ThisiscontentfromElsevier'sDrugInformation

Dexamethasone

Learn more about Elsevier's Drug Information today! Get the drug data and decision support you need, including TRUE Daily Updates™ including every day including weekends and holidays.

Apr.03.2023

Dexamethasone

Indications/Dosage

Labeled

  • acne rosacea
  • acute lymphocytic leukemia (ALL)
  • Addison's disease
  • adrenocortical insufficiency
  • adrenogenital syndrome
  • allergic conjunctivitis
  • allergic rhinitis
  • alopecia
  • anaphylactic shock
  • anaphylaxis
  • angioedema
  • ankylosing spondylitis
  • anterior segment inflammation
  • asthma exacerbation
  • atopic dermatitis
  • bacterial conjunctivitis
  • berylliosis
  • bursitis
  • cerebral edema
  • chronic obstructive pulmonary disease (COPD)
  • congenital adrenal hyperplasia
  • contact dermatitis
  • corneal abrasion
  • corneal ulcer
  • corticosteroid-responsive dermatoses
  • Crohn's disease
  • cutaneous T-cell lymphoma (CTCL)
  • cyclitis
  • dermatitis
  • dermatitis herpetiformis
  • dermatomyositis
  • diabetic macular edema
  • discoid lupus erythematosus
  • drug-resistant tuberculosis infection
  • drug-susceptible tuberculosis infection
  • epicondylitis
  • erythema multiforme
  • erythroblastopenia
  • exfoliative dermatitis
  • food allergy
  • gouty arthritis
  • graft-versus-host disease (GVHD)
  • granuloma annulare
  • hemolytic anemia
  • herpes zoster ocular infection
  • Hodgkin lymphoma
  • hypercalcemia
  • hypoplastic anemia
  • hypothalamic-pituitary-adrenal (HPA) suppression diagnosis
  • immune thrombocytopenic purpura (ITP)
  • iritis
  • juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)
  • keloids
  • keratitis
  • kidney transplant rejection
  • lichen planus
  • lichen simplex
  • Loeffler's syndrome
  • macular edema following retinal vein occlusion
  • multiple myeloma
  • multiple sclerosis
  • myasthenia gravis
  • mycosis fungoides
  • necrobiosis lipoidica diabeticorum
  • nephrotic syndrome
  • non-Hodgkin's lymphoma (NHL)
  • ocular burns
  • ocular inflammation
  • ocular pain
  • ocular pruritus
  • osteoarthritis
  • otitis externa
  • pemphigus
  • perennial allergies
  • pneumonitis
  • polymyositis
  • postoperative ocular inflammation
  • proteinuria
  • pruritus
  • psoriasis
  • psoriatic arthritis
  • rheumatic carditis
  • rheumatoid arthritis
  • sarcoidosis
  • seasonal allergies
  • seborrheic dermatitis
  • serum sickness
  • Stevens-Johnson syndrome
  • systemic lupus erythematosus (SLE)
  • temporal arteritis
  • tenosynovitis
  • thrombocytopenia
  • thyroiditis
  • trichinosis
  • tuberculosis infection
  • ulcerative colitis
  • urticaria
  • uveitis
  • viral conjunctivitis

General dosing information for systemic therapy

  • Dosage requirements are variable. Individualize doses based on the condition being treated and the response of the patient.[54285][54286]
  • Gradual withdrawal of dexamethasone after high-dose or prolonged therapy is recommended due to the possibility of hypothalamic-pituitary-adrenal (HPA) axis suppression. The following recommendations for withdrawal of corticosteroids based on the duration of therapy have been made: less than 2 weeks-may abruptly discontinue; 2 to 4 weeks-taper dose over 1 to 2 weeks; more than 4 weeks-taper slowly over 1 to 2 months to physiologic dose (approximately equivalent to 10 mg/m2/day of hydrocortisone) and discontinue after assessment of adrenal function has demonstrated recovery.[54137]
  • In general, when oral therapy is not an option, the same dose can be given IV.[54557]
  • In general, IM administration of drugs in very low birth weight premature neonates is not practical due to small muscle mass, and absorption is unreliable due to hemodynamic instability that is relatively common in this population.

 

Estimated equivalent systemic Glucocorticoid dosages. These are general approximations and may not apply to all diseases or routes of administration.[64165]

Cortisone-25 mg

Hydrocortisone-20 mg

Prednisolone-5 mg

Prednisone-5 mg

Methylprednisolone-4 mg

Triamcinolone-4 mg

Dexamethasone-0.75 mg

Betamethasone-0.75 mg

Off-Label

  • acute respiratory distress syndrome (ARDS)
  • altitude sickness
  • altitude sickness prophylaxis
  • amyloidosis
  • bronchiolitis
  • chemotherapy-induced nausea/vomiting
  • chemotherapy-induced nausea/vomiting prophylaxis
  • chronic lung disease (CLD)
  • Churg-Strauss syndrome
  • coronavirus disease 2019 (COVID-19)
  • dry eye disease
  • granulomatosis with polyangiitis
  • infertility
  • laryngeal edema prophylaxis
  • laryngotracheobronchitis (croup)
  • macroglobulinemia
  • meningitis
  • mixed connective tissue disease
  • neonatal respiratory distress syndrome prophylaxis
  • pharyngitis
  • polyarteritis nodosa
  • polychondritis
  • post-operative nausea/vomiting (PONV)
  • post-operative nausea/vomiting (PONV) prophylaxis
  • severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection
  • spinal cord compression
  • thyrotoxicosis
  • toxic epidermal necrolysis
† Off-label indication

For the treatment of adrenocortical function abnormalities, such as adrenocortical insufficiency, congenital adrenal hyperplasia, chronic primary (Addison's disease) or secondary adrenocortical insufficiency, or adrenogenital syndrome

Oral dosage (dexamethasone)

Adults

Initially, 0.75 to 9 mg/day PO, given in 2 to 4 divided doses. Adjust according to patient response. NOTE: Parenteral therapy may be needed in acute insufficiency. Hydrocortisone and cortisone are preferred for these conditions; dexamethasone has no mineralocorticoid properties. Dosages required may be variable.

Infants, Children, and Adolescents

0.15 to 0.375 mg/m2/day PO once daily has been recommended for patients with congenital adrenal hyperplasia.[54489] [54490] Although most experts recommend hydrocortisone as first-line treatment of adrenal insufficiency in pediatric patients whose linear growth is incomplete due to a lower incidence of growth suppression, other authors have stated that dexamethasone may be used safely with close monitoring and individualization of dose based on growth, bone age, and hormone levels. Liquid formulations of dexamethasone are recommended for more precise titration of doses.[54123] [54155] 0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range.[54286] Parenteral therapy may be needed in acute insufficiency.

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate)

Adults

Initially, 0.5 to 9 mg/day IV or IM, divided every 6 to 12 hours. Adjust according to patient response. NOTE: Hydrocortisone and cortisone are preferred for these conditions; dexamethasone has no mineralocorticoid properties. Dosages required may be variable.

Infants, Children and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved general dosage range.[54285] [54286] Adjust according to patient response.

INVESTIGATIONAL USE: For adjunctive use in the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection†, the virus that causes coronavirus disease 2019 (COVID-19)†

for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection†, the virus that causes coronavirus disease 2019 (COVID-19)† in hospitalized patients

Oral dosage

Adults

6 mg PO once daily for up to 10 days or until hospital discharge (whichever comes first) is recommended by the National Institutes of Health (NIH) COVID-19 treatment guidelines for use in hospitalized patients who require supplemental oxygen, including those on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). This recommendation also applies to pregnant women, as the potential benefit of decreased maternal mortality justifies the low risk of fetal adverse effects with the short course of therapy. The NIH advises clinicians to review the patient's medical history and assess the potential risks and benefits before starting dexamethasone.[65314] The World Health Organization (WHO) strongly recommends the use of systemic corticosteroids for 7 to 10 days in patients with severe or critical COVID-19.[65876]

Children and Adolescents

0.15 mg/kg/dose (Max: 6 mg/dose) PO once daily for up to 10 days, although data are limited. The National Institutes of Health (NIH) COVID-19 treatment guidelines recommend dexamethasone (with or without remdesivir) for hospitalized pediatric patients who require high-flow oxygen or noninvasive ventilation. Dexamethasone (without remdesivir) is also recommended for pediatric patients requiring mechanical ventilation or extracorporeal membrane oxygenation (ECMO). The addition of baricitinib or tocilizumab may be considered for patients who do not have rapid (e.g., within 24 hours) improvement in oxygenation after initiation of dexamethasone. Corticosteroids are not routinely recommended for pediatric patients who require only conventional oxygen, but corticosteroids can be considered in combination with remdesivir for patients with increasing oxygen needs, particularly adolescents. The use of dexamethasone for treatment of severe COVID-19 in pediatric patients who are profoundly immunocompromised has not been evaluated and may be harmful; in such cases, treatment should be considered on a case-by-case basis.[65314]

Intravenous dosage

Adults

6 mg IV once daily for up to 10 days or until hospital discharge (whichever comes first) is recommended by the National Institutes of Health (NIH) COVID-19 treatment guidelines for use in hospitalized patients who require supplemental oxygen, including those on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). This recommendation also applies to pregnant women, as the potential benefit of decreased maternal mortality justifies the low risk of fetal adverse effects with the short course of therapy. The NIH advises clinicians to review the patient's medical history and assess the potential risks and benefits before starting dexamethasone.[65314] The World Health Organization (WHO) strongly recommends the use of systemic corticosteroids for 7 to 10 days in patients with severe or critical COVID-19.[65876]

Children and Adolescents

0.15 mg/kg/dose (Max: 6 mg/dose) IV once daily for up to 10 days, although data are limited. The National Institutes of Health (NIH) COVID-19 treatment guidelines recommend dexamethasone (with or without remdesivir) for hospitalized pediatric patients who require high-flow oxygen or noninvasive ventilation. Dexamethasone (without remdesivir) is also recommended for pediatric patients requiring mechanical ventilation or extracorporeal membrane oxygenation (ECMO). The addition of baricitinib or tocilizumab may be considered for patients who do not have rapid (e.g., within 24 hours) improvement in oxygenation after initiation of dexamethasone. Corticosteroids are not routinely recommended for pediatric patients who require only conventional oxygen, but corticosteroids can be considered in combination with remdesivir for patients with increasing oxygen needs, particularly adolescents. The use of dexamethasone for treatment of severe COVID-19 in pediatric patients who are profoundly immunocompromised has not been evaluated and may be harmful; in such cases, treatment should be considered on a case-by-case basis.[65314]

for the treatment of hyperinflammation in pediatric coronavirus disease 2019 (COVID-19)†

Oral dosage

Children and Adolescents

0.15 to 0.3 mg/kg/dose (Max: 6 mg/dose) PO once daily for up to 10 days is recommended as first-line immunomodulatory treatment in patients with persistent oxygen requirements due to COVID-19.[65707]

Intravenous dosage

Children and Adolescents

0.15 to 0.3 mg/kg/dose (Max: 6 mg/dose) IV once daily for up to 10 days is recommended as first-line immunomodulatory treatment in patients with persistent oxygen requirements due to COVID-19.[65707]

For hypothalamic-pituitary-adrenal (HPA) suppression diagnosis (e.g., dexamethasone suppression tests)

for use as a test for Cushing's syndrome

Oral dosage (dexamethasone)

Adults

0.5 mg PO every 6 hours for 48 hours. 24-hour urine collections are made for determination of 17-hydroxycorticosteroid excretion. Alternatively, 1 mg PO at 11:00 p.m. with plasma cortisol concentration measured at 8:00 a.m. the following morning.

Children and Adolescents

25 to 30 mcg/kg/dose PO (Max: 2 mg/dose PO) given at 11:00 p.m. with a plasma cortisol concentration measured at 8:00 a.m. the following morning. A plasma cortisol concentration of less than 5 mcg/dL occurs in normal individuals but not those with Cushing's syndrome. Measure a dexamethasone concentration concurrently with the cortisol concentration to ensure adequacy of the dexamethasone dose.[54499]

for use as a test to distinguish Cushing's syndrome secondary to pituitary ACTH excess from Cushing's syndrome secondary to other causes

Oral dosage (dexamethasone)

Adults

2 mg PO every 6 hours for 48 hours. 24-hour urine collections are made for determination of 17-hydroxycorticosteroid excretion.

Children and Adolescents

120 mcg/kg/dose PO (Max: 8 mg/dose PO) given at 11:00 p.m. with a plasma cortisol concentration measured at 8:00 a.m. the following morning. A decrease in the morning cortisol of 20% or more from baseline had a 97.5% sensitivity and 100% specificity in distinguishing patients with Cushing's disease from those with primary adrenal disorders in a retrospective study (n = 125, age 3 to 18 years). Measure a dexamethasone concentration concurrently with the cortisol concentration to ensure adequacy of the dexamethasone dose.[54501] Alternatively, a 2 day test consisting of 30 mcg/kg/day PO on day 1 and 120 mcg/kg/day PO on day 2, each given in 4 divided doses, has been recommended. Cortisol concentrations are suppressed in patients with pituitary Cushing's syndrome after the larger dose but not the smaller dose; cortisol concentrations are not suppressed after dexamethasone in patients with adrenocorticotropic hormone-independent Cushing syndrome.[54499]

for unresponsive anaphylactic shock

Intravenous dosage (dexamethasone sodium phosphate injection)

Adults

Various dosage regimens have been used. 1 to 6 mg/kg IV or 40 mg IV every 4 to 6 hours while shock persists. Alternatively, 20 mg IV injection followed by an IV infusion of 3 mg/kg over 24 hours.[60760] Corticosteroids are given as adjunctive therapy to epinephrine.[66106] [64564]

for treatment of anaphylaxis or other severe allergic disorders

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate injection)

Adults

Initially, 0.5 to 9 mg/day IV or IM, in 2 to 4 divided doses. Adjust according to patient response.[60760] Corticosteroids are not indicated as initial treatment for anaphylaxis, but can be given as adjunctive therapy after the administration of epinephrine.[66106] [64564]

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved general dosage range.[60760] [54286] Adjust according to patient response. Corticosteroids are not indicated as initial treatment for anaphylaxis, but can be given as adjunctive therapy after the administration of epinephrine.[66106] [64564]

Oral dosage (dexamethasone)

Adults

Initially, 0.75 to 9 mg/day PO, given in 2 to 4 divided doses. Adjust according to patient response.[54286]

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range.[54286] Adjust according to patient response.

tapering regimen for acute, self-limited allergic disorders or acute exacerbations of chronic allergic disorders

Intramuscular and Oral dosage

Adults

4 to 8 mg IM as a single dose on day 1. Then change to oral therapy, 1.5 mg PO twice daily on days 2 and 3; then 0.75 mg PO twice daily on day 4; then 0.75 mg PO once daily on days 5 and 6, then discontinue.[54286] [54285]

For the prevention of extubation failure in pediatric patients at increased risk for laryngeal edema (i.e., laryngeal edema prophylaxis†)

Intravenous dosage

Infants, Children, and Adolescents

0.5 mg/kg/dose (Max: 10 mg/dose) IV every 6 hours for 6 doses with the first dose given 6 to 12 hours prior to extubation.[54396] [54507] [64934] One prospective, randomized study (n = 153) found no significant difference in the risk of postextubation stridor, the average number of racemic epinephrine treatments, or the number of patients requiring reintubation in patients receiving dexamethasone compared to those receiving placebo.[54396] Another prospective, randomized study (n = 66) found that dexamethasone-treated patients had a significantly lower rate of postextubation stridor at 10 minutes, 6 hours, and 12 hours but not 24 hours and fewer patients requiring epinephrine or reintubation compared to placebo-treated patients.[54507] A systematic review of clinical trials of dexamethasone for the prevention of postextubation stridor concluded that therapy may be beneficial in high-risk patients, such as those with underlying airway anomalies or multiple airway manipulations.[54508]

Neonates

Various regimens have been used. 0.25 mg/kg/dose IV every 8 hours for 3 doses with the first dose given approximately 4 hours prior to scheduled extubation was studied in a prospective, randomized trial in 50 premature neonates (mean gestational age, 27.7 to 28.7 weeks) who were at high risk for airway edema. The rate of postextubation stridor and reintubation was significantly lower in the dexamethasone group compared to the placebo group.[24997] A systematic review of clinical trials of dexamethasone for the prevention of extubation failure recommends therapy be reserved for use in high risk neonates, such as those with repeated or prolonged intubations, due to a lack of benefit in low risk neonates and the risk of adverse effects.[54509] Use preservative-free products for administration to neonates when possible.

For the treatment of cerebral edema associated with primary or metastatic brain tumor, craniotomy, or head injury

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate injection)

Adults

10 mg IV or IM as a single dose, followed by 4 mg IV or IM every 6 hours, until symptoms subside, then reduce dosage. A response should be seen within 12 to 24 hours, and a gradual dose reduction begun after 2 to 4 days, reducing over another 5 to 7 days. Replace with oral dosage as soon as possible. For palliative maintenance therapy when oral therapy is not feasible, 2 mg IM or IV can be given 2 to 3 times per day, if needed. Use is not a substitute for neurosurgical evaluation and definitive management such as neurosurgery, etc.[60760]

Oral dosage (dexamethasone)

Adults

For cerebral edema, 1 to 3 mg PO three times daily, can follow parenteral therapy; then, taper off over a period of 5 to 7 days.[60760] For palliative management of recurrent or inoperable brain tumors, maintenance with 2 mg PO given 2 or 3 times daily may be effective.[30011]

for treatment of cerebral edema in pediatric patients

Intravenous and Intramuscular dosage (dexamethasone sodium phosphate)

Infants, Children, and Adolescents

Initially, 1 to 1.5 mg/kg/dose IV, then 1 to 1.5 mg/kg/day IV in divided doses every 3 to 4 hours was used in conjunction with hyperventilation, control of body temperature, barbiturates, and continuous intracranial and arterial pressure monitoring in pediatric patients with severe head injury (n = 24, age 3 months to 14 years).[54512] 0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved dosage range. Adjust according to patient response. Use is not a substitute for neurosurgical evaluation and definitive management such as neurosurgery, etc.[54285] [54286]

Oral dosage (dexamethasone)

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day PO or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range.[54286] Adjust according to patient response. Use is not a substitute for neurosurgical evaluation and definitive management such as neurosurgery, etc.

For use as an adjunct in the management of extradural malignant spinal cord compression† (MSCC†) associated with metastatic disease

Oral dosage (dexamethasone) or Intravenous dosage (dexamethasone sodium phosphate)

Adults

A bolus of 8 to 10 mg dexamethasone (or equivalent) PO or IV, followed by 16 mg/day PO (usually in twice-daily to four-times-daily doses for tolerance) is a typical dose; doses are adjusted to patient condition and are either maintained or tapered over a few weeks dependent on radiation therapy cycles and/or anticipated surgery. A broad dosage range of 16 to 100 mg/day has been used depending on the presence of paraparesis, etc. Higher quality data are needed to establish the benefits vs. risks and optimal dose and duration of therapy. Experts generally agree that patients who have neurologic deficits should receive dexamethasone; many patients with MSCC require corticosteroids to help preserve neurologic function, such as ambulation.[24582] [51639]

to mitigate the effects of acute spinal cord compression† or large mediastinal masses† that are causing respiratory failure in pediatric patients with cancer

Intravenous dosage

Infants, Children, and Adolescents

1 to 2 mg/kg IV load followed by 0.25 to 0.5 mg/kg/dose IV every 6 hours. Max: 16 mg/dose.[64934]

For the adjunctive treatment of bacterial meningitis†

NOTE: For CNS infections related to tuberculosis, see tuberculosis.

Intravenous dosage

Adults

0.15 mg/kg/dose IV every 6 hours for 2 to 4 days for pneumococcal meningitis; administer the first dose 10 to 20 minutes before or concomitantly with the first dose of antimicrobial agent. Do not administer to patients who have already received antimicrobial therapy as this is unlikely to improve patient outcome.[32690]

Infants, Children, and Adolescents

0.15 mg/kg/dose IV every 6 hours for 2 to 4 days for H. influenzae type b; administer the first dose 10 to 20 minutes before or concomitantly with the first dose of antimicrobial agent. Do not administer to patients who have already received antimicrobial therapy as this is unlikely to improve patient outcome. Use in pneumococcal meningitis is controversial and may be considered in those older than 6 weeks of age after weighing the possible benefits and risks.[32690]

Oral dosage

Adults

0.15 mg/kg/dose PO every 6 hours for 2 to 4 days for pneumococcal meningitis; administer the first dose 10 to 20 minutes before or concomitantly with the first dose of antimicrobial agent. Do not administer to patients who have already received antimicrobial therapy as this is unlikely to improve patient outcome.[32690]

Infants, Children, and Adolescents

0.15 mg/kg/dose PO every 6 hours for 2 to 4 days for H. influenzae type b; administer the first dose 10 to 20 minutes before or concomitantly with the first dose of antimicrobial agent. Do not administer to patients who have already received antimicrobial therapy as this is unlikely to improve patient outcome. Use in pneumococcal meningitis is controversial and may be considered in those older than 6 weeks of age after weighing the possible benefits and risks.[32690]

For the treatment of drug-susceptible tuberculosis infection or drug-resistant tuberculosis infection as adjunctive therapy in combination with antituberculous therapy

for the treatment of tuberculosis infection as adjunctive therapy in combination with antituberculous therapy in persons without HIV

Oral dosage

Adults

0.4 mg/kg/day PO with a taper over 6 to 8 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[54286] [61094] [65619] [65758]

Infants, Children, and Adolescents

0.3 to 0.6 mg/kg/day PO for 4 to 6 weeks, then taper over 2 to 4 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[54286] [61094] [65619] [65758] [66745]

Intravenous or Intramuscular dosage

Adults

0.4 mg/kg/day IV or IM with a taper over 6 to 8 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[60760] [61094] [65619] [65758]

Infants, Children, and Adolescents

0.3 to 0.6 mg/kg/day IV or IM for 4 to 6 weeks, then taper over 2 to 4 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[54286] [60760] [61094] [65619] [65758] [66745]

for the treatment of tuberculosis infection as adjunctive therapy in combination with antituberculous therapy in persons living with HIV

Oral dosage

Adults

0.3 to 0.4 mg/kg/day PO for 2 to 4 weeks, then taper by 0.1 mg/kg/week until 0.1 mg/kg/day PO, then 4 mg/day PO and taper by 1 mg/week for a total duration of 12 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[34362] [54286] [61094] [65619] [65758]

Adolescents

0.3 to 0.4 mg/kg/day PO for 2 to 4 weeks, then taper by 0.1 mg/kg/week until 0.1 mg/kg/day PO, then 4 mg/day PO and taper by 1 mg/week for a total duration of 12 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[34362] [54286] [61094] [65619] [65758]

Infants and Children

0.3 to 0.6 mg/kg/day PO for 4 to 6 weeks, then taper over 2 to 4 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[34361] [54286] [61094] [65619] [65758] [66745]

Intravenous or Intramuscular dosage

Adults

0.3 to 0.4 mg/kg/day IV or IM for 2 to 4 weeks, then taper by 0.1 mg/kg/week until 0.1 mg/kg/day IV or IM, then 4 mg/day IV or IM and taper by 1 mg/week for a total duration of 12 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[34362] [60760] [61094] [65619] [65758]

Adolescents

0.3 to 0.4 mg/kg/day IV or IM for 2 to 4 weeks, then taper by 0.1 mg/kg/week until 0.1 mg/kg/day IV or IM, then 4 mg/day IV or IM and taper by 1 mg/week for a total duration of 12 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[34362] [60760] [61094] [65619] [65758]

Infants and Children

0.3 to 0.6 mg/kg/day IV or IM for 4 to 6 weeks, then taper over 2 to 4 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[34361] [54286] [60760] [61094] [65619] [65758] [66745]

For the treatment of kidney transplant rejection in conjunction with other immunosuppressants or for the treatment of acute graft-versus-host disease (GVHD)

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate solution for injection)

Adults

Initially, 0.5 to 9 mg/day IV or IM, in divided doses. Adjust according to patient response. Renal transplant guidelines recommend corticosteroids for the initial treatment of acute rejection.[51730] [51731]

Children and Adolescents

0.06 to 0.3 mg/kg/day or 1.2 to 10 mg/m2/day IM or IV in divided doses every 6 to 12 hours. Renal transplant guidelines recommend corticosteroids for the initial treatment of acute rejection.[51730] [51731]

For the reduction of edema and inflammation associated with selected cases of otitis externa

Otic dosage (using dexamethasone sodium phosphate ophthalmic solution)

Adults, Adolescents, and Children

Instill 3 or 4 drops (ophthalmic solution) into the aural canal 2 to 3 times per day. When a favorable response is obtained, reduce dosage gradually and eventually discontinue. If preferred, the aural canal may be packed with a gauze wick saturated with solution. Keep the wick moist with solution and remove from the ear after 12 to 24 hours. May repeat as needed at the discretion of the prescriber. There is no specific otic solution preparation; use ophthalmic solution. Used for steroid responsive inflammatory conditions of the external auditory meatus, such as allergic otitis externa, selected purulent and nonpurulent infective otitis externa when the hazard of steroid use is accepted to decrease edema and inflammation.[54348]

For the treatment of chemotherapy-induced nausea/vomiting† (CINV†) and for chemotherapy-induced nausea/vomiting prophylaxis†

Intravenous (dexamethasone sodium phosphate injection solution) or Oral dosage (dexamethasone)

Adults

American Society of Clinical Oncology (ASCO) guideline-based dosage regimens are stratified according to patient risk. HIGHLY EMETOGENIC CHEMOTHERAPY: 12 mg PO or IV prior to chemotherapy, then 8 mg PO or IV on days 2 to 3 or days 2 to 4. If an NK1 receptor antagonist is not included in the anti-emetic regimen, increase to dexamethasone 20 mg PO or IV prior to chemotherapy, then 16 mg PO or IV on days 2 to 3 or days 2 to 4. MODERATELY EMETOGENIC CHEMOTHERAPY: 8 mg PO or IV prior to chemotherapy, then 8 mg PO or IV on days 2 and 3. LOW EMOTOGENIC RISK CHEMOTHERAPY: 8 mg PO or IV as a single dose prior to chemotherapy.[63197] (NOTE: Other regimens have been used historically during chemotherapy - e.g., 10 to 20 mg IV before administration of chemotherapy, with additional, lower doses given for 24 to 72 hours, as needed).

Children and Adolescents

10 to 14 mg/m2/dose IV is usually used prior to chemotherapy. A 5-HT3 antagonist is usually given along with dexamethasone for highly-emetogenic chemotherapy. An example regimen: dexamethasone 10 mg/m2/dose IV once daily, along with ondansetron. Some patients receive repeat dexamethasone every 12 hours, either IV or PO, but optimal regimens for repeat dosing are not established. For chemotherapy that is less emetogenic, doses as low as 6 mg/m2/dose PO have been given. The optimal dose of steroids for chemotherapy-induced nausea/vomiting (CINV) in children is not determined, and there are safety considerations.[49435] [54434]

For the treatment of pruritus and inflammatory effects of corticosteroid-responsive dermatoses and dermatologic disorders, including alopecia areata, atopic dermatitis, bullous dermatitis herpetiformis, contact dermatitis, cutaneous T-cell lymphoma (CTCL) or mycosis fungoides, discoid lupus erythematosus, exfoliative dermatitis, granuloma annulare, keloids, lichen planus, lichen simplex chronicus or neurodermatitis, necrobiosis lipoidica diabeticorum, pemphigus, plaque psoriasis, severe seborrheic dermatitis, severe erythema multiforme, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis† (TEN)

for the treatment of atopic dermatitis, bullous dermatitis herpetiformis, contact dermatitis, cutaneous T-cell lymphoma (CTCL) or mycosis fungoides, exfoliative dermatitis, pemphigus, severe seborrheic dermatitis, and severe erythema multiforme

Oral dosage (dexamethasone)

Adults

0.75 to 9 mg/day PO in 2 to 4 divided doses. Adjust dose according to response.[30011]

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO in 3 to 4 divided doses, initially. Adjust dose according to response.[54286]

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate)

Adults

0.5 to 9 mg/day IV or IM in 2 to 4 divided doses. Adjust dose according to response.[60760]

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM in 3 to 4 divided doses. Adjust dose according to response.[54286] [60760]

for the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis† (TEN)

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate, standard dose)

Adults

8 to 16 mg or 0.1 to 0.3 mg/kg/dose IV or IM once daily, then taper dose over 7 to 10 days.[68070] [68102]

Infants, Children, and Adolescents

0.1 to 0.3 mg/kg/dose IV or IM once daily, then taper dose over 7 to 10 days.[68070] [68102]

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate, pulse dose)

Adults

100 mg or 1 to 1.5 mg/kg/dose IV or IM once daily for 3 days.[68070] [68100] [68101]

Infants, Children, and Adolescents

1 to 1.5 mg/kg/dose IV or IM once daily for 3 days.[68070] [68100] [68101]

for the treatment of alopecia areata, aponeurosis or tendon (ganglia) cystic tumors, discoid lupus erythematosus, granuloma annulare, keloids, lichen planus, lichen simplex, necrobiosis lipoidica diabeticorum, and plaque psoriasis

Intralesional or Soft Tissue dosage (dexamethasone sodium phosphate)

Adults

2 to 6 mg by intralesional injection; may repeat dose every 3 to 5 days to every 2 to 3 weeks. Dosage dependent upon degree of inflammation, size, disease state, and location of affected area. Usually employed when condition to be treated is limited to 1 or 2 sites.[60760]

For adjunctive therapy in the treatment of rheumatic disorders including acute gouty arthritis, ankylosing spondylitis, rheumatoid arthritis, juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA), post-traumatic osteoarthritis, synovitis of osteoarthritis, and for psoriatic arthritis; or for the treatment of acute episodes or exacerbation of nonrheumatic inflammatory conditions including acute and subacute bursitis, epicondylitis, acute non-specific tenosynovitis, and cystic tumors of an aponeurosis tendon (ganglia)

Oral dosage (dexamethasone)

Adults

Initially, 0.75 to 9 mg/day PO, given in 2 to 4 divided doses. Adjust according to patient response.[30011]

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range.[54286] Adjust according to patient response.

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate injection solution)

Adults

Initially, 0.5 to 9 mg/day IV or IM, in 2 to 4 divided doses. Adjust maintenance dosage according to patient response.[60760]

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved general dosage range.[54285] [54286] Adjust according to patient response.

Intra-Articular or Intrasynovial injection dosage (dexamethasone sodium phosphate injection solution)

Adults

Dosage ranges from 2 to 4 mg for large joints and 0.8 to 1 mg for small joints. Injection into intervertebral joints should not be attempted at any time and hip joint injection cannot be recommended as an office procedure. Intrasynovial should be employed only when affected areas are limited to 1 or 2 sites. May repeat from once every 3 to 5 days to once every 2 to 3 weeks.[60760]

Intralesional or Soft Tissue dosage (dexamethasone sodium phosphate injection solution)

Adults

The 4 mg/mL injection strength may be used for intralesional and soft tissue administration. Doses range from 0.2 mg to 4 mg injected as a single dose at the appropriate site. For soft tissue and bursal injections a dose of 2 to 4 mg is recommended. Ganglia require a dose of 1 to 2 mg. A dose of 0.4 to 1 mg is used for injection into tendon sheaths. Usually employed when condition to be treated is limited to 1 or 2 sites. Dosage dependent upon degree of inflammation, size, disease state, and location of affected area. Repeat doses may be given from once every 3 to 5 days to once every 2 to 3 weeks.[60760]

For the treatment of hematologic disorders such as secondary thrombocytopenia in adults, autoimmune hemolytic anemia, erythroblastopenia, congenital hypoplastic anemia, and thrombocytopenia associated with immune thrombocytopenic purpura (ITP)

Oral dosage (dexamethasone)

Adults

Initially, 0.75 to 9 mg/day PO, given in 2 to 4 divided doses. For many conditions, the dosing of corticosteroids is highly variable. Adjust according to patient response. In an open study of 10 patients with ITP, pulse dosing produced a sustained improvement in platelet count with a total daily dose of 40 mg/day PO for 4 consecutive days out of each 28 day cycle for 6 consecutive cycles.[24390]

Infants, Children and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range.[54286] Adjust according to patient response.

Intramuscular or Intravenous dosage (dexamethasone sodium phosphate)

Adults

Initially, 0.5 to 9 mg/day IV or IM, given in 2 to 4 divided doses. For many conditions, the dosing of corticosteroids is highly variable. Adjust according to patient response.

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved general dosage range.[54285] [54286] Adjust according to patient response.

For the treatment of acute respiratory distress syndrome (ARDS)†

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate)

Adults

Initially, 0.5 to 9 mg/day IV or IM, in 2 to 4 divided doses. Adjust according to patient response.

Children and Adolescents

0.06 to 0.3 mg/kg/day or 1.2 to 10 mg/m2/day IV or IM, in divided doses every 6 to 12 hours.

For the treatment of respiratory conditions including aspiration pneumonitis, berylliosis, chronic obstructive pulmonary disease (COPD) exacerbations, Loeffler's syndrome

Oral dosage (dexamethasone)

Adults

Initially, 0.75 to 9 mg/day PO, given in 2 to 4 divided doses. Dosage of corticosteroids can be highly variable, depending on patient condition. Adjust according to patient response.

Infants, Children and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range.[54286] Adjust according to patient response. Administer dexamethasone IV or IM initially for the treatment of severe respiratory conditions or those compromising the airway.

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate)

Adults

Initially, 0.5 to 9 mg/day IV or IM, in 2 to 4 divided doses. Dosage of corticosteroids can be highly variable, depending on patient condition. Adjust according to patient response.[54557]

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved general dosage range.[54285] [54286] Adjust according to patient response. Administer dexamethasone IV or IM initially for the treatment of severe respiratory conditions or those compromising the airway.

For asthma exacerbation

Oral dosage

Adults

Initially, 0.75 to 9 mg/day PO, given in 2 to 4 divided doses. Adjust according to patient response.[54286] Use of dexamethasone for longer than 2 days may increase the potential for metabolic side effects. Use parenteral dexamethasone dosage for severe respiratory conditions or those compromising the airway.[64807] Although prednisone, prednisolone, or methylprednisolone are the systemic corticosteroids of choice for the management of moderate to severe asthma exacerbations, other corticosteroids such as dexamethasone, given in equipotent daily doses are likely to be as effective.[33558]

Infants, Children, and Adolescents

0.6 mg/kg/dose PO as a single dose or once daily for 2 days. Max: 16 mg/dose.[54531] [54533] [59736] [59737] [64934] Administer dexamethasone IV or IM initially for the treatment of severe respiratory conditions or those compromising the airway. Single or 2-day regimens of dexamethasone have shown similar efficacy, less vomiting, and improved compliance when compared to a 5-day course of oral prednisone or prednisolone.[54531] [54533] [59736] [59737] Use of dexamethasone for longer than 2 days may increase the potential for metabolic side effects.[64807] Although prednisone, prednisolone, or methylprednisolone are the systemic corticosteroids of choice for the management of moderate to severe asthma exacerbations, other corticosteroids such as dexamethasone, given in equipotent daily doses are likely to be as effective.[33558] Of note, 0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved initial dosage range for dexamethasone; however, this is significantly lower than the range used in clinical practice.[54286]

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate solution injection)

Adults

Initially, 0.5 to 9 mg/day IV or IM, in 2 to 4 divided doses. Adjust according to patient response.[54285] Use of dexamethasone for longer than 2 days may increase the potential for metabolic side effects.[64807] Although prednisone, prednisolone, or methylprednisolone are the systemic corticosteroids of choice for the management of moderate to severe asthma exacerbations, other corticosteroids such as dexamethasone, given in equipotent daily doses are likely to be as effective.[33558]

Infants, Children, and Adolescents

0.6 mg/kg/dose IV or IM as a single dose or once daily for 2 days. Max: 16 mg/dose.[54357] [59738] [64934] Single-dose regimens ranging from 0.3 to 1.7 mg/kg/dose have been reported. Max: 36 mg/dose.[59736] In a study of young children with moderate exacerbations, a single day regimen of parenteral dexamethasone resulted in similar efficacy as a 5-day course of oral prednisolone.[59738] Use of dexamethasone for longer than 2 days may increase the potential for metabolic side effects.[64807] Although prednisone, prednisolone, or methylprednisolone are the systemic corticosteroids of choice for the management of moderate to severe asthma exacerbations, other corticosteroids such as dexamethasone, given in equipotent daily doses are likely to be as effective.[33558] Of note, 0.5 to 9 mg per day IV or IM is the FDA-approved initial dosage range depending on the condition being treated; however, higher doses are sometimes used in clinical practice.[54285] [54286]

For fetal lung maturation and neonatal respiratory distress syndrome prophylaxis† in patients at risk for preterm delivery

Intramuscular dosage (dexamethasone sodium phosphate)

Pregnant females

6 mg IM every 12 hours for 4 doses in all pregnant women between 24 and 34 weeks gestation who are at risk for preterm delivery within 7 days. A single course of corticosteroids may also be considered starting at 23 weeks gestation for pregnant women who are at risk of preterm delivery within 7 days, regardless of membrane status. If labor is impending and further doses are unlikely, the first dose of dexamethasone should still be given because treatment with corticosteroids for less than 24 hours is still associated with a significant reduction in neonatal morbidity/mortality. However, no additional benefit has been demonstrated for courses of antenatal steroids with shorter dosage intervals than those recommended, often referred to as accelerated dosing, even when delivery is imminent. A repeat or rescue course of corticosteroids may be considered in women who are less than 34 weeks gestation, who are at risk of preterm delivery within the next 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose if indicated by the clinical situation.[64435] Dexamethasone is comparable to betamethasone in preventing adverse outcomes and reducing neonatal intensive care unit (NICU) stays.[60414]

For the treatment of laryngotracheobronchitis (croup)†

Oral dosage

Infants, Children, and Adolescents

0.15 to 0.6 mg/kg/dose (Usual Max: 16 mg/dose) PO as a single dose.[54351] [54542] [54543] [59648] [64934]

Intravenous and Intramuscular dosage

Infants, Children, and Adolescents

0.15 to 0.6 mg/kg/dose (Usual Max: 16 mg/dose) IV or IM as a single dose.[54542] [54544] [64934]

For the prevention of chronic lung disease (CLD)† in mechanically ventilated neonates

Intravenous dosage (dexamethasone sodium phosphate)

Preterm Neonates

Numerous dosing schedules have been studied. The Dexamethasone: A Randomized Trial (DART) study (n = 70, median gestational age 25 weeks) used the following tapering dose schedule over 10 days: 0.075 mg/kg/dose IV twice daily for 3 days, 0.05 mg/kg/dose IV twice daily for 3 days, 0.025 mg/kg/dose IV twice daily for 2 days, and 0.01 mg/kg/dose IV twice daily for 2 days. This dosing regimen facilitated extubation by day 10 but did not significantly improve mortality or oxygen dependence at 36 weeks; follow-up at 2 years of age did not indicate any significant adverse neurodevelopmental outcomes in patients treated with dexamethasone.[54555] [54556] Use is somewhat controversial, and most experts suggest using low doses and careful patient selection. The American Academy of Pediatrics (AAP) recommends against the use of high-dose dexamethasone (greater than 0.5 mg/kg/day) due to the risk of short- and long-term adverse effects, including neurodevelopmental effects.[54338] Late corticosteroid therapy (initiated after 7 days of age) may be preferred over early therapy (initiated at less than 7 days of age). Late therapy may reduce neonatal mortality without significantly increasing potential adverse long-term neurodevelopmental outcomes.[64673] [64674]

Oral dosage (dexamethasone)

Adults

Initially, 0.75 to 9 mg/day PO, given in 2 to 4 divided doses. For many conditions, the dosing of corticosteroids is highly variable. Adjust to patient response.[30011]

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range.[54286] Adjust according to patient response.

Intravenous or Intramuscular dosage

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved general dosage range.[54285] [54286] Adjust according to patient response.

Oral dosage

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range.[54286] Adjust according to patient response.

Intravenous and Intramuscular dosage

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved general dosage range.[54285] [54286] Adjust according to patient response.

For the treatment of nephrotic syndrome to induce diuresis or decrease proteinuria

Oral dosage

Adults

Initially, 0.75 to 9 mg/day PO, given in 2 to 4 divided doses. Adjust according to patient response until urine is protein-free, then slowly taper as indicated. Some patients may require long-term dosing.

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range.[54286] Adjust according to patient response.

Intravenous or Intramuscular dosage

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved general dosage range.[54285] [54286] Adjust according to patient response.

For therapy in selected cases of acute rheumatic carditis, systemic dermatomyositis (polymyositis), systemic lupus erythematosus (SLE), temporal arteritis, Churg-Strauss syndrome†, mixed connective tissue disease†, polyarteritis nodosa†, relapsing polychondritis†, polymyalgia rheumatica†, symptomatic sarcoidosis, vasculitis†, or granulomatosis with polyangiitis†; also for the treatment of neurologic or myocardial involvement associated with trichinosis

Oral dosage

Adults

Initially, 0.75 to 9 mg/day PO, given in 2 to 4 divided doses. Dosing can be quite variable, depending on the patient's condition. Adjust according to patient response.

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range.[54286] Adjust according to patient response.

Intramuscular or Intravenous dosage (dexamethasone sodium phosphate)

Adults

Initially, 0.5 to 9 mg/day IV or IM, in 2 to 4 divided doses. Adjust according to patient response.

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved general dosage range.[54285] [54286] Adjust according to patient response.

For the treatment of Hodgkin lymphoma

Oral dosage

Adults and Children

Dosages vary depending upon the chemotherapy protocol. Common doses include 1.5 to 6 mg/m2/day PO for 8 to 21 days or 8 mg PO every 8 hours for 10 days.

For the treatment of non-Hodgkin's lymphoma (NHL)

for the palliative treatment of NHL

Oral dosage

Adults

initial, 0.75 to 9 mg orally daily; dose is dependent on the disease being treated and should be individualized based on patient response. Maintenance therapy may be given; use the lowest dose that produces an adequate clinical response. Taper dexamethasone gradually in patients on long-term therapy; do not abruptly stop therapy in these patients.[60761]

Infants, Children, and Adolescents

initial, 0.02 to 0.3 mg/kg (0.6 mg to 9 mg/m2) orally daily in 3 or 4 divided doses. Dose is dependent on the disease being treated and should be individualized based on patient response. Maintenance therapy may be given; use the lowest dose that produces an adequate clinical response. Taper dexamethasone gradually in patients on long-term therapy; do not abruptly stop therapy in these patients.[60761]

Intravenous dosage (dexamethasone sodium phosphate injection)

Adults

initial, 0.5 to 9 mg IV daily; dose is dependent on the disease being treated and should be individualized based on patient response. Maintenance therapy may be given; use the lowest dose that produces an adequate clinical response. Taper dexamethasone gradually in patients receiving IV therapy for more than a few days; do not abruptly stop therapy in these patients.[60760]

for the treatment of relapsed or refractory, aggressive NHL in transplant eligible patients, in combination with gemcitabine and cisplatin (and rituximab for CD20-positive disease)†

Oral dosage

Adults

40 mg orally daily on days 1, 2, 3, and 4 in combination with gemcitabine 1,000 mg/m2 IV on days 1 and 8 and cisplatin 75 mg/m2 IV on day 1 (GDP regimen) every 21 days for 2 cycles was evaluated in a randomized, phase III trial (NCIC-CTG LY.12 trial). In patients with CD20-positive lymphoma, rituximab 375 mg/m2 IV was added on day 1 of each treatment cycle (R-GDP regimen). Patients in the trial could receive a third cycle of therapy if they did not achieve a complete or partial response after the second cycle. Patients with CD20-positive lymphoma who received an autologous stem-cell transplant (ASCT) were randomized to receive either rituximab 375 mg/m2 IV every 2 months for 6 cycles or observation starting 28 days post ASCT.[60756]

for the treatment of relapsed or refractory diffuse large B-cell lymphoma in transplant eligible patients, in combination with cisplatin and cytarabine (DHAP regimen) and ofatumumab†

Oral or Intravenous dosage

Adults

40 mg orally or IV on days 1, 2, 3, and 4 as part of the DHAP regimen with cisplatin 100 mg/m2 as a continuous IV infusion over 24 hours on day 1 and cytarabine 2 grams/m2 IV over 3 hours every 12 hours for 2 doses on day 2 in combination with ofatumumab 1,000 mg IV on days 1 and 8 of cycle 1 then ofatumumab 1,000 mg IV on day 1 of cycles 2 and 3 was evaluated in a randomized, phase III trial (n = 445; the ORCHARRD trial). Cycles were repeated every 21 days for a total of 3 cycles of therapy. Premedication with acetaminophen, diphenhydramine, and an IV glucocorticoid was administered prior to each ofatumumab infusion. If dexamethasone from the DHAP chemotherapy was dosed on the same day as ofatumumab, then the glucocorticoid premedication was omitted and substituted with the 40-mg dose of dexamethasone. Granulocyte colony-stimulating factor use was recommended as follows: filgrastim 5 micrograms (mcg)/kg on days 6 to 13 or pegfilgrastim 6 mg on day 6 on cycles of therapy with no stem-cell mobilization and filgrastim 5 to 10 mcg/kg on days 6 to 13 on cycles of therapy that were followed by stem-cell mobilization. Central nervous system prophylaxis using intrathecal therapy was permitted. Supportive care during treatment consisted of irradiated blood products, oral antibiotics, and antifungal prophylaxis as clinically indicated.[61715]

For the treatment of acute lymphocytic leukemia (ALL)

Oral dosage

Adults

6 to 10 mg/m2/day PO for 14 days as part of induction, consolidation, or intensification combination regimens.

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range [54286]; however, doses may vary according to the specific protocol used.

Intravenous or Intramuscular dosage

Adults

Initially, 0.5 to 9 mg IV or IM daily; dose is dependent on the disease being treated and should be individualized based on patient response. Maintenance therapy may be given; use the lowest dose that produces an adequate response. Taper dexamethasone gradually in patients receiving parenteral therapy for more than a few days; do not abruptly stop treatment.[60760]

Adolescents, Children, and Infants

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved general dosage range [54285] [54286]; however, doses may vary according to the specific protocol used.

For the treatment of multiple myeloma

NOTE: Dexamethasone has been designated an orphan drug by the FDA for the treatment of multiple myeloma.

for the treatment of patients with newly diagnosed multiple myeloma, in combination with lenalidomide

Oral dosage

Adults 75 years and younger

40 mg orally on days 1, 8, 15, and 22; administer in combination with lenalidomide (25 mg orally daily for 21 days followed by 7 days off treatment). Continue 28-day treatment cycles until disease progression in patients who are ineligible for an autologous stem-cell transplantation (ASCT); hematopoietic stem-cell mobilization should occur within four 28-day treatment cycles in patients who are eligible for an ASCT.[65868] [58806]

Geriatric Adults older than 75 years

20 mg orally on days 1, 8, 15, and 22; administer in combination with lenalidomide (25 mg orally daily for 21 days followed by 7 days off treatment). Continue 28-day treatment cycles until disease progression.[65868] [58806]

for the treatment of multiple myeloma in patients who have received at least 1 prior therapy, in combination with lenalidomide

Oral dosage

Adults

40 mg orally daily on days 1 to 4, 9 to 12, and 17 to 20 every 28 days for the first 4 cycles of therapy, and then 40 mg orally daily on days 1 to 4 every 28 days starting with cycle 5. Given in combination with lenalidomide (25 mg orally daily on days 1 to 21 of each cycle). Continue or modify dosing based on clinical and laboratory findings.[65868] [58806]

for newly diagnosed multiple myeloma, in combination with thalidomide

Oral dosage

Adults

40 mg orally daily on days 1 to 4, days 9 to 12, and days 17 to 20 of every 28-day treatment cycle plus thalidomide 200 mg orally daily (given at bedtime and at least 1 hour after the evening meal).[65868] [49713]

for the treatment of relapsed multiple myeloma in patients who have received 1 to 3 prior lines of therapy, in combination with carfilzomib and lenalidomide

Oral and Intravenous dosage

Adults

40 mg PO or IV on days 1, 8, 15, and 22 in combination with lenalidomide (25 mg orally daily for 21 days) and carfilzomib as specified in the protocol.[65868] Treatment cycles are repeated every 28 days until disease progression or unacceptable toxicity; maximum of 18 cycles for carfilzomib only. CYCLE 1: carfilzomib 20 mg/m2 IV over 10 minutes on days 1 and 2; if tolerated, increase to a target dose of 27 mg/m2 IV over 10 minutes on days 8, 9, 15, and 16. CYCLES 2 to 12: carfilzomib 27 mg/m2 IV over 10 minutes on days 1, 2, 8, 9, 15, and 16. CYCLES 13 to 18: carfilzomib 27 mg/m2 IV over 10 minutes on days 1, 2, 15, and 16. Dose carfilzomib at a maximum body surface area (BSA) of 2.2 m2; dose adjustment is not necessary for patients with a weight change of 20% or less. Give dexamethasone 30 minutes to 4 hours prior to the carfilzomib (on carfilzomib dosing days only). Give hydration with both oral fluids and IV fluids prior to each carfilzomib dose in cycle 1. Additional IV hydration may be given after the carfilzomib infusion in cycle 1. Oral and/or IV hydration may be continued as needed in subsequent cycles; adjust hydration to individual patient needs. Thromboprophylaxis is recommended. Consider giving an antiviral agent and an antacid medication.[51306] In a prespecified interim analysis of a multinational, randomized, open-label, phase 3 trial (n = 792; the ASPIRE trial), the median progression-free survival time (primary endpoint) was significantly increased with carfilzomib plus lenalidomide/dexamethasone (26.3 months) compared with lenalidomide/dexamethasone alone (17.6 months; hazard ratio (HR) = 0.69; 95% CI, 0.57 to 0.83; p = 0.0001) in patients with relapsed multiple myeloma who had received 1 to 3 prior therapies (age range, 31 to 91 years; median of 2 prior therapies). In this study, some patients had previously received bortezomib (65.8%) and/or lenalidomide (19.8%). The median overall survival (OS) time had not been reached in either study arm at the time of the interim analysis (median follow-up: carfilzomib arm, 32.3 months; lenalidomide/dexamethasone alone, 31.5 months). The estimated 24-month OS rates were 73.3% and 65% in the carfilzomib/lenalidomide/dexamethasone and lenalidomide/dexamethasone arms, respectively (HR = 0.79; 95% CI, 0.63 to 0.99; p = 0.04); prespecified criteria for stopping the study due to OS benefit was not met and this study is ongoing.[60044]

for the treatment of multiple myeloma in patients who have received at least 2 prior therapies (including bortezomib and an immunomodulatory agent), in combination with panobinostat and bortezomib

Oral dosage

Adults

20 mg orally on days 1, 2, 4, 5, 8, 9, 11, and 12 during cycles 1 to 8, then dexamethasone 20 mg orally on days 1, 2, 8, and 9 during cycles 9 to 16.[65868] Administer in combination with bortezomib (1.3 mg/m2 IV bolus over 3 to 5 seconds on days 1, 4, 8, and 11 in cycles 1 to 8) then bortezomib (1.3 mg/m2 on days 1 and 8 in cycles 9 to 16) and panobinostat (20 mg orally on days 1, 3, 5, 8, 10, and 12). Continue every 21-day treatment cycles for up to 8 cycles; consider giving up to an additional 8 cycles (maximum of 16 treatment cycles) in patients who experience clinical benefit without unresolved severe or medically significant toxicity.[58821] Treatment with panobinostat, bortezomib, and dexamethasone (n = 387; median therapy duration of 5 months) was compared with placebo, bortezomib, and dexamethasone (n = 381; median therapy duration of 6.1 months) in patients with relapsed or relapsed and refractory multiple myeloma who had received 1 to 3 prior therapies in a multinational, randomized, phase 3 trial (the PANORAMA1 trial). The median patient age was 63 years (range, 56 to 69 years), about 51% of patients had received 1 prior therapy, and approximately 57% of patients had previously received a stem-cell transplantation. Patients with primary refractory or bortezomib-refractory disease were ineligible for this study. At a median follow-up time of 6.47 months (interquartile range, 1.81 to 13.47 months), the median progression-free survival time (primary endpoint) was significantly improved in the panobinostat arm (11.99 months) compared with the placebo arm (8.08 months; hazard ratio (HR) = 0.63; 95% CI, 0.52 to 0.76; p less than 0.0001). The overall survival (OS) time was not significantly improved in the panobinostat arm (33.64 months vs. 30.39 months; HR = 0.87; 95% CI, 0.69 to 1.1); however, OS data are not mature. Crossover from the placebo arm to the panobinostat arm was not permitted.[58822]

for the treatment multiple myeloma in patients who have received at least 1 prior therapy, in combination with daratumumab and bortezomib

Oral or Intravenous dosage

Adults 75 years or younger

20 mg orally or IV on days 1, 2, 4, 5, 8, 9, 11, and 12 (or 20 mg orally/IV once weekly in patients with a body-mass index less than 18.5, poorly controlled diabetes mellitus, or a prior intolerance to glucocorticoid therapy) repeated every 3 weeks for 8 cycles in combination with daratumumab and bortezomib.[65868] The bortezomib dosage is 1.3 mg/m2 as a subcutaneous injection or IV infusion on days 1, 4, 8, and 11 repeated every 3 weeks for 8 cycles. The daratumumab dosage is 16 mg/kg (actual body weight) IV weekly on weeks 1 to 9 (9 doses), 16 mg/kg IV every 3 weeks on weeks 10 to 24 (5 doses), and then 16 mg/kg IV every 4 weeks starting on week 25 until disease progression. Administer standard pre-and post-infusion medications with daratumumab infusions. Give dexamethasone prior to the daratumumab infusion when these drugs are scheduled on the same day.[61207] [60311]

Geriatric Adults over 75 years

20 mg orally or IV once weekly repeated every 3 weeks for 8 cycles in combination with daratumumab and bortezomib.[65868] The bortezomib dosage is 1.3 mg/m2 as a subcutaneous injection or IV infusion on days 1, 4, 8, and 11 repeated every 3 weeks for 8 cycles. The daratumumab dosage is 16 mg/kg (actual body weight) IV weekly on weeks 1 to 9 (9 doses), 16 mg/kg IV every 3 weeks on weeks 10 to 24 (5 doses), and then 16 mg/kg IV every 4 weeks starting on week 25 until disease progression. Administer standard pre-and post-infusion medications with daratumumab infusions. Give dexamethasone prior to the daratumumab infusion when these drugs are scheduled on the same day.[61207] [60311]

for the treatment of multiple myeloma in patients who have received at least 1 prior therapy, in combination with daratumumab and lenalidomide

Oral or Intravenous dosage

Adults 75 years or younger

40 mg orally or IV once weekly (or 20 mg orally or IV once weekly for patients with a body-mass index less than 18.5) in combination with lenalidomide and daratumumab until disease progression or unacceptable toxicity.[65868] The lenalidomide dosage is 25 mg orally daily on days 1 to 21 repeated every 28 days in patients with creatinine clearance (CrCl) greater than 60 mL/min and 10 mg orally daily on days 1 to 21 repeated every 28 days in patients with a CrCl of 30 to 60 mL/min. The daratumumab dosage is 16 mg/kg (actual body weight) IV weekly on weeks 1 to 8 (8 doses), 16 mg/kg IV every other week on weeks 9 to 24 (8 doses), and then 16 mg/kg IV every 4 weeks starting on week 25 until disease progression. Administer standard pre-and post-infusion medications with daratumumab infusions. In patients receiving full dose dexamethasone, administer as 20 mg IV prior to the daratumumab infusion and then 20 mg PO the next day when these drugs are scheduled on the same week; patients receiving a 20 mg/week dexamethasone dose should receive the entire dose administered prior to the daratumumab infusion.[61407] [60311]

Geriatric Adults over 75 years

20 mg orally or IV once weekly in combination with lenalidomide and daratumumab until disease progression or unacceptable toxicity.[65868] The lenalidomide dosage is 25 mg orally daily on days 1 to 21 repeated every 28 days in patients with creatinine clearance (CrCl) greater than 60 mL/min and 10 mg orally daily on days 1 to 21 repeated every 28 days in patients with a CrCl of 30 to 60 mL/min. The daratumumab dosage is 16 mg/kg (actual body weight) IV weekly on weeks 1 to 8 (8 doses), 16 mg/kg IV every 2 weeks on weeks 9 to 24 (8 doses), and then 16 mg/kg IV every 4 weeks starting on week 25 until disease progression. Administer standard pre-and post-infusion medications with daratumumab infusions. Give dexamethasone prior to the daratumumab infusion when these drugs are scheduled on the same week.[61407] [60311]

for the treatment of newly diagnosed multiple myeloma in patients ineligible for autologous stem-cell transplant, in combination with daratumumab and lenalidomide

Oral or Intravenous dosage

Adults 75 years or younger

40 mg orally or IV once weekly (or 20 mg orally or IV once weekly for patients with a body-mass index less than 18.5) in combination with lenalidomide and daratumumab until disease progression or unacceptable toxicity.[65868] Give dexamethasone IV prior to the first infusion; oral administration may be considered thereafter. Give the treatment dexamethasone dose as the daratumumab premedication steroid when these drugs are scheduled on the same day. Consider giving a low-dose oral corticosteroid (equivalent to methylprednisolone 20 mg or less) on the day after every infusion. The lenalidomide dosage is 25 mg orally daily on days 1 to 21 repeated every 28 days in patients with creatinine clearance (CrCl) greater than 50 mL/min and 10 mg orally daily on days 1 to 21 repeated every 28 days in patients with a CrCl of 30 to 50 mL/min. The daratumumab dosage is 16 mg/kg (actual body weight) IV weekly on weeks 1 to 8 (8 doses), 16 mg/kg IV every 2 weeks on weeks 9 to 24 (8 doses), and then 16 mg/kg IV every 4 weeks starting on week 25 until disease progression. Administer standard pre-and post-infusion medications with daratumumab infusions.[60311] In the MAIA trial (median follow-up, 56.2 months), the median progression-free survival (time not reached vs. 34.4 months; hazard ratio (HR) = 0.53; 95% CI, 0.43 to 0.66, p less than 0.0001) and overall survival (time not reached in either arm; HR = 0.68; 95% CI, 0.53 to 0.86) times were significantly improved in the daratumumab plus lenalidomide and dexamethasone arm compared with the lenalidomide and dexamethasone arm in patients (median age, 73 years; range, 45 to 90 years) with newly diagnosed multiple myeloma who were ineligible for a stem-cell transplant.[67219]

Geriatric Adults over 75 years

20 mg orally or IV once weekly in combination with lenalidomide and daratumumab until disease progression or unacceptable toxicity.[65868] Give dexamethasone IV prior to the first infusion; oral administration may be considered thereafter. Give the treatment dexamethasone dose as the daratumumab premedication steroid when these drugs are scheduled on the same day. Consider giving a low-dose oral corticosteroid (equivalent to methylprednisolone 20 mg or less) on the day after every infusion. The lenalidomide dosage is 25 mg orally daily on days 1 to 21 repeated every 28 days in patients with creatinine clearance (CrCl) greater than 50 mL/min and 10 mg orally daily on days 1 to 21 repeated every 28 days in patients with a CrCl of 30 to 50 mL/min. The daratumumab dosage is 16 mg/kg (actual body weight) IV weekly on weeks 1 to 8 (8 doses), 16 mg/kg IV every 2 weeks on weeks 9 to 24 (8 doses), and then 16 mg/kg IV every 4 weeks starting on week 25 until disease progression. Administer standard pre-and post-infusion medications with daratumumab infusions. Give dexamethasone prior to the daratumumab infusion when these drugs are scheduled on the same week.[60311] In the MAIA trial (median follow-up, 56.2 months), the median progression-free survival (time not reached vs. 34.4 months; hazard ratio (HR) = 0.53; 95% CI, 0.43 to 0.66, p less than 0.0001) and overall survival (time not reached in either arm; HR = 0.68; 95% CI, 0.53 to 0.86) times were significantly improved in the daratumumab plus lenalidomide and dexamethasone arm compared with the lenalidomide and dexamethasone arm in patients (median age, 73 years; range, 45 to 90 years) with newly diagnosed multiple myeloma who were ineligible for a stem-cell transplant.[67219]

for the treatment of relapsed or refractory multiple myeloma in patients who have received at least 1 prior therapy, in combination with daratumumab/hyaluronidase and lenalidomide

Oral and Intravenous dosage

Adults 75 years or younger

40 mg IV/PO (or 20 mg PO/IV in patients with a body-mass index less than 18.5) once weekly plus lenalidomide 25 mg PO daily on days 1 to 21 repeated every 28 days in combination with 1,800 mg daratumumab and 30,000 units hyaluronidase subcutaneously weekly on weeks 1 to 8 (8 doses), 1,800 mg daratumumab and 30,000 units hyaluronidase every other week on weeks 9 to 24 (8 doses), and then 1,800 mg daratumumab and 30,000 units hyaluronidase every 4 weeks starting on week 25 until disease progression was evaluated in a single-arm cohort (n = 65) of a multicohort, open-label trial (the PLEIADES trial). The overall response rate was 91% in patients with relapsed or refractory multiple myeloma who received daratumumab/hyaluronidase, lenalidomide, and dexamethasone.[65868] [65366]

Geriatric Adults over 75 years

20 mg PO/IV once weekly plus lenalidomide 25 mg PO daily on days 1 to 21 repeated every 28 days in combination with 1,800 mg daratumumab and 30,000 units hyaluronidase subcutaneously weekly on weeks 1 to 8 (8 doses), 1,800 mg daratumumab and 30,000 units hyaluronidase every other week on weeks 9 to 24 (8 doses), and then 1,800 mg daratumumab and 30,000 units hyaluronidase every 4 weeks starting on week 25 until disease progression was evaluated in a single-arm cohort (n = 65) of a multicohort, open-label trial (the PLEIADES trial). The overall response rate was 91% in patients with relapsed or refractory multiple myeloma who received daratumumab/hyaluronidase, lenalidomide, and dexamethasone.[65868] [65366]

for the treatment of multiple myeloma in patients who have received at least 2 prior therapies including lenalidomide and a proteasome inhibitor, in combination with pomalidomide and daratumumab

Oral or Intravenous dosage

Adults 75 years or younger

40 mg orally or IV once weekly (or 20 mg IV/PO once weekly for patients with a body-mass index less than 18.5) in combination with pomalidomide (4 mg orally daily on days 1 to 21 repeated every 28 days) and daratumumab (16 mg/kg of actual body weight IV weekly on weeks 1 to 8 (8 doses), 16 mg/kg IV every other week on weeks 9 to 24 (8 doses), and then 16 mg/kg IV every 4 weeks starting on week 25) until disease progression was evaluated in a nonrandomized, phase 1b trial (n = 103; EQUULEUS trial). Administer standard pre-and post-infusion medications with daratumumab infusions. In patients receiving full dose dexamethasone, administer as 20 mg IV prior to the daratumumab infusion and then 20 mg orally the next day when these drugs are scheduled on the same week; patients receiving a 20 mg/week dexamethasone dose should receive the entire dose administered prior to the daratumumab infusion.[65868] [60311]

Geriatric Adults over 75 years

20 mg orally or IV once weekly in combination with pomalidomide (4 mg orally daily on days 1 to 21 repeated every 28 days) and daratumumab (16 mg/kg of actual body weight IV weekly on weeks 1 to 8 (8 doses), 16 mg/kg IV every other week on weeks 9 to 24 (8 doses), and then 16 mg/kg IV every 4 weeks starting on week 25) until disease progression was evaluated in a nonrandomized, phase 1b trial (n = 103; EQUULEUS trial). Administer standard pre-and post-infusion medications with daratumumab infusions. Give dexamethasone prior to the daratumumab infusion when these drugs are scheduled on the same week. [65868] [60311]

for the treatment of multiple myeloma in patients who have received 1 to 3 prior therapies, in combination with elotuzumab and lenalidomide

Oral dosage

Adults

28 mg orally (taken 3 to 24 hours prior to elotuzumab) on days 1, 8, 15, and 22 on cycles 1 and 2 and on days 1 and 15 of subsequent cycles in combination with lenalidomide 25 mg orally daily on days 1 through 21 and elotuzumab 10 mg/kg IV once weekly on cycles 1 and 2 (on days 1, 8, 15, and 22), then 10 mg/kg IV every 2 weeks (on days 1 and 15) thereafter. Give dexamethasone 40 mg orally on days 8 and 22 of cycles 3 and beyond. Repeat treatment cycles every 28 days until disease progression.[65868] Administer the following premedications 45 to 90 minutes prior to each elotuzumab infusion: acetaminophen 650 to 1,000 mg PO, diphenhydramine 25 to 50 mg PO or IV (or equivalent), ranitidine 50 mg IV or 150 mg PO (or equivalent), and dexamethasone 8 mg IV.[60354] At a median follow-up time of 24.5 months, the median progression-free survival time was significantly improved with elotuzumab plus lenalidomide and dexamethasone (median duration of therapy, 17 months) compared with lenalidomide and dexamethasone alone (19.4 months vs. 14.9 months; hazard ratio (HR) = 0.7; 95% CI, 0.57 to 0.85; p less than 0.001) in patients with relapsed and/or refractory multiple myeloma in a planned interim analysis of a multicenter, randomized, open-label, phase 3 trial (n = 646; the ELOQUENT-2 trial). In this study, patients had received a median of 2 prior therapies (range, 1 to 4 therapies); 35% of patients had refractory disease to the last therapy and 54% of patients had previously received an autologous stem cell transplantation.[60353] The overall survival time was improved in the elotuzumab-containing arm (48.3 months vs. 39.6 months; HR = 0.82; 95% CI, 0.68 to 1) at the final analysis (minimum follow-up time of 70.6 months). In subgroup analyses, the median OS times were significantly improved in elotuzumab-treated patients who had received 2 or 3 prior therapies (51 months vs. 33.6 months; HR = 0.71; 95% CI, 0.54 to 0.92), were refractory to their most recent therapy (40.4 months vs. 25.9 months; HR = 0.67; 95% CI, 0.49 to 0.91), or were less than 65 years of age (63.5 months vs. 47.7 months; HR = 0.7; 95% CI, 0.52 to 0.96).[65918]

for the treatment of multiple myeloma in patients who have received at least 2 prior therapies including lenalidomide and a proteasome inhibitor, in combination with elotuzumab and pomalidomide

Oral dosage

Adults 75 years or younger

28 mg orally (at 3 to 24 hours prior to elotuzumab) on days 1, 8, 15, and 22 on cycles 1 and 2 and on day 1 of subsequent cycles in combination with elotuzumab 10 mg/kg IV once weekly on cycles 1 and 2 (on days 1, 8, 15, and 22) followed by 20 mg/kg IV every 4 weeks (on day 1) starting on cycle 3 and pomalidomide 4 mg orally daily on days 1 through 21. Additionally, give dexamethasone 40 mg (at 3 to 24 hours prior to elotuzumab) on days 8, 15, and 22 of cycles 3 and beyond. Repeat treatment cycles every 28 days until disease progression.[65868] Administer the following premedications 45 to 90 minutes prior to each elotuzumab infusion: acetaminophen 650 to 1,000 mg orally, diphenhydramine 25 to 50 mg orally or IV (or equivalent), ranitidine 50 mg IV or 150 mg orally (or equivalent), and dexamethasone 8 mg IV. At a minimum follow-up time of 9.1 months, the median investigator-assessed progression-free survival time was significantly improved with elotuzumab plus pomalidomide and dexamethasone (median number of treatment cycles, 9) compared with pomalidomide and dexamethasone alone (10.25 months vs. 4.67 months; hazard ratio (HR) = 0.54; 95% CI, 0.34 to 0.86; p = 0.0078) in patients with relapsed or refractory multiple myeloma in a randomized, phase 2 trial (n = 117; the ELOQUENT-3 trial). In this study, patients had received a median of 3 prior therapies; 70% of patients had refractory disease after both lenalidomide and a proteasome inhibitor and 55% of patients had previously received an autologous stem cell transplantation.[60354]

Geriatric Adults over 75 years

8 mg orally (at 3 to 24 hours prior to elotuzumab) on days 1, 8, 15, and 22 on cycles 1 and 2 and on day 1 of subsequent cycles in combination with elotuzumab 10 mg/kg IV once weekly on cycles 1 and 2 (on days 1, 8, 15, and 22) followed by 20 mg/kg IV every 4 weeks (on day 1) starting on cycle 3 and pomalidomide 4 mg orally daily on days 1 through 21. Additionally, give dexamethasone 20 mg orally (at 3 to 24 hours prior to elotuzumab) on days 8, 15, and 22 of cycles 3 and beyond. Repeat treatment cycles every 28 days until disease progression.[65868] Administer the following premedications 45 to 90 minutes prior to each elotuzumab infusion: acetaminophen 650 to 1,000 mg orally, diphenhydramine 25 to 50 mg orally or IV (or equivalent), ranitidine 50 mg IV or 150 mg orally (or equivalent), and dexamethasone 8 mg IV. At a minimum follow-up time of 9.1 months, the median investigator-assessed progression-free survival time was significantly improved with elotuzumab plus pomalidomide and dexamethasone (median number of treatment cycles, 9) compared with pomalidomide and dexamethasone alone (10.25 months vs. 4.67 months; hazard ratio (HR) = 0.54; 95% CI, 0.34 to 0.86; p = 0.0078) in patients with relapsed or refractory multiple myeloma in a randomized, phase 2 trial (n = 117; the ELOQUENT-3 trial). In this study, patients had received a median of 3 prior therapies; 70% of patients had refractory disease after both lenalidomide and a proteasome inhibitor and 55% of patients had previously received an autologous stem cell transplantation.[60354]

for the treatment of newly diagnosed multiple myeloma, in combination with bortezomib and lenalidomide†

Oral dosage

Adults

20 mg orally on days 1, 2, 4, 5, 8, 9, 11, and 12 repeated every 21 days for 8 cycles (SWOG S0777 trial); 20 mg orally on days 1, 2, 4, 5, 8, 9, 11, and 12 repeated every 21 days for 3 cycles prior to stem-cell transplantation (SCT) followed by 10 mg orally on days 1, 2, 4, 5, 8, 9, 11, and 12 repeated every 21 days for 2 cycles after SCT (IFM 2009 trial); and 20 mg orally on days 1, 2, 4, 5, 8, 9, 11, and 12 repeated every 21 days for 4 cycles, 10 mg orally on days 1, 2, 4, 5, 8, 9, 11, and 12 on cycles 5 to 9, and then 10 mg orally on days 1, 2, 8, and 9 on cycles 9 to 12 (ENDURANCE trial) in combination with bortezomib and lenalidomide (VRd regimen) have been evaluated in 3 randomized, phase 3 trials. Maintenance therapy consisted of lenalidomide and dexamethasone or lenalidomide only.[61788] [65843] [65899]

for newly diagnosed multiple myeloma as induction therapy prior to autologous stem-cell transplantation, in combination with bortezomib†

Oral dosage

Adults 65 years and younger

40 mg orally daily on days 1 to 4 during all cycles and on days 9 to 12 for cycles 1 and 2 only plus bortezomib (1.3 mg/m2 IV on days 1, 4, 8, and 11) repeated every 3 weeks for 4 cycles as induction therapy prior to autologous stem-cell transplantation has been evaluated in newly diagnosed multiple myeloma patients in randomized, phase 3 studies.[49477] [49745]

for newly diagnosed multiple myeloma as induction therapy prior to autologous stem-cell transplantation, in combination with bortezomib and thalidomide†

Oral dosage

Adults 65 years and younger

40 mg orally on days 1, 2, 4, 5, 8, 9, 11, and 12 plus bortezomib (1.3 mg/m2 IV on days 1, 4, 8, and 11) and thalidomide (100 mg orally daily for the first 14 days during cycle 1 only, and then 200 mg orally daily thereafter). Regimen is known as the VTD regimen. Repeated every 21 days for 3 cycles prior to a double (tandem) autologous stem-cell transplant (ASCT). This regimen was studied in a multicenter, randomized, phase 3 study. Patients randomized to induction therapy with VTD also received two 35-day consolidation cycles with VTD (bortezomib 1.3 mg/m2 on days 1, 8, 15, and 22 plus thalidomide 100 mg orally daily and dexamethasone 40 mg orally on days 1, 2, 8, 9, 15, 16, 22, and 23) following the second transplantation. Patients also received maintenance therapy with dexamethasone 40 mg orally on days 1 to 4 every 28 days until relapse or disease progression.[49746] Additionally in a randomized, phase 3 study, dexamethasone 40 mg orally daily on days 1 to 4 and 9 to 12 plus bortezomib (1.3 mg/m2 on days 1, 4, 8, and 11) and thalidomide (200 mg orally daily after dose escalation as follows in the first cycle: thalidomide 50 mg/day on days 1 to 14 and 100 mg/day on days 15 to 28) repeated every 4 weeks for 6 cycles prior to an ASCT was studied. In this study, patients who received up to 3 years of maintenance therapy (starting 3 months after ASCT) with bortezomib (1.3 mg/m2 IV on days 1, 4, 8, and 11 repeated every 3 months) plus thalidomide (100 mg/day) had significantly improved 2-year progression-free survival compared with thalidomide or interferon alfa-2b maintenance therapy.[49747]

for newly diagnosed multiple myeloma as induction therapy prior to autologous stem-cell transplantation, in combination with doxorubicin and vincristine†

Oral dosage

Adults 65 years and younger

40 mg orally daily on days 1 to 4, days 9 to 12, and days 17 to 20 or dexamethasone 40 mg orally daily on days 1 to 4 on all cycles and days 9 to 12 and days 17 to 20 of cycles 1 and 2 only, plus doxorubicin 9 mg/m2 IV daily and vincristine 0.4 mg IV daily on days 1 to 4 (VAD regimen) has been studied. Doxorubicin and vincristine were administered as a continuous IV infusion over 24 hours/day [49477] or as a daily IV infusion. Cycles were repeated every 4 weeks for 3 to 4 cycles as induction therapy prior to autologous stem-cell transplantation.[49477] [49478]

for the treatment of relapsed or refractory multiple myeloma in patients who have received 1 to 3 prior therapies including lenalidomide, in combination with pomalidomide and bortezomib †

Oral dosage

Adults 75 years or younger

20 mg orally on days 1, 2, 4, 5, 8, 9, 11, and 12 repeated every 21 days on cycles 1 to 8 and then 20 mg orally on days 1, 2, 8, and 9 starting on cycle 9 in combination with pomalidomide (4 mg orally daily on days 1 to 14) and bortezomib was evaluated in a randomized, phase 3 trial (n = 559; the OPTIMISMM trial). Bortezomib was administered as follows: 1.3 mg/m2 IV or subcutaneously on days 1, 4, 8, and 11 on cycles 1 to 8 then 1.3 mg/m2 IV or subcutaneously on days 1 and 8 starting on cycle 9. Treatment cycles were repeated every 21 days until disease progression.[64412]

Geriatric Adults older than 75 years

10 mg orally on days 1, 2, 4, 5, 8, 9, 11, and 12 repeated every 21 days on cycles 1 to 8 and then 10 mg orally on days 1, 2, 8, and 9 starting on cycle 9 in combination with pomalidomide (4 mg orally daily on days 1 to 14) and bortezomib. Bortezomib was administered as follows: 1.3 mg/m2 IV or subcutaneously on days 1, 4, 8, and 11 on cycles 1 to 8 then 1.3 mg/m2 IV or subcutaneously on days 1 and 8 starting on cycle 9. Treatment cycles were repeated every 21 days until disease progression.[64412]

for the treatment of newly diagnosed multiple myeloma as induction and consolidation therapy in patients who are eligible for autologous stem-cell transplant, in combination with daratumumab, bortezomib, and thalidomide

Oral and Intravenous dosage

Adults 65 years and younger

40 mg orally or IV on days 1, 2, 8, 9, 15, 16, 22, and 23 in induction cycles 1 and 2; 40 mg orally or IV on days 1 and 2 and 20 mg PO or IV on days 8, 9, 15, and 16 in induction cycles 3 and 4; and 20 mg orally or IV on days 1, 2, 8, 9, 15, and 16 for 2 consolidation cycles in combination with daratumumab, bortezomib, and thalidomide was evaluated in a multicenter, randomized, phase 3 trial (n = 1,085; the CASSIOPEIA trial).[65868] In this trial, dexamethasone was administered for up to four 28-day induction therapy cycles and two 28-day consolidation therapy cycles with daratumumab (16 mg/kg IV weekly in induction cycles 1 and 2 then 16 mg/kg IV every 2 weeks in induction cycles 3 and 4 and for both consolidation cycles; bortezomib 1.3 mg/m2 subcutaneously on days 1, 4, 8, and 11 in each induction and consolidation cycle; and thalidomide 100 mg orally daily. Consolidation therapy was begun after hematopoietic reconstitution but not earlier than 30 days after transplant.[64528]

for the treatment of multiple myeloma in patients who have received at least 2 prior therapies including lenalidomide and a proteasome inhibitor, in combination with isatuximab and pomalidomide

Oral and Intravenous dosage

Adults 74 years and younger

40 mg IV or orally on days 1, 8, 15, and 22 repeated every 28 days until disease progression. Give in combination with isatuximab 10 mg/kg (actual body weight) IV on days 1, 8, 15, and 22 on cycle 1 and isatuximab 10 mg/kg (actual body weight) IV on days 1 and 15 starting on cycle 2 and pomalidomide 4 mg orally daily on days 1 to 21. The scheduled dexamethasone dose should be given prior to isatuximab and pomalidomide on days these drugs are given together.[65868] [65066] At a median follow-up time of 11.6 months, the median progression-free survival time (evaluated by an independent response committee) was significantly improved in patients with relapsed or refractory multiple myeloma who received isatuximab, pomalidomide, and low-dose dexamethasone compared with pomalidomide and low-dose dexamethasone alone (11.5 months vs. 6.5 months; hazard ratio (HR) = 0.596; 95% CI, 0.44 to 0.81; p = 0.001) in a multinational, randomized, phase 3 trial (the ICARIA-MM trial; n = 307). Patients (median age, 67 years) in this study had received a median of 3 prior therapies including lenalidomide and a proteasome inhibitor; 56% of patients had previously received an autologous stem-cell transplantation.[65070] At a second interim analysis (median follow-up, 35.3 months), the median overall survival time was 24.6 months in patients who received isatuximab, pomalidomide, and dexamethasone compared with 17.7 months in patients who received pomalidomide and dexamethasone (HR = 0.76; 95% CI, 0.57 to 1.01). Subsequent therapy was given at disease progression in 60% and 72% of patients in the isatuximab-containing and control arms, respectively. Of patients who received subsequent therapy, fewer patients received daratumumab in the isatuximab-containing arm (24% vs. 58%).[67409]

Geriatric Adults 75 years and older

20 mg IV or orally on days 1, 8, 15, and 22 repeated every 28 days until disease progression. Give in combination with isatuximab 10 mg/kg (actual body weight) IV on days 1, 8, 15, and 22 on cycle 1 and isatuximab 10 mg/kg (actual body weight) IV on days 1 and 15 starting on cycle 2 and pomalidomide 4 mg orally daily on days 1 to 21. The scheduled dexamethasone dose should be given prior to isatuximab and pomalidomide on days these drugs are given together.[65868] [65066] At a median follow-up time of 11.6 months, the median progression-free survival was significantly improved in patients with relapsed or refractory multiple myeloma who received isatuximab, pomalidomide, and low-dose dexamethasone compared with pomalidomide and low-dose dexamethasone alone (11.5 months vs. 6.5 months; hazard ratio = 0.596; 95% CI, 0.44 to 0.81; p = 0.001) in a multinational, randomized, phase 3 trial (the ICARIA-MM trial; n = 307). Patients (median age, 67 years) in this study had received a median of 3 prior therapies including lenalidomide and a proteasome inhibitor; 56% of patients had previously received an autologous stem-cell transplantation.[65070]

for the treatment of relapsed or refractory multiple myeloma in patients who have received 1 to 3 prior lines of therapy, in combination with and carfilzomib and daratumumab

Oral and Intravenous dosage

Adults 75 years or younger

20 mg PO/IV on days 1, 2, 8, 9, 15, and 16 and 40 mg PO/IV on day 22 repeated every 28 days in combination with IV carfilzomib (20 mg/m2 and 56 mg/m2 twice weekly regimen) and IV daratumumab until disease progression or unacceptable toxicity. Alternatively, dexamethasone may be given as follows: 20 mg PO/IV on days 1, 2, 8, 9, 15, 16, 22, and 23 in cycles 1 and 2; 20 mg PO/IV on days 1, 2, 15, and 16 and 40 mg PO/IV on days 8 and 22 in cycles 3, 4, 5, and 6; and 20 mg PO/IV on days 1 and 2 and 40 mg PO/IV on days 8, 15, and 22 in cycles 7 and beyond in combination with IV carfilzomib (20 mg/m2 and 70 mg/m2 once weekly regimen) and IV daratumumab until disease progression or unacceptable toxicity. Treatment cycles are repeated every 28 days. Give dexamethasone 30 minutes to 4 hours prior to the carfilzomib dose and 1 to 3 hours prior to daratumumab.[65868] [51306] At a median follow-up time of about 17 months, the median progression-free survival was significantly improved in patients with relapsed or refractory multiple myeloma who received carfilzomib 20 mg/m2 and 56 mg/m2 twice weekly regimen, daratumumab, and dexamethasone compared with carfilzomib and dexamethasone alone (median time not reached vs. 15.8 months; hazard ratio = 0.63; 95% CI, 0.46 to 0.85; p = 0.0027) in a multicenter, randomized (2:1), open-label, phase 3 trial (n = 466; the CANDOR trial).[65854] At a median follow-up time of 16.6 months (range, 0.5 to 27.4 months), the overall response rate was 84% (complete response rate, 33%) in patients with relapsed or refractory multiple myeloma who received carfilzomib 20 mg/m2 and 70 mg/m2 once weekly regimen, daratuzumab, and dexamethasone in a multicenter, multi-arm, phase 1b trial (n = 85; EQUULEUS trial).[65855]

Geriatric Adults older than 75 years

20 mg PO/IV on days 1 and 2 of cycle 1 only and then 20 mg PO/IV weekly in combination with IV carfilzomib and IV daratumumab until disease progression or unacceptable toxicity. Treatment cycles are repeated every 28 days. Give dexamethasone 30 minutes to 4 hours prior to the carfilzomib dose and 1 to 3 hours prior to daratumumab.[65868] [51306] At a median follow-up time of about 17 months, the median progression-free survival was significantly improved in patients with relapsed or refractory multiple myeloma who received carfilzomib 20 mg/m2 and 56 mg/m2 twice weekly regimen, daratumumab, and dexamethasone compared with carfilzomib and dexamethasone alone (median time not reached vs. 15.8 months; hazard ratio = 0.63; 95% CI, 0.46 to 0.85; p = 0.0027) in a multicenter, randomized (2:1), open-label, phase 3 trial (n = 466; the CANDOR trial).[65854] At a median follow-up time of 16.6 months (range, 0.5 to 27.4 months), the overall response rate was 84% (complete response rate, 33%) in patients with relapsed or refractory multiple myeloma who received carfilzomib 20 mg/m2 and 70 mg/m2 once weekly regimen, daratuzumab, and dexamethasone in a multicenter, multi-arm, phase 1b trial (n = 85; EQUULEUS trial).[65855]

for the treatment of newly diagnosed multiple myeloma in patients who are eligible for autologous stem-cell transplant, in combination with daratumumab, bortezomib, and lenalidomide†

Oral dosage

Adults 70 years or younger

20 mg on days 1, 2, 8, 9, 15, and 16 repeated every 21 days on cycles 1, 2, 3, and 4 followed by high-dose chemotherapy and an autologous stem-cell transplant and then 2 additional cycles of dexamethasone 20 mg on days 1, 2, 8, 9, 15, and 16 repeated every 21 days (cycles 5 and 6) plus lenalidomide 25 mg orally daily on days 1 to 14 and bortezomib 1.3 mg/m2 subcutaneously on days 1, 4, 8, and 11 repeated every 21 days for 6 cycles (VRd regimen) with daratumumab was evaluated in a randomized, phase 2 trial (the GRIFFIN trial; n = 207). Daratumumab treatment consisted of 16 mg/kg IV on days 1, 8, and 15 repeated every 21 days on cycles 1, 2, 3, and 4 and 16 mg/kg IV day 1 repeated every 21 days on cycles 5 and 6. Maintenance therapy was given for up to 2 years and consisted of daratumumab 16 mg/kg IV on day 1 repeated every 4 or 8 weeks and lenalidomide 10 mg orally daily on days 1 to 21 (increased to 15 mg after 3 cycles if tolerated) repeated every 28 days.[66069]

for the treatment of multiple myeloma in patients who have received at least 1 prior therapy, in combination with selinexor and bortezomib†

Oral dosage

Adults

20 mg PO on days 1 and 2 in combination with selinexor 100 mg orally on day 1 once weekly and bortezomib 1.3 mg/m2 subcutaneously on day 1 once weekly for 4 weeks followed by 1 week off; repeat cycles until disease progression.[64399] Treatment with a once-weekly regimen of selinexor plus bortezomib, and dexamethasone (SVd regimen) led to a significantly improved median progression-free survival time compared with bortezomib and dexamethasone (13.93 months vs. 9.46 months; hazard ratio (HR) = 0.7; 95% CI, 0.53 to 0.93) in a randomized, phase 3 trial (n = 402; the Boston trial). At a median follow-up of 17.3 months, the median overall survival (OS) time was not significantly improved in the SVd arm (HR = 0.84; 95% CI, 0.57 to 1.23); however, OS data was not mature at the time of this analysis. Patients (median age, 67 years) in this trial had received a median of 2 prior regimens (range, 1 to 2 regimens) and approximately 70% of patients had received prior bortezomib therapy; 35% of patients had previously received a stem-cell transplant.[66186]

for the treatment of multiple myeloma in patients who have received at least 4 prior therapies and who are refractory to at least 1 proteasome inhibitor, 1 immunomodulatory agent, and 1 anti-CD38 monoclonal antibody, in combination with melphalan flufenamide

Oral and Intravenous dosage

Adults younger than 75 years

40 mg orally or IV on days 1, 8, 15, and 22 in combination with melphalan flufenamide 40 mg IV on day 1 repeated every 28 days until disease progression. Treatment with melphalan flufenamide plus dexamethasone resulted in an overall response rate of 23.7% in 97 patients with multiple myeloma who had received 4 or more previous lines of therapy and were refractory to at least 1 proteasome inhibitor, 1 immunomodulatory agent, and a CD38-directed monoclonal antibody in a nonrandomized phase 2 trial (the HORIZON trial). No patient achieved a complete response. In this trial, the median duration of response was 4.2 months. Patients (median age, 65 years; range, 35 to 86 years) had received a median of 6 prior regimens (range, 4 to 12 regimens); 75% of patients had alkylator refractory disease and 70% of patients had previously received a stem-cell transplant.[66471]

Geriatrics 75 years or older

20 mg orally or IV on days 1, 8, 15, and 22 in combination with melphalan flufenamide 40 mg IV on day 1 repeated every 28 days until disease progression. Treatment with melphalan flufenamide plus dexamethasone resulted in an overall response rate of 23.7% in 97 patients with multiple myeloma who had received 4 or more previous lines of therapy and were refractory to at least 1 proteasome inhibitor, 1 immunomodulatory agent, and a CD38-directed monoclonal antibody in a nonrandomized phase 2 trial (the HORIZON trial). No patient achieved a complete response. In this trial, the median duration of response was 4.2 months. Patients (median age, 65 years; range, 35 to 86 years) had received a median of 6 prior regimens (range, 4 to 12 regimens); 75% of patients had alkylator refractory disease and 70% of patients had previously received a stem-cell transplant.[66471]

for the treatment of relapsed or refractory multiple myeloma in patients who have received 1 to 3 prior lines of therapy, in combination with isatuximab and carfilzomib

Oral or Intravenous dosage

Adults

20 mg on days 1, 2, 8, 9, 15, 16, 22, and 23 in combination with isatuximab (cycle 1: 10 mg/kg IV on days 1, 8, 15, and 22; cycle 2 and beyond: 10 mg/kg IV on days 1 and 15) and carfilzomib (cycle 1: 20 mg/m2 IV on days 1 and 2 and then 56 mg/m2 on days 8, 9, 15, and 16; cycle 2 and beyond: 56 mg/m2 IV on days 1, 2, 8, 9, 15, and 16). Repeat treatment cycles every 28 days until disease progression. Give IV dexamethasone prior to isatuximab and/or carfilzomib on days these agents are given on the same day and then give dexamethasone orally for other scheduled doses.[65066] [51306] At a median follow-up time of 20.7 months, the median progression-free survival was significantly improved in patients with relapsed or refractory multiple myeloma who received isatuximab, carfilzomib, and dexamethasone compared with carfilzomib and dexamethasone alone (median time not calculated vs. 19.15 months; hazard ratio = 0.53; 95% CI, 0.32 to 0.79; p = 0.0007) in a prespecified interim analysis of a multinational, randomized, phase 3 trial (the IKEMA trial; n = 302). Patients (median age, 64 years) in this study had received a median of 2 prior therapies; 61% of patients had previously received a stem-cell transplantation.[67780]

for the treatment of multiple myeloma in patients who have received at least 1 prior therapy, in combination with ixazomib and lenalidomide

Oral dosage

Adults

40 mg orally on days 1, 8, 15, and 22 in combination with ixazomib 4 mg orally on days 1, 8, and 15 and lenalidomide 25 mg orally daily on days 1 through 21. Repeat treatment cycles every 28 days until disease progression.[60335] The median progression-free survival time was significantly improved with ixazomib plus lenalidomide and dexamethasone compared with placebo plus lenalidomide and dexamethasone (20.6 months vs. 14.7 months; hazard ratio (HR) = 0.74; 95% CI, 0.59 to 0.94; p = 0.01) in patients with relapsed and/or refractory multiple myeloma who had received 1 to 3 prior therapies in a multinational, randomized, double-blind, phase 3 trial (n = 722; TOURMALINE-MM1 trial). At a median follow-up time of 85 months, the median overall survival time was not significantly improved in the ixazomib-containing arm (53.6 months vs. 51.6 months; HR = 0.939; 95%CI, 0.784 to 1.125). In this trial, subsequent lines of therapy were given in 71.7% and 69.9% of patients who received ixazomib plus lenalidomide and dexamethasone (median, 2 subsequent therapies; range, 1 to 9) and lenalidomide and dexamethasone (median, 3 subsequent therapies; range, 1 to 12), respectively. The median age of patients in this study was 66 years (range, 30 to 91 years); prior therapy included a stem-cell transplant in 57% of patients, proteasome inhibitor therapy in 70% of patients, and immunomodulatory drug therapy in 55% of patients. Thromboprophylaxis was recommended for all patients.[60856] [66762]

for the treatment of relapsed or refractory multiple myeloma in patients who have received at least 1 prior therapy including lenalidomide and a proteasome inhibitor, in combination with daratumumab/ hyaluronidase and pomalidomide

Oral dosage

Adults and Geriatric patients younger than 75 years

40 mg orally once weekly (on days 1, 8, 15, and 22) repeated every 28 days until disease progression; give in combination with daratumumab/hyaluronidase (1,800 mg daratumumab and 30,000 units hyaluronidase subcutaneously weekly on weeks 1 to 8 (8 doses), every other week on weeks 9 to 24 (8 doses), and then every 4 weeks starting on week 25 until disease progression) and pomalidomide (4 mg PO daily on days 1 to 21 repeated every 28 days). At a median follow-up of 16.9 months, the median progression-free survival was significantly improved (12.4 months vs. 6.9 months; hazard ratio, 0.63; 95%CI, 0.47 to 0.85) in patients with relapsed or refractory multiple myeloma who received daratumumab/hyaluronidase plus pomalidomide and dexamethasone compared with pomalidomide and dexamethasone alone in a randomized, phase 3 trial (n = 304; the APOLLO trial). Overall survival data were not mature at the time of this analysis. In this trial, eligible patients had received at least 1 previous line of therapy with both lenalidomide and a proteasome inhibitor, had a partial response or better to one or more previous lines of antimyeloma therapy, and were refractory to lenalidomide if they had received only 1 previous line of treatment. Patients (median age, 67 years; range, 42 to 86 years) in the daratumumab/hyaluronidase arm had received a median of 2 (range, 1 to 5) prior therapies; 60% of patients had received a prior autologous stem-cell transplantation.[65366] [66809]

Geriatric patients 75 years and older

20 mg orally once weekly (on days 1, 8, 15, and 22) repeated every 28 days until disease progression; give in combination with daratumumab/hyaluronidase (1,800 mg daratumumab and 30,000 units hyaluronidase subcutaneously weekly on weeks 1 to 8 (8 doses), every other week on weeks 9 to 24 (8 doses), and then every 4 weeks starting on week 25 until disease progression) and pomalidomide (4 mg PO daily on days 1 to 21 repeated every 28 days). At a median follow-up of 16.9 months, the median progression-free survival was significantly improved (12.4 months vs. 6.9 months; hazard ratio, 0.63; 95%CI, 0.47 to 0.85) in patients with relapsed or refractory multiple myeloma who received daratumumab/hyaluronidase plus pomalidomide and dexamethasone compared with pomalidomide and dexamethasone alone in a randomized, phase 3 trial (n = 304; the APOLLO trial). Overall survival data were not mature at the time of this analysis. In this trial, eligible patients had received at least 1 previous line of therapy with both lenalidomide and a proteasome inhibitor, had a partial response or better to one or more previous lines of antimyeloma therapy, and were refractory to lenalidomide if they had received only 1 previous line of treatment. Patients (median age, 67 years; range, 42 to 86 years) in the daratumumab/hyaluronidase arm had received a median of 2 (range, 1 to 5) prior therapies; 60% of patients had received a prior autologous stem-cell transplantation.[65366] [66809]

for the treatment of relapsed or refractory multiple myeloma in patients who have received 1 to 3 prior lines of therapy, in combination with daratumumab/hyaluronidase and carfilzomib

Oral and Intravenous dosage

Adults 75 years or younger

40 mg PO or IV per week in combination with carfilzomib and daratumumab/hyaluronidase; treatment cycles are repeated every 28 days until disease progression or unacceptable toxicity. Dexamethasone dosing day(s)/schedule differ with twice weekly or once weekly carfilzomib regimens. Give dexamethasone 30 minutes to 4 hours prior to the carfilzomib. Give the treatment dexamethasone dose as the premedication steroid when these drugs are scheduled on the same day as daratumumab; hyaluronidase. With carfilzomib 20 mg/m2 and 56 mg/m2 twice weekly regimen, give dexamethasone 20 mg PO/IV on days 1, 2, 8, 9, 15, 16, 22 and 23 on cycles 1 and 2 and then 20 mg PO/IV on days 1, 2, 8, 9, 15, and 16 and 40 mg PO/IV on day 22 on subsequent cycles. With carfilzomib 20 mg/m2 and 70 mg/m2 once weekly regimen, give dexamethasone 20 mg PO/IV on days 1, 2, 8, 9, 15, 16, 22, and 23 on cycles 1 and 2; 20 mg PO/IV on days 1, 2, 15, and 16 and 40 mg PO/IV on days 8 and 22 on cycles 3, 4, 5, and 6; and 20 mg PO/IV on days 1 and 2 and 40 mg PO/IV on days 8, 15, and 22 on cycles 7 and beyond. In patients with a BMI of less than 18.5 who received the carfilzomib once weekly regimen, give a reduced dexamethasone dosage of 20 mg PO/IV on days 1 and 2 of cycle 1 then 20 mg PO/IV weekly. Daratumumab; hyaluronidase is administered as follows: 1,800 mg daratumumab and 30,000 units hyaluronidase subcutaneously weekly on weeks 1 to 8 (8 doses), 1,800 mg daratumumab and 30,000 units hyaluronidase every 2 weeks on weeks 9 to 24 (8 doses), and then 1,800 mg daratumumab and 30,000 units hyaluronidase every 4 weeks starting on week 25 until disease progression. The overall response rate was 84.8% in 66 patients with relapsed or refractory multiple myeloma who received carfilzomib (20 mg/m2 and 70 mg/m2 once weekly regimen), daratumumab/hyaluronidase, and dexamethasone in a multicohort, phase 2 trial (the PLEIADES trial). The stringent complete response rate was 16.7% and the complete response rate was 21.2%. At a median follow-up time of 9.2 months, the median duration of response was not reached. Patients (median age, 61 years; range, 42 to 84 years) in this trial had received at least 1 previous therapy line that contained lenalidomide; 79% of patients had a prior stem-cell transplant.[51306] [65366]

Adults older than 75 years

20 mg PO/IV on days 1 and 2 of week 1 and then 20 mg PO/IV once weekly in combination with carfilzomib and daratumumab/hyaluronidase; treatment cycles are repeated every 28 days until disease progression or unacceptable toxicity. Give dexamethasone 30 minutes to 4 hours prior to the carfilzomib. Carfilzomib is administered as either a 20 mg/m2 and 56 mg/m2 twice weekly or a 20 mg/m2 and 70 mg/m2 once weekly regimen. Give the treatment dexamethasone dose as the premedication steroid when these scheduled on the same day as daratumumab; hyaluronidase. Daratumumab; hyaluronidase is administered as follows: 1,800 mg daratumumab and 30,000 units hyaluronidase subcutaneously weekly on weeks 1 to 8 (8 doses), 1,800 mg daratumumab and 30,000 units hyaluronidase every 2 weeks on weeks 9 to 24 (8 doses), and then 1,800 mg daratumumab and 30,000 units hyaluronidase every 4 weeks starting on week 25 until disease progression. The overall response rate was 84.8% in 66 patients with relapsed or refractory multiple myeloma who received carfilzomib (20 mg/m2 and 70 mg/m2 once weekly regimen), daratumumab/hyaluronidase, and dexamethasone in a multicohort, phase 2 trial (the PLEIADES trial). The stringent complete response rate was 16.7% and the complete response rate was 21.2%. At a median follow-up time of 9.2 months, the median duration of response was not reached. Patients (median age, 61 years; range, 42 to 84 years) in this trial had received at least 1 previous therapy line that contained lenalidomide; 79% of patients had a prior stem-cell transplant.[51306] [65366]

For the treatment of acute exacerbations of multiple sclerosis

Oral dosage

Adults

30 mg/day PO for 7 days, followed by doses of 4 to 12 mg PO every other day for 1 month have been shown to be effective. Controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations, they do not show that they affect the ultimate outcome or natural history of the disease.[30011]

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range.[54286] Adjust according to patient response.

Intravenous† or Intramuscular dosage†

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved general dosage range.[54285] [54286] Adjust according to patient response.

For the treatment of a critical period of regional gastroenteritis (Crohn's disease) or ulcerative colitis

Oral dosage (dexamethasone)

Adults

Initially, 0.75 to 9 mg/day PO, given in 2 to 4 divided doses. Adjust according to patient response.[30011] Because of the potential complications of steroid use, steroids should be used selectively and in the lowest dose possible for the shortest duration as possible.[64393] [64397]

Children and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO given in 3 to 4 divided doses is the FDA-approved general dosage range.[54286] Adjust according to patient response. Because of the potential complications of steroid use, steroids should be used selectively and in the lowest dose possible for the shortest duration as possible.[64393] [64397]

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate injection solution)

Adults

Initially, 0.5 to 9 mg/day IV or IM, in 2 to 4 divided doses. Adjust according to patient response.[60760] Because of the potential complications of steroid use, steroids should be used selectively and in the lowest dose possible for the shortest duration as possible.[64393] [64397]

Children and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM given in 3 to 4 divided doses is the FDA-approved general dosage range.[54285] [54286] Adjust according to patient response. Because of the potential complications of steroid use, steroids should be used selectively and in the lowest dose possible for the shortest duration as possible.[64393] [64397]

For the treatment of corticosteroid-responsive ocular inflammation of the palpebral and bulbar conjunctiva, cornea, and anterior segment inflammation of the globe, such as allergic conjunctivitis, including ocular pruritus associated with allergic conjunctivitis, dry eye disease†, eyelid acne rosacea, superficial punctate keratitis, herpes zoster ocular infection associated keratitis, iritis, cyclitis, uveitis, and selected infective bacterial conjunctivitis and viral conjunctivitis, when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation and for corneal abrasion, corneal ulcer, or corneal injury from chemical or thermal ocular burns or penetration of foreign bodies

for the treatment of steroid-responsive inflammatory ocular conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe

Ophthalmic dosage (0.1% ophthalmic solution)

Adults

1 to 2 drops in the affected eye(s) every hour during the day and every 2 hours during the night, initially. Reduce dose to 1 drop in the affected eye(s) every 4 hours when a favorable response occurs, and then 1 drop in the affected eye(s) 3 to 4 times daily as warranted.[54348]

Ophthalmic dosage (0.1% ophthalmic suspension)

Adults

1 to 2 drops in the affected eye(s) every hour for severe disease and every 4 to 6 hours for mild disease. Taper dose to discontinuation as inflammation subsides.[61633]

Children and Adolescents

1 to 2 drops in the affected eye(s) every hour for severe disease and every 4 to 6 hours for mild disease. Taper dose to discontinuation as inflammation subsides.[61633]

Oral dosage

Adults

0.75 to 9 mg/day PO in 2 to 4 divided doses, initially. Adjust according to patient response.[54286]

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day PO in 3 to 4 divided doses, initially. Adjust according to patient response.[54286]

Intravenous or Intramuscular dosage (dexamethasone sodium phosphate)

Adults

0.5 to 9 mg/day IV or IM in 2 to 4 divided doses, initially. Adjust according to patient response.[54285] [54286]

Infants, Children, and Adolescents

0.02 to 0.3 mg/kg/day or 0.6 to 9 mg/m2/day IV or IM in 3 to 4 divided doses. Adjust according to patient response.[54285] [54286]

for the treatment of ocular pruritus associated with allergic conjunctivitis

Intraocular dosage (ophthalmic insert)

Adults

0.4 mg in the lower lacrimal punctum into the canaliculus as a single dose. A single insert releases a 0.4 mg dose od dexamethasone for up to 30 days after insertion.[63796]

for the treatment of non-infectious uveitis affecting the posterior segment of the eye

Intravitreal dosage (ophthalmic implant)

Adults

0.7 mg implant by intravitreal injection.[41921]

for the treatment of dry eye disease†

Ophthalmic dosage (0.1% ophthalmic solution or suspension)

Adults

1 to 2 drops in each eye 4 times daily, initially. Reduce dose to 1 to 2 drops in each eye twice daily after 1 to 2 weeks if positive response in signs and/or symptoms and start cyclosporine, then taper or discontinue steroid therapy after 2 to 4 weeks. Consider extending duration to 4 weeks if no response at 2 weeks, especially in patients with moderate to severe disease.[68206] [68207]

For the treatment of diabetic macular edema

Intravitreal dosage (ophthalmic implant)

Adults

0.7 mg implant by intravitreal injection in the affected eye(s).[41921] Guidelines recommend intravitreous steroids as a second-line alternative treatment for central-involved diabetic macular edema (CIDME). Steroid therapies are associated with inferior visual acuity outcomes and increased rate of cataracts and glaucoma when compared against intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents.[61821] [64926]

For the treatment of macular edema following retinal vein occlusion, including branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO)

Intravitreal dosage (ophthalmic implant)

Adults

0.7 mg implant by intravitreal injection in the affected eye(s).[41921] Retreatment will generally be performed after 3 to 4 months with a mean of approximately 2 to 3 injections/year. Guidelines suggest switching to a steroid in nonresponders who have already been treated with anti-vascular endothelial growth factor (VEGF) (after 3 to 6 injections, depending on the specific response of each patient) is reasonable. Steroids may be considered as a first-line therapy for patients who have a recent history of a major cardiovascular event or those who are unwilling to come for monthly injections (and/or monitoring) in the first 6 months of therapy; however, intraocular pressure still needs to be monitored every 2 to 8 weeks after dexamethasone implant injection.[67516]

For the treatment of postoperative ocular inflammation

Intraocular suspension dosage (Dexycu intraocular suspension only)

Adults

0.005 mL of dexamethasone 9% (equivalent to 517 mcg) as a single dose as directed, intraocularly in the posterior chamber at the end of surgery.[48640]

for the treatment of postoperative ocular inflammation and ocular pain following ophthalmic surgery

Intracanalicular insert dosage (Dextenza ophthalmic insert only)

Adults

Place the insert containing 0.4 mg of dexamethasone into the lower lacrimal canaliculus, just below the punctal opening. A single insert releases a 0.4 mg dose for up to 30 days following insertion.[63796]

For the adjunctive treatment of infertility† in combination with clomiphene therapy

Oral dosage

Adult females

0.5 mg PO once daily at bedtime, administered on cycle days 3 to 12, days 5 to 9, or starting on day 5 and continuing through conception, in combination with clomiphene (doses ranging from 50 to 200 mg/day) has been studied.[32778] [32779] [32781] Alternatively, dexamethasone 2 mg PO once daily on cycle days 5 to 14 in combination with clomiphene 200 mg/day or dexamethasone 1 mg PO twice daily on cycle days 3 to 12 in combination with clomiphene 100 mg/day PO has also been studied; HCG was administered to augment ovulation.[32780] [32782] Optimal timing and dose of dexamethasone is not clear and has varied from study to study. Combination therapy has been shown to increase ovulation rates (range, 75% to 100%) and pregnancy rates (range, 38% to 74%) in women with both normal and elevated DHEA-S concentrations and in those women with or without polycystic ovary syndrome (PCOS). A Cochrane's review indicates that dexamethasone-clomiphene combination is one of the few adjunctive therapies for infertility that has been shown to improve pregnancy rates (fixed OR 11.3, 95% CI 5.3 to 24; NNT 2.7, 95% CI 2.1 to 3.6) [32783]; the 2 studies in this review used differing doses of 0.5 mg PO at bedtime on days 5 to 9 or 2 mg PO/day on days 5 to 14.[32778] [32782] Several theories on the mechanism of dexamethasone in infertility exist. One theory is that dexamethasone enhances folliculogenesis by suppressing adrenal androgen hypersecretion, which should augment the actions of clomiphene. Dexamethasone may increase FSH concentrations thereby facilitating folliculogenesis. Finally, dexamethasone may decrease the elevated LH concentrations in patients with PCOS.

For the treatment of acute altitude sickness†, including high altitude cerebral edema†

for the treatment of acute altitude sickness without high altitude cerebral edema†

Oral dosage

Adults

4 mg PO every 6 hours until symptoms resolve.[56782] [67542]

Infants, Children, and Adolescents

0.15 mg/kg/dose (Max: 4 mg/dose) PO every 6 hours until symptoms resolve.[56398] [56782] [67542]

Intravenous or Intramuscular dosage

Adults

4 mg IV or IM every 6 hours until symptoms resolve.[56782] [67542]

Infants, Children, and Adolescents

0.15 mg/kg/dose (Max: 4 mg/dose) IV or IM every 6 hours until symptoms resolve.[56398] [56782] [67542]

for the treatment of acute altitude sickness with high altitude cerebral edema†

Oral dosage

Adults

8 mg PO once, then 4 mg PO every 6 hours until symptoms resolve. May add acetazolamide.[56782] [67542]

Infants, Children, and Adolescents

0.15 mg/kg/dose (Max: 4 mg/dose) PO every 6 hours until symptoms resolve. May add acetazolamide.[56398] [56782] [67542]

Intravenous or Intramuscular dosage

Adults

8 mg IV or IM once, then 4 mg IV or IM every 6 hours until symptoms resolve. May add acetazolamide.[56782] [67542]

Infants, Children, and Adolescents

0.15 mg/kg/dose (Max: 4 mg/dose) IV or IM every 6 hours until symptoms resolve. May add acetazolamide.[56398] [56782] [67542]

For altitude sickness prophylaxis†, including prevention of high altitude cerebral edema†

Oral dosage

Adults

2 mg PO every 6 hours or 4 mg PO every 12 hours starting the day of ascent and continuing for 2 to 3 days after reaching the target altitude or until descent is initiated. Do not exceed 10 days to prevent glucocorticoid toxicity or adrenal suppression.[56782] [67542] May consider 4 mg PO every 6 hours for very high risk situations (e.g., military or search and rescue personnel being airlifted to altitudes higher than 3,500 meters with immediate performance of physical activity).[56782] Prophylactic medications should be considered in addition to slow ascent for moderate- to high-risk situations. Dexamethasone is suggested as an alternative in individuals with a history of intolerance or allergy to acetazolamide or as an adjunct to acetazolamide in rare, emergency circumstances requiring rapid ascent and immediate performance of physical activity.[56782]

For the treatment of post-operative nausea/vomiting (PONV)†

Intravenous dosage (dexamethasone sodium phosphate injection)

Adults

2 to 4 mg IV once for established post-operative nausea/vomiting (PONV), per treatment guidelines; readministration of longer-acting drugs, such as dexamethasone, is not recommended.[57398] If PONV prophylaxis was either inadequate or not initially given, dexamethasone is an appropriate rescue treatment option if not initially used for PONV prophylaxis. Of note, the 5-HT3 antagonists are the only class of drugs that have been adequately studied for the treatment of established PONV.[57398]

For post-operative nausea/vomiting (PONV) prophylaxis†

Intravenous dosage (dexamethasone sodium phosphate injection solution)

Adults

4 to 5 mg IV at anesthesia induction is recommended by treatment guidelines for patients at an increased risk for post-operative nausea and vomiting (PONV); administration at induction rather than at the end of surgery is preferred. Some studies suggest that 8 mg IV is associated with a dose-dependent increase in quality of recovery, including reduced fatigue, postoperative pain, and need for opioid analgesia; however, further confirmation is necessary before larger doses are universally recommend. Safety data regarding the perioperative use of dexamethasone point to a possible increased risk of wound infection and/or increased blood glucose in some patients. A single dexamethasone dose (4 to 8 mg IV) is, however, considered safe for PONV prophylaxis. For patients with labile glucose control, dexamethasone use is relatively contraindicated.[57398]

Children and Adolescents

0.15 to 1 mg/kg/dose IV (Max: 8 to 25 mg/dose IV) given as a single intraoperative dose reduces the incidence of postoperative nausea/vomiting in the first 24 hours, improves postoperative pain control, and decreases the time to resumption of soft/solid diet without adverse effects and is recommended in patients undergoing tonsillectomy.[54553] [54554] A lower dose of 0.015 mg/kg/dose (Max: 5 mg/dose) in combination with ondansetron 0.1 mg/kg/dose (Max: 4 mg) is recommended first-line for postoperative vomiting prophylaxis in children by the Society for Ambulatory Anesthesiology.[57398]

For the treatment of bronchiolitis†

Oral dosage

Infants

Due to the lack of consistent efficacy data and the high risk of adverse effects, the American Academy of Pediatrics does not recommend systemic corticosteroids for the management of bronchiolitis in any setting.[58442] However, other authors state corticosteroids may be beneficial in severely ill or mechanically ventilated patients.[54551] One randomized trial of 800 infants seen in the emergency department used 1 mg/kg PO once (Max: 10 mg/dose) followed by 0.6 mg/kg/dose PO once daily (Max: 10 mg/dose) for 5 days. Dexamethasone in combination with nebulized epinephrine was effective in reducing hospital admissions by day 7 of illness compared to treatment with dexamethasone alone, epinephrine alone, or placebo.[39327] In a study of 200 infants (median age 3.5 months) with an asthma risk, as determined by eczema or a family history of asthma in a first-degree relative, dexamethasone 1 mg/kg (single dose) PO then 0.6 mg/kg/dose PO once daily for 4 more days was administered with salbutamol. In infants receiving dexamethasone with salbutamol, the time to readiness for discharge was 18.6 hours vs. 27.1 hours in patients not receiving dexamethasone (p = 0.015).[56911] In contrast, 1 mg/kg/dose PO (Max: 12 mg/dose) given as a single dose did not reduce hospitalization rates, Respiratory Assessment Change Scores (RACS), length of hospitalization for those patients who required admission, or subsequent hospitalizations within 7 days compared to placebo in another large, randomized trial (n = 600).[33394]

Intravenous dosage (dexamethasone sodium phosphate injection solution)

Infants

Due to the lack of consistent efficacy data and the high risk of adverse effects, the American Academy of Pediatrics does not recommend systemic corticosteroids for the management of bronchiolitis in any setting.[58442] However, other authors state corticosteroids may be beneficial in severely ill or mechanically ventilated patients.[54551] 0.15 mg/kg/dose IV every 6 hours for 48 hours with the first dose administered within 24 hours of mechanical ventilation was used in patients with respiratory syncytial virus. In a post hoc analysis of patients with bronchiolitis (n = 39), the mean duration of mechanical ventilation and of supplemental oxygen were significantly shorter in patients receiving dexamethasone compared to those receiving placebo (4.9 and 7.7 days vs. 9.2 and 11.3 days, respectively); no differences were seen in the length of intensive care unit or hospital stay.[54547]

For the treatment of Waldenstrom macroglobulinemia†

for the treatment of newly diagnosed Waldenstrom macroglobulinemia, in combination with rituximab and cyclophosphamide†

Intravenous dosage (dexamethasone sodium phosphate)

Adults

20 mg IV on day 1 in combination with rituximab 375 mg/m2 IV on day 1 and cyclophosphamide 100 mg/m2 orally twice daily on days 1 to 5 (total dose of 1,000 mg/m2/cycle) repeated every 21 days for 6 cycles was evaluated in a single-arm, phase II trial.[61073]

for the treatment of newly diagnosed Waldenstrom macroglobulinemia, in combination with bortezomib and rituximab†

Intravenous dosage (dexamethasone sodium phosphate)

Adults

40 mg IV on days 1, 8, 15, and 22 in cycles 2 and 5 in combination with bortezomib and rituximab was evaluated in a nonrandomized phase II trial. Bortezomib was given as follows: 1.3 mg/m2 IV on days 1, 4, 8, and 11 for the first 21-day cycle (cycle 1) then 1.6 mg/m2 IV on days 1, 8, 15, and 22 repeated every 35 days for 4 additional cycles (cycles 2, 3, 4, and 5). Rituximab was given as 375 mg/m2 IV on days 1, 8, 15, and 22 in cycles 2 and 5 (for 8 total doses). All patients received premedication with acetaminophen 1,000 mg PO and diphenhydramine 50 mg IV prior to rituximab and herpes zoster prophylaxis with valacyclovir or acyclovir.[61131]

For the treatment of amyloidosis†

for the treatment of systemic amyloid light-chain amyloidosis, in combination with lenalidomide and cyclophosphamide†

Oral dosage

Adults

Dexamethasone in combination with lenalidomide (15 mg PO daily on days 1 to 21) and cyclophosphamide repeated every 28 days has been evaluated in nonrandomized, phase II studies. Treatment duration, drug dosages of cyclophosphamide and dexamethasone, and thromboprophylaxis agents/recommendations varied in these studies.[61321] [61322] [61323] In one study, 12 cycles of dexamethasone (20 mg PO on days 1, 2, 3, 4, 9, 10, 11, and 12 for 6 cycles; then 20 mg PO on days 1, 2, 3, and 4 for an additional 6 cycles), lenalidomide, and cyclophosphamide (300 mg/m2 IV on days 1 and 8 for 6 cycles; then 300 mg/m2 IV on day 1 for an additional 6 cycles) were given and then maintenance therapy with lenalidomide and dexamethasone was administered for 3 additional years or until disease progression. Patients with cardiac stage III had an upfront dose modification of dexamethasone.[61321] In another study, dexamethasone (40 mg PO on days 1, 8, 15, and 22), lenalidomide, and cyclophosphamide (500 mg PO on days 1, 8, and 15) therapy was given for a maximum of 9 cycles; treatment was discontinued after cycle 6 if a complete response or partial response/very good partial response plus organ response was obtained. In this study, patients with fluid retention over 3% of body weight despite optimal diuretic use received a lower dose of dexamethasone (20 mg once weekly).[61322] In a third study, cycles of dexamethasone (40 mg PO on days 1, 8, 15, and 22), lenalidomide, and cyclophosphamide (300 mg/m2 PO on days 1, 8, and 15) were continued until disease progression, unacceptable toxicity, or up to 2 years; however, cyclophosphamide was given for up to a maximum of 12 cycles only.[61323]

for the treatment of systemic amyloid light-chain amyloidosis, in combination with lenalidomide and melphalan†

Oral dosage

Adults

40 mg orally on days 1, 8, 15, and 22 in combination with lenalidomide (10 mg PO daily on days 1 to 21) and melphalan repeated every 28 days has been evaluated in nonrandomized studies. Treatment duration, the melphalan dosage, and thromboprophylaxis agents/recommendations varied in these studies.[61331] [61332] In one study, melphalan (0.18 mg/kg PO daily on days 1, 2, 3, and 4), lenalidomide, and dexamethasone therapy was given for a maximum of 9 cycles; single-agent lenalidomide was continued in responding patients.[61331] In another study, lenalidomide, melphalan (5 mg/m2 PO daily on days 1, 2, 3, and 4), and dexamethasone were continued until disease progression, unacceptable toxicity, or up to 12 cycles.[61332]

for the treatment of newly diagnosed systemic amyloid light-chain amyloidosis in patients who are ineligible for stem-cell transplantation, in combination with bortezomib and melphalan†

Oral dosage

Adults

40 mg orally daily on days 1, 2, 3, and 4 repeated every 28 days on cycles 1 and 2 and then 40 mg orally daily on days 1, 2, 3, and 4 repeated every 35 days up to a maximum of 8 cycles in combination with bortezomib and melphalan (BMdex regimen) was evaluated in a multicenter, randomized, open-label, phase 3 trial (n = 109). Patients were evaluated for response after 3 and 6 cycles of therapy; patients with a partial response (PR) or better after cycle 3 received an additional 3 cycles of therapy. Patients with a complete response (CR) or a PR and organ response stopped treatment after cycle 6.[65948]

for the treatment of newly diagnosed light-chain amyloidosis, in combination with daratumumab; hyaluronidase, bortezomib, and cyclophosphamide†

Intravenous and Oral dosage

Adults

40 mg IV or PO in combination with bortezomib 1.3 mg/m2 subcutaneously and cyclophosphamide 300 mg/m2 (Max dose of 500 mg) IV or PO each given weekly on days 1, 8, 15, and 22 repeated every 28 days for a maximum of 6 cycles (VCd) plus up to 2 years of subcutaneous daratumumab; hyaluronidase (D-VCd) was evaluated in transplant eligible, newly diagnosed light-chain amyloidosis patients in a randomized, phase 3 trial (n = 388; the ANDROMEDA trial). The dose of dexamethasone was reduced to 20 mg in patients older than 70 years or who had a body mass index less than 18.5, hypervolemia, poorly controlled diabetes mellitus, or prior intolerance to steroid therapy. Daratumumab; hyaluronidase was administered as follows: 1,800 mg daratumumab and 30,000 units hyaluronidase subcutaneously weekly on weeks 1 to 8 (8 doses), 1,800 mg daratumumab and 30,000 units hyaluronidase every 2 weeks on weeks 9 to 24 (8 doses), and then 1,800 mg daratumumab and 30,000 units hyaluronidase every 4 weeks starting on week 25 until disease progression or for a maximum of 2 years.[65366] At a median follow-up time of 11.4 (range, 0.03 to 21.3) months, the hematologic complete response rate was significantly improved (53.3% vs. 18.1%; relative risk ratio = 2.9; 95% CI, 2.1 to 4.1; p less than 0.001) in patients who received D-VCd compared with VCd in the ANDROMEDA trial. The median time to hemCR was 60 and 85 days in the D-VCd and VCd arms, respectively.[66968]

For the treatment of pharyngitis†

Oral dosage

Adults

10 mg PO once daily for 1 to 2 days.[67513]

Children and Adolescents 5 to 17 years

0.6 mg/kg/dose (Max: 10 mg/dose) PO once daily for 1 to 2 days.[67513]

Intramuscular dosage

Adults

10 mg IM once daily for 1 to 2 days.[67513]

Children and Adolescents 5 to 17 years

0.6 mg/kg/dose (Max: 10 mg/dose) IM once daily for 1 to 2 days.[67513]

For the treatment of thyrotoxicosis†, including thyroid storm†

Oral dosage

Adults

2 mg PO every 6 hours. Taper dose based on clinical response and the duration of steroid therapy.[61515] [68189]

Intravenous dosage

Adults

2 mg IV every 6 hours. Taper dose based on clinical response and the duration of steroid therapy.[61515] [68189]

Therapeutic Drug Monitoring

Maximum Dosage Limits

    Patients with Hepatic Impairment Dosing

    Specific guidelines for systemic dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

    Patients with Renal Impairment Dosing

    Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

    † Off-label indication
    Revision Date: 04/03/2023, 03:33:01 PM

    References

    24390 - Andersen JC. Response of resistant idiopathic thrombocytopenic purpura to pulsed high-dose dexamethasone therapy. N Engl J Med 1994;330:1560-4.24582 - Jacox A, Carr DB, Payne R. New clinical-practice guidelines for the management of pain in patients with cancer. N Engl J Med 1994;330:651-5.24997 - Couser RJ, Ferrara TB, Falde B, et al. Effectiveness of dexamethasone in preventing extubation failure in preterm infants at increased risk for airway edema. J Pediatr 1992;121:591-6.30011 - Dexamethasone tablets USP, Dexamethasone oral solution, and Dexamethasone Intensol (oral solution concentrate) package insert. Eatontown, NJ: West-Ward Pharmaceuticals Corp; 2016 March.32690 - Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004;39:1267-84.32778 - Daly DC, Walters CA, Soto-Albors CE, et al. A randomized study of dexamethasone in ovulation induction with clomiphene citrate. Fertil Steril 1984;41:844-8.32779 - Singh KB, Dunnihoo DR, Mahajan DK, et al. Clomiphene-dexamethasone treatment of clomiphene resistant women with and without the polycystic ovary syndrome. J Reprod Med 1992;37:215-8.32780 - Elnashar A, Abdelmageed E, Fayed M, et al. Clomiphene citrate and dexamethazone in treatment of clomiphene-citrate resistant polycystic ovary syndrome: a prospective placebo-controlled study. Hum Reprod 2006;21:1805-8.32781 - Trott EA, Plouffe L, Hansen K, et al. Ovulation induction in clomiphene-resistant anovulatory women with normal dehydroepiandrosterone sulfate levels: beneficial effects of the addition of dexamethasone during the follicular phase. Fertil Steril 1996;66:484-6.32782 - Parsanezhad ME, Alborzi S, Motazedian S, et al. Use of dexamethasone and clomiphene citrate in the treatment of clomiphene citrate-resistant patients with polycystic ovary syndrome and normal dehydroepiandrosterone sulfate levels: a prospective, double-blind, placebo-controlled trial. Fertil Steril 2002;78:1001-4.32783 - Beck JI, Boothroyd C, Proctor M, et al. Oral anti-oestrogens and medical adjuncts for subfertility associated with anovulation. Cochrane Database Syst Rev 2005;(1):CD002249.33394 - Corneli HM, Zorc JJ, Majahan P, et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med 2007;357(4):331-9.33558 - National Asthma Education and Prevention Program Expert Panel 3. Expert panel report 3: guidelines for the diagnosis and management of asthma. Bethesda (MD): National Institutes of Health. National Heart, Lung, and Blood Institute; 2007 Aug. NIH Publication No. 07-4051.34361 - Panel on Opportunistic Infections in HIV-Exposed and HIV-infected Children. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-exposed and HIV-infected children: Department of Health and Human Services. Accessed Dec 18, 2019. Available at: https://aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf34362 - Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the National Institutes of Health, the Centers for Disease Control and Prevention, the HIV Medicine Association, and the Infectious Diseases Society of America. Accessed January 18, 2023. Available at https://clinicalinfo.hiv.gov/en/guidelines/39327 - Plint AC, Johnson DW, Patel H, et al; Pediatric Emergency Research Canada. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med. 2009;360:2079-8941921 - Ozurdex (dexamethasone intravitreal implant) package insert. Madison, NJ: Allergan USA, Inc.; 2022 Dec.48640 - Dexycu (dexamethasone intraocular suspension) package insert. Watertown, MA: EyePoint Pharmaceuticals US, Inc.; 2020 Jun.49435 - Dupuis LL, Sung L, Molassiotis A, et al. 2016 updated MASCC/ESMO consensus recommendations: Prevention of acute chemotherapy-induced nausea and vomiting in children. Support Care Cancer 2017;25:323–331.49477 - Harousseau JL, Attal M, Avet-Loiseau H, et al. Bortezomib plus dexamethasone is superior to vincristine plus doxorubicin plus dexamethasone as induction treatment prior to autologous stem-cell transplantation in newly diagnosed multiple myeloma: results of the IFM 2005-01 phase III trial. J Clin Oncol 2010;28(30):4621-4629.49478 - Lokhorst HM, van der Holt B, Zweegman S, et al. A randomized phase 3 study on the effect of thalidomide combined with adriamycin, dexamethasone, and high-dose melphalan, followed by thalidomide maintenance in patients with multiple myeloma. Blood 2010;115(6):1113-1120.49713 - Thalomid (thalidomide) package insert. Summit, NJ: Celgene Corporation; 2013 Feb.49745 - Moreau P, Avet-Loiseau H, Facon T, et al. Bortezomib plus dexamethasone versus reduced-dose bortezomib, thalidomide plus dexamethasone as induction treatment before autologous stem cell transplantation in newly diagnosed multiple myeloma. Blood 2011;118(22):5752-5758.49746 - Cavo M, Tacchetti P, Patriarca F, et al. Bortezomib with thalidomide plus dexamethasone compared with thalidomide plus dexamethasone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma: a randomised phase 3 study. Lancet 2010;376(9758):2075-2085.49747 - Rosinol L, Oriol A, Teruel AI, et al. Superiority of bortezomib, thalidomide, and dexamethasone (VTD) as induction pretransplantation therapy in multiple myeloma: a randomized phase 3 PETHEMA/GEM study. Blood 2012;120(8):1589-1596.51306 - Kyprolis (carfilzomib) injection package insert. South San Francisco, CA:Onyx Pharmaceuticals, Inc; 2022 June.51639 - Loblaw DA, Mitera G, Ford M, et al. A 2011 updated systematic review and clinical practice guideline for the management of malignant extradural spinal cord compression. Int J Radiat Oncol Biol Phys. 2012;84:312-317. Review. [Epub ahead of print March 2012]51730 - Karam G, Kalble T, Alcaraz A, et al. European Association of Urology. Guidelines on renal transplantation. Retrieved from the World Wide Web November 9, 2016. http://uroweb.org/wp-content/uploads/27-Renal-Transplant_LRV2-May-13th-2014.pdf51731 - Kidney Disease Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 2009;9(3):1-155.54123 - Speiser PW, Azziz R, Baskin LS, et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010;95:4133-60.54137 - Gupta P, Bhatia V. Corticosteroid physiology and principles of therapy. Indian J Pediatr 2008;75:1039-44.54155 - Claahsen-van der Grinten HL, Stikkelbroeck NM, Otten BJ, et al. Congenital adrenal hyperplasia-pharmacologic interventions from the prenatal phase to adulthood. Pharmacol Ther 2011;132:1-14.54285 - Dexamethasone sodium phosphate injection solution. Schaumburg, IL: APP Pharmaceuticals, LLC; 2008 Apr.54286 - Dexamethasone tablets USP, Dexamethasone oral solution, and Dexamethasone Intensol (oral solution concentrate) package insert. Eatontown, NJ: West-Ward Pharmaceuticals Corp; 2016 March.54338 - American Academy of Pediatrics Committee on Fetus and Newborn. Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia. Pediatrics 2010;126:800-8.54348 - Dexamethasone sodium phosphate ophthalmic solution package insert. Bridgewater, NJ: Bausch and Lomb Inc.; 2016 June.54351 - Bjornson CL, Klassen TP, Williamson J, et al. A randomized trial of a single dose of oral dexamethasone for mild croup. N Engl J Med 2004;351:1306-1313.54357 - Ebrahimi S, Sarkari B. Comparative efficacy of dexamethasone versus hydrocortisone in severe acute pediatric asthma. Iran J Allergy Asthma Immunol 2007;6:159-60.54396 - Tellez DW, Galvis AG, Storgion SA, et al. Dexamethasone in the prevention of stridor in children. J Pediatr 1991;118:289-94.54434 - Holdsworth MT, Raisch DW, Frost J. Acute and delayed nausea and emesis control in pediatric oncology patients. Cancer. 2006;106:931-940.54489 - Rivkees SA. Dexamethasone therapy of congenital adrenal hyperplasia and the myth of the "growth toxic" glucocorticoid. Int J Pediatr Endocrinol 2010:1-7.54490 - Joint LWPES/ESPE CAH Working Group. Consensus statement on 21-hydroxylase deficiency from the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology. J Clin Endocrinol Metab 2002;87:4048-53.54499 - White PC. Cushing syndrome. In: Kliegman RM, Stanton BF, St. Geme JW, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier;2011:1939-41.54501 - Batista DL, Riar J, Keil M, et al. Diagnostic tests for children who are referred for the investigation of Cushing syndrome. Pediatrics 2007;120:575-86.54507 - Anene O, Meert KL, Uy H, et al. Dexamethasone for the prevention of postextubation airway obstruction: a prospective, randomized, double-blind, placebo-controlled trial. Crit Care Med 1996;24:1666-9.54508 - Khemani RG, Randolph A, Markovitz B. Corticosteroids for the prevention and treatment of post-extubation stridor in neonates, children and adults. Cochrane Database Syst Rev 2009;3:CD001000.54509 - Davis PG, Henderson-Smart DJ. Intravenous dexamethasone for extubation of newborn infants. Cochrane Database Syst Rev 2001;4:CD000308.54512 - Pfenninger J, Kaiser G, Lutschg J, et al. Treatment and outcome of the severely head injured child. Intensive Care Med 1983;9:13-6.54531 - Greenberg RA, Kerby G, Roosevely GE. A comparison of oral dexamethasone with oral prednisone in pediatric asthma exacerbations treated in the emergency department. Clin Pediatr (Phila) 2008;47:817-23.54533 - Qureshi F, Zaritsky A, Poirier MP. Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma. J Pediatr 2001;139:20-6.54542 - Rittichier KK, Ledwith CA. Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing. Pediatrics 2000;106:1344-8.54543 - Geelhoed GC, Macdonald WB. Oral dexamethasone in the treatment of croup: 0.15mg/kg versus 0.3 mg/kg versus 0.6 mg/kg. Pediatr Pulmonol 1995;20:362-8.54544 - Chub-Uppakarn S, Sangsupawanich P. A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup. Int J Pediatr Otorhinolaryngol 2007;71:473-7.54547 - van Woensel JB, van Aalderen WM, de Weerd W, et al. Dexamethasone for treatment of patients mechanically ventilated for lower respiratory tract infection caused by respiratory syncytial virus. Thorax 2003;58:383-7.54551 - de Benedictis FM, Bush A. Corticosteroids in respiratory diseases in children. Am J Respir Crit Care Med 2012;185:12-232.54553 - Baugh RF, Archer SM, Mitchell RB. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011;144:S1-30.54554 - Steward DL, Grisel J, Meinzen-Derr J. Steroids for improving recovery following tonsillectomy in children. Cochrane Database Syst Rev 2011;8:CD003997.54555 - Doyle LW, Davis PG, Morley CJ, et al. Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: a multicenter, international, randomized, controlled trial. Pediatrics 2006;117:75–83.54556 - Doyle LW, Davis PG, Morley CJ, et al. Outcome at 2 years of age of infants from the DART study: a multicenter, international, randomized, controlled trial of low-dose dexamethasone. Pediatrics 2007;119:716–21.54557 - Dexamethasone sodium phosphate injection package insert. Schaumburg IL: APP Pharmaceuticals; 2008 Jan.56398 - Pollard AJ, Niermeyer S, Barry P, et al. Children at high altitude: an international consensus statement by an ad hoc committee of the international society for mountain medicine, March 12, 2001. High Alt Med Biol 2001;2:389-403.56782 - Luks AM, McIntosh SE, Grissom CK, et al. Wilderness Medical Society consensus guidelines for the prevention and treatment of acute altitude illness. Wilderness Environ Med 2010;21:146-55.56911 - Alansari K, Sakran M, Davidson BL, et al. Oral dexamethasone for bronchiolitis: a randomized trial. Pediatrics. 2013; 132: e810-e816.57398 - Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2014;118:85-113.58442 - Ralson SL, Lieberthal AS, Meissner HC. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014;134:e1474-1502.58806 - Revlimid (lenalidomide) tablets package insert. Summit, NJ: Celgene Corporation; 2023 March.58821 - Farydak (panobinostat) capsules package insert. Las Vegas, NV: Secura Bio, Inc.; 2021 Sept.58822 - San-Miguel JF, Hungria VT, Yoon SS, et al. Panobinostat plus bortezomib and dexamethasone versus placebo plus bortezomib and dexamethasone in patients with relapsed or relapsed and refractory multiple myeloma: a multicentre, randomised, double-blind phase 3 trial. Lancet Oncol 2014;15(11):1195-1206.59648 - Garbutt JM, Conlon B, Sterkel R. The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial. Clin Pediatr (Phila) 2013;52:1014-1021.59736 - Keeney GE, Gray MP, Morrison AK. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics 2014;133:493-499.59737 - Altamimi S, Robertson G, Jastaniah W. Single-dose oral dexamethasone in the emergency management of children with exacerbations of mild to moderate asthma. Pediatr Emerg Care 2006;22:786-793.59738 - Gordon S, Tompkins T, Dayan PS. Randomized trial of single-dose intramuscular dexamethasone compared with prednisolone for children with acute asthma. Pediatr Emerg Care 2007;23:521-527.60044 - Stewart AK, Rajkumar SV, Dimopoulos MA, et al. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. N Engl J Med 2015;372(2):142-152.60311 - Darzalex (daratumumab) injection package insert. Horsham, PA: Janssen Biotech, Inc.; 2023 Jan.60335 - Ninlaro (ixazomib) capsule package insert. Cambridge, MA: Takeda Pharmaceutical Company Limited; 2022 April.60353 - Lonial S, Dimopoulos M, Palumbo A, et al. Elotuzumab therapy for relapsed or refractory multiple myeloma. N Engl J Med 2015;373(7):621-631.60354 - Empliciti (elotuzumab) injection package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2022 Mar.60414 - Brownfoot FC, Gagliardi DI, Bain E, et al. Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2013;8:CD006764.60756 - Crump M, Kuruvilla J, Couban S, et al. Randomized comparison of gemcitabine, dexamethasone, and cisplatin versus dexamethasone, cytarabine, and cisplatin chemotherapy before autologous stem-cell transplantation for relapsed and refractory aggressive lymphomas: NCIC-CTG LY.12. J Clin Oncol 2014;32(31):3490-3496.60760 - Dexamethasone sodium phosphate injection package insert. Eatontown, NJ:West-Ward Pharmaceuticals;2014 Sept.60761 - Dexamethasone tablets USP, Dexamethasone oral solution, and Dexamethasone Intensol (oral solution concentrate) package insert. Eatontown, NJ: West-Ward Pharmaceuticals Corp; 2016 March.60856 - Moreau P, Masszi T, Grzasko N, et al. Oral ixazomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med 2016;374(17):1621-1634.61073 - Dimopoulos MA, Anagnostopoulos A, Kyrtsonis MC, et al. Primary treatment of Waldenstrom macroglobulinemia with dexamethasone, rituximab, and cyclophosphamide. J Clin Oncol 2007;25(22):3344-3349.61094 - Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis 2016.61131 - Dimopoulos MA, Garcia-Sanz R, Gavriatopoulou M, et al. Primary therapy of Waldenstrom macroglobulinemia (WM) with weekly bortezomib, low-dose dexamethasone, and rituximab (BDR): long-term results of a phase 2 study of the European Myeloma Network (EMN). Blood 2013;122(19):3276-3282.61207 - Palumbo A, Chanan-Khan A, Weisel K, et al. Daratumumab, Bortezomib, and Dexamethasone for Multiple Myeloma. N Engl J Med 2016;375(8):754-766.61321 - Cibeira MT, Oriol A, Lahuerta JJ, et al. A phase II trial of lenalidomide, dexamethasone and cyclophosphamide for newly diagnosed patients with systemic immunoglobulin light chain amyloidosis. Br J Haematol 2015;170(6):804-813.61322 - Palladini G, Russo P, Milani P, et al. A phase II trial of cyclophosphamide, lenalidomide and dexamethasone in previously treated patients with AL amyloidosis. Haematologica 2013;98(3):433-436.61323 - Kumar SK, Hayman SR, Buadi FK, et al. Lenalidomide, cyclophosphamide, and dexamethasone (CRd) for light-chain amyloidosis: long-term results from a phase 2 trial. Blood 2012;119(21):4860-4867.61331 - Dinner S, Witteles W, Afghahi A, et al. Lenalidomide, melphalan and dexamethasone in a population of patients with immunoglobulin light chain amyloidosis with high rates of advanced cardiac involvement. Haematologica 2013;98(10):1593-1599.61332 - Sanchorawala V, Patel JM, Sloan JM, et al. Melphalan, lenalidomide and dexamethasone for the treatment of immunoglobulin light chain amyloidosis: results of a phase II trial. Haematologica 2013;98(5):789-792.61407 - Dimopoulos MA, Oriol A, Nahi H, et al. Daratumumab, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med 2016;375(14):1319-1331.61515 - Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016;26:1343-1421.61633 - Maxidex (dexamethasone ophthalmic suspension 0.1%) package insert. East Hanover, NJ; Novartis Pharmaceuticals Corp. 2021 Dec.61715 - van Imhoff GW, McMillan A, Matasar MJ, et al. Ofatumumab versus rituximab salvage chemoimmunotherapy in relapsed or refractory diffuse large B-cell lymphoma: The ORCHARRD study. J Clin Oncol 2016. Epub ahead of print. doi: 10.1200/JCO.2016.69.0198.61788 - Durie BG, Hoering A, Abidi MH, et al. Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trial. Lancet 2017;389(10068):519-527.61821 - Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the American Diabetes Association. Diabetic Care 2017;40:412-418.63197 - Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2017;35:3240-61.63796 - Dextenza (dexamethasone ophthalmic insert) package insert. Bedford, MA: Ocular Therapeutix, Inc.; 2021 Oct.64165 - Dexamethasone (Decadron) tablets package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2019 May.64393 - Rubin DT, Ananthakrishnan AN, Siegel CA, et al.; American College of Gastroenterology Clinical Guideline: Ulcerative Colitis in Adults. Am J Gastroenterol. 2019;114:384–413.64397 - Lichtenstein GR, Loftus EV, Isaacs KL, et al. American College of Gastroenterology Clinical Guideline: Management of Crohn's Disease in Adults. Am J Gastroenterol. 2018;113:481–517.64399 - Xpovio (selinexor) tablet package insert. Newton, MA: Karyopharm Therapeutics Inc.; 2022 July.64412 - Richardson PG, Oriol A, Beksac M, et al. Pomalidomide, bortezomib, and dexamethasone for patients with relapsed or refractory multiple myeloma previously treated with lenalidomide (OPTIMISMM): a randomised, open-label, phase 3 trial. Lancet Oncol 2019;20(6):781-794.64435 - American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 171: Management of Preterm Labor (Interim update). Obstet Gynecol. 2016;128:e155-e164. Reaffirmed 2020.64528 - Moreau P, Attal M, Hulin C, et al. Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): a randomised, open-label, phase 3 study. Lancet 2019; 394(10192):29-38.64564 - Liyanage CK, Galappatthy P, Seneviratne SL. Corticosteroids in management of anaphylaxis; a systematic review of evidence. Eur Ann Allergy Clin Immunol 2017;49:196-207.64673 - Doyle LW, Cheong JL, Ehrenkranz RA, Halliday HL. Early (8 days) days systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants. Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No.: CD00114664674 - Doyle LW, Cheong JL, Ehrenkranz RA, Halliday HL. Late (greater than 8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants. Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No.: CD00114564807 - Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA) 2020. Available from: http://www.ginasthma.org. Accessed May 20th, 2020.64926 - American Diabetes Association. Standards of Medical Care in Diabetes - 2022. Diabetes Care. 2022; 45(Suppl 1):S1-S270. Available at: https://diabetesjournals.org/care/issue/45/Supplement_164934 - Shenoi RP, Timm N, AAP Committee on Drugs, AAP Committee on Emergency Medicine. Drugs used to treat pediatric emergencies. Pediatrics 2020;145:e20193450.65066 - Sarclisa (isatuximab-irfc) injection package insert. Bridgewater, NJ: Sanofi-Aventis U.S. LLC; 2021 Mar.65070 - Attal M, Richardson PG, Rajkumar SV, et al. Isatuximab plus pomalidomide and low-dose dexamethasone versus pomalidomide and low-dose dexamethasone in patients with relapsed and refractory multiple myeloma (ICARIA-MM): a randomised, multicentre, open-label, phase 3study. Lancet 2019;394(10214):2096-2107.65314 - COVID-19 Treatment Guidelines Panel. Coronavirus Diseases 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Accessed April 20, 2023. Available at on the World Wide Web at: https://covid19treatmentguidelines.nih.gov/.65366 - Darzalex Faspro (Daratumumab and hyaluronidase-fihj) injection package insert. Horsham, PA: Janssen Biotech, Inc.; 2022 Nov.65619 - World Health Organization (WHO). Guidelines for treatment of drug-susceptible tuberculosis and patient care: 2017 update. Geneva: World Health Organization; 2017.65707 - Henderson LA, Canna SW, Friedman KG, et al. American college of rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19: Version 3. Arthritis Rheumatol 2022;74:e1-e20.65758 - Thwaites G, Fisher M, Hemingway C, et al. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect 2009;59:167-87.65843 - Attal M, Lauwers-Cances V, Hulin C, et al. Lenalidomide, bortezomib, and dexamethasone with transplantation for myeloma. N Engl J Med 2017;376(14):1311-1320.65854 - Dimopoulos M, Quach H, Mateos MV, et al. Carfilzomib, dexamethasone, and daratumumab versus carfilzomib and dexamethasone for patients with relapsed or refractory multiple myeloma (CANDOR): results from a randomised, multicentre, open-label, phase 3 study. Lancet 2020;396(10245):186-197.65855 - Chari A, Martinez-Lopez J, Mateos MV, et al. Daratumumab plus carfilzomib and dexamethasone in patients with relapsed or refractory multiple myeloma. Blood 2019;134(5):421-431.65868 - Hemady (dexamethasone) tablets package insert. East Windsor, NJ: Acrotech Biopharma, LLC; 2021 June.65876 - World Health Organization Guideline Panel. Corticosteroids for COVID-19. World Health Organization. Accessed September 3, 2020. Available on the World Wide Web at: https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.165899 - Kumar SK, Jacobus SJ, Cohen AD, et al. Carfilzomib or bortezomib in combination with lenalidomide and dexamethasone for patients with newly diagnosed multiple myeloma without intention for immediate autologous stem-cell transplantation (ENDURANCE): a multicentre, open-label, phase 3, randomised, controlled trial. Lancet Oncol 2020. Epub ahead of print, doi: 10.1016/S1470-2045(20)30452-6.65918 - Dimopoulos MA, Lonial S, White D, et al. Elotuzumab, lenalidomide, and dexamethasone in RRMM: final overall survival results from the phase 3 randomized ELOQUENT-2 study. Blood Cancer J 2020;10(9):91.65948 - Kastritis E, Leleu X, Arnulf B, et al. Bortezomib, melphalan, and dexamethasone for light-chain amyloidosis. J Clin Oncol 2020. Epub ahead of print, doi:10.1200/JCO.20.01285.66069 - Voorhees PM, Kaufman JL, Laubach J, et al. Daratumumab, lenalidomide, bortezomib, and dexamethasone for transplant-eligible newly diagnosed multiple myeloma: the GRIFFIN trial. Blood 2020;136(8):936-94566106 - Shaker MS, Wallace DV, Golden DB, et al. Anaphylaxis - a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol 2020;145:1082-1123.66186 - Grosicki S, Simonova M, Spicka I, et al. Once-per-week selinexor, bortezomib, and dexamethasone versus twice-per-week bortezomib and dexamethasone in patients with multiple myeloma (BOSTON): a randomised, open-label, phase 3 trial. Lancet 2020;396(10262):1563-1573.66471 - Pepaxto (melphalan flufenamide) injection package insert. Waltham, MA: Oncopeptides AB; 2021 Feb.66745 - American Academy of Pediatrics. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021.66762 - Richardson PG, Kumar SK, Masszi T, et al. Final overall survival analysis of the TOURMALINE-MM1 phase III trial of ixazomib, lenalidomide, and dexamethasone in patients with relapsed or refractory multiple myeloma. J Clin Oncol 2021. Epub ahead of print, doi: 10.1200/JCO.21.00972.66809 - Dimopoulos MA, Terpos E, Boccadoro M, et al. Daratumumab plus pomalidomide and dexamethasone versus pomalidomide and dexamethasone alone in previously treated multiple myeloma (APOLLO): an open-label, randomised, phase 3 trial. Lancet Oncol 2021;22(6):801-812.66968 - Kastritis E, Palladini G, Minnema MC, et al. Daratumumab-based treatment for tmmunoglobulin light-chain amyloidosis. N Engl J Med 2021;385(1):46-58.67219 - Facon T, Kumar SK, Plesner T, et al. Daratumumab, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone alone in newly diagnosed multiple myeloma (MAIA): overall survival results from a randomised, open-label, phase 3 trial. Lancet Oncol 2021;22(11):1582-1596.67409 - Richardson PG, Perrot A, San-Miguel J, et al. Isatuximab plus pomalidomide and low-dose dexamethasone versus pomalidomide and low-dose dexamethasone in patients with relapsed and refractory multiple myeloma (ICARIA-MM): follow-up analysis of a randomised, phase 3 study. Lancet Oncol 2022. Epub ahead of print, doi: 10.1016/S1470-2045(22)00019-5.67513 - Aertgeerts B, Agoritsas T, Siemieniuk RAC, et al. Corticosteroids for sore throat: a clinical practice guideline. BMJ 2017;358:j4090.67516 - Schmidt-Erfurth U, Garcia-Arumi J, Gerendas BS, et al. Guidelines for the management of retinal vein occlusion by the European Society of Retina Specialists (EURETINA). Ophthalmologica. 2019;242(3):123-162.67542 - Centers for Disease Control and Prevention. CDC Health Information for International Travel 2020 (The Yellow Book). Available on the World Wide Web at https://wwwnc.cdc.gov/travel/page/yellowbook-home-2020.67780 - Moreau P, Dimopoulos MA, Mikhael J, et al. Isatuximab, carfilzomib, and dexamethasone in relapsed multiple myeloma (IKEMA): a multicentre, open-label, randomised phase 3 trial. Lancet 2021;397(10292):2361-2371.68070 - Gupta LK, Martin AM, Agarwal N, et al. Guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis: an Indian perspective. Indian J Dermatol Venereol Leprol 2016;82: 603-25.68100 - Kardaun SH, Jonkman MF. Dexamethasone pulse therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis. Acta Derm Venereol 2007;87:144-8.68101 - Choonhakarn C, Limpawattana P, Chaowattanapanit S. Clinical profiles and treatment outcomes of systemic corticosteroids for toxic epidermal necrolysis: a retrospective study. J Dermatol 2016;43:156-61.68102 - Jagadeesan S, Soghanakumari K, Sadanandan SM, et al. Low dose intravenous Immunoglobulins and steroids in toxic epidermal necrolysis: a prospective comparative open-labelled study of 36 cases. Indian J Dermatol Venereol Leprol 2013;79:506-11.68189 - Carroll R, Matfin G. Endocrine and metabolic emergencies: thyroid storm. Ther Adv Endocrinol Metab. 2010 Jun;1:139-45.68206 - Prokopich CL, Bitton E, Caffery B, et al. Screening, diagnosis and management of dry eye disease: practical guidelines for Canadian optometrists. Can J Optom. 2014;76(Suppl 1). Accessed November 25, 2022. Available on the World Wide Web at: https://openjournals.uwaterloo.ca/index.php/cjo/issue/view/236/CJO%20Vol76%20No1%20Supplement%3A%20Screening%2C%20Diagnosis%20and%20Management%20of.68207 - Akpek EK, Amescua F, Farid M, et al. Dry Eye Syndrome Preferred Practice Pattern. Ophthalmology. 2019;126(1):P286-P334.

    How Supplied

    Dexamethasone Acetate Solution for injection

    Decadron LA 8mg/ml Solution for Injection (00006-7644) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

    Dexamethasone Acetate Suspension for injection

    Dalalone LA 8mg/ml Suspension for Injection (00456-1075) (Allergan USA, Inc.) (off market)

    Dexamethasone Acetate Suspension for injection

    Dalalone DP 16mg/ml Suspension for Injection (00456-1097) (Allergan USA, Inc.) (off market)

    Dexamethasone Acetate Suspension for injection

    Dalalone DP 16mg/ml Suspension for Injection (00785-9080) (UAD Laboratories Inc) (off market)

    Dexamethasone Elixir

    Baycadron 0.5mg/5ml Elixir (64679-0810) (Wockhardt USA, LLC) (off market)

    Dexamethasone Elixir

    Decadron 0.5mg/5ml Elixir (00006-7622) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

    Dexamethasone Elixir

    Dexamethasone 0.5mg/5ml Elixir (00603-1147) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Elixir

    Dexamethasone 0.5mg/5ml Elixir (00364-7182) (Schein Pharmaceutical Inc, an Actavis Company) (off market)

    Dexamethasone Elixir

    Dexamethasone 0.5mg/5ml Elixir (00677-0601) (Sun Pharmaceutical Industries, Inc.) (off market)

    Dexamethasone Elixir

    Dexamethasone 0.5mg/5ml Elixir (00182-1013) (Teva Pharmaceuticals USA) (off market)

    Dexamethasone Implant

    Ozurdex 0.7mg Ophthalmic Implant (00023-3348) (Allergan USA, Inc.) null

    Dexamethasone Ophthalmic drops, suspension

    Maxidex 0.1% Ophthalmic Suspension (00998-0615) (Alcon Laboratories, Inc) (off market)Maxidex 0.1% Ophthalmic Suspension package photo

    Dexamethasone Ophthalmic drops, suspension

    Maxidex 0.1% Ophthalmic Suspension (00065-0615) (Alcon Laboratories, Inc) (off market)

    Dexamethasone Ophthalmic drops, suspension

    Maxidex 0.1% Ophthalmic Suspension (00078-0925) (Novartis Pharmaceuticals Corporation) null

    Dexamethasone Ophthalmic insert

    Dextenza 0.4mg Ophthalmic Insert (70382-0204) (Ocular Therapeutix, Inc.) null

    Dexamethasone Oral solution

    Decadron 0.5mg/5mL Elixir (58463-0010) (Pragma Pharmaceuticals, LLC) (off market)

    Dexamethasone Oral solution

    Dexamethasone 0.5mg/5ml Elixir (62135-0114) (Chartwell Pharmaceuticals) null

    Dexamethasone Oral solution

    Dexamethasone 0.5mg/5ml Elixir (60432-0466) (Morton Grove Pharmaceuticals Inc, a subsidiary of Wockhardt, Ltd.) nullDexamethasone 0.5mg/5ml Elixir package photo

    Dexamethasone Oral solution

    Dexamethasone 0.5mg/5ml Elixir (64980-0509) (Rising Pharmaceuticals Inc) nullDexamethasone 0.5mg/5ml Elixir package photo

    Dexamethasone Oral solution

    Dexamethasone 0.5mg/5ml Elixir (00472-0972) (Teva/Actavis US) (off market)Dexamethasone 0.5mg/5ml Elixir package photo

    Dexamethasone Oral solution

    Dexamethasone 0.5mg/5mL Elixir (54879-0003) (STI Pharma LLC) null

    Dexamethasone Oral solution

    Dexamethasone 0.5mg/5mL Solution (00054-3177) (Hikma Pharmaceuticals USA Inc.) nullDexamethasone 0.5mg/5mL Solution package photo

    Dexamethasone Oral solution

    Dexamethasone Intensol 1mg/mL Solution (00054-3176) (Hikma Pharmaceuticals USA Inc.) nullDexamethasone Intensol 1mg/mL Solution package photo

    Dexamethasone Oral tablet

    Decadron 0.5mg Tablet (00006-0041) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

    Dexamethasone Oral tablet

    Decadron 0.5mg Tablet (58463-0014) (Pragma Pharmaceuticals, LLC) null

    Dexamethasone Oral tablet

    Decadron 0.75mg Tablet (00006-0063) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

    Dexamethasone Oral tablet

    Decadron 0.75mg Tablet (58463-0015) (Pragma Pharmaceuticals, LLC) null

    Dexamethasone Oral tablet

    Dexamethasone 0.25mg Tablet (49884-0083) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 0.5mg Tablet (48102-0045) (Fera Pharmaceuticals) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 0.5mg Tablet (00054-8179) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 0.5mg Tablet (00054-4179) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 0.5mg Tablet (49884-0084) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 0.5mg Tablet (49884-0084) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 0.75mg Tablet (48102-0046) (Fera Pharmaceuticals) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 0.75mg Tablet (00054-8180) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 0.75mg Tablet (00054-4180) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 0.75mg Tablet (66267-0066) (NuCare Pharmaceuticals Inc) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 0.75mg Tablet (49884-0085) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 0.75mg Tablet (49884-0085) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 0.75mg Tablet (55289-0903) (PD-Rx Pharmaceuticals, Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 0.75mg Tablet (55289-0903) (PD-Rx Pharmaceuticals, Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 0.75mg Tablet (00182-0488) (Teva Pharmaceuticals USA) (off market)

    Dexamethasone Oral tablet

    Dexabliss 11-DAY DOSE PACK 1.5mg Tablet (71905-0400) (Levins Pharmaceuticals, LLC) null

    Dexamethasone Oral tablet

    Dexamethasone 1.5mg Tablet (00054-4182) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 1.5mg Tablet (00054-8181) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 1.5mg Tablet (68047-0702) (Larken Laboratories) null

    Dexamethasone Oral tablet

    Dexamethasone 1.5mg Tablet (70954-0401) (Novitium Pharma, LLC ) null

    Dexamethasone Oral tablet

    Dexamethasone 1.5mg Tablet (49884-0086) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 1.5mg Tablet (49884-0086) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 1.5mg Tablet (42195-0151) (Xspire Pharma Brand) null

    Dexamethasone Oral tablet

    Dexamethasone 10-DAY DOSE PACK 1.5mg Tablet (68047-0702) (Larken Laboratories) nullDexamethasone 10-DAY DOSE PACK 1.5mg Tablet package photo

    Dexamethasone Oral tablet

    Dexamethasone 13-DAY DOSE PACK 1.5mg Tablet (68047-0702) (Larken Laboratories) null

    Dexamethasone Oral tablet

    Dexamethasone 1mg Tablet (00054-4181) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 1mg Tablet (00054-8174) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 6-DAY DOSE PACK 1.5mg Tablet (68047-0702) (Larken Laboratories) null

    Dexamethasone Oral tablet

    DexPak 10-day TaperPak 1.5mg Tablet (00095-0087) (Bausch Health US, LLC) (off market)

    Dexamethasone Oral tablet

    DexPak 10-day TaperPak 1.5mg Tablet (00095-0087) (ECR Pharmaceuticals) (off market)DexPak 10-day TaperPak 1.5mg Tablet package photo

    Dexamethasone Oral tablet

    DexPak 10-day TaperPak 1.5mg Tablet (00095-0086) (ECR Pharmaceuticals) (off market)

    Dexamethasone Oral tablet

    DexPak 13-day TaperPak 1.5mg Tablet (00095-0088) (Bausch Health US, LLC) (off market)

    Dexamethasone Oral tablet

    DexPak 13-day TaperPak 1.5mg Tablet (00095-0086) (ECR Pharmaceuticals) (off market)DexPak 13-day TaperPak 1.5mg Tablet package photo

    Dexamethasone Oral tablet

    DexPak 13-day TaperPak 1.5mg Tablet (00095-0088) (ECR Pharmaceuticals) (off market)DexPak 13-day TaperPak 1.5mg Tablet package photo

    Dexamethasone Oral tablet

    DexPak 6-day TaperPak 1.5mg Tablet (00095-0089) (Bausch Health US, LLC) (off market)

    Dexamethasone Oral tablet

    DexPak 6-day TaperPak 1.5mg Tablet (00095-0089) (ECR Pharmaceuticals) (off market)DexPak 6-day TaperPak 1.5mg Tablet package photo

    Dexamethasone Oral tablet

    DexPak Jr 10-day TaperPak 1.5mg Tablet (00095-0086) (ECR Pharmaceuticals) (off market)

    Dexamethasone Oral tablet

    Dxevo 11-DAY DOSE PACK 1.5mg Tablet (70569-0151) (Phlight Pharma, LLC) null

    Dexamethasone Oral tablet

    Dxevo 11-DAY DOSE PACK 1.5mg Tablet (70362-0702) (Skylar Laboratories, LLC) null

    Dexamethasone Oral tablet

    HiDex 6-day Tablet (15014-0211) (Gentex Pharma LLC) null

    Dexamethasone Oral tablet

    LoCort 11-Day Tablet (71297-0211) (Allegis Holdings, LLC) (off market)

    Dexamethasone Oral tablet

    LoCort 7-Day Tablet (71297-0127) (Allegis Holdings, LLC) (off market)

    Dexamethasone Oral tablet

    TaperDex 12-Day Tablet (42195-0149) (Xspire Pharma Brand) null

    Dexamethasone Oral tablet

    TaperDex 6-Day Tablet (42195-0121) (Xspire Pharma Brand) null

    Dexamethasone Oral tablet

    TaperDex 7-Day Tablet (42195-0127) (Xspire Pharma Brand) null

    Dexamethasone Oral tablet

    ZCORT 7-Day Tapered 1.5mg Tablet (79043-0200) (Scite Pharma, LLC) null

    Dexamethasone Oral tablet

    Zema-Pak 10-day TaperPak 1.5mg Tablet (44183-0507) (Macoven Pharmaceuticals, LLC, a subsidiary of Currax Pharmaceuticals, LLC) (off market)

    Dexamethasone Oral tablet

    Zema-Pak 13-day TaperPak 1.5mg Tablet (44183-0508) (Macoven Pharmaceuticals, LLC, a subsidiary of Currax Pharmaceuticals, LLC) (off market)

    Dexamethasone Oral tablet

    Zema-Pak 6-day TaperPak 1.5mg Tablet (44183-0509) (Macoven Pharmaceuticals, LLC, a subsidiary of Currax Pharmaceuticals, LLC) (off market)

    Dexamethasone Oral tablet

    ZoDex 12-Day Tablet (42195-0150) (Xspire Pharma, LLC) (off market)

    Dexamethasone Oral tablet

    ZoDex 6-Day Tablet (42195-0150) (Xspire Pharma, LLC) (off market)

    Dexamethasone Oral tablet

    ZonaCort 11 Day Tapered 1.5mg Tablet (70868-0111) (Key Therapeutics, LLC) (off market)

    Dexamethasone Oral tablet

    ZonaCort 7 Day Tapered 1.5mg Tablet (70868-0107) (Key Therapeutics, LLC) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 2mg Tablet (60219-2056) (Amneal Pharmaceuticals LLC.) null

    Dexamethasone Oral tablet

    Dexamethasone 2mg Tablet (00054-4183) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 2mg Tablet (00054-8176) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 2mg Tablet (70954-0402) (Novitium Pharma, LLC ) nullDexamethasone 2mg Tablet package photo

    Dexamethasone Oral tablet

    Dexamethasone 2mg Tablet (43063-0266) (PD-Rx Pharmaceuticals, Inc.) null

    Dexamethasone Oral tablet

    Decadron 4mg Tablet (00006-0097) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

    Dexamethasone Oral tablet

    Decadron 4mg Tablet (58463-0016) (Pragma Pharmaceuticals, LLC) null

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (47781-0914) (Alvogen, Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (60687-0718) (American Health Packaging) null

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (60219-2043) (Amneal Pharmaceuticals LLC.) null

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (42291-0155) (AvKARE, Inc.) nullDexamethasone 4mg Tablet package photo

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (10544-0212) (Blenheim Pharmacal, Inc.) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (48102-0047) (Fera Pharmaceuticals) null

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (48102-0051) (Fera Pharmaceuticals) null

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (51407-0361) (Golden State Medical Supply, Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (00054-4184) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (00054-8175) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (00904-7266) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) nullDexamethasone 4mg Tablet package photo

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (70954-0403) (Novitium Pharma, LLC ) null

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (49884-0087) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (49884-0087) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (55289-0582) (PD-Rx Pharmaceuticals, Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (66993-0730) (Prasco Laboratories) null

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (00677-0849) (Sun Pharmaceutical Industries, Inc.) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 4mg Tablet (00182-1614) (Teva Pharmaceuticals USA) (off market)

    Dexamethasone Oral tablet

    Decadron 6mg Tablet (58463-0017) (Pragma Pharmaceuticals, LLC) null

    Dexamethasone Oral tablet

    Dexamethasone 6mg Tablet (47781-0916) (Alvogen, Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 6mg Tablet (60687-0729) (American Health Packaging) null

    Dexamethasone Oral tablet

    Dexamethasone 6mg Tablet (60219-2044) (Amneal Pharmaceuticals LLC.) null

    Dexamethasone Oral tablet

    Dexamethasone 6mg Tablet (48102-0048) (Fera Pharmaceuticals) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 6mg Tablet (00054-8183) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 6mg Tablet (00054-4186) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Oral tablet

    Dexamethasone 6mg Tablet (70954-0404) (Novitium Pharma, LLC ) null

    Dexamethasone Oral tablet

    Dexamethasone 6mg Tablet (49884-0129) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 6mg Tablet (49884-0373) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Oral tablet

    Dexamethasone 6mg Tablet (49884-0129) (Par Pharmaceuticals, an Endo Company) (off market)

    Dexamethasone Oral tablet

    Hemady 20mg Tablet (72893-0015) (Acrotech Biopharma, LLC) null

    Dexamethasone Sodium Phosphate Inhalation vapour, solution

    Dexacort 84mcg Turbinaire Inhalant (53014-0203) (UCB Pharma Inc) (off market)

    Dexamethasone Sodium Phosphate Inhalation vapour, solution

    Dexacort PH 84mcg Turbinaire Inhalant (53014-0201) (UCB Pharma Inc) (off market)

    Dexamethasone Sodium Phosphate Ophthalmic drops, solution

    AK-Dex 0.1% Ophthalmic Solution (17478-0279) (Akorn Inc) (off market)

    Dexamethasone Sodium Phosphate Ophthalmic drops, solution

    Decadron Phosphate 0.1% Ophthalmic Solution (00006-7643) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

    Dexamethasone Sodium Phosphate Ophthalmic drops, solution

    Dexamethasone Sodium Phosphate 0.1% Ophthalmic Solution (24208-0720) (Bausch Health US, LLC) nullDexamethasone Sodium Phosphate 0.1% Ophthalmic Solution package photo

    Dexamethasone Sodium Phosphate Ophthalmic drops, solution

    Dexamethasone Sodium Phosphate 0.1% Ophthalmic Solution (00904-3006) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

    Dexamethasone Sodium Phosphate Ophthalmic drops, solution

    Dexamethasone Sodium Phosphate 0.1% Ophthalmic Solution (57319-0065) (Phoenix Pharmaceuticals Inc) null

    Dexamethasone Sodium Phosphate Ophthalmic drops, solution

    Dexamethasone Sodium Phosphate 0.1% Ophthalmic Solution (61314-0294) (Sandoz Inc. a Novartis Company) null

    Dexamethasone Sodium Phosphate Ophthalmic drops, solution

    Dexamethasone Sodium Phosphate 0.1% Ophthalmic Solution (60855-0720) (Sight Pharmaceuticals Inc) (off market)

    Dexamethasone Sodium Phosphate Ophthalmic drops, solution

    Dexamethasone Sodium Phosphate 0.1% Ophthalmic Solution (11695-4188) (WA Butler Co) (off market)

    Dexamethasone Sodium Phosphate Ophthalmic ointment

    Decadron Phosphate 0.05% Ophthalmic Ointment (00006-7615) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

    Dexamethasone Sodium Phosphate Ophthalmic ointment

    Ocu-Dex 0.05% Ophthalmic Ointment (51944-3390) (Ocumed Inc) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Decadron 4mg/ml Solution for Injection (00006-7628) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 120mg/30mL Solution for Injection (55150-0239) (Eugia US LLC fka AuroMedics Pharma LLC) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 120mg/30mL Solution for Injection (67457-0421) (Mylan Institutional LLC ) nullDexamethasone Sodium Phosphate 120mg/30mL Solution for Injection package photo

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 120mg/30ml Solution for Injection (NOVAPLUS) (00069-0192) (Mylan Institutional LLC ) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 120mg/30ml Solution for Injection (NOVAPLUS) (00069-0192) (Pfizer Injectables) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 120mg/30mL Solution for Injection (NOVAPLUS) (67457-0484) (Mylan Institutional LLC ) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 20mg/5mL Solution for Injection (55150-0238) (Eugia US LLC fka AuroMedics Pharma LLC) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 20mg/5mL Solution for Injection (00641-6146) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 20mg/5ml Solution for Injection (NOVAPLUS) (00069-0178) (Mylan Institutional LLC ) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 20mg/5ml Solution for Injection (NOVAPLUS) (00069-0178) (Pfizer Injectables) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 20mg/5mL Solution for Injection (NOVAPLUS) (67457-0418) (Mylan Institutional LLC ) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 20mg/5mL Solution for Injection (PREMIER ProRx) (63323-0165) (Fresenius Kabi AG) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (00517-4901) (American Regent Inc, a division of Luitpold Pharmaceuticals) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (00517-4930) (American Regent Inc, a division of Luitpold Pharmaceuticals) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (00517-4905) (American Regent Inc, a division of Luitpold Pharmaceuticals) (off market)Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection package photo

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (00641-2273) (Baxter Anesthesia/Critical Care) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (67457-0423) (Mylan Institutional LLC ) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (67457-0422) (Mylan Institutional LLC ) nullDexamethasone Sodium Phosphate 4mg/ml Solution for Injection package photo

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (00069-4543) (Mylan Institutional LLC ) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (00069-4545) (Mylan Institutional LLC ) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (00069-4547) (Mylan Institutional LLC ) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (00069-4543) (Pfizer Injectables) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (00069-4545) (Pfizer Injectables) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (00069-4547) (Pfizer Injectables) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/mL Solution for Injection (72572-0120) (Civica, Inc.) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/mL Solution for Injection (55150-0237) (Eugia US LLC fka AuroMedics Pharma LLC) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/mL Solution for Injection (63323-0165) (Fresenius Kabi AG) nullDexamethasone Sodium Phosphate 4mg/mL Solution for Injection package photo

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/mL Solution for Injection (00641-6145) (Hikma Pharmaceuticals USA Inc.) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/ml Solution for Injection (NOVAPLUS) (00069-0179) (Pfizer Injectables) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/mL Solution for Injection (NOVAPLUS) (67457-0419) (Mylan Institutional LLC ) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 4mg/mL Solution for Injection (PREMIER ProRx) (63323-0165) (Fresenius Kabi AG) null

    Dexamethasone Sodium Phosphate Solution for injection

    Simplist Dexamethasone Sodium Phosphate 4mg/mL Prefilled Syringe Solution for Injection (76045-0106) (BD Rx Inc., a Fresenius Kabi USA Company) null

    Dexamethasone Sodium Phosphate Solution for injection

    Solurex 4mg/ml Solution for Injection (00314-0896) (Hyrex Pharmaceuticals) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 100mg/10ml Solution for Injection (67457-0420) (Mylan Institutional LLC ) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 100mg/10mL Solution for Injection (55150-0305) (Eugia US LLC fka AuroMedics Pharma LLC) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 100mg/10mL Solution for Injection (63323-0516) (Fresenius Kabi AG) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 100mg/10mL Solution for Injection (70069-0025) (Somerset Therapeutics, LLC) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 100mg/10mL Solution for Injection (NOVAPLUS) (67457-0483) (Mylan Institutional LLC ) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/ml Solution for Injection (00641-0367) (Baxter Anesthesia/Critical Care) (off market)Dexamethasone Sodium Phosphate 10mg/ml Solution for Injection package photo

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/ml Solution for Injection (00641-0367) (Hikma Pharmaceuticals USA inc.) nullDexamethasone Sodium Phosphate 10mg/ml Solution for Injection package photo

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/ml Solution for Injection (00069-4541) (Mylan Institutional LLC ) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/ml Solution for Injection (00069-4541) (Pfizer Injectables) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/ml Solution for Injection (00703-3524) (Teva Pharmaceuticals USA) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/mL Solution for Injection (70121-1399) (Amneal Biosciences) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/mL Solution for Injection (72572-0122) (Civica, Inc.) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/mL Solution for Injection (55150-0304) (Eugia US LLC fka AuroMedics Pharma LLC) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/mL Solution for Injection (63323-0506) (Fresenius Kabi AG) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/mL Solution for Injection (70069-0021) (Somerset Therapeutics, LLC) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/ml Solution for Injection (NOVAPLUS) (00069-0177) (Mylan Institutional LLC ) null

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/ml Solution for Injection (NOVAPLUS) (00069-0177) (Pfizer Injectables) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Dexamethasone Sodium Phosphate 10mg/mL Solution for Injection (PREMIER ProRx) (63323-0506) (Fresenius Kabi AG) null

    Dexamethasone Sodium Phosphate Solution for injection

    DoubleDex Kit (76420-0766) (Enovachem Manufacturing) null

    Dexamethasone Sodium Phosphate Solution for injection

    ReadySharp Dexamethasone (53225-3660) (Terrain Pharmaceuticals) (off market)

    Dexamethasone Sodium Phosphate Solution for injection

    Simplist Dexamethasone Sodium Phosphate 10mg/mL Prefilled Syringe Solution for Injection (76045-0109) (BD Rx Inc., a Fresenius Kabi USA Company) null

    Dexamethasone Sodium Phosphate Solution for injection

    Decadron 24mg/ml Solution for Injection (00006-7646) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

    Dexamethasone Sodium Phosphate Suspension for injection

    Dalalone 4mg/mL Suspension for Injection (00456-1074) (Allergan USA, Inc.) (off market)

    Dexamethasone Suspension for injection

    DEXYCU 9% Intraocular Suspension Kit (71879-0001) (EyePoint Pharmaceuticals) null

    Description/Classification

    Description

    Dexamethasone and its derivatives, dexamethasone sodium phosphate and dexamethasone acetate, are synthetic glucocorticoids used as anti-inflammatory or immunosuppressive agents. Dexamethasone is available as oral, parenteral, as well as topical ophthalmic and intraocular dosage forms. Dexamethasone is used for many conditions in adult and pediatric patients, including cerebral edema, prevention of transplant rejection, and many allergic, dermatologic, ophthalmic, and systemic inflammatory conditions. Systemic dexamethasone is usually selected for the management of cerebral edema because of its superior ability to penetrate the CNS. Dexamethasone is also commonly used in antiemetic regimens for chemotherapy patients and is included in the American Society of Clinical Oncology (ASCO) guideline-based dosage regimens.[63197] In general, prednisone is more commonly prescribed as an oral corticosteroid when systemic treatment is needed for most conditions. Dexamethasone has little to no mineralocorticoid activity and is therefore not used by itself in the management of adrenal insufficiency. Systemic corticosteroids may be added to other long-term maintenance medications in the management of uncontrolled severe persistent asthma. Once stabilization of asthma is achieved, regular attempts should be made to reduce or eliminate the use of systemic corticosteroids due to the side effects associated with chronic administration. Short courses of treatment may be used in the management of asthma exacerbations.[64807][66299]

     

    Updates for coronavirus disease 2019 (COVID-19):

    The National Institutes of Health (NIH) COVID-19 treatment guidelines have released recommendations for the use of corticosteroids that are based on disease severity.

    Adult patients

    • The NIH guideline recommends dexamethasone for use in the following patients with COVID-19:
      • For most hospitalized patients who require conventional oxygen BUT NOT on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO), the NIH recommends dexamethasone (with or without remdesivir) as a treatment option. For patients with rapidly increasing oxygen needs and systemic inflammation, baricitinib or tocilizumab may be added to dexamethasone.
      • For all hospitalized patients who require oxygen through a high-flow device or noninvasive ventilation, dexamethasone should be given with baricitinib (preferred option) or tocilizumab (secondary option). If baricitinib or tocilizumab (or the alternatives tofacitinib or sarilumab) are not available or are contraindicated, dexamethasone may be given alone. Remdesivir may be added for certain patients.
      • For all hospitalized patients who require mechanical ventilation or ECMO, dexamethasone should be given with either baricitinib or tocilizumab. If baricitinib or tocilizumab (or the alternatives tofacitinib or sarilumab) are not available or are contraindicated, dexamethasone may be given alone. For patients who initially received remdesivir monotherapy and progressed to requiring mechanical ventilation or ECMO, add dexamethasone and continue remdesivir until the treatment course is completed.
    • The NIH recommends against the use or continuing use of corticosteroids in the following patients with COVID-19:
      • Patients with mild to moderate COVID-19 (i.e., non-hospitalized patients or hospitalized patients that do not require supplemental oxygen) unless the patient has another clinical indication for steroid therapy.
      • Patients discharged from inpatient hospital settings in stable condition, even if receiving supplemental oxygen.[65314]

    Pediatric patients

    • The NIH guidelines recommend dexamethasone (with or without remdesivir) for hospitalized pediatric patients who require high-flow oxygen or noninvasive ventilation. Dexamethasone (without remdesivir) is also recommended for pediatric patients requiring mechanical ventilation or ECMO. The addition of baricitinib or tocilizumab may be considered for children who do not have rapid (e.g., within 24 hours) improvement in oxygenation after initiation of dexamethasone.
    • Corticosteroids are not routinely recommended for pediatric patients who require only conventional oxygen, but corticosteroids can be considered in combination with remdesivir for patients with increasing oxygen needs, particularly adolescents.
    • The use of dexamethasone for treatment of severe COVID-19 in pediatric patients who are profoundly immunocompromised has not been evaluated and may be harmful; in such cases, treatment should be considered on a case-by-case basis.[65314]

     

    The World Health Organization strongly recommends the use of systemic corticosteroids, including dexamethasone, in patients with severe or critical COVID-19; but suggests against use in patients with non-severe COVID-19.[65876]

    Classifications

    • Respiratory System
      • Agents for Reactive and Obstructive Airway Diseases
        • Corticosteroids
          • Respiratory Corticosteroids
    • Sensory Organs
      • Ophthalmologicals
        • Ophthalmological Corticosteroids
    • Systemic Hormonal Agents (excluding Sex Hormones)
      • Systemic Corticosteroids
        • Systemic Corticosteroid Combinations
        • Systemic Corticosteroids, Plain
    Revision Date: 04/21/2023, 04:21:30 PM

    References

    63197 - Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2017;35:3240-61.64807 - Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA) 2020. Available from: http://www.ginasthma.org. Accessed May 20th, 2020.65314 - COVID-19 Treatment Guidelines Panel. Coronavirus Diseases 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Accessed April 20, 2023. Available at on the World Wide Web at: https://covid19treatmentguidelines.nih.gov/.65876 - World Health Organization Guideline Panel. Corticosteroids for COVID-19. World Health Organization. Accessed September 3, 2020. Available on the World Wide Web at: https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.166299 - Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC), et al. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020;146:1217-1270.

    Administration Information

    General Administration Information

    For storage information, see the specific product information within the How Supplied section.

    Route-Specific Administration

    Oral Administration

    • Administer with food to minimize GI upset.
    • If given once daily, give in the morning to coincide with the body's normal cortisol secretion.

    Oral Liquid Formulations

    Dexamethasone Intensol (Oral Solution Concentrate)

    • 1 mg/mL concentrated solution; contains 30% alcohol.
    • Measure the appropriate dose, using only the calibrated dropper provided with product.
    • Mix the dose with liquid or semi-solid food such as water, juice, soda, applesauce, or pudding and stir the preparation for a few seconds.
    • Consume the entire mixture immediately; do not store for future use.[60761]

    Injectable Administration

    • Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
    • Some injectable formulations contain benzyl alcohol; avoid the use of these formulations in premature neonates, and use with caution in neonates.[60760]

    Intravenous Administration

    Direct IV injection:

    • Dexamethasone sodium phosphate solution for injection 4 mg/mL or 10 mg/mL may be given directly from the vial.[60760]

     

    Intermittent or continuous IV infusion:

    • Dexamethasone sodium phosphate solution for injection 4 mg/mL or 10 mg/mL may be added to 5% Dextrose injection or 0.9% Sodium Chloride injection, USP and given by IV infusion.
    • Use diluted solutions within 24 hours, as infusion solutions generally do not contain preservatives.[60760]

    Intramuscular Administration

    • Dexamethasone sodium phosphate solution for injection 4 mg/mL or 10 mg/mL may be administered intramuscularly.[60760]

    Other Injectable Administration

    Intra-articular, Soft tissue, or Intralesional injection

    • Dexamethasone sodium phosphate solution for injection 4 mg/mL may be administered into joints, soft tissues, or lesions, but administration of dexamethasone via these routes requires specialized techniques.
    • Only clinicians familiar with these methods of administration and with management of potential complications should administer dexamethasone by these routes.
    • Frequent intra-articular injections may result in damage to joint tissues.
    • Dexamethasone sodium phosphate injection is particularly recommended for use in conjunction with one of the less soluble, longer-acting steroids for intra-articular and soft tissue injection.[60760]

    Ophthalmic Administration

    Ophthalmic solution or suspension:

    • Apply ophthalmic solution or suspension topically to the eye.
    • For ophthalmic suspensions, shake well prior to each administration.
    • Instruct patient on appropriate instillation technique.
    • Do not to touch the tip of the dropper or tube to the eye, fingertips, or other surfaces.
    • To prevent contamination, each dropper is for 1 individual, do not share among patients.
    • The initial prescription and renewal of the ophthalmic suspension should be made by a physician only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy and fluorescein staining (where appropriate). Prescribe no more than 1 bottle at a time.[54348] [61633]

     

    Intraocular Administration

    • For administration by the physician at the end of the ophthalmic surgical procedure.

    Dexycu Intraocular Suspension

    Preparation of intraocular suspension:

    • Prepare a sterile field. Remove the components of the administration kit from their respective pouches and place onto the sterile field.
    • Withdraw the syringe plunger approximately 1 inch. Place the syringe ring on the plunger (slit facing the plunger). Apply slight downward pressure until the syringe ring "snaps" into place.
    • Place the 18-gauge needle firmly on the syringe. Remove the cap from the needle. Depress the plunger completely and then withdraw the plunger to fill the syringe with air.
    • Mix using a vortex mixer or vigorously shake the vial sideways for a minimum of 30 seconds; the suspended drug material must be used immediately after shaking.
    • Remove the blue plastic flip-cap from the vial and wipe the top of the rubber stopper with an alcohol pad. Invert the vial.
    • Insert the needle into the vial and inject the air into the vial. Making sure the needle tip is immersed in the drug material pooled in the neck of the inverted vial, fill the syringe by slowly withdrawing the plunger approximately 0.2 mL. Remove the needle from the vial and discard the unused portion in the vial.
    • Remove the needle from the syringe. Firmly place the cannula on the syringe and remove the plastic cap. Hold the syringe vertically with the cannula pointing up. Depress the plunger to expel air bubbles from the syringe.
    • Affix the syringe guide over the syringe ring on the plunger.
    • Depress the plunger until the syringe guide/ring mechanism comes gently into contact with the flange of the syringe. Lightly tap/flick the barrel of the syringe to remove any excess drug from the tip of the cannula. Do not wipe or touch the tip of the cannula to remove excess drug.
    • Remove the syringe guide, leaving the syringe ring in place. CAUTION: DO NOT MOVE THE PLUNGER. The space between the syringe ring and the top of the plunger is the medication injection volume that will be applied to the patient's eye; the syringe is now ready for injection.[48640]

     

    Intraocular Administration:

    • In a single slow-motion, inject 0.005 mL of the drug material behind the iris in the inferior portion of the posterior chamber. If the sphere of the administered drug after intraocular injection appears to be larger than 2 mm in diameter, excess drug material may be removed by irrigation and aspiration in the sterile surgical setting.
    • Some drug material will remain in the syringe after the injection; this is necessary for accurate dosing. Discard the unused portion remaining in the syringe after administration.[48640]

     

    Dextenza Ophthalmic Insert

    Intracanalicular Administration:

    • Do not use if pouch has been damaged or opened. Do not re-sterilize.
    • Carefully remove foam carrier and transfer to a clean and dry area. If necessary, dilate the punctum with an ophthalmic dilator. Care should be taken not to perforate the canaliculus during dilation or placement of the insert. If perforation occurs, do not place the insert in the eye.
    • After drying the punctal area, using blunt (non-toothed) forceps, grasp the insert and place into the lower lacrimal canaliculus by pulling the lid temporally and inserting nasally. Ensure the insert is placed just below the punctal opening. Excessive squeezing of the insert with forceps may cause deformation.
    • To aid in the hydration of the insert, 1 to 2 drops of balanced salt solution can be instilled into the punctum. The insert hydrates quickly upon contact with moisture. If the insert begins to hydrate before fully inserted, discard the product and use a new insert.
    • The insert can be visualized when illuminated by a blue light source (e.g., slit lamp or hand held blue light) with yellow filter.[63796]
    • The insert is for single-use only.
    • Insert is resorbable; removal not required.

    Otic Administration

    Otic Administration of Ophthalmic Solution:

    • Clean the ear canal thoroughly and sponge dry prior to administration.
    • Instill the solution directly into the ear canal.
    • Alternatively, a gauze wick may be saturated with solution and packed into the ear canal. Keep the gauze wick moist with solution and remove from ear after 12 to 24 hours.[54348]

    Other Administration Route(s)

    Intravitreal Implant Administration

    • Intravitreal implantation should be performed only by surgeons who have observed or assisted in surgical implantation of the implant. Consult specialized instructions regarding insertion of the implant.
    • Administer via intravitreal injection with the provided single-use plastic applicator.
    • Use controlled aseptic conditions, which include the use of sterile gloves, a sterile drape, and a sterile eyelid speculum (or equivalent).
    • Use each applicator for a single treatment only. If the contralateral eye requires treatment, a new applicator must be used and the sterile field should be changed.
    • After the intravitreal injection, monitor patients for elevation in intraocular pressure and for endophthalmitis. Monitoring may consist of a check for reperfusion of the optic nerve head immediately after the injection, tonometry within 30 minutes after the injection, and biomicroscopy 2 to 7 days after the injection.
    • Instruct patients to promptly report any symptoms suggestive of endophthalmitis.[41921]

    Clinical Pharmaceutics Information

    From Trissel's 2‚Ñ¢ Clinical Pharmaceutics Database

    Dexamethasone sodium phosphate

    pH Range
    10 mg/mL- pH range of 7 to 8.5 4 mg/mL- pH range of 7.5 to 10.5 In NS 0.5 to 2 mg/mL- pH 7.3 to 7.5
    ReferencesAnon. Manufacturer's information and labeling. (Package insert).
    ReferencesSchneider JJ, Wilson KM, Ravenscroft PJ. A study of the osmolality and pH of subcutaneous drug infusion solutions. Austral J Hosp Pharm. 1997; 27
    Osmolality/Osmolarity
    Dexamethasone sodium phosphate injections are near isotonicity. The 4-mg/mL concentration of dexamethasone sodium phosphate had a measured osmolality of 356 mOsm/kg. Dexamethasone sodium phosphate diluted to concentrations of 0.5, 1, and 2 mg/mL in sodium chloride 0.9% had measured osmolalities of 269, 260, and 238 mOsm/kg, respectively.
    ReferencesAnon. Manufacturer's information and labeling. (Package insert).
    ReferencesBretschneider H. Osmolalities of commercially supplied drugs often used in anesthesia. Anesth Analg. 1987; 66
    ReferencesSchneider JJ, Wilson KM, Ravenscroft PJ. A study of the osmolality and pH of subcutaneous drug infusion solutions. Austral J Hosp Pharm. 1997; 27
    Stability
    Dexamethasone sodium phosphate injection in intact containers stored as directed by the manufacturer is stable until the labeled expiration date. Dexamethasone sodium phosphate is sensitive to heat; the vials should not be autoclaved. Lugo and Nahata reported that dexamethasone sodium phosphate1 mg/mL in bacteriostatic sodium chloride 0.9% packaged in glass vials remained clear and was stable exhibiting little or no loss by HPLC analysis in 28 days stored at room temperature or refrigerated. Infusion Solutions: Dexamethasone sodium phosphate diluted for infusion has been found to be stable for extended periods up to 14 days at room temperature in dextrose 5% and up to 22 days in sodium chloride 0.9%. Packaged in Syringes: Dexamethasone sodium phosphate injection packaged in glass syringes or syringe cartridges has been reported to be stable for periods ranging from 91 days to 196 days. In plastic syringes, conflicting information exists, but stability-indicating HPLC analysis indicates the drug is stable at room temperature for periods up to 55 days. Lau et al. evaluated dexamethasone sodium phosphate 10 mg/mL packaged in Glaspak disposable glass syringes and polypropylene plastic syringes. No loss of drug was found by stability-indicating HPLC analysis in 90 days at 4 and 23 degree C. This is consistent with Levin et al. and Kirschenbaum et al. who reported room temperature drug stability for 3 months in Tubex cartridges and for 196 days in disposable glass syringes, respectively. Lau et al also reported that the 10-mg/mL concentration packaged in 1- and 3-mL Monoject polypropylene plastic syringes exhibited 3% loss in 35 days and 7% loss in 55 days at room temperature using a stability-indicating HPLC analysis specific for dexamethasone. However Speaker et al. reported substantial changes in ultraviolet light absorbance for dexamethasone 4 mg/mL packaged in 3-mL Becton Dickinson, Monoject, and Terumo plastic syringes. The changes were attributed to loss of dexamethasone; losses ranged from 5 to 20% in one day. The UV analysis is non-specific, and the changes could be from other components. Gupta reported that dexamethasone sodium phosphate 1 and 0.1 mg/ml in sodium chloride 0.9% packaged in 3- and 5-ml Becton Dickinson polypropylene syringes was stable when stored at 25 ?C. The solutions remained clear throughout the study, and less than 3% loss occurred by HPLC analysis in 22 days. Dobrinas et al. evaluated the stability of dexamethasone sodium phosphate 4 mg/mL in aqueous solution for use as intraocular injections during ophthalmic surgery. The solution was packaged in 1-mL syringes with tip seals, placed in light protective plastic bags, and stored frozen at -18 degree C for 6 months. Samples were thawed at room temperature for evaluation. The syringes remained sterile, endotoxin-free, and tightly sealed when challenged with a methylene blue 1% solution. Stability-indicating HPLC analysis found little or no drug loss over 6 months of frozen storage. Paramedic Vehicles: Valenzuela et al. reported the stability of dexamethasone exposed to temperatures ranging from 26 to 38 degree C under simulated summer conditions in paramedic vehicles over 4 weeks. Gas chromatography coupled with mass spectrometry found no change in the drug over 4 weeks under these simulated use conditions.
    ReferencesAnon. Manufacturer's information and labeling. (Package insert).
    ReferencesChin A, Suk Y, Moon K, et al. Stability of granisetron hydrochloride with dexamethasone sodium phosphate for 14 days. Am J Health-Syst Pharm. 1996; 53
    ReferencesDobrinas M, Fleury-Souverain S, Sadeghipour F, et al. Stability of ophthalmic injections of ceftazidime, vancomycin and dexamethasone in aqueous humor after freezing, storage and thawing (accessed at http://pharmacie.hug-ge/rd/posters). Pharm Hopitaux Univ Geneve. 2007;
    ReferencesGupta VD. Chemical stability of dexamethasone sodium phosphate after reconstitution in 0.9% sodium chloride injection and storage in polypropylene syringes. Int J Pharmaceut Compound. 2002; 6
    ReferencesKirschenbaum BE, Latiolais CJ. Injectable medications - a guide to stability and reconstitution. New York, NY: McMahon Group. Data on file. 1993;
    ReferencesLau DWC, Law S, Walker SE, et al. Dexamethasone phosphate stability and contamination of solutions stored in syringes. PDA J Pharm Sci Tech. 1996; 50
    ReferencesLevin HJ, Fieber RA, Levi RS. Stability data for Tubex filled by hospital pharmacists. Hosp Pharm. 1973; 8
    ReferencesLugo RA, Nahata MC. Stability of diluted dexamethasone sodium phosphate injection at two temperatures. Ann Pharmacother. 1994; 28
    ReferencesValenzuela TD, Criss EA, Hammargen WM, et al. Thermal stability of prehospital medications. Ann Emerg Med. 1989; 18
    Light Exposure
    No unacceptable adverse effect on drug concentration due to normal fluorescent light exposure was observed in a stability study of dexamethasone sodium phosphate in infusion solutions and in syringes.
    ReferencesHagan RL, Mallett MS, Fox JL. Stability of ondansetron hydrochloride and dexamethasone sodium phosphate in infusion bags and syringes for 32 days. Am J Health-Syst Pharm. 1996; 53
    ReferencesLau DWC, Law S, Walker SE, et al. Dexamethasone phosphate stability and contamination of solutions stored in syringes. PDA J Pharm Sci Tech. 1996; 50
    Freezing
    The manufacturer states that dexamethasone sodium phosphate injection should be protected from freezing during storage. Rolin et al. found little or no loss of dexamethasone sodium phosphate in an admixture with ondansetron hydrochloride mixed in dextrose 5% when stored for 3 months frozen at -20 degree C. Dobrinas et al. evaluated the stability of dexamethasone sodium phosphate 4 mg/mL in aqueous solution for use as intraocular injections during ophthalmic surgery. The solution was packaged in 1-mL syringes with tip seals, placed in light protective plastic bags, and stored frozen at -18 degree C for 6 months. Samples were thawed at room temperature for evaluation. The syringes remained sterile, endotoxin-free, and tightly sealed when challenged with a methylene blue 1% solution. Stability-indicating HPLC analysis found little or no drug loss over 6 months of frozen storage.
    ReferencesAnon. Manufacturer's information and labeling. (Package insert).
    ReferencesDobrinas M, Fleury-Souverain S, Sadeghipour F, et al. Stability of ophthalmic injections of ceftazidime, vancomycin and dexamethasone in aqueous humor after freezing, storage and thawing (accessed at http://pharmacie.hug-ge/rd/posters). Pharm Hopitaux Univ Geneve. 2007;
    ReferencesRolin C, Hecq JD, Vanbeckbergen DF, et al. Stability of ondansetron and dexamethasone infusion upon refrigeration. Ann Pharmacother. 2011; 45
    Filtration
    Dexamethasone sodium phosphate has not shown loss due to binding to cellulose ester membranes filters (Ivex-2 and S-A-I-F), polycarbonate membrane filters (In-Sure Filter set), and stainless steel depth filters (Argyle Filter Connector). Mueller et al. reported no loss of dexamethasone sodium phosphate from ViaSpan organ cold storage solution filtered through Pall SQ40S 40-micron blood transfusion filters. Dexamethasone sodium phosphate 80 mcg/mL underwent no loss due to filtration through a Pall Supor membrane filter.
    ReferencesAnon. Pall Medical Supor-membrane IV filter device drug-adsorption data. Data on file. 2004; 8
    ReferencesMueller BJ, Guessford SA, Chen TT, et al. Effect of inline filtration on ViaSpan cold-storage solution. Am J Health-Syst Pharm. 1998; 55
    ReferencesRusmin S, Welton S, DeLuca P, et al. Effect of inline filtration on the potency of drugs administered intravenously. Am J Hosp Pharm. 1977; 34
    ReferencesStiles ML, Allen LV Jr. Retention of drugs during inline filtration of parenteral solutions. Infusion. 1979; 3
    Sorption Leaching
    Dexamethasone sodium phosphate has been shown not to undergo sorption to polyvinyl chloride (PVC) plastic bags and PVC administration tubing, polyethylene tubing, Silastic tubing, cellulose propionate burettes, and polypropylene or polypropylene/polyethylene plastic syringes. In addition, Xu et al. reported no sorption occurred to a polyurethane central catheter from Arrow International as well as no leaching of the chlorhexidine antimicrobial in it.
    ReferencesChin A, Suk Y, Moon K, et al. Stability of granisetron hydrochloride with dexamethasone sodium phosphate for 14 days. Am J Health-Syst Pharm. 1996; 53
    ReferencesGupta VD. Chemical stability of dexamethasone sodium phosphate after reconstitution in 0.9% sodium chloride injection and storage in polypropylene syringes. Int J Pharmaceut Compound. 2002; 6
    ReferencesHagan RL, Mallett MS, Fox JL. Stability of ondansetron hydrochloride and dexamethasone sodium phosphate in infusion bags and syringes for 32 days. Am J Health-Syst Pharm. 1996; 53
    ReferencesKowaluk EA, Roberts MA, Blackburn HD, et al. Interactions between drugs and polyvinyl chloride infusion bags. Am J Hosp Pharm. 1981; 38
    ReferencesKowaluk EA, Roberts MS, Polack AE. Interactions between drugs and intravenous delivery systems. Am J Hosp Pharm. 1982; 39
    ReferencesLau DWC, Law S, Walker SE, et al. Dexamethasone phosphate stability and contamination of solutions stored in syringes. PDA J Pharm Sci Tech. 1996; 50
    ReferencesXu QA, Zhang Y, Trissel LA, et al. Adequacy of a new chlorhexidine-bearing polyurethane central catheter for administration of 82 selected parenteral drugs. Ann Pharmacother. 2000; 34
    Other Information
    Dolasetron: Walker et al. reported that the pH-dependency of dolasetron solubility (See pH Effects) is most likely responsible for the variable amounts and time frames of precipitate formation that may occur when dolasetron mesylate and dexamethasone sodium phosphate are admixed or given by simultaneous Y-site administration. Multiple Drugs: Study 1: Targett et al. reported the physical and chemical stability of 5-drug combinations at 2 concentrations that included the drugs noted below. The mixture was packaged in Terumo polypropylene syringes with tip caps and stored at room temperature and under refrigeration. The mixtures were physically stable over 2 weeks. HPLC analysis found midazolam was stable for 14 days under refrigeration but was stable at room temperature for only 12 days at the higher concentration and 5 days at the lower concentration exhibiting more than 10% loss after those times. The other drugs were all stable throughout the 14-day study period at both storage temperatures. Concentration 1- Morphine tartrate 400 mg Dexamethasone sodium phosphate 8 mg Droperidol 2 mg Scopolamine hydrobromide 20 mg Midazolam HCl 5 mg Concentration 2- Morphine tartrate 40 mg Dexamethasone sodium phosphate 8 mg Droperidol 2 mg Scopolamine hydrobromide 20 mg Midazolam HCl 5 mg Sodium chloride 0.9% qs 10 mL Study 2: Negro et al. evaluated the compatibility of morphine hydrochloride (Grunenthal) and also tramadol hydrochloride (Andromaco) in 3-, 4-, and 5-drug combinations with five other drugs, including dexamethasone sodium phosphate, diluted in sodium chloride 0.9% in elastomeric pump reservoirs for subcutaneous infusion for palliative care in cancer patients when stored at room temperature of 25 degree C and protected from exposure to light. Morphine hydrochloride 1.68 mg/mL or Tramadol hydrochloride 11.18 mg/mL was tested with dexamethasone sodium phosphate (Merck) 0.44 mg/mL, haloperidol lactate (Esteve) 0.21 mg/mL, hyoscine butylbromide (Boehringer-Ingelheim) 1.68 mg/mL, metoclopramide hydrochloride 1.11 mg/mL, and midazolam hydrochloride (Roche) 0.5 mg/mL. Morphine hydrochloride 5 mg/mL or Tramadol hydrochloride 33.3 mg/mL was tested with dexamethasone sodium phosphate (Merck) 1.33 mg/mL, haloperidol lactate (Esteve) 0.62 mg/mL, hyoscine butylbromide (Boehringer-Ingelheim) 5 mg/mL, metoclopramide hydrochloride 3.33 mg/mL, midazolam hydrochloride (Roche) 1.5 mg/mL. All 3-, 4-, and 5-drug combinations that contained dexamethasone sodium phosphate with midazolam hydrochloride and/or haloperidol lactate resulted in precipitation immediately upon preparation. The precipitation was most likely free dexamethasone that formed due to the lower pH of the admixtures containing haloperidol lactate and/or midazolam hydrochloride. All 3-, 4-, and 5-drug combinations without dexamethasone sodium phosphate and midazolam hydrochloride and/or haloperidol lactate remained compatible for 7 days.
    ReferencesTargett PL, Keefe PA, Merridew CG. Compatibility and stability of drug adjuvants and morphine tartrate in 10 mL polypropylene syringes. Austral J Hosp Pharm. 1997; 27
    ReferencesWalker SE, Dip SL. Stability and compatibility of combinations of dolasetron and dexamethasone. Can J Hosp Pharm. 1998; 51
    Stability Max
    Maximum reported stability periods: In D5W- 14 days at room temperature. In NS- 22 days at room temperature.
    ReferencesChin A, Suk Y, Moon K, et al. Stability of granisetron hydrochloride with dexamethasone sodium phosphate for 14 days. Am J Health-Syst Pharm. 1996; 53
    ReferencesGupta VD. Chemical stability of dexamethasone sodium phosphate after reconstitution in 0.9% sodium chloride injection and storage in polypropylene syringes. Int J Pharmaceut Compound. 2002; 6
    Revision Date: 12/15/2021, 01:26:08 PMCopyright 2004-2023 by Lawrence A. Trissel. All Rights Reserved.

    References

    41921 - Ozurdex (dexamethasone intravitreal implant) package insert. Madison, NJ: Allergan USA, Inc.; 2022 Dec.48640 - Dexycu (dexamethasone intraocular suspension) package insert. Watertown, MA: EyePoint Pharmaceuticals US, Inc.; 2020 Jun.54348 - Dexamethasone sodium phosphate ophthalmic solution package insert. Bridgewater, NJ: Bausch and Lomb Inc.; 2016 June.60760 - Dexamethasone sodium phosphate injection package insert. Eatontown, NJ:West-Ward Pharmaceuticals;2014 Sept.60761 - Dexamethasone tablets USP, Dexamethasone oral solution, and Dexamethasone Intensol (oral solution concentrate) package insert. Eatontown, NJ: West-Ward Pharmaceuticals Corp; 2016 March.61633 - Maxidex (dexamethasone ophthalmic suspension 0.1%) package insert. East Hanover, NJ; Novartis Pharmaceuticals Corp. 2021 Dec.63796 - Dextenza (dexamethasone ophthalmic insert) package insert. Bedford, MA: Ocular Therapeutix, Inc.; 2021 Oct.

    Adverse Reactions

    Moderate

    • adrenocortical insufficiency
    • amnesia
    • angina
    • blurred vision
    • candidiasis
    • cataracts
    • conjunctival hyperemia
    • conjunctivitis
    • corneal edema
    • Cushing's syndrome
    • delirium
    • depression
    • diabetes mellitus
    • edema
    • EEG changes
    • elevated hepatic enzymes
    • erythema
    • esophagitis
    • euphoria
    • exophthalmos
    • fluid retention
    • gastritis
    • glycosuria
    • growth inhibition
    • hallucinations
    • hepatomegaly
    • hypercholesterolemia
    • hyperemia
    • hyperglycemia
    • hypernatremia
    • hypertension
    • hypocalcemia
    • hypokalemia
    • hypotension
    • hypothalamic-pituitary-adrenal (HPA) suppression
    • immunosuppression
    • impaired cognition
    • impaired wound healing
    • iritis
    • mania
    • memory impairment
    • meningitis
    • metabolic alkalosis
    • myasthenia
    • myopathy
    • neuritis
    • ocular infection
    • ocular inflammation
    • osteopenia
    • osteoporosis
    • palpitations
    • paresis
    • peripheral neuropathy
    • phlebitis
    • photophobia
    • physiological dependence
    • pseudotumor cerebri
    • psychosis
    • sinus tachycardia
    • skin ulcer
    • sodium retention
    • withdrawal

    Severe

    • anaphylactoid reactions
    • angioedema
    • arachnoiditis
    • arrhythmia exacerbation
    • avascular necrosis
    • bone fractures
    • bradycardia
    • cardiac arrest
    • cardiomyopathy
    • corneal erosion
    • endophthalmitis
    • esophageal ulceration
    • exfoliative dermatitis
    • GI bleeding
    • GI perforation
    • heart failure
    • increased intracranial pressure
    • keratitis
    • keratoconjunctivitis
    • macular edema
    • myocardial infarction
    • ocular hemorrhage
    • ocular hypertension
    • optic neuritis
    • pancreatitis
    • papilledema
    • peptic ulcer
    • pulmonary edema
    • retinal detachment
    • retinopathy
    • seizures
    • skin atrophy
    • stroke
    • tendon rupture
    • thromboembolism
    • thrombosis
    • vasculitis
    • visual impairment

    Mild

    • abdominal pain
    • acne vulgaris
    • acneiform rash
    • alopecia
    • anxiety
    • appetite stimulation
    • arthralgia
    • arthropathy
    • dizziness
    • ecchymosis
    • emotional lability
    • fever
    • foreign body sensation
    • headache
    • hiccups
    • hirsutism
    • hyperhidrosis
    • hypertrichosis
    • infection
    • injection site reaction
    • insomnia
    • irritability
    • lacrimation
    • lethargy
    • leukocytosis
    • malaise
    • menstrual irregularity
    • myalgia
    • mydriasis
    • nausea
    • ocular discharge
    • ocular hypotonia
    • ocular irritation
    • ocular pain
    • ocular pruritus
    • paresthesias
    • perineal pain
    • petechiae
    • pruritus
    • ptosis
    • purpura
    • rash
    • restlessness
    • skin hyperpigmentation
    • skin hypopigmentation
    • striae
    • syncope
    • telangiectasia
    • urticaria
    • vertigo
    • vomiting
    • weakness
    • weight gain
    • xerophthalmia
    • xerosis

    Pharmacologic doses of systemic corticosteroids (e.g. dexamethasone) administered for prolonged periods can result in physiological dependence due to hypothalamic-pituitary-adrenal (HPA) suppression. Exogenously administered corticosteroids exert a negative feedback effect on the pituitary, inhibiting the secretion of adrenocorticotropin (ACTH). This results in a decrease in ACTH-mediated synthesis of endogenous corticosteroids and androgens by the adrenal cortex. The severity of secondary adrenocortical insufficiency varies among individuals and is dependent on the dose, frequency, time of administration, and duration of therapy. Systemic administration of the drug on alternate days may help to alleviate this adverse effect. Patients with HPA suppression will require increased doses of corticosteroid therapy during periods of physiologic stress. Acute adrenal insufficiency and even death can occur with abrupt discontinuation of therapy. Discontinuation of prolonged oral corticosteroid therapy should be gradual since HPA suppression can last for up to 12 months following cessation of therapy. Patients may continue to need supplemental corticosteroid treatment during periods of physiologic stress or infectious conditions, even after the drug has been discontinued. A withdrawal syndrome unrelated to adrenocortical insufficiency can occur following sudden discontinuance of corticosteroid therapy. This syndrome includes symptoms such as appetite loss, malaise, lethargy, nauseousness, head pain/ache, joint pain, muscle pain, fever, exfoliative dermatitis, loss of weight, and hypotension. These effects are believed to be due to the sudden change in corticosteroid concentration rather than to low corticosteroid levels. Increased intracranial pressure with papilledema (i.e., pseudotumor cerebri) has also been reported with glucocorticoids usually after treatment withdrawal.[60760] [60761] [64165]

    Prolonged systemic dexamethasone therapy can adversely affect the endocrine system, resulting in hypercorticism (Cushing's syndrome including fat abnormalities such as buffalo hump and moon face), hypertrichosis or hirsutism, menstrual irregularity, or a decrease in carbohydrate or glucose tolerance.[60760] [60761] [64165]

    Systemic corticosteroids are a common cause of drug-induced hyperglycemia. In the hospital setting, there is evidence that more than 50% of the patients receiving high-dose systemic steroids develop hyperglycemia, with many more having at least 1 episode of hyperglycemia or a mean blood glucose of 140 mg/dL or greater. Long-term use produces metabolic and endocrine effects that include insulin resistance that may lead to new diagnoses of diabetes mellitus (DM) in patients without a history of hyperglycemia or DM prior to corticosteroid use. Glucosuria (glycosuria) and aggravation of existing DM may also occur.[68700] [60760] [60761] [64165]

    Endogenous glucocorticoids are responsible for protein metabolism; prolonged therapy with pharmaceutical glucocorticoids like dexamethasone can result in various musculoskeletal and joint manifestations, including myopathy (myalgia, muscle wasting, muscle weakness or myasthenia, and quadriplegia), arthralgia, tendon rupture, bone matrix atrophy (osteoporosis and osteopenia), bone fractures such as vertebral compression fractures or fractures of long bones, and avascular necrosis of femoral or humeral heads. These effects are more likely to occur in older or debilitated patients. Of note, abrupt cessation of corticosteroids can cause arthralgia and myalgia. Glucocorticoids interact with calcium metabolism at many sites, including: decreasing the synthesis by osteoblasts of the principal proteins of bone matrix, malabsorption of calcium in both the nephron and the gut, and reduction of sex hormone concentrations. Although all of these actions probably contribute to glucocorticoid-induced osteoporosis, the actions on osteoblasts are most important. Glucocorticoids do not modify vitamin D metabolism. Intra-articular injections of corticosteroids can cause Charcot-like arthropathy and post-injection flare. Atrophy at the site of injection has been reported following administration of soluble glucocorticoids.[24837] [60760] [60761] [64165] Because of retardation of bone growth, children receiving prolonged systemic corticosteroid therapy, like dexamethasone, may have growth inhibition. Growth inhibition has been observed in the absence of laboratory evidence of hypothalamic-pituitary-adrenal (HPA) suppression, suggesting that growth velocity is a more sensitive indicator of systemic corticosteroid exposure in pediatric patients.[60760] [60761] [64165]

    Adverse gastrointestinal (GI) effects associated with systemic corticosteroid (e.g., dexamethasone) administration include nausea and vomiting. Abdominal pain or distention, appetite stimulation, weight gain, pancreatitis, gastritis, hiccups, peptic ulcer with possible GI perforation and GI bleeding, perforation of the small and large bowel (particularly in patients with inflammatory bowel disease), and esophageal ulceration (ulcerative esophagitis) have also been reported.[60760] [60761] [64165] Although it was once believed that corticosteroids contributed to the development of peptic ulcer disease, in a review of 93 studies of corticosteroid use, the incidence of peptic ulcer disease was not found to be higher in steroid recipients compared to control groups. While most of these studies did not utilize endoscopy, it is unlikely that corticosteroids contribute to the development of peptic ulcer disease.[24362]

    Corticosteroid therapy including dexamethasone can mask the symptoms of infection and should generally be avoided during an acute viral, fungal, or bacterial infection. Leukocytosis is a common physiologic effect of systemic corticosteroid therapy and may need to be differentiated from the leukocytosis that occurs with inflammatory or infectious processes.[30943] [65096] [65097] Immunosuppression from corticosteroids is most likely to occur in patients receiving high-dose (e.g., equivalent to 1 mg/kg or more of prednisone daily), systemic corticosteroid therapy for any period of time, particularly in conjunction with corticosteroid-sparing drugs (e.g., troleandomycin) and/or concomitant immunosuppressant agents; however, patients receiving moderate dosages of systemic corticosteroids for short periods or low dosages for prolonged periods may also be at risk. Corticosteroid-induced immunosuppression may result in the activation of latent viral (e.g., herpes) or bacterial (e.g., tuberculosis) infections and should not be used in patients with an active infection except when appropriate anti-infective therapy is instituted concomitantly. Patients receiving immunosuppressive doses of corticosteroids should be advised to avoid exposure to measles or varicella (chickenpox) and, if exposed to these diseases, to seek medical advice immediately. Monitoring systemic corticosteroid recipients for signs of opportunistic fungal infection is recommended, as cases of oropharyngeal candidiasis have been reported. Development of Kaposi's sarcoma has also been associated with prolonged administration of corticosteroids; discontinuation of the corticosteroid may result in clinical improvement.[60760] [60761] [64165] Bronchitis was noted in 5% of dexamethasone ophthalmic implant recipients during clinical trials and at an incidence higher than with placebo; secondary ophthalmic infection or exacerbation of infection has also been reported with other ophthalmic and intraocular dosage forms.[41921] [48640] [54348]

