Corticosteroid — ENT Inflammation / Croup Pregnancy: Crosses the placenta. Prescribe in pregnancy (particularly first trimester) only if benefit outweighs risk. Long-term/repeated therapy increases risk of intrauterine growth retardation; prenatal exposure carries risk of neonatal adrenal insufficiency.

Dexamethasone

Brand names: Dexsol, Martapan

Dexamethasone is a potent long-acting corticosteroid used systemically in ENT practice for indications such as severe airway or laryngeal oedema, control of postoperative swelling and nausea, and as an adjunct in some inflammatory and oncological settings.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Initial dose usually 0.5-10 mg daily, titrated to individual response and disease severity

Route: Oral (soluble tablets, taken with or after food; dissolve in at least ~50 ml water and drink immediately)

Frequency: Once daily, or divided into 3-4 doses depending on indication

Max: In more severe conditions doses above 10 mg/day may be required; very high doses up to 96 mg used in palliative treatment of neoplastic disease

ENT / airway context: SPC lists croup in children as 0.15-0.6 mg/kg as a single dose (paediatric - verify against a children's formulary), and acute asthma in adults 16 mg/day for two days. General systemic dosing: use the lowest effective dose. Other indication-specific regimens (SPC, guidance only): cerebral oedema 6-16 mg (up to 24 mg)/day in 3-4 doses; acute skin diseases 8-40 mg/day (up to 100 mg); SLE 6-16 mg/day; idiopathic thrombocytopenic purpura 40 mg for 4 days in cycles; palliative neoplastic disease 3-20 mg/day; chemotherapy-induced emesis 8-20 mg before then 4-16 mg/day days 2-3; postoperative vomiting single 8 mg before surgery. Long-term treatment should be switched to prednisone/prednisolone after initial therapy; discontinue gradually after prolonged high-dose use. Elderly: reduce dose (higher plasma levels, slower excretion). Severe hepatic impairment: dose adjustment may be necessary.

Dose adjustments

Renal

Patients on active haemodialysis may show increased drug clearance via the dialysate and thus require an adjustment (increase) of steroid dose.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to dexamethasone or any excipient
Systemic infection unless specific anti-infective therapy is employed
Stomach ulcer or duodenal ulcer
Vaccination with live vaccines during treatment with large therapeutic doses

Side effects

Weight gain and central obesity (Cushingoid features)
Glucose intolerance / manifestation of latent diabetes mellitus
Suppression of the hypothalamic-pituitary-adrenal axis; secondary adrenal insufficiency
Osteoporosis, muscle atrophy, skin fragility
Psychological disorders (from euphoria to psychosis, depression, insomnia)
Increased susceptibility to or exacerbation of infections; elevated intraocular pressure/glaucoma, cataract

Interactions

Live vaccines - contraindicated during high-dose therapy
Fluoroquinolones - increased risk of tendinitis and tendon rupture
Anticholinesterases - may produce severe weakness in myasthenia gravis (US label)
Oral anticoagulants (warfarin) - usually inhibits response; monitor coagulation (US label)
Potassium-depleting agents (e.g. amphotericin B, diuretics) - risk of hypokalaemia (US label)
Antidiabetics - corticosteroids may raise blood glucose; dose adjustment may be needed (US label)

Clinical monograph

How it works

It is a glucocorticoid with potent anti-inflammatory and immunosuppressant actions and minimal mineralocorticoid effect, reducing inflammatory mediator production and tissue oedema.

Prescribing in practice

Corticosteroids should not be stopped abruptly after more than a short course because of the risk of adrenal insufficiency, and patients on prolonged therapy need a steroid treatment card and gradual withdrawal.
It can cause hyperglycaemia, mood and sleep disturbance, increased infection risk and gastrointestinal effects, so use cautiously in diabetes, active infection and peptic ulcer disease.
Even short courses may unmask or worsen infection, so exclude untreated systemic infection before use.

Monitoring

For more than brief use, monitor blood glucose, blood pressure, mood and signs of infection, and review the need for continued treatment.

Counselling the patient

Do not stop suddenly if you have taken it for more than a few days.
Tell other healthcare professionals you are taking a steroid, and carry a steroid card if on a longer course.
Report signs of infection, marked mood change or high blood sugars.

Evidence & guidelines

Systemic corticosteroids such as dexamethasone are established for reducing airway oedema and perioperative swelling, with use guided by standard corticosteroid prescribing principles.

Reference: NICE NG205 (SSNHL 2023); NICE CKS Croup; Cochrane (Steward et al. 2011) Dexamethasone post-tonsillectomy; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways