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Corticosteroid Pregnancy: Use only if benefit outweighs risk; may suppress neonatal adrenal function.

Dexamethasone

Brand names: Dexamethasone, Martapan

Adult dose

Dose: Cerebral oedema (tumour): 8–16 mg/day in 2–4 divided doses; Bacterial meningitis: 0.15 mg/kg four times daily for 4 days
Route: IV or oral
Frequency: Every 6 hours (meningitis); twice to four times daily (cerebral oedema)
Max: 16 mg/day (cerebral oedema)
Cerebral oedema: 8 mg IV/IM immediately, then 4–8 mg every 6 hours; taper over 5–7 days. Bacterial meningitis (adjunctive): 0.15 mg/kg QDS for 4 days — give with or just before first antibiotic dose. Anti-emetic: 8 mg IV/oral.

Paediatric dose

Dose: 0.15 mg/kg
Route: IV
Frequency: Every 6 hours for 4 days (bacterial meningitis)
Max: 8 mg/dose
Concentration: 4 mg/ml
Bacterial meningitis: 0.15 mg/kg (max 10 mg) every 6 hours for 4 days. Give before or with first antibiotic. Croup: 0.15 mg/kg single dose (mild-moderate); 0.6 mg/kg for severe.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Use with caution in severe hepatic impairment.

Paediatric weight-based calculator

Bacterial meningitis: 0.15 mg/kg (max 10 mg) every 6 hours for 4 days. Give before or with first antibiotic. Croup: 0.15 mg/kg single dose (mild-moderate); 0.6 mg/kg for severe.

Clinical pearls

  • No mineralocorticoid activity — preferred for neurological oedema
  • For brain tumour headache, add PPI cover
  • Evidence for dexamethasone in bacterial meningitis in adults; less clear in children <3 months
  • Does not prevent deafness as reliably as previously thought — NICE recommends use in bacterial meningitis
  • Used for peritumoral oedema to reduce ICP

Contraindications

  • Systemic infection (unless life-threatening and with appropriate antimicrobial cover)
  • Live vaccines (during high-dose therapy)

Side effects

  • Hyperglycaemia
  • Fluid retention and oedema
  • Insomnia
  • GI irritation (less than other steroids as no mineralocorticoid effect)
  • Adrenal suppression (prolonged use)
  • Immunosuppression
  • Osteoporosis (long-term)

Interactions

  • NSAIDs — increased GI bleeding risk
  • Hypoglycaemics — antagonises glucose-lowering effect
  • Anticoagulants (warfarin) — may enhance or reduce effect
  • Phenytoin, rifampicin — reduced dexamethasone effect

Monitoring

  • Blood glucose
  • Blood pressure
  • U&E
  • Signs of infection
  • Weight

Reference: BNFc; BNF; NICE NG240 Bacterial Meningitis; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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