    Various adverse dermatologic effects reported during systemic corticosteroid therapy include skin atrophy (thin fragile skin), increased sweating (hyperhidrosis), acne vulgaris, striae, acneiform rash, alopecia, xerosis, perineal pain and irritation, purpura, rash (unspecified), telangiectasia, facial erythema, petechiae, ecchymosis or easy bruising, and suppression of reactions to skin tests. An increased susceptibility to skin ulcer may occur in patients with impaired circulation. Hypersensitivity reactions may manifest as allergic dermatitis, urticaria, anaphylactoid reactions, and/or angioedema. Burning or tingling in the perineal area may occur following IV injection of corticosteroids. Parenteral corticosteroid therapy has also produced skin hypopigmentation, skin hyperpigmentation, scarring, and other types of injection site reaction (e.g., induration, delayed pain or soreness, subcutaneous and cutaneous atrophy, and sterile abscesses).[60760] [60761] [64165]

    In general, systemic corticosteroids like dexamethasone can lead to impaired wound healing.[60760] [60761] [64165]

    Prolonged administration of systemic dexamethasone can result in edema and fluid retention due to sodium retention; electrolyte disturbances (hypokalemia, hypokalemic metabolic alkalosis, hypernatremia, hypocalcemia); and hypertension.[60760] [60761] [64165] In a review of 93 studies of corticosteroid use, hypertension was found to develop 4 times as often in steroid recipients compared to control groups.[24362] In another study, an increased risk of heart failure was observed for medium-dose glucocorticoid use as compared with nonuse. At the beginning of the study, patients were at least 40 years of age and had not been hospitalized for cardiovascular disease. Medium exposure was defined as less than 7.5 mg daily of prednisolone or the equivalent given orally, rectally, or parenterally.[30697] Increased blood pressure was noted in 13% of dexamethasone ophthalmic insert recipients for one of the products during clinical trials.[41921]

    Adverse neurologic effects have been reported during prolonged systemic dexamethasone administration and include insomnia, vertigo or dizziness, restlessness, amnesia and memory impairment, increased motor activity, impaired cognition, paresthesias, ischemic peripheral neuropathy, seizures, neuritis, and EEG changes. Mental disturbances, including depression, anxiety, euphoria, personality changes, emotional lability, delirium, dementia, hallucinations, irritability, mania, mood swings, schizophrenic reactions, withdrawn behavior, and psychosis have also been reported; emotional lability and psychotic problems can be exacerbated by corticosteroid therapy. Headache may be a sign of elevated intracranial pressure.[60760] [60761] [64165] Arachnoiditis, meningitis, paresis, paraplegia, and sensory disturbances have occurred after intrathecal administration. Serious neurologic events, some resulting in death, have been reported with epidural injection of corticosteroids. Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke.[60760] Headache was noted in 1% to 4% of dexamethasone ophthalmic insert/implant recipients during clinical trials, at incidences higher than with placebo.[41921] [63796]

    Dexamethasone can cause increased intraocular pressure or ocular hypertension, the magnitude of which depends on the formulation used, indication for use, and the frequency and duration of dosing. Ocular hypertension can occur after 1 to 6 weeks of topical ophthalmic therapy, and it is usually reversible upon discontinuance of the drug. Use of the intravitreal implant has resulted in ocular hypertension (glaucoma) in 5% of patients in clinical trials and increased ocular pressure (IOP) occurred in 25% to 35% of patients receiving the intravitreal implant. In retinal vein occlusion (RVO) and uveitis trials, IOP peaked at 60 days, returning to baseline by day 180. During the initial treatment period with the intravitreal implant for RVO and uveitis, 1% of patients required laser or surgical procedures to manage elevated IOP. In a 2-year observational study with the intravitreal implant, among patients who received more than 2 injections, increased IOP was reported in 24% (n = 68) patients. Frequently check IOP during receipt of ophthalmic preparations of dexamethasone. In diseases that cause thinning of the cornea or sclera, topical ocular steroids have been known to cause perforation. Intravitreal injections have also been associated with endophthalmitis, ocular inflammation, and retinal detachment. In clinical trials, the use of the intravitreal implant has resulted in ocular hemorrhage (conjunctival hemorrhage) (22% to 23%), ocular pain (8%), conjunctival hyperemia (7%), conjunctivitis (6%), vitreous floaters (5%), conjunctival edema (5%), xerophthalmia (5%), vitreous opacities (3%), retinal aneurysm (3%), foreign body sensation (2%), corneal erosion (2%), keratitis (2%), anterior chamber inflammation (2%), retinal tear (2%), eyelid ptosis (2%), vitreous hemorrhage (ocular hemorrhage, 6%), and vitreous detachment (2% to 4%). Postmarketing, complication of device insertion resulting in ocular tissue injury including sclera, subconjunctiva, lens and retina (implant misplacement), device dislocation with or without corneal edema, and ocular hypotonia (associated with vitreous leakage due to injection) were noted. Patients with an absent or torn posterior capsule of the lens are at increased risk of migration of the intravitreal implant into the anterior chamber.[41921] The most common ocular adverse reactions that occurred in patients treated with dexamethasone ophthalmic insert for ocular inflammation and pain following ophthalmic surgery were: anterior chamber inflammation including iritis and iridocyclitis (10%), increased intraocular pressure (6%), reduced visual acuity (2%), ocular pain (1%), cystoid macular edema (1%), corneal edema (1%), and conjunctival hyperemia (1%). The most common ocular adverse reactions that occurred in patients treated with dexamethasone ophthalmic insert for itching associated with allergic conjunctivitis were: increased intraocular pressure (3%), increased lacrimation (1%), ocular discharge (1%), and reduced visual acuity (1%).[63796] Ocular irritation including transient stinging, burning, or tearing and keratoconjunctivitis may occur during use of ophthalmic dexamethasone. Allergic reactions have also been reported; ocular pruritus can occur. Ocular discomfort (10%) and eye irritation (1%) were the most frequently reported adverse reactions in clinical studies with dexamethasone ophthalmic suspension. All other adverse reactions from these studies occurred with a frequency less than 1% including keratitis, conjunctivitis, dry eye (xerophthalmia), photophobia, blurred vision, ocular pruritus, foreign body sensation, increased lacrimation, abnormal ocular sensation, eyelid margin crusting, and ocular hyperemia. Postmarketing adverse reactions with dexamethasone topical ophthalmic suspension use include corneal erosion, dizziness, ocular pain, eyelid ptosis, headache, hypersensitivity reactions, and mydriasis.[61633] In patients receiving dexamethasone intraocular suspension for injection, the most common adverse reactions occurring in 5% to 15% of patients included intraocular pressure or ocular hypertension, corneal edema and iritis. Other ocular adverse reactions occurring in 1% to 5% of patients included corneal endothelial cell loss, blepharitis, ocular pain, cystoid macular edema, xerophthalmia, ocular inflammation, posterior capsule opacification, blurred vision, reduced visual acuity, vitreous floaters, foreign body sensation, photophobia, and vitreous detachment.[48640] Prolonged use of dexamethasone therapy by any route can result in ocular nerve damage including optic neuritis and visual defects. Temporary or permanent visual impairment, including blurred vision and blindness, has been reported with glucocorticoid administration by several routes of administration including intranasal and ophthalmic administration. Other ocular adverse reactions resulting from systemic corticosteroid therapy can include corneal perforation, exophthalmos, slowing of corneal wound healing, increased intraocular pressure, glaucoma with possible damage to the optic nerves, blurred vision, or retinopathy.[60760] [60761] [64165] Consider referring patients who develop ocular symptoms or use systemic corticosteroid-containing products for more than 6 weeks to an ophthalmologist for evaluation.[41921] [48640] [60760] [60761] [61633] [64165] Dexamethasone (by any route) can reduce host resistance to infection. Secondary fungal and viral infections of the eye (ocular infection) can be masked or exacerbated by corticosteroid therapy. Investigate the possibility of fungal infection if patients have persistent corneal ulceration. Prolonged use of dexamethasone therapy by any route has resulted in posterior subcapsular cataracts.[48640] [60760] [60761] [64165] The mechanism of corticosteroid-induced cataract formation is uncertain but may involve disruption of sodium-potassium pumps in the lens epithelium leading to accumulation of water in lens fibers and agglutination of lens proteins.[24813] The incidence of cataracts with initial use of the intravitreal implant in clinical trials of patients with RVO or uveitis was 5% within the first 6 months; however, the overall incidence after a second intravitreal implant injection was higher after 1 year. In diabetic macular edema (DME) trials, the incidence of cataract development in patients who had a phakic study eye was higher in the dexamethasone group (68%) compared with sham (21%). Among these patients, 61% of dexamethasone subjects vs. 8% of sham-controlled subjects underwent cataract surgery. In a 2-year observational study, among patients who received more than 2 injections, the most frequent adverse reaction was cataract 54% (n = 96 out of 178 phakic eyes at baseline).[41921]

    Hypercholesterolemia, atherosclerosis, fat embolism, palpitations, sinus tachycardia, bradycardia, syncope, vasculitis, necrotizing angiitis, thrombosis, thromboembolism, and phlebitis, specifically, thrombophlebitis, have been associated with systemic corticosteroid therapy such as dexamethasone. Systemic glucocorticoid use appears to increase the risk of cardiovascular events such as myocardial infarction, left ventricular rupture (in persons who recently experienced a myocardial infarction), angina, angioplasty, coronary revascularization, stroke, transient ischemic attack, cardiomegaly, arrhythmia exacerbation and ECG changes, hypertrophic cardiomyopathy (in premature infants), congestive heart failure and pulmonary edema, cardiac arrest or cardiovascular death.[60760] [60761] [64165] As determined from observational data, the rate of cardiovascular events was 17 per 1,000 person-years among 82,202 non-users of glucocorticoids. In contrast, the rate was 23.9 per 1,000 person-years among 68,781 glucocorticoid users. Furthermore, the rate of cardiovascular events was 76.5 per 1,000 person-years for high exposure patients. After adjustment for known covariates by multivariate analysis, high-dose glucocorticoid use was associated with a 2.56-fold increased risk of cardiovascular events as compared with nonuse. At the beginning of the study, patients were at least 40 years of age and had not been hospitalized for cardiovascular disease. High glucocorticoid exposure was defined as at least 7.5 mg daily of prednisolone (or equivalent) given orally, rectally, or parenterally whereas medium exposure was defined as less than the above dosage by any of the 3 routes. Low-dose exposure was defined as inhaled, topical, or nasal usage only.[30697]

    Cases of elevated hepatic enzymes (usually reversible upon discontinuation) and hepatomegaly have been associated with corticosteroid receipt such as dexamethasone.[60760] [60761] [64165]

    Revision Date: 03/12/2023, 04:26:23 PM

    References

    24362 - Conn HO, Poynard T. Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J Intern Med 1994;236:619-32.24813 - Cumming RG, Mitchell P, Leeder SR, et al. Use of inhaled corticosteroids and the risk of cataracts. N Engl J Med 1997;337:8-14.24837 - Reid IR. Preventing glucocorticoid-induced osteoporosis. N Engl J Med 1997;337:420-1.30697 - Wei L, MacDonald TM, Walker BR. Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med 2004;141:764-70.30943 - Schimmer B, Parker K. Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Hardman JG, Limbird LE, Molinoff PB, et al., eds. Goodman and Gilman's the Pharmacological Basis of Therapeutics, 10th edition. New York: McGraw Hill, 2001;1649-1674.41921 - Ozurdex (dexamethasone intravitreal implant) package insert. Madison, NJ: Allergan USA, Inc.; 2022 Dec.48640 - Dexycu (dexamethasone intraocular suspension) package insert. Watertown, MA: EyePoint Pharmaceuticals US, Inc.; 2020 Jun.54348 - Dexamethasone sodium phosphate ophthalmic solution package insert. Bridgewater, NJ: Bausch and Lomb Inc.; 2016 June.60760 - Dexamethasone sodium phosphate injection package insert. Eatontown, NJ:West-Ward Pharmaceuticals;2014 Sept.60761 - Dexamethasone tablets USP, Dexamethasone oral solution, and Dexamethasone Intensol (oral solution concentrate) package insert. Eatontown, NJ: West-Ward Pharmaceuticals Corp; 2016 March.61633 - Maxidex (dexamethasone ophthalmic suspension 0.1%) package insert. East Hanover, NJ; Novartis Pharmaceuticals Corp. 2021 Dec.63796 - Dextenza (dexamethasone ophthalmic insert) package insert. Bedford, MA: Ocular Therapeutix, Inc.; 2021 Oct.64165 - Dexamethasone (Decadron) tablets package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2019 May.65096 - Abramson N, Melton B. Leukocytosis: basic of clinical assessment. Am Fam Physician 2000;62:2053-60.65097 - Shoenfeld Y, Gurewich Y, Gallant LA, et al. Prednisone-induced leukocytosis. Influenced of dosage, method and duration of administration on the degree of leukocytosis. Am J Med 1981;71:773-8.68700 - Tamez-Perez HE, Quintanilla-Flores DL, Rodriguez-Gutierrez R, et al. Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review. World J Diabetes. 2015;6:1073-1081.

    Contraindications/Precautions

    Absolute contraindications are italicized.

    • fungal infection
    • glaucoma
    • herpes simplex virus epithelial keratitis
    • rupture of posterior ocular lens capsule
    • tympanic membrane perforation
    • abrupt discontinuation
    • adrenal insufficiency
    • benzyl alcohol hypersensitivity
    • breast-feeding
    • cataracts
    • corneal abrasion
    • corticosteroid hypersensitivity
    • Cushing's syndrome
    • diabetes mellitus
    • diverticulitis
    • epidural administration
    • geriatric
    • GI perforation
    • growth inhibition
    • head trauma
    • heart failure
    • helminth infection
    • hepatic disease
    • herpes infection
    • hypertension
    • hyperthyroidism
    • hypothalamic-pituitary-adrenal (HPA) suppression
    • hypothyroidism
    • immunosuppression
    • impaired wound healing
    • increased intracranial pressure
    • increased intraocular pressure
    • infection
    • measles
    • myasthenia gravis
    • myocardial infarction
    • myopia
    • neonates
    • neuromuscular disease
    • ocular infection
    • osteopenia
    • osteoporosis
    • peptic ulcer disease
    • pregnancy
    • premature neonates
    • psychosis
    • renal disease
    • seizure disorder
    • sulfite hypersensitivity
    • surgery
    • thyroid disease
    • tuberculosis
    • ulcerative colitis
    • vaccination
    • varicella
    • viral infection
    • visual disturbance

    Epidural administration of corticosteroids should be used with great caution. Rare, but serious adverse reactions, including cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been associated with epidural administration of injectable corticosteroids. These events have been reported with and without the use of fluoroscopy. Many cases were temporally associated with the corticosteroid injection; reactions occurred within minutes to 48 hours after injection. Some cases of neurologic events were confirmed through magnetic resonance imaging (MRI) or computed tomography (CT) scan. Many patients did not recover from the reported adverse effects. Discuss the benefits and risks of epidural corticosteroid injections with the patient before treatment. If a decision is made to proceed with corticosteroid epidural administration, counsel patients to seek emergency medical attention if they experience symptoms after injection such as vision changes, tingling in the arms or legs, dizziness, severe headache, seizures, or sudden weakness or numbness of face, arm, or leg.[57052] [57053]

    Dexamethasone is contraindicated in patients with a hypersensitivity to the drug or any of its components. Although true corticosteroid hypersensitivity is rare, it is possible, though also rare, that such patients will display cross-hypersensitivity to other corticosteroids. It is advisable that patients who have a hypersensitivity reaction to any corticosteroid undergo skin testing, which, although not a conclusive predictor, may help to determine if hypersensitivity to another corticosteroid exists. Such patients should be carefully monitored during and following the administration of any corticosteroid.[65868] [27616] [54285] [54286] [64165] [48640] [41921] [63796] [49533] [54348]

    Prolonged administration of pharmacological doses of systemic, nasal, inhaled or topical corticosteroids (resulting in systemic absorption) may result in hypothalamic-pituitary-adrenal (HPA) suppression and/or manifestations of Cushing's syndrome in some patients. Adrenal suppression and increased intracranial pressure have been reported with the use and/or withdrawal of various corticosteroid formulations in pediatric patients.[60760] [51792] Acute adrenal insufficiency and even death may occur following abrupt discontinuation of systemic therapy. In addition, a withdrawal syndrome unrelated to adrenocortical insufficiency may occur following sudden discontinuation of corticosteroid therapy.[60760] [60761] [64165] These effects are thought to be due to the sudden change in glucocorticoid concentration rather than to low corticosteroid concentrations. Withdraw prolonged systemic corticosteroid therapy (duration of treatment of more than 2 weeks) gradually. HPA suppression can last for up to 12 months following cessation of systemic therapy. Recovery of HPA axis function is generally prompt and complete upon discontinuation of the topical corticosteroid. HPA-suppressed patients may need supplemental corticosteroid treatment during periods of physiologic stress, such as post-surgical stress, acute blood loss, or infectious conditions, even after the corticosteroid has been discontinued. Encourage patients currently receiving chronic corticosteroid therapy or who have had corticosteroids discontinued within the last 12 months to carry identification advising the need for administration of corticosteroids in situations of increased stress.[54138] [54286] [64165] [60760] [60761]

    Potential adverse effects of chronic corticosteroid therapy should be weighed against the clinical benefits obtained and the availability of other treatment alternatives. Prolonged systemic corticosteroid therapy can lead to osteopenia, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, and pathologic fractures of long bones secondary to decreased bone formation, increased bone resorption, and protein catabolism in any patient.[60760] [60761] [64165] A high-protein diet may alleviate or prevent the adverse effects associated with protein catabolism. The elderly, post-menopausal, and pediatric patients may be more susceptible to the effects on bone. Chronic systemic dexamethasone therapy may cause growth inhibition in pediatric patients due to hypothalamic-pituitary-adrenal axis suppression and inhibition of bone growth. Corticosteroids should be titrated to the lowest effective dose. Because bone development is critical in pediatric patients, monitoring is warranted in patients receiving high-dose or chronic corticosteroid treatment. Use of the lowest effective dose is recommended to minimize the occurrence of systemic adverse effects. Monitor growth routinely.[51792] [60760] [60761] [64165]

    Patients receiving high-dose (e.g., equivalent to 1 mg/kg or more of prednisone daily) or systemic corticosteroid therapy, such as dexamethasone, for any period of time, particularly in conjunction with corticosteroid-sparing drugs (e.g., troleandomycin) are at risk to develop immunosuppression; however, patients receiving moderate dosages of systemic corticosteroids for short periods or low dosages for prolonged periods also may be at risk. Treatment with topical or inhaled corticosteroids lessens the risk of immunosuppression; although localized effects may be seen in some patients. When given in combination with other immunosuppressive agents, there is a risk of over-immunosuppression.[60760] [60761] [64165] Intra-articularly injected corticosteroids are systemically absorbed and may cause immunosuppression. Advise patients to contact their health care provider if they develop fever or other signs or symptoms of an infectious process. Local injection of a corticosteroid into a previously infected joint is not usually recommended. Examine any joint fluid to exclude a septic process. Injection into unstable joints is generally not recommended.[60760]

    If surgery is required, patients should advise their physician that they received prolonged systemic corticosteroid therapy, such as dexamethasone, within the last 12 months and state the disease for which they were being treated. For systemic therapy, identification cards that include disease state, type and dose of corticosteroid, and physician should always be carried with the patient. Long-acting dexamethasone injection preparations, which are no longer marketed in the U.S., are not suitable for use in acute stress situations. To avoid drug-induced adrenal insufficiency, a supportive corticosteroid dosage may be required in times of stress (such as trauma, surgery, or severe illness) both during treatment with these injections and for a year afterward.[60760] [60761] [64165]

    Corticosteroids may increase the risks related to infections with any pathogen, including viral, bacterial, fungal, protozoan, or helminth infection. The degree to which the dose, route, and duration of corticosteroid administration correlate with the specific risks of infection is not well characterized, however, with increasing doses of corticosteroids, the rate of occurrence of infectious complications increases. Corticosteroids may also mask some signs of current infection. Although the FDA-approved product labeling states that corticosteroids are contraindicated in patients with systemic fungal infections, most clinicians believe that systemic corticosteroids can be administered to these patients as long as appropriate therapy is administered simultaneously. Avoid the use in patients with a fungal infection or bacterial infection that is not adequately controlled with anti-infective agents. Activation of latent disease or exacerbation of intercurrent infection due to pathogens such as Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, or Toxoplasma can occur in patients receiving systemic corticosteroids. Rule out infection with latent or active amebiasis before initiating corticosteroid therapy in patients who have spent time in the tropics or who have unexplained diarrhea. Use corticosteroids with caution in patients with known or suspected Strongyloides (threadworm) infestation as the immunosuppressive effects may lead to disseminated infection, severe enterocolitis, and sepsis. Cases of severe and disseminated strongyloidiasis have been reported following use of corticosteroids in combination with tocilizumab to treat patients with coronavirus disease 2019 (COVID-19). Before giving these drugs together to patients from strongyloidiasis endemic areas, consider administering ivermectin as prophylactic treatment.[65314] Reserve systemic corticosteroid therapy in active tuberculosis for patients with fulminating or disseminated disease and only in conjunction with appropriate antituberculosis therapy. Reactivation of tuberculosis may occur in patients with latent tuberculosis or tuberculin reactivity; close observation for disease reactivation is needed if corticosteroids are indicated in such patients. Furthermore, chemoprophylaxis is advised if prolonged corticosteroid therapy is needed. Advise patients receiving immunosuppressive doses of systemic corticosteroids to avoid exposure to persons with a viral infection (i.e., measles or varicella) because these diseases may be more serious or even fatal in immunosuppressed patients. Instruct patients to get immediate medical advice if exposure occurs. If exposed to chickenpox, prophylaxis with varicella-zoster immune globulin may be indicated. If exposed to measles, prophylaxis with pooled intramuscular immunoglobulin may be indicated. Avoid the use of corticosteroids in active ocular herpes infection due to the risk of corneal perforation. Corticosteroids should not be used in cerebral malaria.[65868] [60760] [60761] [64165] The use of ophthalmic dexamethasone formulations is contraindicated in most forms of cornea and conjunctiva viral ocular infections including herpes simplex virus epithelial keratitis, ocular vaccinia, and ocular varicella, and also in mycobacterial infection of the eye or fungal diseases of the eye.[48640] [41921] [63796] [49533] [54348]

    Do not use high doses of systemic corticosteroids such as dexamethasone for the treatment of traumatic brain injury. An increase in early mortality (at 2 weeks) and late mortality (at 6 months) was noted in patients with head trauma who were determined not to have other clear indications for corticosteroid treatment; in the trial, patients received methylprednisolone hemisuccinate.[60760]

    Corticosteroid therapy, including systemic dexamethasone therapy, has been associated with left ventricular free-wall rupture in patients with recent myocardial infarction, and should therefore be used cautiously in these patients. As sodium retention with resultant edema and potassium loss may occur in patients receiving systemic corticosteroids, these agents should be used with caution in patients with congestive heart failure, hypertension, or renal disease or insufficiency.[60760] [60761] [64165]

    Systemic corticosteroids, such as dexamethasone, may decrease glucose tolerance, produce hyperglycemia, and aggravate or precipitate diabetes mellitus. This may especially occur in patients predisposed to diabetes mellitus. When corticosteroid therapy is necessary for patients with diabetes mellitus, changes in insulin, oral antidiabetic agent dosage, and/or diet may be required.[60760] [60761] [64165]

    An acute myopathy has been observed with the use of high doses of systemic corticosteroids, most often occurring in patients with neuromuscular disease disorders (e.g., myasthenia gravis), or in patients receiving concomitant therapy with neuromuscular blocking drugs. This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Elevation of creatinine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.[60760] [60761] [64165]

    Existing emotional instability or psychosis may be aggravated by corticosteroids. Psychiatric derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychosis. Use dexamethasone with caution in patients with a seizure disorder; systemic steroids can lower the seizure threshold.[60760] [60761] [64165]

    Metabolic clearance of corticosteroids is decreased in hypothyroidism and increased in hyperthyroidism. Changes in thyroid disease status of a patient may necessitate an adjustment in systemic dexamethasone dosage.[60760] [60761] [64165]

    Systemic corticosteroids should be used with caution in patients with active or latent peptic ulcer disease, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis, since steroids may increase the risk of a gastrointestinal (GI) perforation. Signs of peritoneal irritation following GI perforation in patients receiving corticosteroids may be minimal or absent. Corticosteroids should not be used in patients where there is a possibility of impending GI perforation, abscess, or pyogenic infection. There is an enhanced effect due to decreased metabolism of systemic corticosteroids in patients with severe hepatic disease with cirrhosis.[60760] [60761] [64165]

    Systemic corticosteroids, like dexamethasone, may cause impaired wound healing. Ophthalmic and ocular dosage forms may cause impairment of wound healing within or near the site of application.[60760] [60761] [64165] [48640] [41921] [63796] [49533] [54348]

    Prolonged use of corticosteroids including dexamethasone may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. Corticosteroids can cause cataracts and exacerbate pre-existing glaucoma. Periodically assess patients receiving corticosteroids chronically for cataract formation, visual disturbance, or increased intraocular pressure. Consider referring patients who develop ocular symptoms or use systemic corticosteroid-containing products for more than 6 weeks to an ophthalmologist for evaluation.[60760] [60761] [64165] Ophthalmic dexamethasone is more likely than other ophthalmic agents to increase intraocular pressure, so intraocular pressure should be measured every 2 to 4 weeks for the first 2 months of therapy, and every 1 to 2 months thereafter. Ophthalmic dexamethasone therapy should be undertaken with caution in patients with a history of open-angle glaucoma, myopia, Krukenberg's spindle, or diabetes because these patients have an increased risk of developing ocular hypertension during therapy. The dexamethasone intravitreal implant is contraindicated in patients with glaucoma who have cup to disc ratio more than 0.8. Ophthalmic dexamethasone should be used with caution in patients with corneal abrasion.[54348] [61633] [41921] [48640] [63796]  Dexamethasone intravitreal implant is also contraindicated in patients who have a tear or a rupture of posterior ocular lens capsule; these patients with an absent or torn posterior capsule of the lens are at increased risk of migration of the intravitreal implant into the anterior chamber. Laser posterior capsulotomy in pseudophakic patients is not a contraindication for the dexamethasone intravitreal implant.[41921] The initial prescription and renewal of the medication order of dexamethasone intravitreal implant should be made only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy, and, where appropriate, fluorescein staining. If signs and symptoms fail to improve after 2 days, re-evaluate the patient.[63796] The safety and efficacy of dexamethasone intravitreal implant, ophthalmic injection suspension, and ophthalmic insert have not been established in pediatric patients.[41921] [48640] [63796]

    Corticosteroid therapy usually does not contraindicate vaccination with live-virus vaccines when such therapy is of short-term (less than 2 weeks); low to moderate dose; long-term alternate-day treatment with short-acting preparations; maintenance physiologic doses (replacement therapy); ophthalmic administration, or by intra-articular, bursal or tendon injection. The immunosuppressive effects of steroid treatment differ, but many clinicians consider a dose equivalent to either 2 mg/kg/day or 20 mg/day of prednisone as sufficiently immunosuppressive to raise a concern about the safety of immunization with live-virus vaccines. In general, patients with severe immunosuppression due to large doses of corticosteroids should not receive vaccination with live-virus vaccines. When cancer chemotherapy or immunosuppressive therapy is being considered (e.g., for patients with Hodgkin's disease or organ transplantation), vaccination should precede the initiation of chemotherapy or immunotherapy by 2 or more weeks. Patients vaccinated while on immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated at least 3 months after discontinuation of therapy. In patients who have received high-dose, systemic corticosteroids for 2 or more weeks, it is recommended to wait at least 3 months after discontinuation of therapy before administering a live-virus vaccine.[60760] [60761]

    There are no adequate, well-controlled studies for the use of dexamethasone in pregnant women; therefore, the manufacturers recommend that the drug be used during pregnancy only if the potential benefit to the mother outweighs the potential risk to the fetus. For COVID-19, the National Institutes of Health (NIH) recommends use of the drug in pregnant patients, if indicated, as the potential benefit of decreased maternal mortality justifies the low risk of fetal adverse effects with the short course of therapy.[65314] Corticosteroids have been shown to be teratogenic in many species when given in systemic doses equivalent to the human dose. Animal studies in which corticosteroids have been given to pregnant mice, rats, and rabbits have yielded an increased incidence of cleft palate in the offspring.[60760] [60761] [64165] In addition, dexamethasone has been shown to be teratogenic in mice and rabbits following topical ophthalmic application in multiples of the therapeutic dose.[61633] Topical ocular administration of dexamethasone to pregnant mice and rabbits during organogenesis produced embryofetal lethality, cleft palate and multiple visceral malformations.[41921] [63796] Topical and otic corticosteroids should not be used in large amounts, on large areas, or for prolonged periods of time in pregnant women. Dexamethasone injections have been used medically later in pregnancy to induce fetal lung maturation in patients at risk for pre-term delivery; use is for select circumstances and for a limited duration of time.[33038] [33039] [33040] An infant who is born to a woman receiving large doses of systemic corticosteroids during pregnancy should be monitored for signs of adrenal insufficiency, and appropriate therapy should be initiated, if necessary.

    Systemic use of dexamethasone has not been studied during breast-feeding; corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. Caution is warranted, and some manufacturers recommend discontinuing breast-feeding if systemic dexamethasone treatment is needed.[60760] [60761] [64165] However, experts generally consider inhaled corticosteroids and oral corticosteroids (e.g., prednisone and prednisolone), acceptable to use during breast-feeding.[33723] [33724] [31822] There is no information regarding dexamethasone effects on breastfed infants or milk production or its presence in human milk following placement of the intravitreal implant or intracanalicular insert to inform risk to an infant during lactation.[41921] [63796] However, the systemic concentration of dexamethasone following administration of the intracanalicular insert is low.[63796] It is not known whether topical ophthalmic administration of dexamethasone could result in sufficient systemic absorption to produce detectable quantities in breast milk.[61633] [49533] For COVID-19, the National Institutes of Health (NIH) recommends dexamethasone be offered to lactating mothers who qualify for therapy without interruption of breast-feeding.[65314] Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition.

    The routine use of high-dose (greater than 0.5 mg/kg/day) dexamethasone for either the prevention or treatment of chronic lung disease in premature neonates is not recommended by the American Academy of Pediatrics (AAP) due to a lack of survival benefit and concern about long-term adverse outcomes, particularly increased rates of cerebral palsy. Studies utilizing lower doses of dexamethasone (less than 0.2 mg/kg/day) have not reported increased rates of adverse neurodevelopmental effects; however, due to the small number of patients included in these studies, the AAP states that there is insufficient evidence to recommend the use of low-dose dexamethasone and further study is warranted.[54338] In a geographical cohort study of 148 extremely premature pediatric patients (born less than 28 weeks gestation), 55 (27%) received postnatal dexamethasone (mean cumulative dose 7.7 mg/kg) during the neonatal period. Patients receiving dexamethasone had smaller total brain tissue volume (mean difference -3.6%, p value = 0.04) and smaller white matter, thalami, and basal ganglia volumes (p is less than 0.05 for all) when compared with participants who did not receive postnatal dexamethasone. There was also a trend of smaller total brain and white matter volumes with an increased dose of postnatal dexamethasone.[56910] Avoid the use of dexamethasone injectable formulations containing benzyl alcohol in premature neonates and neonates. Administration of benzyl alcohol to neonates can result in 'gasping syndrome,' which is a potentially fatal condition characterized by metabolic acidosis and CNS, respiratory, circulatory, and renal dysfunction; it is also characterized by high concentrations of benzyl alcohol and its metabolites in the blood and urine. While the minimum amount of benzyl alcohol at which toxicity may occur is not known, 'gasping syndrome' has been associated with daily benzyl alcohol exposure above 99 mg/kg/day in neonates and low-birth-weight neonates. Additional symptoms may include gradual neurological deterioration, seizures, intracranial hemorrhage, hematologic abnormalities, skin breakdown, hepatic failure, renal failure, hypotension, bradycardia, and cardiovascular collapse. Rare cases of death, primarily in premature neonates, have been reported. Further, an increased incidence of kernicterus, especially in small, premature neonates has been reported. Practitioners administering this and other medications containing benzyl alcohol should consider the combined daily metabolic load of benzyl alcohol from all sources. Premature neonates, neonates with low birth weight, and patients who receive a high dose may be more likely to develop toxicity.[60760]

    Use systemic corticosteroids with caution in the geriatric patient; the risks and benefits of therapy should be considered for any individual patient. Geriatric and debilitated patients are especially susceptible to corticosteroid-induced decreases in bone mineral density and resultant fractures. Detrimental effects on bone metabolism, such as osteoporosis, are a risk with chronic, systemically-administered corticosteroids.[60760] [60761] [64165] According to the Beers Criteria, systemic corticosteroids are considered potentially inappropriate medications (PIMs) for use in geriatric patients with delirium or at high risk for delirium and should be avoided in these patient populations due to the possibility of new-onset delirium or exacerbation of the current condition. The Beers expert panel notes that oral and parenteral corticosteroids may be required for conditions such as exacerbation of chronic obstructive pulmonary disease (COPD) but should be prescribed in the lowest effective dose and for the shortest possible duration.[63923] The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities (LTCFs); the need for continued use of a systemic glucocorticoid should be documented, along with monitoring for adverse consequences with intermediate or longer-term use.[60742]

    Some commercially available formulations of dexamethasone injection or ophthalmic solution may contain sulfites; some parenteral products also contain benzyl alcohol. Sulfites and benzyl alcohol may cause allergic reactions in some people. They should be used with caution in patients with known sulfite hypersensitivity or benzyl alcohol hypersensitivity. Patients who have asthma are more likely to experience a sulfite sensitivity reaction than non-asthmatic patients.[54348] [60760]

    Dexamethasone ophthalmic solutions are sometimes used off-label in the ear for otic conditions. Otic dexamethasone use is contraindicated for use in patients with tympanic membrane perforation.[54348]

    Revision Date: 04/21/2023, 01:41:44 PM

    References

    27616 - Butani L. Corticosteroid-induced hypersensitivity reactions. Ann Allergy Asthma Immunol 2002;89(5):439-445.31822 - NAEPP Working Group Report on Managing Asthma During Pregnancy. Recommendations for Pharmacologic Treatment-Update 2004. NIH Publication No. 05-3279. Bethesda, MD: U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute, 200433038 - Di Renzo GC, Roura LC, European Association of Perinatal Medicine-Study Group on Preterm Birth. International guidelines: Guidelines for the management of spontaneous preterm labor. J Perinat Med 2006;34:359-66.33039 - ACOG Committee on Practice Bulletins. ACOG Practice Bulletin: Management of preterm labor. Int J Gynecol Obstet 2003;82:127-35.33040 - Ballard PL, Ballard RA. Scientific basis and therapeutic regimens for use of antenatal glucocorticoids. Am J Obstet Gynecol 1995;173:254-62.33723 - Greenberger PA, Patterson R. The management of asthma during pregnancy and lactation. Clin Rev Allergy 1987;5:317-24.33724 - Ellsworth A. Pharmacotherapy of asthma while breastfeeding. J Hum Lact 1994;10:39-41.41921 - Ozurdex (dexamethasone intravitreal implant) package insert. Madison, NJ: Allergan USA, Inc.; 2022 Dec.48640 - Dexycu (dexamethasone intraocular suspension) package insert. Watertown, MA: EyePoint Pharmaceuticals US, Inc.; 2020 Jun.49533 - Maxidex (dexamethasone) ophthalmic ointment package insert. Ft. Worth, TX: Alcon Laboratories, Inc.; 2006 Dec.51792 - Patradoon-Ho P, Gunasekera H, Ryan MM. Inhaled corticosteroids, adrenal suppression and benign intracranial hypertension. Med J Aust 2006;185:279-28054138 - Shulman DI, Palmert MR, Kemp SF. Adrenal insufficiency: still a cause of morbidity and death in childhood. Pediatrics 2007;119(2):e484-494.54285 - Dexamethasone sodium phosphate injection solution. Schaumburg, IL: APP Pharmaceuticals, LLC; 2008 Apr.54286 - Dexamethasone tablets USP, Dexamethasone oral solution, and Dexamethasone Intensol (oral solution concentrate) package insert. Eatontown, NJ: West-Ward Pharmaceuticals Corp; 2016 March.54338 - American Academy of Pediatrics Committee on Fetus and Newborn. Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia. Pediatrics 2010;126:800-8.54348 - Dexamethasone sodium phosphate ophthalmic solution package insert. Bridgewater, NJ: Bausch and Lomb Inc.; 2016 June.56910 - Cheong JL, Burnett AC, Lee KJ. Association between postnatal dexamethasone for treatment of bronchopulmonary dysplasia and brain volumes at adolescence in infants born very preterm. J Pediatr. 2014; 164(4): 737-743.57052 - Food and Drug Administration (US FDA) MedWatch. Epidural corticosteroid injections: drug safety communications - risk of rare but serious neurologic problems. Retrieved April 23, 2014. Available on the World Wide Web at:http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm394530.htm.57053 - Food and Drug Administration (US FDA) Drug Medwatch-FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. Retrieved April 23, 2014. Available on the World Wide Web at http://www.fda.gov/downloads/Drugs/DrugSafety/UCM394286.pdf.60742 - Health Care Financing Administration. Interpretive Guidelines for Long-term Care Facilities. Title 42 CFR 483.25(l) F329: Unnecessary Drugs. Revised 2015.60760 - Dexamethasone sodium phosphate injection package insert. Eatontown, NJ:West-Ward Pharmaceuticals;2014 Sept.60761 - Dexamethasone tablets USP, Dexamethasone oral solution, and Dexamethasone Intensol (oral solution concentrate) package insert. Eatontown, NJ: West-Ward Pharmaceuticals Corp; 2016 March.61633 - Maxidex (dexamethasone ophthalmic suspension 0.1%) package insert. East Hanover, NJ; Novartis Pharmaceuticals Corp. 2021 Dec.63796 - Dextenza (dexamethasone ophthalmic insert) package insert. Bedford, MA: Ocular Therapeutix, Inc.; 2021 Oct.63923 - The American Geriatrics Society 2019 Beers Criteria Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019;00:1-21.64165 - Dexamethasone (Decadron) tablets package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2019 May.65314 - COVID-19 Treatment Guidelines Panel. Coronavirus Diseases 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Accessed April 20, 2023. Available at on the World Wide Web at: https://covid19treatmentguidelines.nih.gov/.65868 - Hemady (dexamethasone) tablets package insert. East Windsor, NJ: Acrotech Biopharma, LLC; 2021 June.

    Mechanism of Action

    Glucocorticoids are naturally occurring hormones that prevent or suppress inflammation and immune responses when administered at pharmacological doses. At the molecular level, unbound glucocorticoids readily cross cell membranes and bind with high affinity to specific cytoplasmic receptors. This binding induces a response by modifying transcription and, ultimately, protein synthesis to achieve the steroid's intended action. Such actions can include: inhibition of leukocyte infiltration at the site of inflammation, interference in the function of mediators of the inflammatory response, and suppression of humoral immune responses. Some of the net effects include reduction in edema or scar tissue and a general suppression in an immune response. The degree of clinical effect is normally related to the dose administered. The anti-inflammatory actions of corticosteroids are thought to involve phospholipase A2 inhibitory proteins, collectively called lipocortins. Lipocortins, in turn, control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of the precursor molecule arachidonic acid. Likewise, the numerous adverse effects related to corticosteroid use usually depend on the dose administered and the duration of therapy.[30943][50600]

    Revision Date: 06/25/2020, 06:57:57 PM

    References

    30943 - Schimmer B, Parker K. Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Hardman JG, Limbird LE, Molinoff PB, et al., eds. Goodman and Gilman's the Pharmacological Basis of Therapeutics, 10th edition. New York: McGraw Hill, 2001;1649-1674.50600 - Barnes PJ. Anti-inflammatory actions of glucocorticoids: molecular mechanisms. Clin Sci (Lond). 1998;94(6):557-572.

    Pharmacokinetics

    Dexamethasone is administered via oral, intravenous, intramuscular, intraarticular, intravitreal, ophthalmic, and otic routes. Certain dosage forms, like inhalational products, have been removed from marketing. Circulating drug binds weakly to plasma proteins, with only the unbound portion of a dose being active. Systemic dexamethasone is quickly distributed into the kidneys, intestines, skin, liver, and muscle. Corticosteroids distribute into breast milk and cross the placenta. Systemic dexamethasone is metabolized by the liver to inactive metabolites. These inactive metabolites, as well as a small portion of unchanged drug, are excreted in the urine. The plasma elimination half-life of dexamethasone is approximately 1.8 to 3.5 hours whereas the biological half-life is 36 to 54 hours.[34477]

     

    Affected cytochrome P450 (CYP450) isoenzymes and drug transporters: CYP3A4, P-glycoprotein (P-gp)

    Dexamethasone is an inducer of CYP3A4 and is a substrate for both P-glycoprotein (P-gp) and CYP3A4.[34477]

    Route-Specific Pharmacokinetics

    Oral Route

    Dexamethasone is rapidly and well absorbed after oral administration.[38183] In adults, bioavailability has been reported to be in the range of approximately 60% to 100%, with no significant differences between the elixir and tablet formulations.[54046][54366] Peak concentrations occur 1 to 2 hours after oral administration.[54046] However, 1 study of 13 patients (aged 14 to 28 years) with congenital adrenal hyperplasia reported a mean time to peak concentrations for oral dexamethasone of 45 minutes (range 30 to 120 minutes).[54352]

    Intravenous Route

    Peak concentrations were reached approximately 60 minutes after single-dose administration of IV dexamethasone in neonates.[54368]

    Intramuscular Route

    The onset and duration of action of dexamethasone injection ranges from 2 days to 3 weeks and is dependent on whether the drug is administered by intra-articular or IM injection and by the extent of the local blood supply.

    Other Route(s)

    Intra-articular Route

    The onset and duration of action of dexamethasone injection ranges from 2 days to 3 weeks and is dependent on whether the drug is administered by intra-articular or IM injection and by the extent of the local blood supply.

     

    Ophthalmic Route

    Following ophthalmic administration, dexamethasone is absorbed through the aqueous humor and distribute into the local tissues, with only minimal systemic absorption occurring. Ophthalmic doses are metabolized locally.

     

    Intravitreal Implant Route

    After the insertion of the dexamethasone intravitreal implant (0.35 mg or 0.7 mg) in 21 patients, plasma concentrations were obtained on days 1, 7, 30, 60, and 90. Overall, the majority of dexamethasone plasma concentration measurements were below the lower limit of quantitation (LLOQ = 50 pg/mL). Ten of the 73 samples in the patients receiving the 0.7 mg dose and 2 of the 42 samples in the patients receiving the 0.35 mg dose were above the LLOQ (range, 52 to 94 pg/mL). The highest plasma concentration (94 pg/mL) was observed in one patient who had received the 0.7 mg dose. Age, body weight, and gender did not affect the plasma dexamethasone concentrations. In vitro metabolism studies of the intravitreal implant showed no metabolites.[41921]

     

    Intraocular Route

    Systemic exposure to dexamethasone was evaluated in a subgroup of patients enrolled in 2 studies (n = 25 for the first study and n = 13 for the second study). The patients received a single intraocular injection of dexamethasone containing 342 mcg or 517 mcg of dexamethasone at the end of cataract surgery and blood samples were collected prior to surgery and at the several time points post-surgery between Day 1 and up to Day 30. In the first study, the dexamethasone plasma concentrations on post-surgery Day 1 ranged from 0.09 to 0.86 ng/mL and from 0.07 to 1.16 ng/mL following administration of dexamethasone 342 mcg and 517 mcg, respectively. In the second study, dexamethasone plasma concentrations on post-surgery Day 1 ranged from 0.349 to 2.79 ng/mL following administration of dexamethasone 517 mcg. In both the studies, dexamethasone plasma concentrations declined over time and very few patients had quantifiable dexamethasone plasma concentrations at the final time point of sampling (Day 15 or Day 30).[48640]

     

    Intracanalicular Route

    Systemic exposure to dexamthasone was evaluated in 16 healthy volunteers. Plasma samples were obtained prior to and at several time points on Days 1 to 29. Dexamethasone plasma concentrations were detectable (above 50 pg/mL, the lower limit of quantification of the assay) in 11% of samples (21 of 189), and ranged from 0.05 ng/mL to 0.81 ng/mL.[63796]

    Special Populations

    Hepatic Impairment

    In adult patients with chronic liver disease, dexamethasone clearance is reduced and the elimination half-life is prolonged. Pharmacokinetic data are unavailable in pediatric patients with hepatic impairment.[54046]

    Renal Impairment

    In adult patients with renal impairment, dexamethasone clearance is increased and the elimination half-life is shorter. This is due to decreased protein binding of dexamethasone to albumin in uremic patients. Pharmacokinetic data are unavailable in pediatric patients with renal impairment.[54046]

    Pediatrics

    Infants, Children, and Adolescents

    Pharmacokinetics of dexamethasone in pediatric patients are similar to adults. In a pharmacokinetic study in 12 pediatric patients (4 months to 16 years) who received IV dexamethasone (0.1 to 0.3 mg/kg/dose), the mean elimination half-life of dexamethasone was 4.34 hours (range 2.33 to 9.54 hours), which is similar to that reported in adults. The mean volume of distribution (Vd) was 2.07 L/kg (range 0.48 to 8.99 L/kg).[54361] Another study that included adolescents and adults (14 to 28 years) reported a mean elimination half-life of 3.53 hours (range 2.18 to 4.5 hours) after dexamethasone administration.[54352]

     

    Neonates

    Clearance of dexamethasone in neonates is a function of gestational age (GA) with premature neonates having a slower clearance. In a pharmacokinetic study in 9 neonates (mean GA 27.3 weeks [range 25 to 30 weeks]; mean postnatal age 21.8 days), mean clearance was 1.69 mL/kg/minute in neonates with a GA less than 27 weeks compared with 7.57 mL/kg/minute in neonates with a GA more than 27 weeks. Corresponding elimination half-life values were 10.2 and 4.9 hours, respectively. The mean Vd was 1.78 L/kg, which was also correlated with GA (1.26 vs 2.19 L/kg for neonates with GA less than 27 weeks and more than 27 weeks, respectively). The mean Vd was higher than what has been reported in adults (0.77 L/kg).[54358] Another study in 7 extremely low birth weight neonates (mean GA 25.6 weeks; mean birthweight 735 g) found similar results after administration of single-dose IV dexamethasone. In this study, mean values for clearance, Vd, and elimination half-life were 2.4 mL/kg/minute, 1.9 L/kg, and 9.26 hours, respectively.[54368]

    Revision Date: 06/25/2020, 07:02:51 PM

    References

    34477 - Kovarik JM, Purba HS, Pongowski M, et al. Pharmacokinetics of dexamethasone and valspodar, a P-glycoprotein (mdr1) modulator: implications for coadministration. Pharmacother 1998;18:1230-6.38183 - Sparrow A, Geelhoed G. Prednisolone versus dexamethasone in croup: a randomised equivalence trial. Arch Dis Child. 2006;91:580-583.41921 - Ozurdex (dexamethasone intravitreal implant) package insert. Madison, NJ: Allergan USA, Inc.; 2022 Dec.48640 - Dexycu (dexamethasone intraocular suspension) package insert. Watertown, MA: EyePoint Pharmaceuticals US, Inc.; 2020 Jun.54046 - Czock D, Keller F, Rasche FM, et al. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet 2005;44:61-98.54352 - Young MC, Cook N, Read GF, et al. The pharmacokinetics of low-dose dexamethasone in congenital adrenal hyperplasia. Eur J Clin Pharmacol 1989;37:75-77.54358 - Lugo RA, Nahata MC, Menke JA, et al. Pharmacokinetics of dexamethasone in premature neonates. Eur J Clin Pharmacol 1996;49:477-483.54361 - Richter O, Ern B, Reinhardt D, et al. Pharmacokinetics of dexamethasone in children. Pediatr Pharmacol 1983;3:329-337.54366 - Duggan DE, Yeh KC, Matalia N, et al. Bioavailability of oral dexamethasone. Clin Pharmacol Ther 1975;18:205-209.54368 - Charles B, Schild P, Steer P, et al. Pharmacokinetics of dexamethasone following single-dose intravenous administration to extremely low birth weight infants. Dev Pharmacol Ther 1993;20:205-210.63796 - Dextenza (dexamethasone ophthalmic insert) package insert. Bedford, MA: Ocular Therapeutix, Inc.; 2021 Oct.

    Pregnancy/Breast-feeding

    pregnancy

    There are no adequate, well-controlled studies for the use of dexamethasone in pregnant women; therefore, the manufacturers recommend that the drug be used during pregnancy only if the potential benefit to the mother outweighs the potential risk to the fetus. For COVID-19, the National Institutes of Health (NIH) recommends use of the drug in pregnant patients, if indicated, as the potential benefit of decreased maternal mortality justifies the low risk of fetal adverse effects with the short course of therapy.[65314] Corticosteroids have been shown to be teratogenic in many species when given in systemic doses equivalent to the human dose. Animal studies in which corticosteroids have been given to pregnant mice, rats, and rabbits have yielded an increased incidence of cleft palate in the offspring.[60760] [60761] [64165] In addition, dexamethasone has been shown to be teratogenic in mice and rabbits following topical ophthalmic application in multiples of the therapeutic dose.[61633] Topical ocular administration of dexamethasone to pregnant mice and rabbits during organogenesis produced embryofetal lethality, cleft palate and multiple visceral malformations.[41921] [63796] Topical and otic corticosteroids should not be used in large amounts, on large areas, or for prolonged periods of time in pregnant women. Dexamethasone injections have been used medically later in pregnancy to induce fetal lung maturation in patients at risk for pre-term delivery; use is for select circumstances and for a limited duration of time.[33038] [33039] [33040] An infant who is born to a woman receiving large doses of systemic corticosteroids during pregnancy should be monitored for signs of adrenal insufficiency, and appropriate therapy should be initiated, if necessary.

    breast-feeding

    Systemic use of dexamethasone has not been studied during breast-feeding; corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. Caution is warranted, and some manufacturers recommend discontinuing breast-feeding if systemic dexamethasone treatment is needed.[60760] [60761] [64165] However, experts generally consider inhaled corticosteroids and oral corticosteroids (e.g., prednisone and prednisolone), acceptable to use during breast-feeding.[33723] [33724] [31822] There is no information regarding dexamethasone effects on breastfed infants or milk production or its presence in human milk following placement of the intravitreal implant or intracanalicular insert to inform risk to an infant during lactation.[41921] [63796] However, the systemic concentration of dexamethasone following administration of the intracanalicular insert is low.[63796] It is not known whether topical ophthalmic administration of dexamethasone could result in sufficient systemic absorption to produce detectable quantities in breast milk.[61633] [49533] For COVID-19, the National Institutes of Health (NIH) recommends dexamethasone be offered to lactating mothers who qualify for therapy without interruption of breast-feeding.[65314] Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition.

    Revision Date: 04/21/2023, 01:41:44 PM

    References

    31822 - NAEPP Working Group Report on Managing Asthma During Pregnancy. Recommendations for Pharmacologic Treatment-Update 2004. NIH Publication No. 05-3279. Bethesda, MD: U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute, 200433038 - Di Renzo GC, Roura LC, European Association of Perinatal Medicine-Study Group on Preterm Birth. International guidelines: Guidelines for the management of spontaneous preterm labor. J Perinat Med 2006;34:359-66.33039 - ACOG Committee on Practice Bulletins. ACOG Practice Bulletin: Management of preterm labor. Int J Gynecol Obstet 2003;82:127-35.33040 - Ballard PL, Ballard RA. Scientific basis and therapeutic regimens for use of antenatal glucocorticoids. Am J Obstet Gynecol 1995;173:254-62.33723 - Greenberger PA, Patterson R. The management of asthma during pregnancy and lactation. Clin Rev Allergy 1987;5:317-24.33724 - Ellsworth A. Pharmacotherapy of asthma while breastfeeding. J Hum Lact 1994;10:39-41.41921 - Ozurdex (dexamethasone intravitreal implant) package insert. Madison, NJ: Allergan USA, Inc.; 2022 Dec.49533 - Maxidex (dexamethasone) ophthalmic ointment package insert. Ft. Worth, TX: Alcon Laboratories, Inc.; 2006 Dec.60760 - Dexamethasone sodium phosphate injection package insert. Eatontown, NJ:West-Ward Pharmaceuticals;2014 Sept.60761 - Dexamethasone tablets USP, Dexamethasone oral solution, and Dexamethasone Intensol (oral solution concentrate) package insert. Eatontown, NJ: West-Ward Pharmaceuticals Corp; 2016 March.61633 - Maxidex (dexamethasone ophthalmic suspension 0.1%) package insert. East Hanover, NJ; Novartis Pharmaceuticals Corp. 2021 Dec.63796 - Dextenza (dexamethasone ophthalmic insert) package insert. Bedford, MA: Ocular Therapeutix, Inc.; 2021 Oct.64165 - Dexamethasone (Decadron) tablets package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2019 May.65314 - COVID-19 Treatment Guidelines Panel. Coronavirus Diseases 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Accessed April 20, 2023. Available at on the World Wide Web at: https://covid19treatmentguidelines.nih.gov/.

    Interactions

    Level 1 (Severe)

    • Cabotegravir; Rilpivirine
    • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
    • Dolutegravir; Rilpivirine
    • Emtricitabine; Rilpivirine; Tenofovir alafenamide
    • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
    • Iopamidol
    • Live Vaccines
    • Lonafarnib
    • Mavacamten
    • Metyrapone
    • Ombitasvir; Paritaprevir; Ritonavir
    • Rilpivirine

    Level 2 (Major)

    • Abemaciclib
    • Amiodarone
    • Amoxicillin; Clarithromycin; Omeprazole
    • Artemether; Lumefantrine
    • Atazanavir
    • Atazanavir; Cobicistat
    • Atogepant
    • Avacopan
    • Avapritinib
    • Axitinib
    • Bedaquiline
    • Capmatinib
    • Cariprazine
    • Caspofungin
    • Clarithromycin
    • Cobicistat
    • Cobimetinib
    • Corticorelin, Ovine
    • Dabrafenib
    • Daclatasvir
    • Daridorexant
    • Darunavir
    • Darunavir; Cobicistat
    • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
    • Deflazacort
    • Desmopressin
    • Dofetilide
    • Dronedarone
    • Duvelisib
    • Elacestrant
    • Elbasvir; Grazoprevir
    • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
    • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
    • Encorafenib
    • Entrectinib
    • Erdafitinib
    • Erlotinib
    • Etravirine
    • Fedratinib
    • Finerenone
    • Flibanserin
    • Ganaxolone
    • Glasdegib
    • Guanfacine
    • Hylan G-F 20
    • Ibrexafungerp
    • Idelalisib
    • Imatinib
    • Infigratinib
    • Iohexol
    • Isavuconazonium
    • Lansoprazole; Amoxicillin; Clarithromycin
    • Lapatinib
    • Larotrectinib
    • Lefamulin
    • Lemborexant
    • Lenacapavir
    • Leniolisib
    • Lorlatinib
    • Lumateperone
    • Macimorelin
    • Mifepristone
    • Mitapivat
    • Mitotane
    • Mobocertinib
    • Nanoparticle Albumin-Bound Sirolimus
    • Natalizumab
    • Neratinib
    • Nisoldipine
    • Olaparib
    • Olutasidenib
    • Omaveloxolone
    • Pacritinib
    • Pazopanib
    • Pemigatinib
    • Penicillamine
    • Perampanel
    • Pimavanserin
    • Pirtobrutinib
    • Pretomanid
    • Rimegepant
    • Ripretinib
    • Roflumilast
    • Romidepsin
    • Saquinavir
    • Sargramostim, GM-CSF
    • Selpercatinib
    • Selumetinib
    • Simeprevir
    • Sipuleucel-T
    • Sirolimus
    • Sofosbuvir; Velpatasvir
    • Sofosbuvir; Velpatasvir; Voxilaprevir
    • Sonidegib
    • Sorafenib
    • Tazemetostat
    • Temsirolimus
    • Toremifene
    • Ubrogepant
    • Ulipristal
    • Vemurafenib
    • Venetoclax
    • Vigabatrin
    • Voclosporin
    • Vonoprazan; Amoxicillin
    • Vonoprazan; Amoxicillin; Clarithromycin
    • Voxelotor
    • Zanubrutinib

    Level 3 (Moderate)

    • Abatacept
    • Acetaminophen; Aspirin
    • Acetaminophen; Aspirin, ASA; Caffeine
    • Acetaminophen; Aspirin; Diphenhydramine
    • Acetaminophen; Caffeine; Dihydrocodeine
    • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
    • Acetaminophen; Chlorpheniramine; Phenylephrine
    • Acetaminophen; Codeine
    • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
    • Acetaminophen; Dextromethorphan; Phenylephrine
    • Acetaminophen; Guaifenesin; Phenylephrine
    • Acetaminophen; Hydrocodone
    • Acetaminophen; Oxycodone
    • Acetazolamide
    • Acetohexamide
    • Adagrasib
    • Albiglutide
    • Alemtuzumab
    • Aliskiren; Hydrochlorothiazide, HCTZ
    • Alogliptin; Metformin
    • Alpha-glucosidase Inhibitors
    • Ambenonium Chloride
    • Amifampridine
    • Amiloride; Hydrochlorothiazide, HCTZ
    • Aminosalicylate sodium, Aminosalicylic acid
    • Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ
    • Amphotericin B
    • Amphotericin B lipid complex (ABLC)
    • Amphotericin B liposomal (LAmB)
    • Antithymocyte Globulin
    • Apalutamide
    • Aripiprazole
    • Arsenic Trioxide
    • Articaine; Epinephrine
    • Asparaginase Erwinia chrysanthemi
    • Aspirin, ASA
    • Aspirin, ASA; Butalbital; Caffeine
    • Aspirin, ASA; Caffeine
    • Aspirin, ASA; Caffeine; Orphenadrine
    • Aspirin, ASA; Carisoprodol
    • Aspirin, ASA; Carisoprodol; Codeine
    • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
    • Aspirin, ASA; Dipyridamole
    • Aspirin, ASA; Omeprazole
    • Aspirin, ASA; Oxycodone
    • Aspirin, ASA; Pravastatin
    • Atenolol; Chlorthalidone
    • Atracurium
    • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
    • Azilsartan; Chlorthalidone
    • Benazepril; Hydrochlorothiazide, HCTZ
    • Bendroflumethiazide; Nadolol
    • Benzhydrocodone; Acetaminophen
    • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
    • Bismuth Subsalicylate
    • Bismuth Subsalicylate; Metronidazole; Tetracycline
    • Bisoprolol; Hydrochlorothiazide, HCTZ
    • Brentuximab vedotin
    • Brexpiprazole
    • Brigatinib
    • Bromocriptine
    • Brompheniramine; Dextromethorphan; Phenylephrine
    • Brompheniramine; Phenylephrine
    • Budesonide
    • Budesonide; Formoterol
    • Budesonide; Glycopyrrolate; Formoterol
    • Bupivacaine; Epinephrine
    • Bupivacaine; Lidocaine
    • Bupropion
    • Bupropion; Naltrexone
    • Buspirone
    • Butabarbital
    • Butalbital; Acetaminophen
    • Butalbital; Acetaminophen; Caffeine
    • Butalbital; Acetaminophen; Caffeine; Codeine
    • Butalbital; Aspirin; Caffeine; Codeine
    • Caffeine; Sodium Benzoate
    • Calcium Carbonate
    • Calcium Carbonate; Famotidine; Magnesium Hydroxide
    • Calcium Carbonate; Magnesium Hydroxide
    • Calcium Carbonate; Magnesium Hydroxide; Simethicone
    • Calcium Carbonate; Risedronate
    • Calcium Carbonate; Simethicone
    • Calcium; Vitamin D
    • Canagliflozin
    • Canagliflozin; Metformin
    • Candesartan; Hydrochlorothiazide, HCTZ
    • Captopril; Hydrochlorothiazide, HCTZ
    • Carbamazepine
    • Carbinoxamine; Phenylephrine
    • Ceritinib
    • Certolizumab pegol
    • Chlorothiazide
    • Chlorpheniramine; Codeine
    • Chlorpheniramine; Dextromethorphan; Phenylephrine
    • Chlorpheniramine; Dihydrocodeine; Phenylephrine
    • Chlorpheniramine; Hydrocodone
    • Chlorpheniramine; Phenylephrine
    • Chlorpropamide
    • Chlorthalidone
    • Chlorthalidone; Clonidine
    • Cholestyramine
    • Choline Salicylate; Magnesium Salicylate
    • Cisapride
    • Cisatracurium
    • Clozapine
    • Codeine
    • Codeine; Guaifenesin
    • Codeine; Guaifenesin; Pseudoephedrine
    • Codeine; Phenylephrine; Promethazine
    • Codeine; Promethazine
    • Cyclosporine
    • Dapagliflozin
    • Dapagliflozin; Metformin
    • Dapagliflozin; Saxagliptin
    • Dapsone
    • Deferasirox
    • Denosumab
    • Dextromethorphan; Bupropion
    • Dextromethorphan; Diphenhydramine; Phenylephrine
    • Dextromethorphan; Guaifenesin; Phenylephrine
    • Dextromethorphan; Quinidine
    • Dipeptidyl Peptidase-4 Inhibitors
    • Diphenhydramine; Phenylephrine
    • Doravirine
    • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
    • Doxacurium
    • Dronabinol
    • Droperidol
    • Dulaglutide
    • Echinacea
    • Elagolix
    • Elagolix; Estradiol; Norethindrone acetate
    • Eliglustat
    • Empagliflozin
    • Empagliflozin; Linagliptin
    • Empagliflozin; Linagliptin; Metformin
    • Empagliflozin; Metformin
    • Enalapril; Hydrochlorothiazide, HCTZ
    • Enzalutamide
    • Ephedrine
    • Ephedrine; Guaifenesin
    • Epinephrine
    • Eprosartan; Hydrochlorothiazide, HCTZ
    • Ertugliflozin
    • Ertugliflozin; Metformin
    • Ertugliflozin; Sitagliptin
    • Erythromycin
    • Esomeprazole
    • Estrogens
    • Eszopiclone
    • Everolimus
    • Exenatide
    • Fentanyl
    • Fluoxymesterone
    • Fosamprenavir
    • Fosinopril; Hydrochlorothiazide, HCTZ
    • Gallium Ga 68 Dotatate
    • Gefitinib
    • Glecaprevir; Pibrentasvir
    • Glimepiride
    • Glimepiride; Rosiglitazone
    • Glipizide
    • Glipizide; Metformin
    • Glyburide
    • Glyburide; Metformin
    • Glycerol Phenylbutyrate
    • Golimumab
    • Guaifenesin; Hydrocodone
    • Guaifenesin; Hydrocodone; Pseudoephedrine
    • Guaifenesin; Phenylephrine
    • Haloperidol
    • Hemin
    • Homatropine; Hydrocodone
    • Hydantoins
    • Hydralazine; Hydrochlorothiazide, HCTZ
    • Hydrochlorothiazide, HCTZ
    • Hydrochlorothiazide, HCTZ; Methyldopa
    • Hydrochlorothiazide, HCTZ; Moexipril
    • Hydrocodone
    • Hydrocodone; Ibuprofen
    • Hydrocodone; Pseudoephedrine
    • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
    • Ibritumomab Tiuxetan
    • Ibrutinib
    • Ibuprofen; Oxycodone
    • Ifosfamide
    • Incretin Mimetics
    • Indapamide
    • Indinavir
    • Inebilizumab
    • Infliximab
    • Insulin Degludec; Liraglutide
    • Insulin Glargine; Lixisenatide
    • Insulins
    • Irbesartan; Hydrochlorothiazide, HCTZ
    • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
    • Isoniazid, INH; Rifampin
    • Isoproterenol
    • Itraconazole
    • Ketoconazole
    • L-Asparaginase Escherichia coli
    • Ledipasvir; Sofosbuvir
    • Letermovir
    • Levoketoconazole
    • Lidocaine
    • Lidocaine; Epinephrine
    • Lidocaine; Prilocaine
    • Linagliptin; Metformin
    • Liraglutide
    • Lisinopril; Hydrochlorothiazide, HCTZ
    • Lixisenatide
    • Lonapegsomatropin
    • Loop diuretics
    • Lopinavir; Ritonavir
    • Losartan; Hydrochlorothiazide, HCTZ
    • Lumacaftor; Ivacaftor
    • Lurasidone
    • Magnesium Salicylate
    • Mannitol
    • Maraviroc
    • Mecasermin rinfabate
    • Mecasermin, Recombinant, rh-IGF-1
    • Mefloquine
    • Meglitinides
    • Metformin
    • Metformin; Repaglinide
    • Metformin; Rosiglitazone
    • Metformin; Saxagliptin
    • Metformin; Sitagliptin
    • Methazolamide
    • Methenamine; Sodium Acid Phosphate
    • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
    • Methenamine; Sodium Salicylate
    • Methyclothiazide
    • Metolazone
    • Metoprolol; Hydrochlorothiazide, HCTZ
    • Micafungin
    • Mivacurium
    • Nanoparticle Albumin-Bound Paclitaxel
    • Naproxen; Esomeprazole
    • Nateglinide
    • Neostigmine
    • Netupitant, Fosnetupitant; Palonosetron
    • Neuromuscular blockers
    • Nilotinib
    • Nirmatrelvir; Ritonavir
    • Nonsteroidal antiinflammatory drugs
    • Ocrelizumab
    • Ofatumumab
    • Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ
    • Olmesartan; Hydrochlorothiazide, HCTZ
    • Omeprazole
    • Omeprazole; Amoxicillin; Rifabutin
    • Omeprazole; Sodium Bicarbonate
    • Oxycodone
    • Oxymetholone
    • Ozanimod
    • Pancuronium
    • Pegaspargase
    • Peginterferon Alfa-2a
    • Phenobarbital
    • Phenobarbital; Hyoscyamine; Atropine; Scopolamine
    • Phenylephrine
    • Physostigmine
    • Pimozide
    • Pioglitazone; Glimepiride
    • Pioglitazone; Metformin
    • Ponesimod
    • Posaconazole
    • Potassium Phosphate; Sodium Phosphate
    • Pramlintide
    • Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
    • Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
    • Praziquantel
    • Prilocaine; Epinephrine
    • Primidone
    • Promethazine; Phenylephrine
    • Propranolol
    • Propranolol; Hydrochlorothiazide, HCTZ
    • Pyridostigmine
    • Quinapril; Hydrochlorothiazide, HCTZ
    • Quinidine
    • Quinolones
    • Rapacuronium
    • Repaglinide
    • Ribociclib
    • Ribociclib; Letrozole
    • Rifampin
    • Rifapentine
    • Rilonacept
    • Ritonavir
    • Rituximab
    • Rituximab; Hyaluronidase
    • Rocuronium
    • Ruxolitinib
    • Salicylates
    • Salsalate
    • SARS-CoV-2 (COVID-19) vaccines
    • Semaglutide
    • SGLT2 Inhibitors
    • Siponimod
    • Sodium Benzoate; Sodium Phenylacetate
    • Sodium Phenylbutyrate
    • Sodium Phenylbutyrate; Taurursodiol
    • Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
    • Somatropin, rh-GH
    • Spironolactone; Hydrochlorothiazide, HCTZ
    • Succinylcholine
    • Sufentanil
    • Sulfonylureas
    • Tasimelteon
    • Telbivudine
    • Telmisartan; Hydrochlorothiazide, HCTZ
    • Terbinafine
    • Testosterone
    • Thalidomide
    • Thiazide diuretics
    • Thiazolidinediones
    • Ticagrelor
    • Tirzepatide
    • Tolazamide
    • Tolbutamide
    • Triamterene; Hydrochlorothiazide, HCTZ
    • Tuberculin Purified Protein Derivative, PPD
    • Tucatinib
    • Valsartan; Hydrochlorothiazide, HCTZ
    • Vecuronium
    • Vincristine
    • Vincristine Liposomal
    • Vorapaxar
    • Voriconazole
    • Vorinostat
    • Warfarin
    • Zolpidem

    Level 4 (Minor)

    • Albendazole
    • Aldesleukin, IL-2
    • Alosetron
    • Altretamine
    • Aminolevulinic Acid
    • Amlodipine
    • Amlodipine; Atorvastatin
    • Amlodipine; Benazepril
    • Amlodipine; Celecoxib
    • Amlodipine; Olmesartan
    • Amlodipine; Valsartan
    • Aprepitant, Fosaprepitant
    • Armodafinil
    • Avanafil
    • Azathioprine
    • Basiliximab
    • Bexarotene
    • Bortezomib
    • Cabozantinib
    • Carmustine, BCNU
    • Carvedilol
    • Cenobamate
    • Chlorambucil
    • Clofarabine
    • Delavirdine
    • Denileukin Diftitox
    • Econazole
    • Escitalopram
    • Estramustine
    • Finasteride; Tadalafil
    • Hydroxyurea
    • Interferon Alfa-2b
    • Isotretinoin
    • Lansoprazole
    • Lansoprazole; Naproxen
    • Levamlodipine
    • Lomustine, CCNU
    • Lurbinectedin
    • Methoxsalen
    • Mitoxantrone
    • Modafinil
    • Nelarabine
    • Oritavancin
    • Perindopril; Amlodipine
    • Pexidartinib
    • Photosensitizing agents (topical)
    • Potassium-sparing diuretics
    • Purine analogs
    • Rivaroxaban
    • Sildenafil
    • Tadalafil
    • Telmisartan; Amlodipine
    • Tositumomab
    • Tretinoin, ATRA
    • Zafirlukast
    Abatacept: (Moderate) Concomitant use of immunosuppressives, as well as long-term corticosteroids, may potentially increase the risk of serious infection in abatacept treated patients. Advise patients taking abatacept to seek immediate medical advice if they develop signs and symptoms suggestive of infection. [8565] Abemaciclib: (Major) Avoid coadministration of dexamethasone with abemaciclib due to decreased exposure to abemaciclib and its active metabolites, which may lead to reduced efficacy. Consider alternative treatments. Abemaciclib is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Coadministration with moderate CYP3A4 inducers is predicted to decrease the relative potency adjusted unbound AUC of abemaciclib plus its active metabolites (M2, M18, and M20) by 53%, 41%, and 29% respectively. [54286] [62393] Acetaminophen; Aspirin, ASA; Caffeine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Acetaminophen; Aspirin: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Acetaminophen; Caffeine; Dihydrocodeine: (Moderate) Concomitant use of dihydrocodeine with dexamethasone can decrease dihydrocodeine levels, resulting in less metabolism by CYP2D6 and decreased dihydromorphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. If coadministration is necessary, monitor for reduced efficacy of dihydrocodeine and signs of opioid withdrawal; consider increasing the dose of dihydrocodeine as needed. If dexamethasone is discontinued, consider a dose reduction of dihydrocodeine and frequently monitor for signs or respiratory depression and sedation. Dexamethasone is a moderate inducer of CYP3A4, an isoenzyme partially responsible for the metabolism of dihydrocodeine. [30282] [54286] Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Acetaminophen; Chlorpheniramine; Phenylephrine : (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Acetaminophen; Codeine: (Moderate) Concomitant use of codeine with dexamethasone can decrease codeine levels, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when codeine is being used for cough. If coadministration is necessary, monitor for reduced efficacy of codeine and signs of opioid withdrawal; consider increasing the dose of codeine as needed. If dexamethasone is discontinued, consider a dose reduction of codeine and frequently monitor for signs or respiratory depression and sedation. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Dexamethasone is a moderate CYP3A4 inducer. [33654] [34883] [54286] Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Acetaminophen; Dextromethorphan; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Acetaminophen; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Acetaminophen; Hydrocodone: (Moderate) Concomitant use of hydrocodone with dexamethasone can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when hydrocodone is being used for cough. If coadministration is necessary, monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal; consider increasing the dose of hydrocodone as needed. If dexamethasone is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [30011] [30379] [56303] Acetaminophen; Oxycodone: (Moderate) Monitor for reduced efficacy of oxycodone and signs of opioid withdrawal if coadministration with dexamethasone is necessary; consider increasing the dose of oxycodone as needed. If dexamethasone is discontinued, consider a dose reduction of oxycodone and frequently monitor for signs of respiratory depression and sedation. Oxycodone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease oxycodone concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. [39926] [54286] Acetazolamide: (Moderate) Corticosteroids may increase the risk of hypokalemia if used concurrently with acetazolamide. Hypokalemia may be especially severe with prolonged use of corticotropin, ACTH. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. [26417] [28267] Acetohexamide: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Adagrasib: (Moderate) Monitor for steroid-related adverse reactions if coadministration of adagrasib with dexamethasone is necessary, due to increased dexamethasone exposure; Cushing's syndrome and adrenal suppression could potentially occur with long-term use. Consider the use of corticosteroids such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A inhibitors, especially for long-term use. Adagrasib is a strong CYP3A inhibitor and dexamethasone is primarily metabolized by CYP3A. Another strong CYP3A inhibitor has been reported to decrease the metabolism of certain corticosteroids by up to 60%, leading to increased risk of corticosteroid side effects. [30011] [68325] Albendazole: (Minor) Concomitant administration of albendazole with dexamethasone increases the plasma concentration of albendazole sulfoxide, presumably via reduction in albendazole sulfoxide clearance. [4768] Albiglutide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Aldesleukin, IL-2: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [41853] [7592] [7714] Alemtuzumab: (Moderate) Concomitant use of alemtuzumab with immunosuppressant doses of corticosteroids may increase the risk of immunosuppression. Monitor patients carefully for signs and symptoms of infection. [58461] Aliskiren; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Alogliptin; Metformin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] Alosetron: (Minor) Dexamethasone can induce the activity of CYP3A4 and increase the metabolism of alosetron by increasing the metabolism of the drug, thus potentially reducing the effect of alosetron. [5112] Alpha-glucosidase Inhibitors: (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Altretamine: (Minor) Concurrent use of altretamine with other agents which cause bone marrow or immune suppression such as corticosteroids may result in additive effects. [4661] [7714] Ambenonium Chloride: (Moderate) Concomitant use of anticholinesterase agents, such as ambenonium chloride, and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents used to treat myasthenia should be withdrawn at least 24 hours before initiating corticosteroid therapy. [29779] [30015] [30028] [42863] [56146] [64165] Amifampridine: (Moderate) Carefully consider the need for concomitant treatment with systemic corticosteroids and amifampridine, as coadministration may increase the risk of seizures. If coadministration occurs, closely monitor patients for seizure activity. Seizures have been observed in patients without a history of seizures taking amifampridine at recommended doses. Systemic corticosteroids may increase the risk of seizures in some patients. [45339] [63790] Amiloride; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Aminolevulinic Acid: (Minor) Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment. [6625] Aminosalicylate sodium, Aminosalicylic acid: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Amiodarone: (Major) Use caution when coadministering amiodarone with drugs which may induce hypokalemia and, or hypomagnesemia, including corticosteroids. Since antiarrhythmic drugs may be ineffective or may be arrhythmogenic in patients with hypokalemia, any potassium or magnesium deficiency should be corrected before instituting and during amiodarone therapy. [26417] [28224] [29377] Amlodipine: (Minor) Coadministration of CYP3A4 inducers with amlodipine can theoretically increase the hepatic metabolism of amlodipine (a CYP3A4 substrate). Caution should be used when CYP3A4 inducers, such as dexamethasone, are coadministered with amlodipine. Monitor therapeutic response; the dosage requirements of amlodipine may be increased. [34477] [35588] [54286] Amlodipine; Atorvastatin: (Minor) Coadministration of CYP3A4 inducers with amlodipine can theoretically increase the hepatic metabolism of amlodipine (a CYP3A4 substrate). Caution should be used when CYP3A4 inducers, such as dexamethasone, are coadministered with amlodipine. Monitor therapeutic response; the dosage requirements of amlodipine may be increased. [34477] [35588] [54286] Amlodipine; Benazepril: (Minor) Coadministration of CYP3A4 inducers with amlodipine can theoretically increase the hepatic metabolism of amlodipine (a CYP3A4 substrate). Caution should be used when CYP3A4 inducers, such as dexamethasone, are coadministered with amlodipine. Monitor therapeutic response; the dosage requirements of amlodipine may be increased. [34477] [35588] [54286] Amlodipine; Celecoxib: (Minor) Coadministration of CYP3A4 inducers with amlodipine can theoretically increase the hepatic metabolism of amlodipine (a CYP3A4 substrate). Caution should be used when CYP3A4 inducers, such as dexamethasone, are coadministered with amlodipine. Monitor therapeutic response; the dosage requirements of amlodipine may be increased. [34477] [35588] [54286] Amlodipine; Olmesartan: (Minor) Coadministration of CYP3A4 inducers with amlodipine can theoretically increase the hepatic metabolism of amlodipine (a CYP3A4 substrate). Caution should be used when CYP3A4 inducers, such as dexamethasone, are coadministered with amlodipine. Monitor therapeutic response; the dosage requirements of amlodipine may be increased. [34477] [35588] [54286] Amlodipine; Valsartan: (Minor) Coadministration of CYP3A4 inducers with amlodipine can theoretically increase the hepatic metabolism of amlodipine (a CYP3A4 substrate). Caution should be used when CYP3A4 inducers, such as dexamethasone, are coadministered with amlodipine. Monitor therapeutic response; the dosage requirements of amlodipine may be increased. [34477] [35588] [54286] Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] (Minor) Coadministration of CYP3A4 inducers with amlodipine can theoretically increase the hepatic metabolism of amlodipine (a CYP3A4 substrate). Caution should be used when CYP3A4 inducers, such as dexamethasone, are coadministered with amlodipine. Monitor therapeutic response; the dosage requirements of amlodipine may be increased. [34477] [35588] [54286] Amoxicillin; Clarithromycin; Omeprazole: (Major) Coadministration of dexamethasone and clarithromycin may decrease clarithromycin serum concentrations due to CYP3A4 enzyme induction. While the 14-OH-clarithromycin active metabolite concentrations are increased, this metabolite has different antimicrobial activity compared to clarithromycin. The intended therapeutic effect of clarithromycin could be decreased. It is not clear if clarithromycin activity against other organisms would be reduced, but reduced efficacy is possible. Alternatives to clarithromycin should be considered in patients who are taking CYP3A4 inducers. Additionally, clarithromycin inhibits CYP3A4 and has the potential to result in increased plasma concentrations of dexamethasone. Increased blood concentrations and physiologic activity may necessitate a decrease in corticosteroid dosage. [28238] [34477] (Moderate) Monitor for decreased efficacy of omeprazole if coadministration with dexamethasone is necessary. Omeprazole is metabolized by CYP2C19 and CYP3A4. Dexamethasone is a moderate CYP3A4 inducer. The manufacturer of omeprazole recommends avoidance with strong inducers because decreased exposure of omeprazole can occur. Recommendations are not available for concomitant use with moderate inducers of CYP3A4. [29564] [54286] Amphotericin B lipid complex (ABLC): (Moderate) The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Serum potassium levels should be monitored in patients receiving these drugs concomitantly. [30011] [40134] Amphotericin B liposomal (LAmB): (Moderate) The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Serum potassium levels should be monitored in patients receiving these drugs concomitantly. [30011] [40134] Amphotericin B: (Moderate) The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Serum potassium levels should be monitored in patients receiving these drugs concomitantly. [30011] [40134] Antithymocyte Globulin: (Moderate) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [6303] [7714] Apalutamide: (Moderate) Monitor for decreased efficacy of dexamethasone if coadministration with apalutamide is necessary; consider increasing the dose of dexamethasone if clinically appropriate. Dexamethasone is a CYP3A4 substrate and apalutamide is a strong CYP3A4 inducer. [54286] [62874] Aprepitant, Fosaprepitant: (Minor) Aprepitant, fosaprepitant is indicated for the treatment of chemotherapy-induced nausea/vomiting (CINV) in combination with dexamethasone and a 5HT3 antagonist; the pharmacokinetic interactions discussed here are accounted for in the recommended dosing for this indication. No dosage adjustment is needed when dexamethasone is used in combination with a single 40-mg dose of oral aprepitant. Dexamethasone is a CYP3A4 substrate. Aprepitant, when administered as a 3-day oral regimen (125 mg/80 mg/80 mg), is a moderate CYP3A4 inhibitor and inducer. The AUC of dexamethasone (8 mg PO on days 1, 2, and 3) was increased by approximately 2-fold on days 1 and 2 when given with a single 150-mg dose of IV fosaprepitant. After a 5-day regimen of oral aprepitant (125 mg/80 mg/80 mg/80 mg/80 mg), the AUC of dexamethasone increased 2.2-fold on days 1 and 5. A single dose of aprepitant 40 mg increased the AUC of dexamethasone by 1.45-fold, which was not considered clinically significant. [30676] [40027] Aripiprazole: (Moderate) Because aripiprazole is metabolized by CYP3A4, concurrent use of CYP3A4 inducers such as dexamethasone may result in decreased plasma concentrations of aripiprazole. If these agents are used in combination, the patient should be carefully monitored for a decrease in aripiprazole efficacy. An increase in aripiprazole dosage may be clinically warranted in some patients. Avoid concurrent use of Abilify Maintena with a CYP3A4 inducer when the combined treatment period exceeds 14 days because aripiprazole blood concentrations decline and may become suboptimal. There are no dosing recommendations for Aristada or Aristada Initio during concurrent use of a mild or moderate CYP3A4 inducer. [30011] [31327] [53394] [63328] Armodafinil: (Minor) Armodafinil is partially metabolized via CYP3A4/5 isoenzymes. CYP3A4 inducers, such as dexamethasone, may potentially increase the metabolism of armodafinil. Decreased serum levels of armodafinil could potentially result in decreased efficacy of the drug. [10318] Arsenic Trioxide: (Moderate) Caution is advisable during concurrent use of arsenic trioxide and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with arsenic trioxide. [26417] [59438] Artemether; Lumefantrine: (Major) Dexamethasone is a substrate/inducer and both components of artemether; lumefantrine are substrates of the CYP3A4 isoenzyme; therefore, coadministration may lead to decreased artemether; lumefantrine concentrations. Concomitant use warrants caution due to a possible reduction in antimalarial activity. [11334] [35401] [6759] Articaine; Epinephrine: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Corticosteroids may potentiate the hypokalemic effects of epinephrine. [26417] [56575] Asparaginase Erwinia chrysanthemi: (Moderate) Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia. L-Asparaginase transiently inhibits insulin production contributing to hyperglycemia seen during concurrent corticosteroid therapy. Insulin therapy may be required in some cases. Administration of L-asparaginase after rather than before corticosteroids reportedly has produced fewer hypersensitivity reactions. [55362] Aspirin, ASA: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Butalbital; Caffeine: (Moderate) Coadministration may result in decreased exposure to dexamethasone. Butalbital is a CYP3A4 inducer; dexamethasone is a CYP3A4 substrate. Monitor for decreased response to dexamethasone during concurrent use. [28001] (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Butalbital; Caffeine; Codeine: (Moderate) Coadministration may result in decreased exposure to dexamethasone. Butalbital is a CYP3A4 inducer; dexamethasone is a CYP3A4 substrate. Monitor for decreased response to dexamethasone during concurrent use. [28001] (Moderate) Concomitant use of codeine with dexamethasone can decrease codeine levels, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when codeine is being used for cough. If coadministration is necessary, monitor for reduced efficacy of codeine and signs of opioid withdrawal; consider increasing the dose of codeine as needed. If dexamethasone is discontinued, consider a dose reduction of codeine and frequently monitor for signs or respiratory depression and sedation. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Dexamethasone is a moderate CYP3A4 inducer. [33654] [34883] [54286] (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Caffeine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Caffeine; Orphenadrine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Carisoprodol: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Concomitant use of codeine with dexamethasone can decrease codeine levels, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when codeine is being used for cough. If coadministration is necessary, monitor for reduced efficacy of codeine and signs of opioid withdrawal; consider increasing the dose of codeine as needed. If dexamethasone is discontinued, consider a dose reduction of codeine and frequently monitor for signs or respiratory depression and sedation. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Dexamethasone is a moderate CYP3A4 inducer. [33654] [34883] [54286] (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Dipyridamole: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Omeprazole: (Moderate) Monitor for decreased efficacy of omeprazole if coadministration with dexamethasone is necessary. Omeprazole is metabolized by CYP2C19 and CYP3A4. Dexamethasone is a moderate CYP3A4 inducer. The manufacturer of omeprazole recommends avoidance with strong inducers because decreased exposure of omeprazole can occur. Recommendations are not available for concomitant use with moderate inducers of CYP3A4. [29564] [54286] (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Oxycodone: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] (Moderate) Monitor for reduced efficacy of oxycodone and signs of opioid withdrawal if coadministration with dexamethasone is necessary; consider increasing the dose of oxycodone as needed. If dexamethasone is discontinued, consider a dose reduction of oxycodone and frequently monitor for signs of respiratory depression and sedation. Oxycodone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease oxycodone concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. [39926] [54286] Aspirin, ASA; Pravastatin: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Atazanavir: (Major) Avoid concurrent use of dexamethasone with atazanavir. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance to atazanavir; consider use of an alternative corticosteroid. In addition, serum concentrations of dexamethasone may be increased, potentially resulting in Cushing's syndrome and adrenal suppression. Dexamethasone is a CYP3A4 substrate and inducer; atazanavir is a substrate of this enzyme as well as a strong CYP3A inhibitor. Corticosteroids, such as beclomethasone and prednisolone) whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. [28142] [58000] Atazanavir; Cobicistat: (Major) Avoid concurrent use of dexamethasone with atazanavir. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance to atazanavir; consider use of an alternative corticosteroid. In addition, serum concentrations of dexamethasone may be increased, potentially resulting in Cushing's syndrome and adrenal suppression. Dexamethasone is a CYP3A4 substrate and inducer; atazanavir is a substrate of this enzyme as well as a strong CYP3A inhibitor. Corticosteroids, such as beclomethasone and prednisolone) whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. [28142] [58000] (Major) Avoid concurrent use of dexamethasone with cobicistat containing regimens. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance. In addition, serum concentrations of dexamethasone may be increased, potentially resulting in Cushing's syndrome and adrenal suppression. Dexamethasone is a CYP3A4 substrate and inducer; cobicistat is a substrate of this enzyme as well as a strong CYP3A inhibitor. Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. [51664] [58000] Atenolol; Chlorthalidone: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Atogepant: (Major) Avoid use of atogepant and dexamethasone when atogepant is used for chronic migraine. Use an atogepant dose of 30 or 60 mg PO once daily for episodic migraine if coadministered with dexamethasone. Concurrent use may decrease atogepant exposure and reduce efficacy. Atogepant is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. [54286] [67011] Atracurium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Avacopan: (Major) Avoid concomitant use of avacopan and dexamethasone due to the risk of decreased avacopan exposure which may reduce its efficacy. Avacopan is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. [54286] [67036] Avanafil: (Minor) Avanafil is primarily metabolized by CYP3A4, and although no studies have been performed, concomitant administration of CYP3A4 inducers, such as dexamethasone, may decrease avanafil plasma levels. Concomitant use is not recommended. [4718] [49866] Avapritinib: (Major) Avoid coadministration of avapritinib with dexamethasone due to the risk of decreased avapritinib efficacy. Avapritinib is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Coadministration with another moderate CYP3A4 inducer is predicted to decrease the AUC and Cmax of avapritinib by 62% and 55%, respectively. [54286] [64922] Axitinib: (Major) Avoid coadministration of axitinib with dexamethasone due to the risk of decreased efficacy of axitinib. Selection of a concomitant medication with no or minimal CYP3A4 induction potential is recommended. Axitinib is a CYP3A4/5 substrate and dexamethasone is a CYP3A4 inducer. Coadministration with a strong CYP3A4/5 inducer significantly decreased the plasma exposure of axitinib in healthy volunteers. [34477] [48494] [54286] Azathioprine: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [4710] [7714] Azilsartan; Chlorthalidone: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Basiliximab: (Minor) Because systemically administered corticosteroids have immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives. [4746] Bedaquiline: (Major) Avoid concurrent use of dexamethasone with bedaquiline. Dexamethasone is a CYP3A4 inducer, which may result in decreased bedaquiline systemic exposure (AUC) and possibly reduced therapeutic effect. [34477] [52746] Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Bendroflumethiazide; Nadolol: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Benzhydrocodone; Acetaminophen: (Moderate) Concurrent use of benzhydrocodone with dexamethasone may decrease hydrocodone plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to opioid agonists. If concomitant use is necessary, consider increasing the benzhydrocodone dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal. Discontinuation of dexamethasone may increase the risk of increased opioid-related adverse reactions, such as fatal respiratory depression. If dexamethasone is discontinued, consider a benzhydrocodone dosage reduction and monitor patients for respiratory depression and sedation at frequent intervals. Benzhydrocodone is a prodrug of hydrocodone. Dexamethasone is an inducer of CYP3A4, an isoenzyme partially responsible for the metabolism of hydrocodone. [48640] [62889] Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Bexarotene: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents, such as bexarotene. [30943] Bismuth Subsalicylate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Bismuth Subsalicylate; Metronidazole; Tetracycline: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Bisoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Bortezomib: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Brentuximab vedotin: (Moderate) Concomitant administration of brentuximab vedotin and dexamethasone may decrease the exposure of monomethyl auristatin E (MMAE), one of the 3 components released from brentuximab vedotin. MMAE is a CYP3A4 substrate and dexamethasone is a potent CYP3A4 inducer; therefore, the efficacy of brentuximab may be reduced. [45378] [48640] Brexpiprazole: (Moderate) Because brexpiprazole is partially metabolized by CYP3A4, concurrent use of CYP3A4 inducers such as dexamethasone may result in decreased plasma concentrations of brexpiprazole. If these agents are used in combination, the patient should be carefully monitored for a decrease in brexpiprazole efficacy. An increase in brexpiprazole dosage may be clinically warranted in some patients. [59949] [6759] Brigatinib: (Moderate) Avoid coadministration of brigatinib with dexamethasone due to decreased plasma exposure to brigatinib which may result in decreased efficacy. If concomitant use is unavoidable, after 7 days of concomitant treatment with dexamethasone, increase the dose of brigatinib as tolerated in 30 mg increments to a maximum of twice the original brigatinib dose. After discontinuation of dexamethasone, resume the brigatinib dose that was tolerated prior to initiation of dexamethasone. Brigatinib is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Coadministration with a moderate CYP3A inducer is predicted to decrease the AUC of brigatinib by approximately 50%. [54286] [61909] Bromocriptine: (Moderate) Caution and close monitoring are advised if bromocriptine and dexamethasone are used together. Concurrent use may decrease the plasma concentrations of bromocriptine resulting in loss of efficacy. Bromocriptine is extensively metabolized by the liver via CYP3A4; dexamethasone is a moderate inducer of CYP3A4. [35591] [54285] Brompheniramine; Dextromethorphan; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Brompheniramine; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Budesonide: (Moderate) Theoretically, induction of the cytochrome P450 (CYP) 3A4 isoenzyme may result in a lowering of budesonide plasma concentrations, reducing the clinical effect. Drugs known to induce the 3A4 isoenzyme include dexamethasone. [28001] Budesonide; Formoterol: (Moderate) Theoretically, induction of the cytochrome P450 (CYP) 3A4 isoenzyme may result in a lowering of budesonide plasma concentrations, reducing the clinical effect. Drugs known to induce the 3A4 isoenzyme include dexamethasone. [28001] Budesonide; Glycopyrrolate; Formoterol: (Moderate) Theoretically, induction of the cytochrome P450 (CYP) 3A4 isoenzyme may result in a lowering of budesonide plasma concentrations, reducing the clinical effect. Drugs known to induce the 3A4 isoenzyme include dexamethasone. [28001] Bupivacaine; Epinephrine: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Corticosteroids may potentiate the hypokalemic effects of epinephrine. [26417] [56575] Bupivacaine; Lidocaine: (Moderate) Concomitant use of systemic lidocaine and dexamethasone may decrease lidocaine plasma concentrations. Higher lidocaine doses may be required; titrate to effect. Lidocaine is a CYP3A4 and CYP1A2 substrate; dexamethasone induces CYP3A4. [32857] [54286] Bupropion: (Moderate) Monitor for seizure activity during concomitant bupropion and corticosteroid use. Bupropion is associated with a dose-related seizure risk; concomitant use of other medications that lower the seizure threshold, such as systemic corticosteroids, increases the seizure risk. [44094] Bupropion; Naltrexone: (Moderate) Monitor for seizure activity during concomitant bupropion and corticosteroid use. Bupropion is associated with a dose-related seizure risk; concomitant use of other medications that lower the seizure threshold, such as systemic corticosteroids, increases the seizure risk. [44094] Buspirone: (Moderate) Potent inducers of hepatic cytochrome P450 3A4, such as dexamethasone, may increase the rate of buspirone metabolism. [28001] Butabarbital: (Moderate) Coadministration may result in decreased exposure to dexamethasone. Butabarbital is a CYP3A4 inducer; dexamethasone is a CYP3A4 substrate. Monitor for decreased response to dexamethasone during concurrent use. [28001] Butalbital; Acetaminophen: (Moderate) Coadministration may result in decreased exposure to dexamethasone. Butalbital is a CYP3A4 inducer; dexamethasone is a CYP3A4 substrate. Monitor for decreased response to dexamethasone during concurrent use. [28001] Butalbital; Acetaminophen; Caffeine: (Moderate) Coadministration may result in decreased exposure to dexamethasone. Butalbital is a CYP3A4 inducer; dexamethasone is a CYP3A4 substrate. Monitor for decreased response to dexamethasone during concurrent use. [28001] Butalbital; Acetaminophen; Caffeine; Codeine: (Moderate) Coadministration may result in decreased exposure to dexamethasone. Butalbital is a CYP3A4 inducer; dexamethasone is a CYP3A4 substrate. Monitor for decreased response to dexamethasone during concurrent use. [28001] (Moderate) Concomitant use of codeine with dexamethasone can decrease codeine levels, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when codeine is being used for cough. If coadministration is necessary, monitor for reduced efficacy of codeine and signs of opioid withdrawal; consider increasing the dose of codeine as needed. If dexamethasone is discontinued, consider a dose reduction of codeine and frequently monitor for signs or respiratory depression and sedation. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Dexamethasone is a moderate CYP3A4 inducer. [33654] [34883] [54286] Cabotegravir; Rilpivirine: (Contraindicated) Concurrent use of dexamethasone (more than 1 dose) and rilpivirine is contraindicated. When these drugs are coadministered, there is a potential for treatment failure and/or the development of rilpivirine or NNRTI resistance. Dexamethasone is an inducer of CYP3A4, which is primarily responsible for the metabolism of rilpivirine. Coadministration may result in decreased rilpivirine serum concentrations, which could cause impaired virologic response to rilpivirine. [44376] [54286] Cabozantinib: (Minor) Monitor for an increase in dexamethasone-related adverse reactions if coadministration with cabozantinib is necessary. Dexamethasone is a P-glycoprotein (P-gp) substrate. Cabozantinib is a P-gp inhibitor and has the potential to increase plasma concentrations of P-gp substrates; however, the clinical relevance of this finding is unknown. [34477] [52506] [54286] [60738] Caffeine; Sodium Benzoate: (Moderate) Corticosteroids may cause protein breakdown, which could lead to elevated blood ammonia concentrations, especially in patients with an impaired ability to form urea. Corticosteroids should be used with caution in patients receiving treatment for hyperammonemia. [8083] Calcium Carbonate: (Moderate) Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Systemic corticosteroids induce a negative calcium balance by inhibiting intestinal calcium absorption as well as by increasing renal calcium losses. The mechanism by which these drugs inhibit calcium absorption in the intestine is likely to involve a direct inhibition of absorptive cell function. [8255] [8256] Calcium Carbonate; Famotidine; Magnesium Hydroxide: (Moderate) Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Systemic corticosteroids induce a negative calcium balance by inhibiting intestinal calcium absorption as well as by increasing renal calcium losses. The mechanism by which these drugs inhibit calcium absorption in the intestine is likely to involve a direct inhibition of absorptive cell function. [8255] [8256] Calcium Carbonate; Magnesium Hydroxide: (Moderate) Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Systemic corticosteroids induce a negative calcium balance by inhibiting intestinal calcium absorption as well as by increasing renal calcium losses. The mechanism by which these drugs inhibit calcium absorption in the intestine is likely to involve a direct inhibition of absorptive cell function. [8255] [8256] Calcium Carbonate; Magnesium Hydroxide; Simethicone: (Moderate) Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Systemic corticosteroids induce a negative calcium balance by inhibiting intestinal calcium absorption as well as by increasing renal calcium losses. The mechanism by which these drugs inhibit calcium absorption in the intestine is likely to involve a direct inhibition of absorptive cell function. [8255] [8256] Calcium Carbonate; Risedronate: (Moderate) Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Systemic corticosteroids induce a negative calcium balance by inhibiting intestinal calcium absorption as well as by increasing renal calcium losses. The mechanism by which these drugs inhibit calcium absorption in the intestine is likely to involve a direct inhibition of absorptive cell function. [8255] [8256] Calcium Carbonate; Simethicone: (Moderate) Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Systemic corticosteroids induce a negative calcium balance by inhibiting intestinal calcium absorption as well as by increasing renal calcium losses. The mechanism by which these drugs inhibit calcium absorption in the intestine is likely to involve a direct inhibition of absorptive cell function. [8255] [8256] Calcium; Vitamin D: (Moderate) Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Systemic corticosteroids induce a negative calcium balance by inhibiting intestinal calcium absorption as well as by increasing renal calcium losses. The mechanism by which these drugs inhibit calcium absorption in the intestine is likely to involve a direct inhibition of absorptive cell function. [8255] [8256] Canagliflozin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Canagliflozin; Metformin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Candesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Capmatinib: (Major) Avoid coadministration of capmatinib and dexamethasone due to the risk of decreased capmatinib exposure, which may reduce its efficacy. Capmatinib is a CYP3A substrate and dexamethasone is a moderate CYP3A4 inducer. Coadministration with another moderate CYP3A4 inducer decreased capmatinib exposure by 44%. [34477] [54286] [65377] Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Carbamazepine: (Moderate) Hepatic microsomal enzyme inducers, including carbamazepine, can increase the metabolism of dexamethasone. Dosage adjustments may be necessary, and closer monitoring of clinical and/or adverse effects is warranted when carbamazepine is used with dexamethasone. [41237] Carbinoxamine; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Cariprazine: (Major) Cariprazine and its active metabolites are extensively metabolized by CYP3A4. Concurrent use of cariprazine with CYP3A4 inducers, such as dexamethasone, has not been evaluated and is not recommended because the net effect on active drug and metabolites is unclear. [30011] [60164] Carmustine, BCNU: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [5946] [7714] [7944] Carvedilol: (Minor) Increased concentrations of dexamethasone may occur if it is coadministered with carvedilol; exercise caution. Carvedilol is a P-glycoprotein (P-gp) inhibitor and dexamethasone is a P-gp substrate. [34477] [51834] [58220] Caspofungin: (Major) Data suggest that coadministration of inducers or mixed inducers/inhibitors of hepatic drug clearance along with caspofungin may result in reduced caspofungin blood concentrations. The reductions may be clinically significant. It is not known how caspofungin drug clearance is induced. Drugs that may lead to reductions in caspofungin concentrations include dexamethasone. For adult patients receiving dexamethasone, an increase in the caspofungin dose to 70 mg/day should be considered. For pediatric patients receiving dexamethasone, a daily dosage of 70 mg/m2, not to exceed 70 mg, should be considered. [28782] Cenobamate: (Minor) A dose adjustment of systemic dexamethasone may be necessary if cenobamate is initiated or withdrawn during therapy. Cenobamate may increase the metabolism of dexamethasone resulting in decreased exposure. Cenobamate is a moderate inducer of CYP3A4; dexamethasone is a CYP3A4 substrate. [54286] [64768] Ceritinib: (Moderate) Monitor for steroid-related adverse reactions if coadministration of ceritinib with dexamethasone is necessary, due to increased dexamethasone exposure; Cushings syndrome and adrenal suppression could potentially occur with long-term use. Consider the use of corticosteroids such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, especially for long-term use. Ceritinib is a strong CYP3A4 inhibitor and dexamethasone is primarily metabolized by CYP3A4. Another strong CYP3A4 inhibitor has been reported to decrease the metabolism of certain corticosteroids by up to 60%, leading to increased risk of corticosteroid side effects. [54286] [57094] Certolizumab pegol: (Moderate) The safety and efficacy of certolizumab in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with certolizumab may be at a greater risk of developing an infection. Many of the serious infections occurred in patients on immunosuppressive therapy who received certolizumab. [10783] Chlorambucil: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [4757] [7714] Chlorothiazide: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Chlorpheniramine; Codeine: (Moderate) Concomitant use of codeine with dexamethasone can decrease codeine levels, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when codeine is being used for cough. If coadministration is necessary, monitor for reduced efficacy of codeine and signs of opioid withdrawal; consider increasing the dose of codeine as needed. If dexamethasone is discontinued, consider a dose reduction of codeine and frequently monitor for signs or respiratory depression and sedation. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Dexamethasone is a moderate CYP3A4 inducer. [33654] [34883] [54286] Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Moderate) Concomitant use of dihydrocodeine with dexamethasone can decrease dihydrocodeine levels, resulting in less metabolism by CYP2D6 and decreased dihydromorphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. If coadministration is necessary, monitor for reduced efficacy of dihydrocodeine and signs of opioid withdrawal; consider increasing the dose of dihydrocodeine as needed. If dexamethasone is discontinued, consider a dose reduction of dihydrocodeine and frequently monitor for signs or respiratory depression and sedation. Dexamethasone is a moderate inducer of CYP3A4, an isoenzyme partially responsible for the metabolism of dihydrocodeine. [30282] [54286] (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Chlorpheniramine; Hydrocodone: (Moderate) Concomitant use of hydrocodone with dexamethasone can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when hydrocodone is being used for cough. If coadministration is necessary, monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal; consider increasing the dose of hydrocodone as needed. If dexamethasone is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [30011] [30379] [56303] Chlorpheniramine; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Chlorpropamide: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Chlorthalidone: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Chlorthalidone; Clonidine: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Cholestyramine: (Moderate) Cholestyramine may increase the clearance of corticosteroids. [8844] Choline Salicylate; Magnesium Salicylate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Cisapride: (Moderate) Cisapride is metabolized by the hepatic cytochrome P450 enzyme system, specifically the CYP3A4 isoenzyme. Inducers of CYP3A4, such as dexamethasone, may increase the clearance of cisapride. [4718] [5137] Cisatracurium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Clarithromycin: (Major) Coadministration of dexamethasone and clarithromycin may decrease clarithromycin serum concentrations due to CYP3A4 enzyme induction. While the 14-OH-clarithromycin active metabolite concentrations are increased, this metabolite has different antimicrobial activity compared to clarithromycin. The intended therapeutic effect of clarithromycin could be decreased. It is not clear if clarithromycin activity against other organisms would be reduced, but reduced efficacy is possible. Alternatives to clarithromycin should be considered in patients who are taking CYP3A4 inducers. Additionally, clarithromycin inhibits CYP3A4 and has the potential to result in increased plasma concentrations of dexamethasone. Increased blood concentrations and physiologic activity may necessitate a decrease in corticosteroid dosage. [28238] [34477] Clofarabine: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7557] [7714] Clozapine: (Moderate) Caution is advisable during concurrent use of dexamethasone and clozapine. Dexamethasone is an inducer of CYP3A4, one of the isoenzymes responsible for the metabolism of clozapine. According to the manufacturer, patients receiving clozapine in combination with a weak to moderate CYP3A4 inducer should be monitored for loss of effectiveness. Consideration should be given to increasing the clozapine dose if necessary. Concurrent use with strong CYP3A4 inducers is not recommended. Topical corticosteroids are not likely to interact. [28262] [6759] Cobicistat: (Major) Avoid concurrent use of dexamethasone with cobicistat containing regimens. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance. In addition, serum concentrations of dexamethasone may be increased, potentially resulting in Cushing's syndrome and adrenal suppression. Dexamethasone is a CYP3A4 substrate and inducer; cobicistat is a substrate of this enzyme as well as a strong CYP3A inhibitor. Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. [51664] [58000] Cobimetinib: (Major) Avoid the concurrent use of cobimetinib with dexamethasone due to decreased cobimetinib efficacy. Cobimetinib is a CYP3A substrate in vitro, and dexamethasone is a moderate inducer of CYP3A. Based on simulations, cobimetinib exposure would decrease by 73% when coadministered with a moderate CYP3A inducer. [34477] [54286] [60281] Codeine: (Moderate) Concomitant use of codeine with dexamethasone can decrease codeine levels, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when codeine is being used for cough. If coadministration is necessary, monitor for reduced efficacy of codeine and signs of opioid withdrawal; consider increasing the dose of codeine as needed. If dexamethasone is discontinued, consider a dose reduction of codeine and frequently monitor for signs or respiratory depression and sedation. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Dexamethasone is a moderate CYP3A4 inducer. [33654] [34883] [54286] Codeine; Guaifenesin: (Moderate) Concomitant use of codeine with dexamethasone can decrease codeine levels, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when codeine is being used for cough. If coadministration is necessary, monitor for reduced efficacy of codeine and signs of opioid withdrawal; consider increasing the dose of codeine as needed. If dexamethasone is discontinued, consider a dose reduction of codeine and frequently monitor for signs or respiratory depression and sedation. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Dexamethasone is a moderate CYP3A4 inducer. [33654] [34883] [54286] Codeine; Guaifenesin; Pseudoephedrine: (Moderate) Concomitant use of codeine with dexamethasone can decrease codeine levels, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when codeine is being used for cough. If coadministration is necessary, monitor for reduced efficacy of codeine and signs of opioid withdrawal; consider increasing the dose of codeine as needed. If dexamethasone is discontinued, consider a dose reduction of codeine and frequently monitor for signs or respiratory depression and sedation. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Dexamethasone is a moderate CYP3A4 inducer. [33654] [34883] [54286] Codeine; Phenylephrine; Promethazine: (Moderate) Concomitant use of codeine with dexamethasone can decrease codeine levels, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when codeine is being used for cough. If coadministration is necessary, monitor for reduced efficacy of codeine and signs of opioid withdrawal; consider increasing the dose of codeine as needed. If dexamethasone is discontinued, consider a dose reduction of codeine and frequently monitor for signs or respiratory depression and sedation. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Dexamethasone is a moderate CYP3A4 inducer. [33654] [34883] [54286] (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Codeine; Promethazine: (Moderate) Concomitant use of codeine with dexamethasone can decrease codeine levels, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when codeine is being used for cough. If coadministration is necessary, monitor for reduced efficacy of codeine and signs of opioid withdrawal; consider increasing the dose of codeine as needed. If dexamethasone is discontinued, consider a dose reduction of codeine and frequently monitor for signs or respiratory depression and sedation. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Dexamethasone is a moderate CYP3A4 inducer. [33654] [34883] [54286] Corticorelin, Ovine: (Major) Patients pretreated with dexamethasone have demonstrated an inhibited or blunted response to corticotropin, ovine. Patients receiving corticotropin, ovine should not be pretreated with dexamethasone; no specific guidelines are available. [6759] Cyclosporine: (Moderate) Convulsions have been reported during concurrent use of cyclosporine and other corticosteroids. In addition, mutual inhibition of metabolism occurs with concurrent use of cyclosporine and dexamethasone; therefore, the potential for adverse events associated with either drug may be increased. Coadministration should be approached with caution. [29779] [30015] [30028] [36319] [41361] Dabrafenib: (Major) Use dabrafenib and dexamethasone together with caution; concentrations of either agent may be decreased. Use an alternate agent in place of dexamethasone if possible. If concomitant use cannot be avoided, monitor patients for loss of dexamethasone efficacy. Dexamethasone and dabrafenib are both CYP3A4 substrates and moderate CYP3A4 inducers. [54286] [54802] Daclatasvir: (Major) The dose of daclatasvir, a CYP3A4 substrate, must be increased to 90 mg PO once daily when administered in combination with moderate CYP3A4 inducers, such as dexamethasone. Taking these drugs together may decrease daclatasvir serum concentrations, potentially resulting in reduced antiviral efficacy and antimicrobial resistance. Conversely, the therapeutic effects of dexamethasone, a P-glycoprotein (P-gp) substrate, may be increased by daclatasvir, a P-gp inhibitor. [34477] [54286] [60001] Dapagliflozin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Dapagliflozin; Metformin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Dapagliflozin; Saxagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Dapsone: (Moderate) Closely monitor for a reduction in dapsone efficacy and signs of hemolytic anemia if coadministration with dexamethasone is necessary. Dapsone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Coadministration may decrease plasma concentrations of dapsone and increase the formation of dapsone hydroxylamine (a metabolite associated with hemolysis). [34335] [34470] [60612] Daridorexant: (Major) Avoid concomitant use of daridorexant and dexamethasone. Coadministration may decrease daridorexant exposure which may reduce its efficacy. Daridorexant is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. Concomitant use of another moderate CYP3A inducer decreased daridorexant overall exposure by over 50%. [54286] [67248] Darunavir: (Major) Avoid concurrent use of darunavir with dexamethasone. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance to darunavir; consider use of an alternative corticosteroid. In addition, serum concentrations of dexamethasone may be increased, potentially resulting in Cushing's syndrome and adrenal suppression. Dexamethasone is a CYP3A4 substrate and inducer; darunavir is a substrate of this enzyme as well as a strong CYP3A inhibitor. Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. [32432] [58000] Darunavir; Cobicistat: (Major) Avoid concurrent use of darunavir with dexamethasone. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance to darunavir; consider use of an alternative corticosteroid. In addition, serum concentrations of dexamethasone may be increased, potentially resulting in Cushing's syndrome and adrenal suppression. Dexamethasone is a CYP3A4 substrate and inducer; darunavir is a substrate of this enzyme as well as a strong CYP3A inhibitor. Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. [32432] [58000] (Major) Avoid concurrent use of dexamethasone with cobicistat containing regimens. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance. In addition, serum concentrations of dexamethasone may be increased, potentially resulting in Cushing's syndrome and adrenal suppression. Dexamethasone is a CYP3A4 substrate and inducer; cobicistat is a substrate of this enzyme as well as a strong CYP3A inhibitor. Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. [51664] [58000] Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: (Major) Avoid concurrent use of darunavir with dexamethasone. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance to darunavir; consider use of an alternative corticosteroid. In addition, serum concentrations of dexamethasone may be increased, potentially resulting in Cushing's syndrome and adrenal suppression. Dexamethasone is a CYP3A4 substrate and inducer; darunavir is a substrate of this enzyme as well as a strong CYP3A inhibitor. Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. [32432] [58000] (Major) Avoid concurrent use of dexamethasone with cobicistat containing regimens. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance. In addition, serum concentrations of dexamethasone may be increased, potentially resulting in Cushing's syndrome and adrenal suppression. Dexamethasone is a CYP3A4 substrate and inducer; cobicistat is a substrate of this enzyme as well as a strong CYP3A inhibitor. Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. [51664] [58000] Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: (Contraindicated) Concurrent administration of dexamethasone with dasabuvir; ombitasvir; paritaprevir; ritonavir is contraindicated. Taking these drugs together could result in elevated dexamethasone plasma concentrations and decreased concentrations of dasabuvir, paritaprevir, and ritonavir. Antiviral efficacy could be affected. Dexamethasone is a P-glycoprotein (P-gp) substrate and a CYP3A4 substrate/inducer. Ritonavir is a P-gp inhibitor and a CYP3A4 substrate/potent inhibitor. Both paritaprevir and dasabuvir (minor) are CYP3A4 substrates. [34477] [54286] [58664] (Contraindicated) Concurrent administration of dexamethasone with dasabuvir; ombitasvir; paritaprevir; ritonavir or ombitasvir; paritaprevir; ritonavir is contraindicated. Taking these drugs together could result in elevated dexamethasone plasma concentrations and decreased concentrations of dasabuvir, paritaprevir, and ritonavir. Antiviral efficacy could be affected. Dexamethasone is a P-glycoprotein (P-gp) substrate and a CYP3A4 substrate/inducer. Ritonavir is a P-gp inhibitor and a CYP3A4 substrate/potent inhibitor. Both paritaprevir and dasabuvir (minor) are CYP3A4 substrates. [34477] [54286] [58664] (Moderate) Close monitoring of therapeutic and adverse effects is required when dexamethasone is coadministered with ritonavir. Ritonavir inhibits CYP3A4 and dexamethasone is a CYP3A4 substrate. [4718] [5070] [5206] Deferasirox: (Moderate) Because gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including corticosteroids. [31807] Deflazacort: (Major) Avoid concomitant use of deflazacort and dexamethasone. Concurrent use may significantly decrease concentrations of 21-desDFZ, the active metabolite of deflazacort, resulting in loss of efficacy. Deflazacort is a CYP3A4 substrate; dexamethasone is a moderate inducer of CYP3A4. Administration of deflazacort with multiple doses of rifampin (a strong CYP3A4 inducer) resulted in geometric mean exposures that were approximately 95% lower compared to administration alone. [54286] [61750] Delavirdine: (Minor) Since dexamethasone may induce metabolism of delavirdine, concomitant use of these agents should be done with caution. Delavirdine therapy may be less effective due to decreased plasma levels in patients taking these drugs concomitantly. [5206] Denileukin Diftitox: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Denosumab: (Moderate) The safety and efficacy of denosumab use in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with denosumab may be at a greater risk of developing an infection. [40862] Desmopressin: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. [42295] [61806] Dextromethorphan; Bupropion: (Moderate) Monitor for seizure activity during concomitant bupropion and corticosteroid use. Bupropion is associated with a dose-related seizure risk; concomitant use of other medications that lower the seizure threshold, such as systemic corticosteroids, increases the seizure risk. [44094] Dextromethorphan; Diphenhydramine; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Dextromethorphan; Quinidine: (Moderate) Quinidine is a substrate of the CYP3A4 isoenzyme. Inducers of CYP3A4 such as dexamethasone may increase hepatic elimination of quinidine with the potential for reduced efficacy of quinidine. [10571] [6759] Dipeptidyl Peptidase-4 Inhibitors: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Diphenhydramine; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Dofetilide: (Major) Corticosteroids can cause increases in blood pressure, sodium and water retention, and hypokalemia, predisposing patients to interactions with certain other medications. Corticosteroid-induced hypokalemia could also enhance the proarrhythmic effects of dofetilide. [49489] Dolutegravir; Rilpivirine: (Contraindicated) Concurrent use of dexamethasone (more than 1 dose) and rilpivirine is contraindicated. When these drugs are coadministered, there is a potential for treatment failure and/or the development of rilpivirine or NNRTI resistance. Dexamethasone is an inducer of CYP3A4, which is primarily responsible for the metabolism of rilpivirine. Coadministration may result in decreased rilpivirine serum concentrations, which could cause impaired virologic response to rilpivirine. [44376] [54286] Doravirine: (Moderate) Concurrent administration of doravirine and dexamethasone may result in decreased doravirine exposure, resulting in potential loss of virologic control. Doravirine is a CYP3A4 substrate; dexamethasone is a moderate CYP3A4 inducer. [54286] [63484] Doravirine; Lamivudine; Tenofovir disoproxil fumarate: (Moderate) Concurrent administration of doravirine and dexamethasone may result in decreased doravirine exposure, resulting in potential loss of virologic control. Doravirine is a CYP3A4 substrate; dexamethasone is a moderate CYP3A4 inducer. [54286] [63484] Doxacurium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Dronabinol: (Moderate) Use caution if coadministration of dronabinol with dexamethasone is necessary, and monitor for a decrease in the efficacy of dronabinol. Dronabinol is a CYP2C9 and 3A4 substrate; dexamethasone is a moderate inducer of CYP3A4. Concomitant use may result in decreased plasma concentrations of dronabinol. [30431] [34477] [54286] [60951] Dronedarone: (Major) The concomitant use of dronedarone and CYP3A4 inducers should be avoided. Dronedarone is metabolized by CYP3A and is an inhibitor of CYP3A and P-gp. Dexamethasone induces CYP3A4 and is a substrate for CYP3A4 and P-gp. Coadministration of CYP3A4 inducers, such as dexamethasone, with dronedarone may result in reduced plasma concentration and subsequent reduced effectiveness of dronedarone therapy; the plasma concentrations of dexamethasone may also be increased. [36101] Droperidol: (Moderate) Caution is advised when using droperidol in combination with corticosteroids which may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia, as such abnormalities may increase the risk for QT prolongation or cardiac arrhythmias. [5468] Dulaglutide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Duvelisib: (Major) Avoid concomitant use of duvelisib with dexamethasone. Coadministration may decrease the exposure of duvelisib, which may reduce the efficacy of duvelisib. If concomitant use is necessary, increase the dose of duvelisib on day 12 of coadministration from 25 mg PO twice daily to 40 mg PO twice daily; or from 15 mg PO twice daily to 25 mg PO twice daily. When dexamethasone has been discontinued for at least 14 days, resume duvelisib at the dose taken prior to initiating treatment with dexamethasone. Duvelisib is a CYP3A substrate; dexamethasone is a moderate CYP3A inducer. Coadministration of duvelisib with another moderate CYP3A inducer for 12 days decreased duvelisib exposure by 35%. [54286] [63571] Echinacea: (Moderate) Echinacea possesses immunostimulatory activity and may theoretically reduce the response to immunosuppressant drugs like corticosteroids. For some patients who are using corticosteroids for serious illness, such as cancer or organ transplant, this potential interaction may result in the preferable avoidance of Echinacea. Although documentation is lacking, coadministration of echinacea with immunosuppressants is not recommended by some resources. [25398] [32073] [61902] [61905] Econazole: (Minor) In vitro studies indicate that corticosteroids inhibit the antifungal activity of econazole against C. albicans in a concentration-dependent manner. When the concentration of the corticosteroid was equal to or greater than that of econazole on a weight basis, the antifungal activity of econazole was substantially inhibited. When the corticosteroid concentration was one-tenth that of econazole, no inhibition of antifungal activity was observed. [6968] Elacestrant: (Major) Avoid concurrent use of elacestrant and dexamethasone due to the risk of decreased elacestrant exposure which may reduce its efficacy. Elacestrant is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. Concomitant use with another moderate CYP3A inducer reduced elacestrant overall exposure by 55% to 73%. [54286] [68530] Elagolix: (Moderate) Monitor for decreased efficacy of dexamethasone if coadministration with elagolix is necessary; consider increasing the dose of dexamethasone if clinically appropriate. Dexamethasone is a CYP3A4 substrate and elagolix is a weak to moderate CYP3A4 inducer. [54286] [63387] Elagolix; Estradiol; Norethindrone acetate: (Moderate) Monitor for decreased efficacy of dexamethasone if coadministration with elagolix is necessary; consider increasing the dose of dexamethasone if clinically appropriate. Dexamethasone is a CYP3A4 substrate and elagolix is a weak to moderate CYP3A4 inducer. [54286] [63387] Elbasvir; Grazoprevir: (Major) If possible, avoid concurrent administration of elbasvir with dexamethasone. Dexamethasone is a moderate CYP3A inducer, while elbasvir is a substrate of CYP3A. Use of these drugs together is expected to decrease the plasma concentrations of elbasvir, and may result in decreased virologic response. [54286] [60523] (Major) If possible, avoid concurrent administration of grazoprevir with dexamethasone. Dexamethasone is a moderate CYP3A inducer, while grazoprevir is a substrate of CYP3A. Use of these drugs together is expected to decrease the plasma concentrations of grazoprevir, and may result in decreased virologic response. Conversely, concentrations of dexamethasone (also a CYP3A substrate) may be increased when given with grazoprevir (a weak CYP3A inhibitor). [54286] [60523] Eliglustat: (Moderate) Coadministration of dexamethasone and eliglustat may result in increased plasma concentrations of dexamethasone. Monitor patients closely for corticosteroid-related adverse effects; if appropriate, consider reducing the dexamethasone dosage and titrating to clinical effect. Dexamethasone is a P-glycoprotein (P-gp) substrate; eliglustat is a P-gp inhibitor. [34477] [57803] Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Major) Avoid concurrent use of dexamethasone with cobicistat containing regimens. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance. In addition, serum concentrations of dexamethasone may be increased, potentially resulting in Cushing's syndrome and adrenal suppression. Dexamethasone is a CYP3A4 substrate and inducer; cobicistat is a substrate of this enzyme as well as a strong CYP3A inhibitor. Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. [51664] [58000] (Major) Avoid concurrent use of dexamethasone with elvitegravir. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance to elvitegravir; consider use of an alternative corticosteroid, such as beclomethasone and prednisolone. Dexamethasone induces CYP3A4, and elvitegravir is a substrate of this enzyme. [51664] [58001] [60269] Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Major) Avoid concurrent use of dexamethasone with cobicistat containing regimens. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance. In addition, serum concentrations of dexamethasone may be increased, potentially resulting in Cushing's syndrome and adrenal suppression. Dexamethasone is a CYP3A4 substrate and inducer; cobicistat is a substrate of this enzyme as well as a strong CYP3A inhibitor. Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. [51664] [58000] (Major) Avoid concurrent use of dexamethasone with elvitegravir. Coadministration may result in a reduction of antiretroviral efficacy and the potential development of viral resistance to elvitegravir; consider use of an alternative corticosteroid, such as beclomethasone and prednisolone. Dexamethasone induces CYP3A4, and elvitegravir is a substrate of this enzyme. [51664] [58001] [60269] Empagliflozin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Empagliflozin; Linagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Empagliflozin; Linagliptin; Metformin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Empagliflozin; Metformin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Emtricitabine; Rilpivirine; Tenofovir alafenamide: (Contraindicated) Concurrent use of dexamethasone (more than 1 dose) and rilpivirine is contraindicated. When these drugs are coadministered, there is a potential for treatment failure and/or the development of rilpivirine or NNRTI resistance. Dexamethasone is an inducer of CYP3A4, which is primarily responsible for the metabolism of rilpivirine. Coadministration may result in decreased rilpivirine serum concentrations, which could cause impaired virologic response to rilpivirine. [44376] [54286] Emtricitabine; Rilpivirine; Tenofovir Disoproxil Fumarate: (Contraindicated) Concurrent use of dexamethasone (more than 1 dose) and rilpivirine is contraindicated. When these drugs are coadministered, there is a potential for treatment failure and/or the development of rilpivirine or NNRTI resistance. Dexamethasone is an inducer of CYP3A4, which is primarily responsible for the metabolism of rilpivirine. Coadministration may result in decreased rilpivirine serum concentrations, which could cause impaired virologic response to rilpivirine. [44376] [54286] Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Encorafenib: (Major) Avoid coadministration of encorafenib and dexamethasone due to decreased encorafenib exposure and potential loss of efficacy. Encorafenib is a CYP3A4 substrate; dexamethasone is a moderate CYP3A4 inducer. Coadministration with CYP3A4 inducers has not been studied with encorafenib; however, in clinical trials, steady-state encorafenib exposures were lower than encorafenib exposures after the first dose, suggesting CYP3A4 auto-induction. [54286] [63317] Entrectinib: (Major) Avoid coadministration of entrectinib with dexamethasone due to decreased entrectinib exposure and risk of decreased efficacy. Entrectinib is a CYP3A4 substrate; dexamethasone is a moderate CYP3A4 inducer. Coadministration of a moderate CYP3A4 inducer is predicted to reduce the entrectinib AUC by 56%. [54286] [64567] Enzalutamide: (Moderate) Monitor for decreased efficacy of dexamethasone if coadministration with enzalutamide is necessary; consider increasing the dose of dexamethasone if clinically appropriate. Dexamethasone is a CYP3A4 substrate and enzalutamide is a strong CYP3A4 inducer. [51727] [54286] Ephedrine: (Moderate) Ephedrine may enhance the metabolic clearance of corticosteroids. Decreased blood concentrations and lessened physiologic activity may necessitate an increase in corticosteroid dosage. [8844] Ephedrine; Guaifenesin: (Moderate) Ephedrine may enhance the metabolic clearance of corticosteroids. Decreased blood concentrations and lessened physiologic activity may necessitate an increase in corticosteroid dosage. [8844] Epinephrine: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Corticosteroids may potentiate the hypokalemic effects of epinephrine. [26417] [56575] Eprosartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Erdafitinib: (Major) If coadministration of erdafitinib and dexamethasone is necessary at the initiation of erdafitinib therapy, administer the dose of erdafitinib as recommended (8 mg once daily with potential to increase the dose to 9 mg on days 14 to 21 based on phosphate levels and tolerability). If dexamethasone must be added to erdafitinib therapy after the initial dose increase period (days 14 to 21), increase the dose of erdafitinib up to 9 mg. If dexamethasone is discontinued, continue erdafitinib at the same dose in the absence of drug-related toxicity. Erdafitinib is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [54286] [64064] Erlotinib: (Major) Avoid the coadministration of erlotinib with dexamethasone if possible due to the risk of decreased erlotinib efficacy. If concomitant use is unavoidable, increase the dose of erlotinib by 50 mg increments at 2-week intervals as tolerated, to a maximum of 450 mg. Also, monitor for symptoms of gastrointestinal (GI) perforation (e.g., severe abdominal pain, fever, nausea, and vomiting); permanently discontinue erlotinib in patients who develop GI perforation. Erlotinib is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Coadministration may decrease plasma concentrations of erlotinib. The pooled incidence of GI perforation clinical trials of erlotinib ranged from 0.1% to 0.4%, including fatal cases; patients receiving concomitant dexamethasone may be at increased risk. [30555] [54286] Ertugliflozin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Ertugliflozin; Metformin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Ertugliflozin; Sitagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Erythromycin: (Moderate) Caution is warranted with the use of dexamethasone and erythromycin. Erythromycin inhibits CYP3A4 and has the potential to result in increased plasma concentrations of corticosteroids such as dexamethasone. [28251] Escitalopram: (Minor) Escitalopram is metabolized by CYP2C19 and CYP3A4. Dexamethasone can induce the metabolism of various CYP 450 isoenzymes, including those involved in escitalopram metabolism. Although no clinical data are available to support a clinically significant interaction, escitalopram may need to be administered in higher doses in patients chronically taking dexamethasone. [4718] [4997] Esomeprazole: (Moderate) Monitor for decreased efficacy of esomeprazole if coadministration with dexamethasone is necessary. Esomeprazole is extensively metabolized in the liver by CYP2C19 and CYP3A4. Dexamethasone is a moderate CYP3A4 inducer. Drugs known to induce CYP3A4 may lead to decreased esomeprazole plasma concentrations. The manufacturer of esomeprazole recommends avoidance with strong inducers because decreased exposure of esomeprazole can occur. Recommendations are not available for concomitant use with moderate inducers of CYP3A4. [29524] [54286] Estramustine: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [4744] [7714] Estrogens: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Eszopiclone: (Moderate) Potent inducers of CYP3A4, such as dexmethasone, may cause a reduction in the plasma concentration of eszopiclone. [28001] [30571] Etravirine: (Major) Dexamethasone can induce the activity of CYP3A4 and increase the metabolism of etravirine; decreased antiviral efficacy may be seen. While concomitant administration has not been evaluated, a potentially significant interaction may occur. Use these drugs concomitantly with caution, or consider alternative corticosteroids, particularly for long-term use. [33718] Everolimus: (Moderate) Monitor everolimus whole blood trough concentrations as appropriate if coadministration with dexamethasone is necessary. The dose of everolimus may need to be increased. Everolimus is a sensitive CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Coadministration with CYP3A4 inducers may increase the metabolism of everolimus and decrease everolimus blood concentrations. [49823] [49903] [54286] Exenatide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Fedratinib: (Major) Avoid coadministration of fedratinib with dexamethasone as concurrent use may decrease fedratinib exposure which may result in decreased therapeutic response. Fedratinib is a CYP3A4 substrate; dexamethasone is a moderate CYP3A4 inducer. Coadministration of fedratinib with another moderate CYP3A4 inducer decreased the overall exposure of fedratinib by 47%. [54286] [64568] Fentanyl: (Moderate) Consider an increased dose of fentanyl and monitor for evidence of opioid withdrawal if concurrent use of dexamethasone is necessary. If dexamethasone is discontinued, consider reducing the fentanyl dosage and monitor for evidence of respiratory depression. Coadministration of a CYP3A4 inducer like dexamethasone with fentanyl, a CYP3A4 substrate, may decrease exposure to fentanyl resulting in decreased efficacy or onset of withdrawal symptoms in a patient who has developed physical dependence to fentanyl. Fentanyl plasma concentrations will increase once the inducer is stopped, which may increase or prolong the therapeutic and adverse effects, including serious respiratory depression. [29623] [29763] [32731] [40943] [54286] Finasteride; Tadalafil: (Minor) Tadalafil is metabolized principally by cytochrome P450 3A4. Studies have shown that concomitant administration of CYP3A4 enzyme-inducers, such as dexamethasone, will decrease plasma levels of tadalafil. [4946] Finerenone: (Major) Avoid concurrent use of finerenone and dexamethasone due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%. [54286] [66793] Flibanserin: (Major) The concomitant use of flibanserin with CYP3A4 inducers significantly decreases flibanserin exposure compared to the use of flibanserin alone. Therefore, concurrent use of flibanserin and CYP3A4 inducers, such as dexamethasone, is not recommended. [60099] [6759] Fluoxymesterone: (Moderate) Coadministration of corticosteroids and fluoxymesterone may increase the risk of edema, especially in patients with underlying cardiac or hepatic disease. Corticosteroids with greater mineralocorticoid activity, such as fludrocortisone, may be more likely to cause edema. Administer these drugs in combination with caution. [11342] Fosamprenavir: (Moderate) Monitor for decreased fosamprenavir efficacy if coadministered with dexamethasone. Concurrent use may decrease the plasma concentrations of fosamprenavir leading to a reduction of antiretroviral efficacy and the potential development of viral resistance. Fosamprenavir is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. [29012] [54286] Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Gallium Ga 68 Dotatate: (Moderate) Repeated administration of high corticosteroid doses prior to gallium Ga 68 dotatate may result in false negative imaging. High-dose corticosteroid therapy is generally defined as at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. Corticosteroids can down-regulate somatostatin subtype 2 receptors: thereby, interfering with binding of gallium Ga 68 dotatate to malignant cells that overexpress these receptors. [60852] Ganaxolone: (Major) Avoid concurrent use of ganaxolone and dexamethasone due to the risk of decreased ganaxolone efficacy. If concomitant use is unavoidable, consider increasing ganaxolone dose without exceeding the maximum daily dose. Ganaxolone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [54286] [67478] Gefitinib: (Moderate) Monitor for clinical response of gefitinib if used concomitantly with dexamethasone. Gefitinib is metabolized significantly by CYP3A4 and dexamethasone is a CYP3A4 inducer; coadministration may increase gefitinib metabolism and decrease gefitinib concentrations. While the manufacturer has provided no guidance regarding the use of gefitinib with mild or moderate CYP3A4 inducers, administration of a single 500 mg gefitinib dose with a concurrent strong CYP3A4 inducer (rifampin) resulted in reduced mean AUC of gefitinib by 83%. [34477] [45935] [54286] Glasdegib: (Major) Avoid coadministration of glasdegib and dexamethasone due to the potential for decreased glasdegib exposure and risk of decreased efficacy. If concurrent use cannot be avoided, increase the glasdegib dosage (i.e., from 100 mg PO daily to 200 mg PO daily; or from 50 mg PO daily to 100 mg PO daily). Resume the previous dose of glasdegib after dexamethasone has been discontinued for 7 days. Glasdegib is a CYP3A4 substrate; dexamethasone is a moderate CYP3A4 inducer. Coadministration with another moderate CYP3A4 inducer was predicted to decrease the glasdegib AUC value by 55% [54286] [63777] Glecaprevir; Pibrentasvir: (Moderate) Caution is advised with the coadministration of glecaprevir and dexamethasone as coadministration may increase serum concentrations of dexamethasone and increase the risk of adverse effects. Dexamethasone is a substrate of P-glycoprotein (P-gp); glecaprevir is a P-gp inhibitor. [34477] [62201] (Moderate) Caution is advised with the coadministration of pibrentasvir and dexamethasone as coadministration may increase serum concentrations of dexamethasone and increase the risk of adverse effects. Dexamethasone is a substrate of P-glycoprotein (P-gp); pibrentasvir is a P-gp inhibitor. [34477] [62201] Glimepiride: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Glimepiride; Rosiglitazone: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Glipizide: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Glipizide; Metformin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Glyburide: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Glyburide; Metformin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Glycerol Phenylbutyrate: (Moderate) Corticosteroids may induce elevated blood ammonia concentrations. Corticosteroids should be used with caution in patients receiving glycerol phenylbutyrate. Monitor ammonia concentrations closely. [53022] Golimumab: (Moderate) The safety and efficacy of golimumab in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with golimumab may be at a greater risk of developing an infection. [35501] Guaifenesin; Hydrocodone: (Moderate) Concomitant use of hydrocodone with dexamethasone can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when hydrocodone is being used for cough. If coadministration is necessary, monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal; consider increasing the dose of hydrocodone as needed. If dexamethasone is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [30011] [30379] [56303] Guaifenesin; Hydrocodone; Pseudoephedrine: (Moderate) Concomitant use of hydrocodone with dexamethasone can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when hydrocodone is being used for cough. If coadministration is necessary, monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal; consider increasing the dose of hydrocodone as needed. If dexamethasone is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [30011] [30379] [56303] Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Guanfacine: (Major) Dexamethasone may significantly decrease guanfacine plasma concentrations. FDA-approved labeling for extended-release (ER) guanfacine recommends that, if these agents are taken together, doubling the recommended dose of guanfacine should be considered; if dexamethasone is added in a patient already receiving guanfacine, this escalation should occur over 1 to 2 weeks. If dexamethasone is discontinued, decrease the guanfacine ER dosage back to the recommended dose over 1 to 2 weeks. Specific recommendations for immediate-release (IR) guanfacine are not available. Guanfacine is primarily metabolized by CYP3A4, and dexamethasone is a moderate CYP3A4 inducer. [43566] [54286] Haloperidol: (Moderate) Caution is advisable during concurrent use of haloperidol and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with haloperidol. [28307] Hemin: (Moderate) Hemin works by inhibiting aminolevulinic acid synthetase. Corticosteroids increase the activity of this enzyme should not be used with hemin. [6702] Homatropine; Hydrocodone: (Moderate) Concomitant use of hydrocodone with dexamethasone can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when hydrocodone is being used for cough. If coadministration is necessary, monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal; consider increasing the dose of hydrocodone as needed. If dexamethasone is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [30011] [30379] [56303] Hydantoins: (Moderate) Hydantoin anticonvulsants induce hepatic microsomal enzymes and may increase the metabolism of dexamethasone, leading to reduced efficacy. Depending on the individual clinical situation and the indication for the interacting medication, enzyme-induction interactions may not always produce reductions in treatment efficacy. [28001] [28771] Hydralazine; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Hydrochlorothiazide, HCTZ; Methyldopa: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Hydrocodone: (Moderate) Concomitant use of hydrocodone with dexamethasone can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when hydrocodone is being used for cough. If coadministration is necessary, monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal; consider increasing the dose of hydrocodone as needed. If dexamethasone is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [30011] [30379] [56303] Hydrocodone; Ibuprofen: (Moderate) Concomitant use of hydrocodone with dexamethasone can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when hydrocodone is being used for cough. If coadministration is necessary, monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal; consider increasing the dose of hydrocodone as needed. If dexamethasone is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [30011] [30379] [56303] Hydrocodone; Pseudoephedrine: (Moderate) Concomitant use of hydrocodone with dexamethasone can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. It is recommended to avoid this combination when hydrocodone is being used for cough. If coadministration is necessary, monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal; consider increasing the dose of hydrocodone as needed. If dexamethasone is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [30011] [30379] [56303] Hydroxyurea: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Hylan G-F 20: (Major) The safety and efficacy of hylan G-F 20 given concomitantly with other intra-articular injectables have not been established. Other intra-articular injections may include intra-articular steroids (betamethasone, dexamethasone, hydrocortisone, prednisolone, methylprednisolone, and triamcinolone). [45238] [45239] Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] (Moderate) Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. [57713] [57714] [57715] Ibrexafungerp: (Major) Avoid concurrent administration of ibrexafungerp with dexamethasone. Use of these drugs together is expected to significantly decrease ibrexafungerp exposure, which may reduce its efficacy. Ibrexafungerp is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. [54286] [66705] Ibritumomab Tiuxetan: (Moderate) Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. [57713] [57714] [57715] (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Ibrutinib: (Moderate) Use ibrutinib and dexamethasone together with caution; decreased ibrutinib levels may occur resulting in reduced ibrutinib efficacy. Monitor patients for signs of decreased ibrutinib efficacy if these agents are used together. Ibrutinib is a CYP3A4 substrate; dexamethasone is a moderate CYP3A inducer. Simulations suggest that coadministration with a moderate CYP3A4 inducer may decrease ibrutinib exposure by 3-fold. [54286] [56410] Ibuprofen; Oxycodone: (Moderate) Monitor for reduced efficacy of oxycodone and signs of opioid withdrawal if coadministration with dexamethasone is necessary; consider increasing the dose of oxycodone as needed. If dexamethasone is discontinued, consider a dose reduction of oxycodone and frequently monitor for signs of respiratory depression and sedation. Oxycodone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease oxycodone concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. [39926] [54286] Idelalisib: (Major) Avoid concomitant use of idelalisib, a strong CYP3A inhibitor, with dexamethasone, a CYP3A substrate, as dexamethasone toxicities may be significantly increased. The AUC of a sensitive CYP3A substrate was increased 5.4-fold when coadministered with idelalisib. [57675] [6759] Ifosfamide: (Moderate) Closely monitor for increased ifosfamide-related toxicities (e.g., neurotoxicity, nephrotoxicity) if coadministration with dexamethasone is necessary. The significance of this interaction is unknwon, however, as dexamethasone is widely used as an antiemetic with chemotherapy such as ifosfamide. Ifosfamide is metabolized to its active alkylating metabolites by CYP3A4; dexamethasone is a moderate CYP3A4 inducer. Concomitant use may increase the formation of the neurotoxic/nephrotoxic ifosfamide metabolite, chloroacetaldehyde. [51027] [54286] Imatinib: (Major) Avoid coadministration of imatinib and dexamethasone if possible due to decreased plasma concentrations of imatinib. If concomitant use is unavoidable, increase the dose of imatinib by at least 50%, carefully monitoring clinical response; imatinib doses up to 1,200 mg per day (600 mg twice daily) have been given to patients receiving concomitant strong CYP3A4 inducers. Imatinib is a CYP3A4 substrate and dexamethasone is a CYP3A4 inducer. [58770] Incretin Mimetics: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Indapamide: (Moderate) Additive hypokalemia may occur when indapamide is coadministered with other drugs with a significant risk of hypokalemia such as systemic corticosteroids. Coadminister with caution and careful monitoring. [26417] Indinavir: (Moderate) Dexamethasone is a moderate inducer of CYP3A4. Coadministration with other drugs that are metabolized by CYP3A4 (e.g., indinavir) may increase their clearance, resulting in decreased plasma concentration. [8844] Inebilizumab: (Moderate) Concomitant usage of inebilizumab with immunosuppressant drugs, including systemic corticosteroids, may increase the risk of infection. Consider the risk of additive immune system effects when coadministering therapies that cause immunosuppression with inebilizumab. [65576] Infigratinib: (Major) Avoid concurrent use of infigratinib and dexamethasone. Coadministration may decrease infigratinib exposure resulting in decreased efficacy. Infigratinib is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [54286] [66702] Infliximab: (Moderate) Many serious infections during infliximab therapy have occurred in patients who received concurrent immunosuppressives that, in addition to their underlying Crohn's disease or rheumatoid arthritis, predisposed patients to infections. The impact of concurrent infliximab therapy and immunosuppression on the development of malignancies is unknown. In clinical trials, the use of concomitant immunosuppressant agents appeared to reduce the frequency of antibodies to infliximab and appeared to reduce infusion reactions. [4711] Insulin Degludec; Liraglutide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulin Glargine; Lixisenatide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulins: (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Interferon Alfa-2b: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Iohexol: (Major) Serious adverse events, including death, have been observed during intrathecal administration of both corticosteroids (i.e., dexamethasone) and radiopaque contrast agents (i.e., iohexol); therefore, concurrent use of these medications via the intrathecal route is contraindicated. Cases of cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been temporally associated (i.e., within minutes to 48 hours after injection) with epidural administration of injectable corticosteroids. In addition, patients inadvertently administered iohexol formulations not indicated for intrathecal use have experienced seizures, convulsions, cerebral hemorrhages, brain edema, and death. Administering these medications together via the intrathecal route may increase the risk for serious adverse events. [28963] [57053] Iopamidol: (Contraindicated) Because both intrathecal corticosteroids (i.e., dexamethasone) and intrathecal radiopaque contrast agents (i.e., iopamidoll) can increase the risk of seizures, the intrathecal administration of corticosteroids with intrathecal radiopaque contrast agents is contraindicated. [5442] Irbesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Isavuconazonium: (Major) Avoid concurrent use of dexamethasone with isavuconazonium. An alternative corticosteroid should be considered. Dexamethasone is a substrate and inducer of the hepatic isoenzyme CYP3A4 and a substrate of the drug transporter P-glycoprotein (P-gp); isavuconazole, the active moiety of isavuconazonium, is a sensitive substrate and moderate inhibitor of CYP3A4 and an inhibitor of P-gp. Concurrent use may result in significant decreases in the plasma concentrations of isavuconazole, leading to a reduction of antifungal efficacy and the potential for treatment failure. In addition, serum concentrations of dexamethasone may be increased, potentially resulting in Cushing's syndrome and adrenal suppression. [34477] [54286] [59042] Isoniazid, INH; Pyrazinamide, PZA; Rifampin: (Moderate) Monitor for decreased efficacy of dexamethasone if coadministration with rifampin is necessary; consider increasing the dose of dexamethasone if clinically appropriate. Dexamethasone is a CYP3A4 substrate and rifampin is a strong CYP3A4 inducer. [30314] [54286] Isoniazid, INH; Rifampin: (Moderate) Monitor for decreased efficacy of dexamethasone if coadministration with rifampin is necessary; consider increasing the dose of dexamethasone if clinically appropriate. Dexamethasone is a CYP3A4 substrate and rifampin is a strong CYP3A4 inducer. [30314] [54286] Isoproterenol: (Moderate) The risk of cardiac toxicity with isoproterenol in asthma patients appears to be increased with the coadministration of corticosteroids. Intravenous infusions of isoproterenol in refractory asthmatic children at rates of 0.05 to 2.7 mcg/kg/min have caused clinical deterioration, myocardial infarction (necrosis), congestive heart failure and death. [28004] Isotretinoin: (Minor) Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Patients receiving systemic corticosteroids should receive isotretinoin therapy with caution. [5283] Itraconazole: (Moderate) Monitor for corticosteroid-related adverse effects and altered response to itraconazole if coadminsitration is necessary. Itraconazole is a strong CYP3A4 inhibitor and substrate; dexamethasone is a moderate CYP3A4 inducer and substrate. Another strong CYP3A4 inhibitor has been reported to decrease the metabolism of certain corticosteroids by up to 60%, leading to increased risk of corticosteroid side effects. The clearance of itraconazole may also be increased, resulting in decreased plasma concentrations. [27983] [30011] [40233] Ketoconazole: (Moderate) Coadministration may result in increased exposure to dexamethasone and increased corticosteroid-related adverse effects. Ketoconazole has been reported to decrease the metabolism of certain corticosteroids by up to 60%. In addition, ketoconazole alone can inhibit adrenal corticosteroid synthesis and may cause adrenal insufficiency during corticosteroid withdrawal. [27982] [28001] [28279] [28761] [34535] Lansoprazole: (Minor) Monitor for decreased efficacy of lansoprazole if coadministration with dexamethasone is necessary. Lansoprazole is metabolized by CYP2C19 and CYP3A4. Dexamethasone is a moderate CYP3A4 inducer. Drugs known to induce CYP3A4 may lead to decreased lansoprazole plasma concentrations. [40596] [54286] Lansoprazole; Amoxicillin; Clarithromycin: (Major) Coadministration of dexamethasone and clarithromycin may decrease clarithromycin serum concentrations due to CYP3A4 enzyme induction. While the 14-OH-clarithromycin active metabolite concentrations are increased, this metabolite has different antimicrobial activity compared to clarithromycin. The intended therapeutic effect of clarithromycin could be decreased. It is not clear if clarithromycin activity against other organisms would be reduced, but reduced efficacy is possible. Alternatives to clarithromycin should be considered in patients who are taking CYP3A4 inducers. Additionally, clarithromycin inhibits CYP3A4 and has the potential to result in increased plasma concentrations of dexamethasone. Increased blood concentrations and physiologic activity may necessitate a decrease in corticosteroid dosage. [28238] [34477] (Minor) Monitor for decreased efficacy of lansoprazole if coadministration with dexamethasone is necessary. Lansoprazole is metabolized by CYP2C19 and CYP3A4. Dexamethasone is a moderate CYP3A4 inducer. Drugs known to induce CYP3A4 may lead to decreased lansoprazole plasma concentrations. [40596] [54286] Lansoprazole; Naproxen: (Minor) Monitor for decreased efficacy of lansoprazole if coadministration with dexamethasone is necessary. Lansoprazole is metabolized by CYP2C19 and CYP3A4. Dexamethasone is a moderate CYP3A4 inducer. Drugs known to induce CYP3A4 may lead to decreased lansoprazole plasma concentrations. [40596] [54286] Lapatinib: (Major) Avoid coadministration of lapatinib with dexamethasone due to decreased plasma concentrations of lapatinib. If concomitant use is unavoidable, gradually titrate the dose of lapatinib from 1,250 mg per day to 4,500 mg per day in patients receiving concomitant capecitabine (HER2-positive metastatic breast cancer), and from 1,500 mg per day to 5,500 mg per day in patients receiving concomitant aromatase inhibitor therapy (HR-positive, HER2-positive breast cancer) based on tolerability. If dexamethasone is discontinued, reduce lapatinib to the indicated dose. Lapatinib is a CYP3A4 substrate and dexamethasone is a CYP3A4 inducer. Concomitant use with a strong CYP3A4 inducer decreased lapatinib exposure by 72%. [33192] Larotrectinib: (Major) Avoid concurrent use of larotrectinib and dexamethasone due to the risk of decreased larotrectinib exposure which may reduce its efficacy. If concomitant use is necessary, double the dose of larotrectinib and monitor response. If dexamethasone is discontinued, resume the original larotrectinib dose after 3 to 5 elimination half-lives of dexamethasone. Larotrectinib is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. Coadministration with a moderate CYP3A inducer is predicted to decrease larotrectinib exposure by 72%. [54286] [63780] L-Asparaginase Escherichia coli: (Moderate) Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia. L-Asparaginase transiently inhibits insulin production contributing to hyperglycemia seen during concurrent corticosteroid therapy. Insulin therapy may be required in some cases. Administration of L-asparaginase after rather than before corticosteroids reportedly has produced fewer hypersensitivity reactions. [55362] Ledipasvir; Sofosbuvir: (Moderate) Caution and close monitoring of dexamethasone-associated adverse reactions is advised with concomitant administration of ledipasvir. Dexamethasone is a substrate of the drug transporter P-glycoprotein (P-gp); ledipasvir is a P-gp inhibitor. Taking these drugs together may increase dexamethasone plasma concentrations. [34477] [58167] Lefamulin: (Major) Avoid coadministration of lefamulin with dexamethasone unless the benefits outweigh the risks as concurrent use may decrease lefamulin exposure and efficacy. Lefamulin is a CYP3A4 substrate; dexamethasone is a moderate CYP3A4 inducer. [54286] [64576] Lemborexant: (Major) Avoid coadministration of lemborexant and dexamethasone as concurrent use may decrease lemborexant exposure which may reduce efficacy. Lemborexant is a CYP3A4 substrate; dexamethasone is a moderate CYP3A4 inducer. [54286] [64870] Lenacapavir: (Major) Avoid concurrent use of lenacapavir and dexamethasone due to the risk of decreased lenacapavir exposure which may result in loss of therapeutic effect and development of resistance. Concurrent use may also increase the exposure of dexamethasone, resulting in increased risk of Cushing's syndrome and adrenal suppression. Lenacapavir is a CYP3A substrate and moderate CYP3A inhibitor; dexamethasone is a CYP3A substrate and moderate CYP3A inducer. Concomitant use with another moderate CYP3A inducer reduced lenacapavir overall exposure by 56%. [54286] [68383] Leniolisib: (Major) Avoid concomitant use of leniolisib and dexamethasone. Concomitant use may decrease leniolisib exposure which may reduce its efficacy. Leniolisib is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. Concomitant use with another moderate CYP3A inducer reduced leniolisib overall exposure by 58%. [54286] [68778] Letermovir: (Moderate) An increase in the plasma concentration of dexamethasone may occur if given with letermovir. In patients who are also receiving treatment with cyclosporine, the magnitude of this interaction may be amplified. Dexamethasone is a CYP3A4 substrate. Letermovir is a moderate CYP3A4 inhibitor; however, when given with cyclosporine, the combined effect on CYP3A4 substrates may be similar to a strong CYP3A4 inhibitor. In a drug interaction study, concurrent administration of certain corticosteroids with another potent CYP3A4 inhibitor significantly decreased the corticosteroid metabolism (up to 60% reduction). [54286] [62611] Levamlodipine: (Minor) Coadministration of CYP3A4 inducers with amlodipine can theoretically increase the hepatic metabolism of amlodipine (a CYP3A4 substrate). Caution should be used when CYP3A4 inducers, such as dexamethasone, are coadministered with amlodipine. Monitor therapeutic response; the dosage requirements of amlodipine may be increased. [34477] [35588] [54286] Levoketoconazole: (Moderate) Coadministration may result in increased exposure to dexamethasone and increased corticosteroid-related adverse effects. Ketoconazole has been reported to decrease the metabolism of certain corticosteroids by up to 60%. In addition, ketoconazole alone can inhibit adrenal corticosteroid synthesis and may cause adrenal insufficiency during corticosteroid withdrawal. [27982] [28001] [28279] [28761] [34535] Lidocaine: (Moderate) Concomitant use of systemic lidocaine and dexamethasone may decrease lidocaine plasma concentrations. Higher lidocaine doses may be required; titrate to effect. Lidocaine is a CYP3A4 and CYP1A2 substrate; dexamethasone induces CYP3A4. [32857] [54286] Lidocaine; Epinephrine: (Moderate) Concomitant use of systemic lidocaine and dexamethasone may decrease lidocaine plasma concentrations. Higher lidocaine doses may be required; titrate to effect. Lidocaine is a CYP3A4 and CYP1A2 substrate; dexamethasone induces CYP3A4. [32857] [54286] (Moderate) Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Corticosteroids may potentiate the hypokalemic effects of epinephrine. [26417] [56575] Lidocaine; Prilocaine: (Moderate) Concomitant use of systemic lidocaine and dexamethasone may decrease lidocaine plasma concentrations. Higher lidocaine doses may be required; titrate to effect. Lidocaine is a CYP3A4 and CYP1A2 substrate; dexamethasone induces CYP3A4. [32857] [54286] Linagliptin; Metformin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] Liraglutide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Live Vaccines: (Contraindicated) Live vaccines should generally not be administered to an immunosuppressed patient. Live vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. The immunosuppressive effects of steroid treatment differ, but many clinicians consider a dose equivalent to either 2 mg/kg/day or 20 mg/day of prednisone as sufficiently immunosuppressive to raise concern about the safety of immunization with live vaccines. Patients on corticosteroid treatment for 2 weeks or more may be vaccinated after steroid therapy has been discontinued for at least 3 months in accordance with general recommendations for the use of live vaccines. The CDC has stated that discontinuation of steroids for 1 month prior to live vaccine administration may be sufficient. Live vaccines should not be given to individuals who are considered to be immunocompromised until more information is available. [43236] [54286] Lixisenatide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Lomustine, CCNU: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [5946] [7714] [7944] Lonafarnib: (Contraindicated) Coadministration of lonafarnib and dexamethasone is contraindicated; concurrent use may decrease lonafarnib exposure, which may reduce its efficacy. The exposure of dexamethasone may also be increased, increasing the risk for dexamethasone-related adverse reactions. Lonafarnib is a sensitive CYP3A4 substrate and strong CYP3A4 inhibitor; dexamethasone is a CYP3A4 substrate and moderate CYP3A4 inducer. [54286] [66129] Lonapegsomatropin: (Moderate) Corticosteroids can retard bone growth and therefore, can inhibit the growth-promoting effects of somatropin. If corticosteroid therapy is required, the corticosteroid dose should be carefully adjusted. [6807] Loop diuretics: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and loop diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and loop diuretics cause increased renal potassium loss. [26417] [28429] [29779] Lopinavir; Ritonavir: (Moderate) Close monitoring of therapeutic and adverse effects is required when dexamethasone is coadministered with ritonavir. Ritonavir inhibits CYP3A4 and dexamethasone is a CYP3A4 substrate. [4718] [5070] [5206] (Moderate) Decreased lopinavir plasma concentrations are seen when dexamethasone and lopinavir are coadministered. Consider use of an alternative corticosteroid. If these drugs are used together, carefully monitor for decreased clinical efficacy of lopinavir. [28341] Lorlatinib: (Major) Avoid coadministration of lorlatinib with dexamethasone due to decreased plasma concentrations of both drugs, which may reduce their efficacy. If concomitant use is necessary, increase the dose of lorlatinib to 125 mg PO once daily. A dose adjustment of systemic dexamethasone may be necessary if lorlatinib is initiated or withdrawn during therapy. Both drugs are CYP3A substrates and moderate inducers. Administration with another moderate CYP3A inducer decreased lorlatinib exposure by 23%. [34477] [54286] [63732] Losartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Lumacaftor; Ivacaftor: (Moderate) Concomitant use of dexamethasone and lumacaftor; ivacaftor may alter dexamethasone exposure. If used together, dexamethasone dosages may need to be adjusted to achieve desired therapeutic effects. Dexamethasone is a substrate and moderate inducer of CYP3A and a substrate of the P-glycoprotein (P-gp) drug transporter. Ivacaftor is a sensitive CYP3A substrate and lumacaftor is a strong CYP3A inducer; in vitro data suggests lumacaftor; ivacaftor may also induce and/or inhibit P-gp. Although induction of dexamethasone through the CYP3A pathway may lead to decreased drug efficacy, the net effect of lumacaftor; ivacaftor on P-gp transport is not clear. Monitor the patient for decreased corticosteroid efficacy or increased or prolonged therapeutic effects and adverse events. Additionally, ivacaftor exposure could theoretically be further decreased when given with another CYP3A inducer; however, ivacaftor; lumacaftor dosage adjustments are not recommended with concomitant use of a moderate CYP3A inducer such as dexamethasone. [30676] [34477] [54286] [59891] Lumateperone: (Major) Avoid coadministration of lumateperone and dexamethasone as concurrent use may decrease lumateperone exposure which may reduce efficacy. Lumateperone is a CYP3A4 substrate; dexamethasone is a moderate CYP3A4 inducer. [54286] [64885] Lurasidone: (Moderate) Because lurasidone is primarily metabolized by CYP3A4, decreased plasma concentrations of lurasidone may occur when the drug is co-administered with inducers of CYP3A4. Decreased plasma concentrations of lurasidone may lead to a decrease in efficacy of lurasidone. If lurasidone is used with a moderate CYP3A4 inducer, it may be necessary to increase the lurasidone dose after chronic treatment (7 days or more). [30011] [42227] Lurbinectedin: (Minor) Although there may be an interaction, these drugs may be used together. The manufacturer of lurbinectedin, a CYP3A substrate, recommends avoiding coadministration with moderate CYP3A inducers like dexamethasone due to the risk of decreased lurbinectedin exposure which may reduce its efficacy. However, the manufacturer specifically recommends administration of dexamethasone as a premedication for lurbinectedin to prevent chemotherapy-induced nausea and vomiting. [54286] [65593] Macimorelin: (Major) Avoid use of macimorelin with drugs that directly affect pituitary growth hormone secretion, such as corticosteroids. Healthcare providers are advised to discontinue corticosteroid therapy and observe a sufficient washout period before administering macimorelin. Use of these medications together may impact the accuracy of the macimorelin growth hormone test. [62723] Magnesium Salicylate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Mannitol: (Moderate) Corticosteroids may accentuate the electrolyte loss associated with diuretic therapy resulting in hypokalemia. Also, corticotropin may cause calcium loss and sodium and fluid retention. Mannitol itself can cause hypernatremia. Close monitoring of electrolytes should occur in patients receiving these drugs concomitantly. [6524] Maraviroc: (Moderate) Use caution if coadministration of maraviroc with dexamethasone is necessary, due to a possible decrease in maraviroc exposure. Maraviroc is a CYP3A substrate and dexamethasone is a CYP3A4 inducer. Monitor for a decrease in maraviroc efficacy with concomitant use. [33473] [54286] Mavacamten: (Contraindicated) Mavacamten is contraindicated for use with dexamethasone due to risk for reduced mavacamten efficacy. Concomitant use decreases mavacamten exposure. Mavacamten is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. [54286] [67543] Mecasermin rinfabate: (Moderate) Additional monitoring may be required when coadministering systemic or inhaled corticosteroids and mecasermin, recombinant, rh-IGF-1. In animal studies, corticosteroids impair the growth-stimulating effects of growth hormone (GH) through interference with the physiological stimulation of epiphyseal chondrocyte proliferation exerted by GH and IGF-1. Dexamethasone administration on long bone tissue in vitro resulted in a decrease of local synthesis of IGF-1. Similar counteractive effects are expected in humans. If systemic or inhaled glucocorticoid therapy is required, the steroid dose should be carefully adjusted and growth rate monitored. [8314] [8315] Mecasermin, Recombinant, rh-IGF-1: (Moderate) Additional monitoring may be required when coadministering systemic or inhaled corticosteroids and mecasermin, recombinant, rh-IGF-1. In animal studies, corticosteroids impair the growth-stimulating effects of growth hormone (GH) through interference with the physiological stimulation of epiphyseal chondrocyte proliferation exerted by GH and IGF-1. Dexamethasone administration on long bone tissue in vitro resulted in a decrease of local synthesis of IGF-1. Similar counteractive effects are expected in humans. If systemic or inhaled glucocorticoid therapy is required, the steroid dose should be carefully adjusted and growth rate monitored. [8314] [8315] Mefloquine: (Moderate) Mefloquine is metabolized by CYP3A4. Dexamethasone is an inducer of CYP3A4, and may increase the metabolism of mefloquine and reduce mefloquine plasma concentrations if coadministered. [4718] [5213] [8888] Meglitinides: (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Metformin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] Metformin; Repaglinide: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Metformin; Rosiglitazone: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] Metformin; Saxagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] Metformin; Sitagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] Methazolamide: (Moderate) Corticosteroids may increase the risk of hypokalemia if used concurrently with methazolamide. Hypokalemia may be especially severe with prolonged use of corticotropin, ACTH. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. The chronic use of corticosteroids may augment calcium excretion with methazolamide leading to increased risk for hypocalcemia and/or osteoporosis. [5023] Methenamine; Sodium Acid Phosphate: (Moderate) Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. [57713] [57714] [57715] Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: (Moderate) Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. [57713] [57714] [57715] Methenamine; Sodium Salicylate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Methoxsalen: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Methyclothiazide: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Metolazone: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Metoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Metyrapone: (Contraindicated) Medications which affect pituitary or adrenocortical function, including all corticosteroid therapy, should be discontinued prior to and during testing with metyrapone. Patients taking inadvertent doses of corticosteroids on the test day may exhibit abnormally high basal plasma cortisol levels and a decreased response to the test. Although systemic absorption of ocular, inhaled and topical corticosteroids is minimal, temporary discontinuation of these products should be considered if possible to reduce the potential for interference with the test results. [33528] Micafungin: (Moderate) Leukopenia, neutropenia, anemia, and thrombocytopenia have been associated with micafungin. Patients who are taking immunosuppressives such as the corticosteroids with micafungin concomitantly may have additive risks for infection or other side effects. In a pharmacokinetic trial, micafungin had no effect on the pharmacokinetics of prednisolone. Acute intravascular hemolysis and hemoglobinuria was seen in a healthy volunteer during infusion of micafungin (200 mg) and oral prednisolone (20 mg). This reaction was transient, and the subject did not develop significant anemia. [44913] Mifepristone: (Major) Mifepristone for termination of pregnancy is contraindicated in patients on long-term corticosteroid therapy and mifepristone for Cushing's disease or other chronic conditions is contraindicated in patients who require concomitant treatment with systemic corticosteroids for life-saving purposes, such as serious medical conditions or illnesses (e.g., immunosuppression after organ transplantation). For other situations where corticosteroids are used for treating non-life threatening conditions, mifepristone may lead to reduced corticosteroid efficacy and exacerbation or deterioration of such conditions. This is because mifepristone exhibits antiglucocorticoid activity that may antagonize corticosteroid therapy and the stabilization of the underlying corticosteroid-treated illness. Mifepristone may also cause adrenal insufficiency, so patients receiving corticosteroids for non life-threatening illness require close monitoring. Because serum cortisol levels remain elevated and may even increase during treatment with mifepristone, serum cortisol levels do not provide an accurate assessment of hypoadrenalism. Patients should be closely monitored for signs and symptoms of adrenal insufficiency, If adrenal insufficiency occurs, stop mifepristone treatment and administer systemic glucocorticoids without delay; high doses may be needed to treat these events. Factors considered in deciding on the duration of glucocorticoid treatment should include the long half-life of mifepristone (85 hours). [28003] [48697] Mitapivat: (Major) Avoid coadministration of mitapivat with dexamethasone, if possible, due to decreased mitapivat efficacy. Coadministration decreases mitapivat concentrations. If concomitant use is necessary, up-titration of mitapivat may be required. Monitor hemoglobin and titrate the mitapivat dose based on response; do not exceed 100 mg PO twice daily. Mitapivat is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased mitapivat overall exposure by 55% to 60%. [54286] [67403] Mitotane: (Major) Use caution if mitotane and dexamethasone are used concomitantly, and monitor for decreased efficacy of dexamethasone and a possible change in dosage requirements. Mitotane is a strong CYP3A4 inducer and dexamethasone is a CYP3A4 substrate; coadministration may result in decreased plasma concentrations of dexamethasone. [34477] [41934] [54286] Mitoxantrone: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Mivacurium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Mobocertinib: (Major) Avoid concomitant use of mobocertinib and dexamethasone. Coadministration may decrease mobocertinib exposure resulting in decreased efficacy. Mobocertinib is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. Use of a moderate CYP3A inducer is predicted to decrease the overall exposure of mobocertinib and its active metabolites by 58%. [54286] [66990] Modafinil: (Minor) Drugs that exhibit significant induction of the hepatic microsomal CYP3A4 isoenzyme, such as dexamethasone, may potentially increase the metabolism of modafinil. Decreased serum levels of modafinil could potentially result in decreased efficacy of modafinil. [5259] Nanoparticle Albumin-Bound Paclitaxel: (Moderate) Monitor for decreased efficacy of nab-paclitaxel or increased paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with dexamethasone is necessary. Nab-paclitaxel is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer; plasma concentrations of dexamethasone may decrease. In vitro however, the metabolism of paclitaxel is inhibited by dexamethasone at concentrations that exceed those found in vivo following normal therapeutic doses. [30742] [54286] Nanoparticle Albumin-Bound Sirolimus: (Major) Dexamethasone is an inducer of CYP3A4. Sirolimus is extensively metabolized by CYP3A4 in the gut and liver. Concurrent use of sirolimus with dexamethasone may decrease patient exposure to sirolimus. Consider alternative steroid therapy. Use sirolimus and dexamethasone with caution, if at all, and monitor patients closely. [4718] [5341] Naproxen; Esomeprazole: (Moderate) Monitor for decreased efficacy of esomeprazole if coadministration with dexamethasone is necessary. Esomeprazole is extensively metabolized in the liver by CYP2C19 and CYP3A4. Dexamethasone is a moderate CYP3A4 inducer. Drugs known to induce CYP3A4 may lead to decreased esomeprazole plasma concentrations. The manufacturer of esomeprazole recommends avoidance with strong inducers because decreased exposure of esomeprazole can occur. Recommendations are not available for concomitant use with moderate inducers of CYP3A4. [29524] [54286] Natalizumab: (Major) Ordinarily, patients receiving chronic immunosuppressant therapy should not be treated with natalizumab. Treatment recommendations for combined corticosteroid therapy are dependent on the underlying indication for natalizumab therapy. Corticosteroids should be tapered in those patients with Crohn's disease who are on chronic corticosteroids when they start natalizumab therapy, as soon as a therapeutic benefit has occurred. If the patient cannot discontinue systemic corticosteroids within 6 months, discontinue natalizumab. The concomitant use of natalizumab and corticosteroids may further increase the risk of serious infections, including progressive multifocal leukoencephalopathy, over the risk observed with use of natalizumab alone. In multiple sclerosis (MS) clinical trials, an increase in infections was seen in patients concurrently receiving short courses of corticosteroids. However, the increase in infections in natalizumab-treated patients who received steroids was similar to the increase in placebo-treated patients who received steroids. Short courses of steroid use during natalizumab, such as when they are needed for MS relapse treatment, appear to be acceptable for use concurrently. [30470] [62264] Nateglinide: (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Nelarabine: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Neostigmine: (Moderate) Concomitant use of anticholinesterase agents, such as neostigmine, and systemic corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating systemic corticosteroid therapy. [29779] [30015] [30028] [31123] [54891] [56146] [64165] Neratinib: (Major) Avoid concomitant use dexamethasone with neratinib due to decreased efficacy of neratinib. Neratinib is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Simulations using physiologically based pharmacokinetic (PBPK) models suggest that another moderate CYP3A4 inducer may decrease neratinib exposure by 52%. [34477] [54286] [62127] Netupitant, Fosnetupitant; Palonosetron: (Moderate) Netupitant is a moderate inhibitor of CYP3A4 and should be used with caution in patients receiving concomitant medications that are primarily metabolized through CYP3A4, such as dexamethasone. The plasma concentrations of CYP3A4 substrates can increase when co-administered with netupitant. The inhibitory effect on CYP3A4 can last for multiple days. A two-fold increase in the systemic exposure of dexamethasone was observed 4 days after single dose of netupitant. The duration of the effect was not studied beyond 4 days. If coadministration is necessary, decrease the dose of dexamethasone. [58171] Neuromuscular blockers: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Nilotinib: (Moderate) Monitor for steroid-related adverse reactions if coadministration of nilotinib with dexamethasone is necessary due to increased dexamethasone exposure. Dexamethasone is a CYP3A4 substrate and nilotinib is a moderate CYP3A4 inhibitor. A strong CYP3A4 inhibitor has been reported to decrease the metabolism of certain corticosteroids by up to 60%, increasing the risk of corticosteroid-related side effects. [54286] [58766] Nirmatrelvir; Ritonavir: (Moderate) Close monitoring of therapeutic and adverse effects is required when dexamethasone is coadministered with ritonavir. Ritonavir inhibits CYP3A4 and dexamethasone is a CYP3A4 substrate. [4718] [5070] [5206] (Moderate) Monitor for a diminished response to nirmatrelvir if concomitant use of dexamethasone is necessary. Concomitant use of nirmatrelvir and dexamethasone may reduce the therapeutic effect of nirmatrelvir. Nirmatrelvir is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. [54286] [67203] Nisoldipine: (Major) Avoid coadministration of nisoldipine with dexamethasone due to decreased plasma concentrations of nisoldipine. Alternative antihypertensive therapy should be considered. Nisoldipine is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Coadministration with a strong CYP3A4 inducer lowered nisoldipine plasma concentrations to undetectable levels. [29088] [54286] Nonsteroidal antiinflammatory drugs: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29611] [35893] [63923] Ocrelizumab: (Moderate) Ocrelizumab has not been studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids. Concomitant use of ocrelizumab with any of these therapies may increase the risk of immunosuppression. Monitor patients carefully for signs and symptoms of infection. [61838] Ofatumumab: (Moderate) Concomitant use of ofatumumab with corticosteroids may increase the risk of immunosuppression. Monitor patients carefully for signs and symptoms of infection. Ofatumumab has not been studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids. [65850] Olaparib: (Major) Avoid coadministration of olaparib with dexamethasone due to the risk of decreasing the efficacy of olaparib. Olaparib is a CYP3A substrate and dexamethasone is a moderate CYP3A4 inducer; concomitant use may decrease olaparib exposure. Coadministration with a moderate CYP3A inducer is predicted to decrease the olaparib Cmax by 31% and the AUC by 60%. [34477] [54286] [58662] Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] (Minor) Coadministration of CYP3A4 inducers with amlodipine can theoretically increase the hepatic metabolism of amlodipine (a CYP3A4 substrate). Caution should be used when CYP3A4 inducers, such as dexamethasone, are coadministered with amlodipine. Monitor therapeutic response; the dosage requirements of amlodipine may be increased. [34477] [35588] [54286] Olmesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Olutasidenib: (Major) Avoid concurrent use of olutasidenib and dexamethasone due to the risk of decreased olutasidenib exposure which may reduce its efficacy. Olutasidenib is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. [54286] [68242] Omaveloxolone: (Major) Avoid concurrent use of omaveloxolone and dexamethasone. Concurrent use may decrease omaveloxolone exposure which may reduce its efficacy. Omaveloxolone is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. [54286] [68644] Ombitasvir; Paritaprevir; Ritonavir: (Contraindicated) Concurrent administration of dexamethasone with dasabuvir; ombitasvir; paritaprevir; ritonavir or ombitasvir; paritaprevir; ritonavir is contraindicated. Taking these drugs together could result in elevated dexamethasone plasma concentrations and decreased concentrations of dasabuvir, paritaprevir, and ritonavir. Antiviral efficacy could be affected. Dexamethasone is a P-glycoprotein (P-gp) substrate and a CYP3A4 substrate/inducer. Ritonavir is a P-gp inhibitor and a CYP3A4 substrate/potent inhibitor. Both paritaprevir and dasabuvir (minor) are CYP3A4 substrates. [34477] [54286] [58664] (Moderate) Close monitoring of therapeutic and adverse effects is required when dexamethasone is coadministered with ritonavir. Ritonavir inhibits CYP3A4 and dexamethasone is a CYP3A4 substrate. [4718] [5070] [5206] Omeprazole: (Moderate) Monitor for decreased efficacy of omeprazole if coadministration with dexamethasone is necessary. Omeprazole is metabolized by CYP2C19 and CYP3A4. Dexamethasone is a moderate CYP3A4 inducer. The manufacturer of omeprazole recommends avoidance with strong inducers because decreased exposure of omeprazole can occur. Recommendations are not available for concomitant use with moderate inducers of CYP3A4. [29564] [54286] Omeprazole; Amoxicillin; Rifabutin: (Moderate) Monitor for decreased efficacy of omeprazole if coadministration with dexamethasone is necessary. Omeprazole is metabolized by CYP2C19 and CYP3A4. Dexamethasone is a moderate CYP3A4 inducer. The manufacturer of omeprazole recommends avoidance with strong inducers because decreased exposure of omeprazole can occur. Recommendations are not available for concomitant use with moderate inducers of CYP3A4. [29564] [54286] Omeprazole; Sodium Bicarbonate: (Moderate) Monitor for decreased efficacy of omeprazole if coadministration with dexamethasone is necessary. Omeprazole is metabolized by CYP2C19 and CYP3A4. Dexamethasone is a moderate CYP3A4 inducer. The manufacturer of omeprazole recommends avoidance with strong inducers because decreased exposure of omeprazole can occur. Recommendations are not available for concomitant use with moderate inducers of CYP3A4. [29564] [54286] Oritavancin: (Minor) Dexamethasone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of dexamethasone may be reduced if these drugs are administered concurrently. Dosages of dexamethasone may require adjustment if oritavancin is initiated or withdrawn during dexamethasone therapy. [34477] [54557] [57741] Oxycodone: (Moderate) Monitor for reduced efficacy of oxycodone and signs of opioid withdrawal if coadministration with dexamethasone is necessary; consider increasing the dose of oxycodone as needed. If dexamethasone is discontinued, consider a dose reduction of oxycodone and frequently monitor for signs of respiratory depression and sedation. Oxycodone is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease oxycodone concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. [39926] [54286] Oxymetholone: (Moderate) Concomitant use of oxymetholone with corticosteroids or corticotropin, ACTH may cause increased edema. Manage edema with diuretic and/or digitalis therapy. [48342] Ozanimod: (Moderate) Concomitant use of ozanimod with dexamethasone may increase the risk of immunosuppression. Monitor patients carefully for signs and symptoms of infection. In clinical studies for ulcerative colitis, the use of systemic corticosteroids did not appear to influence safety or efficacy of ozanimod. [65169] Pacritinib: (Major) Avoid concurrent use of pacritinib with dexamethasone due to the risk of decreased pacritinib exposure which may impair efficacy. Pacritinib is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. [54286] [67427] Pancuronium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Pazopanib: (Major) Avoid administering pazopanib in patients who require chronic treatment with a strong CYP3A4 inducer, such as dexamethasone. The concomitant use of pazopanib, a weak CYP3A4 inhibitor and a substrate for CYP3A4 and P-glycoprotein (P-gp), and dexamethasone, a strong CYP3A4 inducer and a CYP3A4and P-gp substrate, may result in altered pazopanib and/or dexamethasone concentrations. In addition, because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with antineoplastic agents. While therapy is designed to take advantage of this effect, patients may be predisposed to over-immunosuppression resulting in an increased risk for the development of severe infections. Close clinical monitoring is advised with concurrent use; in the presence of serious infections, continuation of the corticosteroid or immunosuppressive agent may be necessary but should be accompanied by appropriate antimicrobial therapies as indicated. [49829] [6759] [7714] Pegaspargase: (Moderate) Monitor for an increase in glucocorticoid-related adverse reactions such as hyperglycemia and osteonecrosis during concomitant use of pegaspargase and glucocorticoids. [61310] Peginterferon Alfa-2a: (Moderate) Additive myelosuppressive effects may be seen when alpha interferons are given concurrently with other myelosuppressive agents, such as antineoplastic agents or immunosuppressives. [6161] Pemigatinib: (Major) Avoid coadministration of pemigatinib and dexamethasone due to the risk of decreased pemigatinib exposure which may reduce its efficacy. Pemigatinib is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Coadministration with a moderate CYP3A4 inducer is predicted to decrease pemigatinib exposure by more than 50%. [54286] [65307] Penicillamine: (Major) Agents such as immunosuppressives have adverse reactions similar to those of penicillamine. Concomitant use of penicillamine with these agents is contraindicated because of the increased risk of developing severe hematologic and renal toxicity. [5567] Perampanel: (Major) Start perampanel at a higher initial dose of 4 mg once daily at bedtime when using concurrently with dexamethasone due to a potential reduction in perampanel plasma concentration. If introduction or withdrawal of dexamethasone occurs during perampanel therapy, closely monitor patient response; a dosage adjustment may be necessary. Dexamethasone is a moderate CYP3A4 inducer, and perampanel is a CYP3A4 substrate. [52140] [54286] Perindopril; Amlodipine: (Minor) Coadministration of CYP3A4 inducers with amlodipine can theoretically increase the hepatic metabolism of amlodipine (a CYP3A4 substrate). Caution should be used when CYP3A4 inducers, such as dexamethasone, are coadministered with amlodipine. Monitor therapeutic response; the dosage requirements of amlodipine may be increased. [34477] [35588] [54286] Pexidartinib: (Minor) A dose adjustment of systemic dexamethasone may be necessary if pexidartinib is initiated or withdrawn during therapy. Pexidartinib may increase the metabolism of dexamethasone resulting in decreased exposure. Pexidartinib is a moderate inducer of CYP3A4; dexamethasone is a CYP3A4 substrate. [54286] [64535] Phenobarbital: (Moderate) Coadministration may result in decreased exposure to dexamethasone. Phenobarbital is a CYP3A4 inducer; dexamethasone is a CYP3A4 substrate. Monitor for decreased response to dexamethasone during concurrent use. [28001] Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Moderate) Coadministration may result in decreased exposure to dexamethasone. Phenobarbital is a CYP3A4 inducer; dexamethasone is a CYP3A4 substrate. Monitor for decreased response to dexamethasone during concurrent use. [28001] Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Photosensitizing agents (topical): (Minor) Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment. [6625] Physostigmine: (Moderate) Concomitant use of anticholinesterase agents. such as physostigmine, and systemic corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase inhibitors at least 24 hours before initiating corticosteroid therapy. [29779] [30015] [30028] [31123] [56146] [64165] Pimavanserin: (Major) Because pimavanserin is primarily metabolized by CYP3A4 and CYP3A5, the manufacturer recommends avoiding concomitant use of pimavanserin with moderate CYP3A4 inducers, such as dexamethasone. Moderate inducers of CYP3A4 can reduce pimavanserin exposure, potentially decreasing the effectiveness of pimavanserin. [54286] [60748] Pimozide: (Moderate) According to the manufacturer of pimozide, the drug should not be coadministered with drugs known to cause electrolyte imbalances, such as high-dose, systemic corticosteroid therapy. Pimozide is associated with a well-established risk of QT prolongation and torsade de pointes (TdP), and electrolyte imbalances (e.g., hypokalemia, hypocalcemia, hypomagnesemia) may increase the risk of life-threatening arrhythmias. Pimozide is contraindicated in patients with known hypokalemia or hypomagnesemia. Topical corticosteroids are less likely to interact. [28225] [43463] Pioglitazone; Glimepiride: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Pioglitazone; Metformin: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] Pirtobrutinib: (Major) Avoid concurrent use of pirtobrutinib and dexamethasone due to the risk of decreased pirtobrutinib exposure which may reduce its efficacy. If concomitant use is necessary, an empiric pirtobrutinib dosage increase is required. If the current dosage is 200 mg once daily, increase the dose to 300 mg; if the current dosage is 50 mg or 100 mg once daily, increase the dose by 50 mg. Pirtobrutinib is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. Concomitant use with other moderate CYP3A inducers reduced pirtobrutinib overall exposure by 27% and 49%. [54286] [68520] Ponesimod: (Moderate) Monitor for signs and symptoms of infection. Additive immune suppression may result from concomitant use of ponesimod and high-dose corticosteroid therapy which may extend the duration or severity of immune suppression. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. [66527] Posaconazole: (Moderate) Posaconazole and dexamethasone should be coadministered with caution due to an increased potential for adverse events. Posaconazole is a potent inhibitor of CYP3A4, an isoenzyme partially responsible for the metabolism of dexamethasone. Further, both dexamethasone and posaconazole are substrates of the drug efflux protein, P-glycoprotein, which when administered together may increase the absorption or decrease the clearance of the other drug. This complex interaction may cause alterations in the plasma concentrations of both posaconazole and dexamethasone, ultimately resulting in an increased risk of adverse events. [11334] [32723] [6759] Potassium Phosphate; Sodium Phosphate: (Moderate) Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. [57713] [57714] [57715] Potassium-sparing diuretics: (Minor) The manufacturer of spironolactone lists corticosteroids as a potential drug that interacts with spironolactone. Intensified electrolyte depletion, particularly hypokalemia, may occur. However, potassium-sparing diuretics such as spironolactone do not induce hypokalemia. In fact, hypokalemia is one of the indications for potassium-sparing diuretic therapy. Therefore, drugs that induce potassium loss, such as corticosteroids, could counter the hyperkalemic effects of potassium-sparing diuretics. [26417] [29016] [30011] Pramlintide: (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements): (Moderate) Corticosteroids blunt the adrenal secretion of endogenous DHEA and DHEAS, resulting in reduced DHEA and DHEAS serum concentrations. [2460] Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved): (Moderate) Corticosteroids blunt the adrenal secretion of endogenous DHEA and DHEAS, resulting in reduced DHEA and DHEAS serum concentrations. [2460] Praziquantel: (Moderate) Drugs that induce hepatic metabolism via the microsomal CYP450 enzyme system decrease the bioavailability of praziquantel. Plasma levels of praziquantel have been reported to be 50% lower when dexamethasone was given simultaneously, presumably due to CYP induction by dexamethasone. [4558] Pretomanid: (Major) Avoid coadministration of pretomanid with dexamethasone as concurrent use may decrease pretomanid exposure which may lead to decreased efficacy. Pretomanid is a CYP3A4 substrate; dexamethasone is a moderate CYP3A4 inducer. Coadministration with another moderate CYP3A4 inducer decreased pretomanid exposure by 35%. [54286] [64561] Prilocaine; Epinephrine: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Corticosteroids may potentiate the hypokalemic effects of epinephrine. [26417] [56575] Primidone: (Moderate) Coadministration may result in decreased exposure to dexamethasone. Primidone is a CYP3A4 inducer; dexamethasone is a CYP3A4 substrate. Monitor for decreased response to dexamethasone during concurrent use. [28001] Promethazine; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Propranolol: (Moderate) Monitor blood sugar during concomitant corticosteroid and propranolol use due to risk for hypoglycemia. Concurrent use may increase risk of hypoglycemia because of loss of the counter-regulatory cortisol response. [56853] Propranolol; Hydrochlorothiazide, HCTZ: (Moderate) Monitor blood sugar during concomitant corticosteroid and propranolol use due to risk for hypoglycemia. Concurrent use may increase risk of hypoglycemia because of loss of the counter-regulatory cortisol response. [56853] (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Purine analogs: (Minor) Concurrent use of purine analogs with other agents which cause bone marrow or immune suppression such as other antineoplastic agents or immunosuppressives may result in additive effects. [5504] Pyridostigmine: (Moderate) Concomitant use of anticholinesterase agents. such as pyridostigmine, and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy. [29779] [30015] [30028] [31123] [34253] [56146] [64002] [64165] Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Quinidine: (Moderate) Quinidine is a substrate of the CYP3A4 isoenzyme. Inducers of CYP3A4 such as dexamethasone may increase hepatic elimination of quinidine with the potential for reduced efficacy of quinidine. [10571] [6759] Quinolones: (Moderate) Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids. Discontinue quinolone therapy at the first sign of tendon inflammation or tendon pain, as these are symptoms that may precede rupture of the tendon. [28423] [28424] [28764] [29818] [30738] [62028] [65562] Rapacuronium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Repaglinide: (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Ribociclib: (Moderate) Monitor for an increase in dexamethasone-related adverse reactions if coadministration with ribociclib is necessary. Dexamethasone is a CYP3A4 substrate and ribociclib is a strong CYP3A4 inhibitor. [54286] [61816] Ribociclib; Letrozole: (Moderate) Monitor for an increase in dexamethasone-related adverse reactions if coadministration with ribociclib is necessary. Dexamethasone is a CYP3A4 substrate and ribociclib is a strong CYP3A4 inhibitor. [54286] [61816] Rifampin: (Moderate) Monitor for decreased efficacy of dexamethasone if coadministration with rifampin is necessary; consider increasing the dose of dexamethasone if clinically appropriate. Dexamethasone is a CYP3A4 substrate and rifampin is a strong CYP3A4 inducer. [30314] [54286] Rifapentine: (Moderate) Monitor for decreased efficacy of dexamethasone if coadministration with rifapentine is necessary; consider increasing the dose of dexamethasone if clinically appropriate. Dexamethasone is a CYP3A4 substrate and rifapentine is a strong CYP3A4 inducer. [54286] [65685] Rilonacept: (Moderate) Patients receiving immunosuppressives along with rilonacept may be at a greater risk of developing an infection. [10690] Rilpivirine: (Contraindicated) Concurrent use of dexamethasone (more than 1 dose) and rilpivirine is contraindicated. When these drugs are coadministered, there is a potential for treatment failure and/or the development of rilpivirine or NNRTI resistance. Dexamethasone is an inducer of CYP3A4, which is primarily responsible for the metabolism of rilpivirine. Coadministration may result in decreased rilpivirine serum concentrations, which could cause impaired virologic response to rilpivirine. [44376] [54286] Rimegepant: (Major) Avoid coadministration of rimegepant with dexamethasone; concurrent use may significantly decrease rimegepant exposure which may result in loss of efficacy. Rimegepant is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [54286] [65052] Ripretinib: (Major) Avoid coadministration of ripretinib with dexamethasone. If concomitant use is unavoidable, increase the frequency of ripretinib dosing from 150 mg once daily to 150 mg twice daily; monitor for clinical response and tolerability. Resume once daily dosing of ripretinib 14 days after discontinuation of dexamethasone. Coadministration is predicted to decrease the exposure of ripretinib and its active metabolite (DP-5439), which may decrease ripretinib anti-tumor activity. Ripretinib and DP-5439 are metabolized by CYP3A and dexamethasone is a moderate CYP3A inducer. Drug interaction modeling studies suggest coadministration with a moderate CYP3A inducer may decrease ripretinib exposure by 56%. [54286] [65431] Ritonavir: (Moderate) Close monitoring of therapeutic and adverse effects is required when dexamethasone is coadministered with ritonavir. Ritonavir inhibits CYP3A4 and dexamethasone is a CYP3A4 substrate. [4718] [5070] [5206] Rituximab: (Moderate) Rituximab and corticosteroids are commonly used together; however, monitor the patient for immunosuppression and signs and symptoms of infection during combined chronic therapy. [30943] [49773] [56233] Rituximab; Hyaluronidase: (Moderate) Rituximab and corticosteroids are commonly used together; however, monitor the patient for immunosuppression and signs and symptoms of infection during combined chronic therapy. [30943] [49773] [56233] Rivaroxaban: (Minor) Coadministration of rivaroxaban and dexamethasone may result in decreased rivaroxaban exposure and may decrease the efficacy of rivaroxaban. Dexamethasone is an inducer of CYP3A4, and rivaroxaban is a substrate of CYP3A4. If these drugs are administered concurrently, monitor the patient for signs of lack of efficacy of rivaroxaban. [11334] [44854] Rocuronium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Roflumilast: (Major) Coadminister dexamethasone and roflumilast cautiously as this may lead to reduced systemic exposure to roflumilast. Dexamethasone induces CYP3A4 and roflumilast is a CYP3A4 substrate. In pharmacokinetic study, administration of a single dose of roflumilast in patients receiving another CYP3A4 inducer, rifampin, resulted in decreased roflumilast Cmax and AUC, as well as increased Cmax and decreased AUC of the active metabolite roflumilast N-oxide. [43551] [6759] Romidepsin: (Major) The concomitant use of romidepsin, a CYP3A4 substrate, and dexamethasone, a strong CYP3A4 inducer, may result in significantly altered romidepsin plasma exposure. Therefore, avoid using romidepsin with potent CYP3A4 inducers if possible. [37292] [6759] Ruxolitinib: (Moderate) Ruxolitinib is a CYP3A4 substrate. When used with drugs that are CYP3A4 inducers such as dexamethasone, a dose adjustment is not necessary, but closely monitor patients and titrate the ruxolitinib dose based on safety and efficacy. The Cmax and AUC of a single 50 mg dose of ruxolitinib was decreased by 32% and 61%, respectively, after rifampin 600 mg once daily was administered for 10 days. The relative exposure to ruxolitinib's active metabolites increased by about 100%, which may partially explain the reported disproportionate 10% reduction in the pharmacodynamic marker pSTAT3 inhibition. [11334] [46782] [6759] Salicylates: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Salsalate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Saquinavir: (Major) Avoid concurrent administration of dexamethasone and saquinavir boosted with ritonavir. Dexamethasone is may induce the CYP3A4 metabolism of saquinavir, resulting in reduced saquinavir plasma concentrations. Decreased saquinavir plasma concentrations could lead to HIV treatment failures or the development of viral-resistance. If used concomitantly, the patient should be observed for changes in the clinical efficacy and concentrations of the antiretroviral regimen. [28995] Sargramostim, GM-CSF: (Major) Avoid the concomitant use of sargramostim and systemic corticosteroid agents due to the risk of additive myeloproliferative effects. If coadministration of these drugs is required, frequently monitor patients for clinical and laboratory signs of excess myeloproliferative effects (e.g., leukocytosis). Sargramostim is a recombinant human granulocyte-macrophage colony-stimulating factor that works by promoting proliferation and differentiation of hematopoietic progenitor cells. [61087] SARS-CoV-2 (COVID-19) vaccines: (Moderate) Patients receiving corticosteroids in greater than physiologic doses may have a diminished response to the SARS-CoV-2 virus vaccine. Counsel patients receiving corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to SARS-CoV-2 virus after receiving the vaccine. [65107] [66080] Selpercatinib: (Major) Avoid coadministration of selpercatinib and dexamethasone due to the risk of decreased selpercatinib exposure which may reduce its efficacy. Selpercatinib is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Coadministration with other moderate CYP3A4 inducers is predicted to decrease selpercatinib exposure by 40% to 70%. [54286] [65387] Selumetinib: (Major) Avoid coadministration of selumetinib and dexamethasone due to the risk of decreased selumetinib exposure which may reduce its efficacy. Selumetinib is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Coadministration with a moderate CYP3A4 inducer is predicted to decrease selumetinib exposure by 38%. [54286] [65246] Semaglutide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] SGLT2 Inhibitors: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Sildenafil: (Minor) Sildenafil is metabolized principally by CYP3A4. It can be expected that concomitant administration of sildenafil with CYP3A4 enzyme inducers like dexamethasone will decrease plasma concentrations of sildenafil. [28001] [28199] Simeprevir: (Major) Avoid concurrent use of simeprevir and systemic dexamethasone. Induction of CYP3A4 by dexamethasone may reduce the plasma concentrations of simeprevir, resulting in treatment failure. [56471] Siponimod: (Moderate) Concomitant use of siponimod and dexamethasone is not recommended for patients with CYP2C9*1/*3 and *2/*3 genotypes due to a significant decrease in siponimod exposure. Siponimod is a CYP2C9 and CYP3A4 substrate; dexamethasone is a moderate CYP3A4 inducer. Across different CYP2C9 genotypes, a moderate CYP3A4 inducer decreased the exposure of siponimod by up to 52% according to in silico evaluation. Additonally, monitor patients carefully for signs and symptoms of infection if coadministration is necessary, as concomitant use may increase the risk of immunosuppression. Siponimod has not been studied in combination with other immunosuppressive therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids. [54286] [64031] Sipuleucel-T: (Major) Concomitant use of sipuleucel-T and immunosuppressives should be avoided. Concurrent administration of immunosuppressives with the leukapheresis procedure that occurs prior to sipuleucel-T infusion has not been studied. Sipuleucel-T stimulates the immune system and patients receiving immunosuppressives may have a diminished response to sipuleucel-T. When appropriate, consider discontinuing or reducing the dose of immunosuppressives prior to initiating therapy with sipuleucel-T. [40277] Sirolimus: (Major) Dexamethasone is an inducer of CYP3A4. Sirolimus is extensively metabolized by CYP3A4 in the gut and liver. Concurrent use of sirolimus with dexamethasone may decrease patient exposure to sirolimus. Consider alternative steroid therapy. Use sirolimus and dexamethasone with caution, if at all, and monitor patients closely. [4718] [5341] Sodium Benzoate; Sodium Phenylacetate: (Moderate) Corticosteroids may cause protein breakdown, which could lead to elevated blood ammonia concentrations, especially in patients with an impaired ability to form urea. Corticosteroids should be used with caution in patients receiving treatment for hyperammonemia. [8083] Sodium Phenylbutyrate: (Moderate) The concurrent use of corticosteroids with sodium phenylbutyrate may increase plasma ammonia levels (hyperammonemia) by causing the breakdown of body protein. Patients with urea cycle disorders being treated with sodium phenylbutyrate usually should not receive regular treatment with corticosteroids. [57685] Sodium Phenylbutyrate; Taurursodiol: (Moderate) The concurrent use of corticosteroids with sodium phenylbutyrate may increase plasma ammonia levels (hyperammonemia) by causing the breakdown of body protein. Patients with urea cycle disorders being treated with sodium phenylbutyrate usually should not receive regular treatment with corticosteroids. [57685] Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous: (Moderate) Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. [57713] [57714] [57715] Sofosbuvir; Velpatasvir: (Major) Avoid coadministration of velpatasvir with dexamethasone. Taking these drugs together may significantly decrease velpatasvir plasma concentrations, potentially resulting in loss of antiviral efficacy. Velpatasvir is a CYP3A4 substrate; dexamethasone a moderate inducer of CYP3A4. Additionally, velpatasvir is an inhibitor of the drug transporter P-glycoprotein (P-gp). Coadministration with substrates of this transporter, such as dexamethasone, may increase their exposure. [34477] [54286] [60911] Sofosbuvir; Velpatasvir; Voxilaprevir: (Major) Avoid coadministration of velpatasvir with dexamethasone. Taking these drugs together may significantly decrease velpatasvir plasma concentrations, potentially resulting in loss of antiviral efficacy. Velpatasvir is a CYP3A4 substrate; dexamethasone a moderate inducer of CYP3A4. Additionally, velpatasvir is an inhibitor of the drug transporter P-glycoprotein (P-gp). Coadministration with substrates of this transporter, such as dexamethasone, may increase their exposure. [34477] [54286] [60911] (Major) Avoid coadministration of voxilaprevir (a CYP3A4 substrate) with moderate to strong inducers of CYP3A4, such as dexamethasone. Taking these drugs together may significantly decrease voxilaprevir plasma concentrations, potentially resulting in loss of antiviral efficacy. In addition, voxilaprevir, a P-glycoprotein (P-gp) inhibitor, may alter concentrations of dexamethasone, a P-gp substrate. [34477] [54286] [62131] Somatropin, rh-GH: (Moderate) Corticosteroids can retard bone growth and therefore, can inhibit the growth-promoting effects of somatropin. If corticosteroid therapy is required, the corticosteroid dose should be carefully adjusted. [6807] Sonidegib: (Major) Avoid the concomitant use of sonidegib and dexamethasone; sonidegib levels may be significantly decreased and its efficacy reduced. Sonidegib is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Physiologic-based pharmacokinetics (PBPK) simulations indicate that a moderate CYP3A4 inducer would decrease the sonidegib AUC by 56% if administered for 14 days and by 69% if the moderate CYP3A inducer is administered for more than 14 days. [54286] [60000] Sorafenib: (Major) Avoid coadministration of sorafenib with dexamethasone due to decreased plasma concentrations of sorafenib. Sorafenib is a CYP3A4 substrate and dexamethasone is a CYP3A4 inducer. Concomitant use with another strong CYP3A4 inducer decreased sorafenib exposure by 37%. [31832] Spironolactone; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Succinylcholine: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Sufentanil: (Moderate) Because the dose of the sufentanil sublingual tablets cannot be titrated, consider an alternate opiate if dexamethasone must be administered. Monitor for reduced efficacy of sufentanil injection and signs of opioid withdrawal if coadministration with dexamethasone is necessary; consider increasing the dose of sufentanil injection as needed. If dexamethasone is discontinued, consider a dose reduction of sufentanil injection and frequently monitor for signs or respiratory depression and sedation. Sufentanil is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease sufentanil concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. [30966] [54286] [63731] Sulfonylureas: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Tadalafil: (Minor) Tadalafil is metabolized principally by cytochrome P450 3A4. Studies have shown that concomitant administration of CYP3A4 enzyme-inducers, such as dexamethasone, will decrease plasma levels of tadalafil. [4946] Tasimelteon: (Moderate) Caution is recommended during concurrent use of tasimelteon and dexamethasone. Because tasimelteon is partially metabolized via CYP3A4, use with CYP3A4 inducers, such as dexamethasone, may reduce the efficacy of tasimelteon. [56665] Tazemetostat: (Major) Avoid coadministration of tazemetostat with dexamethasone as concurrent use may decrease tazemetostat exposure, which may reduce its efficacy. Tazemetostat is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. [54286] [64952] Telbivudine: (Moderate) The risk of myopathy may be increased if corticosteroids are coadministered with telbivudine. Monitor patients for any signs or symptoms of unexplained muscle pain, tenderness, or weakness, particularly during periods of upward dosage titration. [9671] Telmisartan; Amlodipine: (Minor) Coadministration of CYP3A4 inducers with amlodipine can theoretically increase the hepatic metabolism of amlodipine (a CYP3A4 substrate). Caution should be used when CYP3A4 inducers, such as dexamethasone, are coadministered with amlodipine. Monitor therapeutic response; the dosage requirements of amlodipine may be increased. [34477] [35588] [54286] Telmisartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Temsirolimus: (Major) Avoid coadministration of temsirolimus with dexamethasone due to the risk of decreased plasma concentrations of the primary active metabolite of temsirolimus (sirolimus). If concomitant use is unavoidable, consider increasing the dose of temsirolimus from 25 mg per week up to 50 mg per week. If dexamethasone is discontinued, decrease the dose of temsirolimus to the dose used before initiation of dexamethasone. Temsirolimus is a CYP3A4 substrate and dexamethasone is a CYP3A4 inducer. Coadministration with another strong CYP3A4 inducer had no significant effect on the AUC or Cmax of temsirolimus, but decreased the AUC and Cmax of the active metabolite, sirolimus, by 56% and 65%, respectively. [50586] Terbinafine: (Moderate) Due to the risk for breakthrough fungal infections, caution is advised when administering terbinafine with dexamethasone. Although this interaction has not been studied by the manufacturer, and published literature suggests the potential for interactions to be low, taking these drugs together may decrease the systemic exposure of terbinafine. Predictions about the interaction can be made based on the metabolic pathways of both drugs. Terbinafine is metabolized by at least 7 CYP isoenyzmes, with major contributions coming from CYP3A4; dexamethasone induces this enzyme. Monitor patients for breakthrough fungal infections. [11334] [37590] [43880] [43881] [56538] [6759] Testosterone: (Moderate) Monitor for fluid retention during concurrent corticosteroid and testosterone use. Concurrent use may result in increased fluid retention. [33698] Thalidomide: (Moderate) Coadministration of dexamethasone with thalidomide should be employed cautiously, as toxic epidermal necrolysis has been reported with concomitant use. [8844] Thiazide diuretics: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Thiazolidinediones: (Moderate) Monitor blood glucose during concomitant corticosteroid and thiazolidinedione use; a thiazolidinedione dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Ticagrelor: (Moderate) Coadministration of ticagrelor with dexamethasone may result in decreased concentrations of ticagrelor. Use combination with caution and monitor for decreased efficacy of ticagrelor. Ticagrelor is a substrate of CYP3A4/5 and dexamethasone is a moderate CYP3A4 inducer. [44951] Tirzepatide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Tolazamide: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Tolbutamide: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Toremifene: (Major) Avoid coadministration of dexamethasone with toremifene due to decreased plasma concentrations of toremifene which may result in decreased efficacy. Toremifene is a CYP3A4 substrate and dexamethasone is a CYP3A4 inducer. Coadministration with strong CYP3A4 inducers lowers steady-state serum concentrations of toremifene. [28822] Tositumomab: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Tretinoin, ATRA: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Triamterene; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Tuberculin Purified Protein Derivative, PPD: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy. [43298] [43299] Tucatinib: (Moderate) Monitor for steroid-related adverse reactions if coadministration of tucatinib with dexamethasone is necessary, due to increased dexamethasone exposure; Cushing's syndrome and adrenal suppression could potentially occur with long-term use. Consider the use of corticosteroids such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, especially for long-term use. Tucatinib is a strong CYP3A4 inhibitor and dexamethasone is primarily metabolized by CYP3A4. Another strong CYP3A4 inhibitor has been reported to decrease the metabolism of certain corticosteroids by up to 60%, leading to increased risk of corticosteroid side effects. [54286] [65295] Ubrogepant: (Major) Increase the initial and second dose of ubrogepant to 100 mg if coadministered with dexamethasone as concurrent use may decrease ubrogepant exposure and reduce its efficacy. Ubrogepant is a CYP3A4 substrate; dexamethasone is a moderate CYP3A4 inducer. [54286] [64874] Ulipristal: (Major) Avoid administration of ulipristal with drugs that induce CYP3A4. Ulipristal is a substrate of CYP3A4 and dexamethasone is a CYP3A4 inducer. Concomitant use may decrease the plasma concentration and effectiveness of ulipristal. [41569] [48201] [50623] Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Vecuronium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Vemurafenib: (Major) Concomitant use of vemurafenib and dexamethasone may result in altered concentrations of dexamethasone and decreased concentrations vemurafenib. Vemurafenib is a substrate/inducer of CYP3A4 and a substrate/inhibitor of P-glycoprotein (P-gp). Dexamethasone is a substrate/inducer of CYP3A4 and a substrate of P-gp. Avoid using these agents together if possible. [11334] [45335] [6759] Venetoclax: (Major) Avoid the concomitant use of venetoclax and dexamethasone; venetoclax levels may be decreased and its efficacy reduced. Venetoclax is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Consider alternative agents. In a drug interaction study (n = 11), the venetoclax Cmax and AUC values were decreased by 42% and 71%, respectively, following the co-administration of multiple doses of a strong CYP3A4 inducer. Use of venetoclax with a moderate CYP3A4 inducer has not been evaluated. [34477] [54286] [60706] Vigabatrin: (Major) Vigabatrin should not be used with corticosteroids, which are associated with serious ophthalmic effects (e.g., retinopathy or glaucoma) unless the benefit of treatment clearly outweighs the risks. [36250] Vincristine Liposomal: (Moderate) Avoid the concomitant use of dexamethasone and vincristine. Vincristine is a substrate for cytochrome P450 (CYP) 3A4. Agents that induce CYP 3A4 such as dexamethasone may increase the metabolism of vincristine and decrease the efficacy of drug. [4718] [51432] (Moderate) Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. [57713] [57714] [57715] Vincristine: (Moderate) Avoid the concomitant use of dexamethasone and vincristine. Vincristine is a substrate for cytochrome P450 (CYP) 3A4. Agents that induce CYP 3A4 such as dexamethasone may increase the metabolism of vincristine and decrease the efficacy of drug. [4718] [51432] Voclosporin: (Major) Avoid coadministration of voclosporin with dexamethasone. Coadministration may decrease voclosporin exposure resulting in decreased efficacy. Voclosporin is a sensitive CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Coadministration with moderate CYP3A4 inducers is predicted to decrease voclosporin exposure by 70%. [54286] [66336] Vonoprazan; Amoxicillin: (Major) Avoid concomitant use of vonoprazan and dexamethasone due to decreased plasma concentrations of vonoprazan, which may reduce its efficacy. Vonoprazan is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. Vonoprazan exposures are predicted to be 50% lower when coadministered with a moderate CYP3A4 inducer. [54286] [67585] Vonoprazan; Amoxicillin; Clarithromycin: (Major) Avoid concomitant use of vonoprazan and dexamethasone due to decreased plasma concentrations of vonoprazan, which may reduce its efficacy. Vonoprazan is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. Vonoprazan exposures are predicted to be 50% lower when coadministered with a moderate CYP3A4 inducer. [54286] [67585] (Major) Coadministration of dexamethasone and clarithromycin may decrease clarithromycin serum concentrations due to CYP3A4 enzyme induction. While the 14-OH-clarithromycin active metabolite concentrations are increased, this metabolite has different antimicrobial activity compared to clarithromycin. The intended therapeutic effect of clarithromycin could be decreased. It is not clear if clarithromycin activity against other organisms would be reduced, but reduced efficacy is possible. Alternatives to clarithromycin should be considered in patients who are taking CYP3A4 inducers. Additionally, clarithromycin inhibits CYP3A4 and has the potential to result in increased plasma concentrations of dexamethasone. Increased blood concentrations and physiologic activity may necessitate a decrease in corticosteroid dosage. [28238] [34477] Vorapaxar: (Moderate) Use caution during concurrent use of vorapaxar and dexamethasone. Decreased serum concentrations of vorapaxar and thus decreased efficacy are possible when vorapaxar, a CYP3A4 substrate, is coadministered with dexamethasone, a CYP3A inducer. [57151] [6759] Voriconazole: (Moderate) Monitor for potential adrenal dysfunction with concomitant use of voriconazole and dexamethasone. In patients taking corticosteroids, voriconazole-associated CYP3A4 inhibition of their metabolism may lead to corticosteroid excess and adrenal suppression. Corticosteroid exposure is likely to be increased. Voriconazole is a strong CYP3A4 inhibitor, and dexamethasone is a CYP3A4 substrate. [28158] [34447] [54286] Vorinostat: (Moderate) Use vorinostat and corticosteroids together with caution; the risk of QT prolongation and arrhythmias may be increased if electrolyte abnormalities occur. Corticosteroids may cause electrolyte imbalances; hypomagnesemia, hypokalemia, or hypocalcemia and may increase the risk of QT prolongation with vorinostat. Frequently monitor serum electrolytes if concomitant use of these drugs is necessary. [26417] [32789] Voxelotor: (Major) Avoid coadministration of voxelotor and dexamethasone as concurrent use may decrease voxelotor exposure and lead to reduced efficacy. If coadministration is unavoidable, increase voxelotor dosage to 2,000 mg PO once daily in patients 12 years and older. In patients 4 to 11 years old, weight-based dosage adjustments are recommended; consult product labeling for specific recommendations. Voxelotor is a substrate of CYP3A; dexamethasone is a moderate CYP3A inducer. Coadministration of voxelotor with a moderate CYP3A inducer is predicted to decrease voxelotor exposure by up to 24%. [54286] [64778] Warfarin: (Moderate) Monitor the INR if warfarin is administered with corticosteroids. The effect of corticosteroids on warfarin is variable. There are reports of enhanced as well as diminished effects of anticoagulants when given concurrently with corticosteroids; however, limited published data exist, and the mechanism of the interaction is not well described. High-dose corticosteroids appear to pose a greater risk for increased anticoagulant effect. In addition, corticosteroids have been associated with a risk of peptic ulcer and gastrointestinal bleeding. [28549] [29779] Zafirlukast: (Minor) Zafirlukast inhibits the CYP3A4 isoenzymes and should be used cautiously in patients stabilized on drugs metabolized by CYP3A4, such as corticosteroids. [4718] [4948] Zanubrutinib: (Major) Avoid concurrent use of zanubrutinib and dexamethasone due to the risk of decreased zanubrutinib exposure which may reduce its efficacy. If concomitant use is necessary, increase the zanubrutinib dose to 320 mg twice daily and monitor response. Resume the previous dose of zanubrutinib if dexamethasone is discontinued. Zanubrutinib is a CYP3A substrate and dexamethasone is a moderate CYP3A inducer. Concomitant use with another moderate CYP3A inducer decreased zanubrutinib exposure by 44%. [54286] [64748] Zolpidem: (Moderate) It is advisable to closely monitor for reductions in zolpidem efficacy during co-administration of moderate CYP3A4 inducers, such as dexamethasone. CYP3A4 is the primary isoenzyme responsible for zolpidem metabolism, and there is evidence of significant decreases in systemic exposure and pharmacodynamic effects of zolpidem during co-administration of rifampin, a potent CYP3A4 inducer. [48902] [57789]
    Revision Date: 05/04/2023, 01:35:00 AM

