Dexamethasone injections: instructions for use

Release form and composition

Dexon is available in three dosage forms:

• injection;
• eye drops;
• pills.

The active substance in all dosage forms of Dexon is dexamethasone sodium phosphate. Eye drops also contain a second active ingredient – ​​neomycin sulfate, which belongs to the aminoglycoside group of antibiotics.

Next - in more detail about the injection Dexon. The drug is a transparent, colorless liquid with a specific odor, packaged in glass ampoules with a volume of 1 ml.

One milliliter of solution contains 4 mg of the active ingredient.

Pharmacological properties

Dexon has the following medicinal effects.

• Anti-inflammatory. Dexamethasone disrupts the release of kinins, prostaglandins, thromboxane and other proinflammatory proteins from eosinophils. Increases lipocartin production and slows down the formation of mast cells. Narrows the pores of the endothelium, thereby reducing the manifestations of exudation.
• Anti-shock. The drug increases blood pressure, which relieves shock.
• Antiallergic. This therapeutic effect is due to a decrease in the number of allergy mediators, T- and B-lymphocytes, as well as the neutralization of histamine. In addition, Dexamethasone reduces the susceptibility of receptors to allergy mediators.
• Antitoxic. Dexon activates liver enzymes that neutralize toxins.
• Diuretic. By increasing pressure, it accelerates renal filtration and diuresis.
• Immunosuppressive. The drug disrupts the release of cytokines by lymphocytes and macrophages.

Indications and contraindications

Dexon is used both in acute emergency conditions and for systemic therapy. The drug is prescribed in the following cases.

1. Pathologies of the endocrine system:

• adrenal insufficiency;
• shock;
• non-bacterial inflammatory processes in the thyroid gland.

1. Diseases of the musculoskeletal organs:

• rheumatoid arthritis;
• bursitis;
• osteoarthritis;
• synovitis;
• psoriatic arthritis;
• Bekhterev's disease;
• epicondylitis.

1. Diseases of the skin and subcutaneous tissue:

• pemphigus;
• Stevens-Johnson syndrome;
• mycoses;
• psoriasis;
• seborrhea;
• bullous dermatitis;
• exfoliative dermatitis.

1. Allergic diseases:

• bronchial asthma;
• atopic dermatitis;
• contact dermatitis;
• hay fever;
• drug allergies;
• urticarial rash after blood transfusion;
• Quincke's edema.

1. Respiratory diseases:

• berylliosis;
• sarcoidosis;
• milliary tuberculosis;
• tuberculous pleurisy;
• Loeffler's syndrome;
• aspiration pneumonia.

1. Blood diseases:

• hemolytic anemia;
• Werlhof's disease;
• thrombocytopenia;
• erythrocyte anemia;
• aplastic anemia;
• leukemia

1. Eye pathologies:

• iritis;
• iridocyclitis;
• chorioretinitis;
• optic neuritis;
• allergic conjunctivitis;
• keratitis and others.

There are a number of acute emergency conditions in which it is impossible to do without the use of injectable Dexon. These include idiopathic nephrotic syndrome, cerebral edema, tuberculous meningitis and severe hypotension.

At the same time, along with a wide range of indications for the use of Dexon, there is a fairly impressive list of contraindications. The drug should not be used in the following situations:

• individual intolerance to the drug and its components;
• infectious diseases of bacterial, viral and fungal nature;
• decreased bone density;
• bacterial arthritis, in particular gonorrheal or tuberculosis;
• acute phase of peptic ulcer of the stomach and duodenum;
• myopathy;
• shingles;
• polio;
• complications after BCG vaccination;
• increased intraocular pressure and glaucoma;
• gestation period;
• Itsenko-Cushing syndrome;
• two weeks before and a month after vaccination with live immunotherapy drugs;
• gastrointestinal bleeding.

What does Dexamethasone help with, indications and contraindications

The drug is a synthetic corticosteroid, an analogue of the hormone of the adrenal cortex. The component composition of the medication helps:

• normalize the functioning of extracellular structures of cartilage and bone tissues;
• reduce the level of capillary permeability;
• stabilize membranes;
• slow down the processes of cytokine release from lymphocytes and macrophages;
• accelerate protein catabolism;
• slow down glucose utilization and calcium absorption;
• retain water and sodium ions in tissues.

The processing of components occurs in the liver, partially in the kidneys and other organs. Metabolic products are excreted through the genitourinary system.

The drug is used against pathologies amenable to systemic therapy, as an addition to the main course of treatment. Intravenous and intramuscular injections are given when tablets or local medications are ineffective.

Dexamethasone is prescribed to patients:

• with allergies and rheumatic diseases;
• swelling of brain tissue;
• shock states of various origins;
• individual kidney lesions;
• autoimmune disorders;
• diseases of the respiratory tract, blood;
• acute severe dermatoses.

The drug is prescribed for hormone replacement therapy and the fight against inflammatory bowel pathologies. Dexamethasone is contraindicated:

• with hypersensitivity to the component composition;
• infectious, parasitic diseases of bacterial and viral origin;
• systemic mycoses, osteoporosis, immunodeficiency;
• myasthenia gravis, ulcers, colitis and other gastrointestinal diseases;
• lesions of the cardiovascular department;
• diabetes mellitus, psychosis, acute renal or liver failure.

The medicine is not injected into the joints if they are unstable, spontaneous bleeding of the apparatus, fractures or infectious lesions. The ban includes periarticular osteoporosis, the postoperative period - after arthroplasty.

Dexon, injections - instructions for use

Dexon is a parenteral drug that is intended for intramuscular, intravenous, intra-articular and local injections.

Dosage regimen

The dosage of the drug depends on the type of injection, namely:

• intramuscular and intravenous administration - from 0.5 to 9 mg;
• intra-articular administration – from 0.2 to 6 mg;
• local administration – from 0.1 to 6 mg.

For more details, see the drug dosage table for different nosologies.

Method of administration

Intramuscular injections of Dexon are performed into large muscles, for example, the gluteal or quadriceps. The drug is administered deeply to avoid atrophy of the dermis. Dexon is incompatible with other drugs and is therefore administered undiluted.

The intravenous route of administration of the drug is used in acute emergency cases. Dexon can be administered either intravenously as a stream or as a drip. Only physiological sodium chloride solution is used as a solvent.

Intra-articular injections are indicated for diseases of the musculoskeletal system. Before injecting the drug, the synovial fluid must be examined to exclude a bacterial process.

Local administration of the drug is used in the treatment of keloid scars, psoriasis and other skin diseases.

The dose and duration of therapy are selected for each patient individually by the treating doctor. Self-medication with Dexon is unacceptable and dangerous to health.

Side effects and overdose

When treated with Dexon, side effects may occur, the risk of which depends on the dose and duration of therapy.

List of possible adverse reactions when using this drug:

• on the part of the skin - atrophy and thinning of the skin, increased pigmentation, acne, the appearance of stretch marks on the skin, slower wound regeneration, petechiae, skin rash, dermatitis, itching, redness, urticaria;
• from the digestive system - nausea, vomiting, epigastric pain, loss of appetite, bloating, the appearance of ulcers or erosion in the stomach and duodenum;
• from the heart and blood vessels - slow heartbeat, other heart rhythm disturbances, worsening chronic heart failure, increased blood pressure, blood thickening, tendency to thrombosis;
• from the central nervous system - hallucinations, delirium, euphoria, psychosis, paranoia, increased intracranial pressure, increased excitability, cephalgia, dizziness, convulsions, sleep disturbances;
• from the endocrine system - impaired glucose tolerance, development of hormonal diabetes mellitus, disruption of the adrenal glands, Itsenko-Cushing syndrome, abdominal obesity, menstrual disorders, sexual development, increased hairiness in the face, chest and arms;
• from the metabolic side - decreased calcium levels in the blood, increased body weight, hyperhidrosis;
• from the organ of vision - decreased visual acuity, cataracts, glaucoma;
• from the musculoskeletal system - slowdown in physical development in children, decreased bone density, melting of the heads of the humerus and femur, muscle atrophy.

