Corticosteroid — ENT Inflammation / Croup Pregnancy: Use with caution — short courses acceptable for acute ENT emergencies; croup, SSNHL, and severe laryngeal oedema are appropriate indications

Dexamethasone

Brand names: Dexsol, Martapan

Adult dose

Dose: Post-tonsillectomy nausea/oedema: 8–10 mg IV/IM single dose. Airway oedema / severe allergic ENT: 4–8 mg IV/IM. Sudden sensorineural hearing loss: 8–10 mg daily for 14 days (oral or intratympanic)

Route: Oral / IV / IM / Intratympanic (IT)

Frequency: Single dose (prophylactic) or daily (SSNHL/inflammatory)

Max: 10 mg per dose (routine ENT); higher doses in anaphylaxis

Used in ENT for: post-tonsillectomy nausea and oedema prophylaxis (single intraoperative dose), sudden sensorineural hearing loss (SSNHL — oral or intratympanic), periorbital oedema, severe croup (oral or nebulised — for laryngotracheobronchitis in children).

Paediatric dose

Dose: 0.15 mg/kg (croup — oral single dose) mg/kg

Route: Oral / IV / Nebulised

Frequency: Single dose (croup); daily (inflammation)

Max: 0.6 mg/kg for moderate-severe croup (max 10 mg)

BNFc: croup — dexamethasone 0.15 mg/kg oral single dose (mild-moderate); 0.15–0.6 mg/kg for severe croup; nebulised budesonide 2 mg is an alternative. Post-extubation stridor: 0.25 mg/kg IV.

Dose adjustments

Renal

No dose adjustment required for short courses

Hepatic

No dose adjustment required for short courses

Paediatric weight-based calculator

Patient weight (kg)

BNFc: croup — dexamethasone 0.15 mg/kg oral single dose (mild-moderate); 0.15–0.6 mg/kg for severe croup; nebulised budesonide 2 mg is an alternative. Post-extubation stridor: 0.25 mg/kg IV.

Clinical pearls

Croup (laryngotracheobronchitis): single oral dose dexamethasone 0.15 mg/kg is standard of care — NICE-endorsed; superior to budesonide nebuliser in ease of administration and compliance
Croup: nebulised adrenaline (1:1000, 0.5 mL/kg up to 5 mL) for severe croup with impending respiratory failure — short-acting bridge while dexamethasone takes effect (30–60 min)
Sudden sensorineural hearing loss (SSNHL): intratympanic dexamethasone (IT-Dex) is treatment of choice for failed or contraindicated systemic steroids — delivers high local concentrations to cochlea via round window
Post-tonsillectomy: single intraoperative IV dexamethasone 8 mg reduces post-operative nausea, vomiting, and pain — Cochrane meta-analysis supports routine use
SSNHL: treat within 2 weeks of onset — delay significantly reduces prognosis; offer both oral and IT routes (NICE NG205)

Contraindications

Systemic infection without antimicrobial cover (prolonged courses)
Live vaccines (during prolonged immunosuppressive doses)

Side effects

Hyperglycaemia
Insomnia
GI disturbance (short-term)
HPA axis suppression (prolonged use)
Avascular necrosis (prolonged use)
Immunosuppression

Interactions

NSAIDs — additive GI risk
Antidiabetics — hyperglycaemia
CYP3A4 inducers — reduce dexamethasone levels

Monitoring

Blood glucose (diabetics)
Symptom response
Hearing (SSNHL — PTA at 4–6 weeks)

Reference: BNFc; BNF 90; BNFc; NICE NG205 (SSNHL 2023); NICE CKS Croup; Cochrane (Steward et al. 2011) Dexamethasone post-tonsillectomy. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways