Corticosteroid (Systemic)
Pregnancy: Caution — short-term use acceptable; used intentionally for fetal lung maturation at 24–34 weeks
Dexamethasone
Brand names: Dexsol, Neofordex
Adult dose
Dose: 0.5–24 mg/day
Route: Oral / IV / IM
Frequency: Once daily or in divided doses
Max: Depends on indication
Inflammation/allergy: 0.5–9 mg/day. Cerebral oedema: 10 mg IV then 4 mg every 6 hours. Airway oedema: 8–10 mg IV stat. Anti-emetic (chemo): 8–20 mg IV. COVID-19/ARDS: 6 mg once daily for 10 days (RECOVERY trial).
Paediatric dose
Dose: 0.15 mg/kg
Route: Oral / IV / IM
Frequency: Once daily
Max: 10 mg
Croup: 0.15 mg/kg single oral dose (max 10 mg). Bacterial meningitis: 0.15 mg/kg every 6 hours for 4 days (start with or before antibiotics).
Dose adjustments
Renal
No dose adjustment required.
Hepatic
Use with caution in hepatic impairment.
Paediatric weight-based calculator
Croup: 0.15 mg/kg single oral dose (max 10 mg). Bacterial meningitis: 0.15 mg/kg every 6 hours for 4 days (start with or before antibiotics).
Clinical pearls
- RECOVERY trial: 6 mg dexamethasone once daily for 10 days reduced mortality in hospitalised COVID-19 patients requiring oxygen
- Approximately 7× more potent than prednisolone — 1 mg dexamethasone ≈ 7 mg prednisolone
- Avoid evening doses — causes insomnia. Use PPI cover if also on NSAIDs
- Steroid card and sick-day rules required for patients on courses >3 weeks
Contraindications
- Systemic infection without antibiotic cover
- Live vaccines during treatment
Side effects
- Hyperglycaemia
- Adrenal suppression
- Osteoporosis (long-term)
- Cushingoid features
- Psychiatric effects (insomnia, psychosis)
- Peptic ulcer
- Immunosuppression
- Proximal myopathy
Interactions
- NSAIDs (increased GI ulceration risk)
- Rifampicin (reduced steroid effect)
- Antidiabetics (antagonism)
- Warfarin (variable INR effect)
- Live vaccines (contraindicated during treatment)
Monitoring
- Blood glucose (especially in diabetes)
- Blood pressure
- Bone density (long-term)
- Adrenal function on withdrawal after prolonged use
Reference: BNFc; BNF 90; RECOVERY Trial (NEJM 2021); BNFc; MHRA Corticosteroid Safety Update. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators