Corticosteroid (Systemic) 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, Neofordex

Dexamethasone is a potent, long-acting synthetic corticosteroid with minimal mineralocorticoid activity, used for inflammatory and allergic disorders, cerebral oedema, and as an antiemetic and immunomodulator.

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

General medicine context - dose is highly indication-dependent; use the lowest effective dose. Indication-specific regimens (SPC, guidance only): cerebral oedema 6-16 mg (up to 24 mg)/day divided into 3-4 doses; acute asthma (adults) 16 mg/day for two days; acute skin diseases 8-40 mg/day (up to 100 mg), then down-titrate; SLE 6-16 mg/day; active rheumatoid arthritis (fast destructive) 12-16 mg/day, with extra-articular manifestations 6-12 mg/day; idiopathic thrombocytopenic purpura 40 mg for 4 days in cycles; palliative neoplastic disease 3-20 mg/day; prophylaxis/treatment of chemotherapy-induced emesis 8-20 mg before chemotherapy then 4-16 mg/day on days 2-3; postoperative vomiting single 8 mg before surgery; symptomatic multiple myeloma / ALL / Hodgkin's / non-Hodgkin's lymphoma (in combination) usually 40 mg or 20 mg once daily per protocol. Long-term treatment should be switched to prednisone/prednisolone after initial therapy to reduce adrenal suppression; discontinue gradually after prolonged high-dose use. Elderly: reduce dose (higher plasma levels, slower excretion). Severe hepatic impairment: dose adjustment may be necessary. Paediatric SPC doses are indication-specific per kg - verify against a children's formulary.

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 binds glucocorticoid receptors to modulate gene transcription, suppressing inflammatory mediators and immune responses while exerting wide-ranging metabolic effects.

Prescribing in practice

Do not stop abruptly after more than a short course because of the risk of adrenal insufficiency; provide steroid-emergency advice and a steroid treatment card for those on prolonged therapy.
Prolonged use causes hyperglycaemia, hypertension, osteoporosis, weight gain, mood disturbance, infection risk and gastrointestinal effects, with increased susceptibility to and masking of infections including chickenpox.
Its metabolism is affected by CYP3A4 inducers and inhibitors, and it can raise blood glucose and reduce the effect of antidiabetic agents.

Monitoring

Monitor blood glucose, blood pressure, weight, mood and signs of infection during treatment, and bone health with prolonged use.

Counselling the patient

Do not stop suddenly if you have taken it for more than a few weeks; carry a steroid card.
Seek advice if exposed to chickenpox or measles, or if you become unwell or develop a fever.
Take with food to reduce stomach upset and report black stools or significant indigestion.

Evidence & guidelines

The RECOVERY trial established dexamethasone as reducing mortality in patients with COVID-19 requiring oxygen or ventilation.

Reference: RECOVERY Trial (NEJM 2021); MHRA Corticosteroid Safety Update; 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