osteoporosis, tendon rupture, muscle atrophy, delayed healing of the wound surface, thinning of the skin, tendency to develop candidiasis.

Overdose of Dexamethasone

In case of overdose, the described side effects, which requires symptomatic treatment.

What are Dexamethasone analogues?

Vero-Dexamethasone, Dexamed, Decadron, Dexaven, Dexamethasone-Betalek, Dexasone, Dexamethasone-Vial, Maxidex, Dexamethasonelong, in addition, Dexapos, Dexona, Dexafar, Megadexan, Fortecortin, as well as Oftan Dexamethasone.

Conclusion

We reviewed the drug Dexamethasone in ampoules, instructions for use, application, indications, contraindications, action, side effects, analogues, composition, dosage of the drug. Dexamethasone should be used on the advice of a qualified doctor.