In addition to the listed systemic effects, local reactions in the form of skin burning, numbness, and, in severe cases, necrosis may be observed at the site of drug administration.

When treated with high doses of the drug, patients may experience symptoms of overdose:

• abdominal type of obesity;
• “bull hump” – accumulation of fatty tissue on the back below the neck;
• moon-shaped face;
• hirsutism.

Long-term use of the drug leads to inhibition of the endocrine function of the adrenal glands, so discontinuation of the drug should be gradual. There is no specific treatment for an overdose of Dexon.

Dexona-d

Caution should be used in case of parasitic and infectious diseases of a viral, fungal or bacterial nature (currently or recently suffered, including recent contact with a patient) - herpes simplex, herpes zoster (viremic phase), chicken pox, measles, amoebiasis, strongyloidiasis (established or suspected), systemic mycosis; active and latent tuberculosis. Use for severe infectious diseases is permissible only against the background of specific therapy.

It should be used with caution within 8 weeks before and 2 weeks after vaccination, with lymphadenitis after BCG vaccination, with immunodeficiency conditions (including AIDS or HIV infection).

Use with caution in diseases of the gastrointestinal tract: gastric and duodenal ulcers, esophagitis, gastritis, acute or latent peptic ulcers, recently created intestinal anastomosis, nonspecific ulcerative colitis with the threat of perforation or abscess formation, diverticulitis.

Should be used with caution for diseases of the cardiovascular system, incl. after a recent myocardial infarction (in patients with acute and subacute myocardial infarction, the necrotic focus may spread, slowing down the formation of scar tissue and, as a result, rupture of the heart muscle), with decompensated chronic heart failure, arterial hypertension, hyperlipidemia), with endocrine diseases - diabetes mellitus ( including impaired tolerance to carbohydrates), thyrotoxicosis, hypothyroidism, Itsenko-Cushing's disease, with severe chronic renal and/or liver failure, nephrourolithiasis, with hypoalbuminemia and conditions predisposing to its occurrence, with systemic osteoporosis, myasthenia gravis, acute psychosis , obesity (III-IV degree), with poliomyelitis (with the exception of the form of bulbar encephalitis), open- and closed-angle glaucoma.

If intra-articular administration is necessary, it should be used with caution in patients with a general severe condition, ineffectiveness (or short duration) of the action of 2 previous administrations (taking into account the individual properties of the GCS used).

Before and during GCS therapy, it is necessary to monitor a general blood count, glycemic levels and plasma electrolyte levels.

For intercurrent infections, septic conditions and tuberculosis, simultaneous antibiotic therapy is necessary.

Relative adrenal insufficiency caused by dexamethasone may persist for several months after its discontinuation. Taking this into account, in stressful situations that arise during this period, hormonal therapy is resumed with the simultaneous administration of salts and/or mineralocorticoids.

When using dexamethasone in patients with corneal herpes, the possibility of corneal perforation should be kept in mind. During treatment, it is necessary to monitor intraocular pressure and the condition of the cornea.

With the sudden withdrawal of dexamethasone, especially in the case of previous use in high doses, a so-called withdrawal syndrome occurs (not caused by hypocortisolism), manifested by anorexia, nausea, lethargy, generalized musculoskeletal pain, and general weakness. After discontinuation of dexamethasone, relative adrenal insufficiency may persist for several months. If stressful situations arise during this period, GCS is prescribed (according to indications), if necessary in combination with mineralocorticoids.

During the treatment period, monitoring of blood pressure, water and electrolyte balance, peripheral blood picture and glycemic level, as well as observation by an ophthalmologist is required.

In children, during long-term treatment, careful monitoring of the dynamics of growth and development is necessary. Children who during the treatment period were in contact with patients with measles or chickenpox are prescribed specific immunoglobulins prophylactically.

special instructions

When the drug is abruptly discontinued, patients experience withdrawal syndrome, which is characterized by hyperthermia, headache, vertigo, drowsiness, nausea, myalgia and general weakness. In severe cases, drug withdrawal syndrome can be fatal.

The use of Dexon can neutralize the symptoms of fungal and bacterial infections, pulmonary tuberculosis and perforated intestinal ulcers. Therefore, the use of this drug is permissible only for miliary or fulminant tuberculosis. Patients who have had a tuberculosis infection and are receiving glucocorticosteroids should take chemoprophylaxis against relapse of the disease.

Dexon is contraindicated for patients in the acute and subacute periods of myocardial infarction, since it will disrupt myocardial regeneration and can provoke rupture of the heart muscle. The drug also slows down bone healing and wound healing.

During therapy with Dexon, it is necessary to monitor potassium levels and blood cell composition.

Dexon, like other glucocorticosteroids, reduces the immune response in allergy tests, so the result may be false negative.

When the drug is administered intra-articularly, its systemic effects appear. When introducing Dexon into the joint cavity, it is necessary to exclude bacterial inflammation.

Drug interactions

The following variants of drug interactions with Dexon are known:

• During therapy with Dexon, live vaccines cannot be administered, as this is dangerous for infection;
• potentiates the toxicity of digitalis preparations;
• accelerates the elimination of salicylates from the body;
• reduces the effectiveness of ftivazid and mexiletine by accelerating their breakdown in the liver;
• increases the toxic effect of paracetamol on hepatocytes;
• increases the content of vitamin B9 in the body;
• reduces the effectiveness of somatotropin;
• stimulates the effect of muscle relaxants;
• potentiates the effect of coumarin anticoagulants;
• during GCS therapy, the effectiveness of hypoglycemic drugs decreases;
• simultaneous use with Cyclosporine and Ketoconazole increases the toxicity of Dexon;
• non-hormonal anti-inflammatory drugs in combination with Dexon are dangerous for gastrointestinal bleeding;
• sleeping pills, ephedrine, theophylline, fenithion and rifampicin reduce the effect of Dexon;
• preparations with estrogens slow down the removal of dexamethasone from the body and increase the risk of adverse reactions.

Use during pregnancy and breastfeeding

Dexon penetrates the placenta into the bloodstream of the fetus, so it can cause developmental delays or even antenatal death, as well as underdevelopment of the adrenal glands. Therefore, during pregnancy, the drug can be used only in extreme cases, when its effect is higher than all the risks for the mother and child.

If a pregnant woman has been prescribed Dexon or another GCS, then after giving birth the child will be carefully examined for the presence of adrenal insufficiency.

Clinical studies have confirmed that Dexon passes into breast milk, so the lactation period is a contraindication to the use of this drug.

In childhood and old age

Dexon is widely used in pediatrics in acute emergency cases, but during therapy the physical and psychophysiological development of the child is monitored. For long-term systemic therapy, GCS is taken at intervals of four days.

If a child who receives Dexon has been in contact with a patient with measles or chickenpox, then he must be prescribed specific antibodies.

In old age, the number of adverse reactions increases, hypertension, osteoporosis, steroid diabetes, skin atrophy, and decreased resistance to infections are especially common.

Dexonal®

The following interactions are common to all NSAIDs.

Undesirable combinations

With other NSAIDs, including salicylates in high doses (more than 3 g/day):

simultaneous use of several NSAIDs due to the synergistic effect increases the risk of gastrointestinal bleeding and ulcers.

With anticoagulants

: Dexketoprofen, like other NSAIDs, may enhance the effect of anticoagulants such as warfarin due to high plasma protein binding, inhibition of platelet aggregation and damage to the gastrointestinal mucosa. If simultaneous use is necessary, careful monitoring of the patient's condition and regular monitoring of laboratory parameters is necessary.

With heparin

: with simultaneous use, the risk of bleeding increases (due to inhibition of platelet aggregation and damaging effects on the mucous membrane of the gastrointestinal tract). If simultaneous use is necessary, careful monitoring of the patient's condition and regular monitoring of laboratory parameters is necessary.

With glucocorticosteroids:

with simultaneous use, the risk of ulcerative lesions of the gastrointestinal tract and bleeding increases.

With lithium preparations:

NSAIDs increase the concentration of lithium in the blood plasma up to toxic levels, and therefore this indicator must be monitored when used with dexketoprofen, changing the dosage, and also after discontinuation of NSAIDs.

With methotrexate in high doses (15 mg/week or more): the hematological toxicity of methotrexate may increase due to a decrease in its renal clearance when used simultaneously with NSAIDs.

With hydantoins and sulfonamides:

their toxic effect may be enhanced.

Combinations

requiring caution
With diuretics, angiotensin-converting enzyme (ACE) inhibitors, aminoglycoside antibiotics, angiotensin II receptor antagonists :

simultaneous use with NSAIDs is associated with a risk of developing acute renal failure in dehydrated patients (decreased glomerular filtration rate due to decreased synthesis of prostaglandins). When used concomitantly, NSAIDs may reduce the antihypertensive effect of some drugs. When using dexketoprofen and diuretics simultaneously, it is necessary to ensure that the patient has no signs of dehydration, and also monitor renal function at the beginning of simultaneous use.

With methotrexate in low doses (less than 15 mg/week):

it is possible to increase the hematological toxicity of methotrexate due to a decrease in its renal clearance during simultaneous use with NSAIDs. A blood cell count is necessary when coadministration is initiated. In the presence of even mild renal dysfunction, as well as in elderly people, careful medical supervision is necessary.

With pentoxifylline:

there may be an increased risk of bleeding. Close clinical monitoring and regular checking of bleeding time (blood clotting time) is necessary.

With zidovudine:

There is a risk of increased toxicity to red blood cells due to effects on reticulocytes, with the development of severe anemia one week after starting NSAID use. It is necessary to conduct a general blood test with a count of reticulocytes 1-2 weeks after starting NSAID therapy.

With oral hypoglycemic agents:

NSAIDs may enhance the hypoglycemic effect of sulfonylureas due to the displacement of sulfonylurea from sites of binding to plasma proteins.

Combinations to consider

With
β -blockers:
when used simultaneously with NSAIDs, the antihypertensive effect of β-blockers may decrease due to inhibition of prostaglandin synthesis.

With cyclosporine and tacrolimus:

NSAIDs may increase nephrotoxicity, which is mediated by the action of renal prostaglandins. During simultaneous use, it is necessary to monitor renal function.

With thrombolytics:

the risk of bleeding increases.

The risk of bleeding from the gastrointestinal tract increases when used simultaneously with serotonin reuptake inhibitors

(citalopram, fluoxetine, sertraline) and anticoagulants.

With probenecid:

it is possible to increase the concentration of NSAIDs in the blood plasma, which may be due to the inhibitory effect of probenecid on renal tubular secretion and/or conjugation with glucuronic acid; NSAID dose adjustment may be required.

With cardiac glycosides:

Concomitant use with NSAIDs may lead to an increase in the concentration of glycosides in the blood plasma.

With mifepristone:

Due to the theoretical risk of changes in the effectiveness of mifepristone under the influence of prostaglandin synthesis inhibitors, NSAIDs should not be used earlier than 8-12 days after discontinuation of mifepristone.

With quinolones:

Data obtained from experimental animal studies indicate a high risk of seizures when using NSAIDs with quinolones in high doses.

If it is necessary to use Dexonal® simultaneously with the above-mentioned medications, you should consult your doctor.