    References

    2460 - Robinson B, Cutolo M. Should dehydroepiandrosterone replacement therapy be provided with chronic glucocorticoids? Rheumatology (Oxford) 1999;38:488-495.4558 - Vazquez ML, Jung H, Sotelo J. Plasma levels of praziquantel decrease when dexamethasone is given simulatneously. Neurology 1987;37:1561-2.4661 - Hexalen® (alretamine) package insert. Bloomington, MN: MGI Pharma, Inc.; 2001 Jan.4710 - Imuran (azathioprine) package insert. East Brunswisk, NJ: Casper Pharma, LLC; 2018 Dec.4711 - Remicade (infliximab) package insert. Horsham, PA: Janssen Biotech, Inc.; 2021 Oct.4718 - Hansten PD, Horn JR. Cytochrome P450 Enzymes and Drug Interactions, Table of Cytochrome P450 Substrates, Inhibitors, Inducers and P-glycoprotein, with Footnotes. In: The Top 100 Drug Interactions - A guide to Patient Management. 2008 Edition. Freeland, WA: H&H Publications; 2008:142-157.4744 - Premarin (conjugated estrogens, equine) package insert. Philadelphia, PA: Wyeth Pharmaceuticals Inc.; 2003 Jul.4746 - Celestone (betamethasone) package insert. Kenilworth, NJ: Schering Corporation; 1999 Oct.4757 - Leukeran (chlorambucil) package insert. Research Triangle Park, NC: GlaxoSmithKline; 2011 Oct.4768 - Albenza (albendazole) package insert. Hayward, CA: Impax Specialty Pharma; 2019 Jul.4946 - Cialis (tadalafil) package insert. Indianapolis, IN: Lilly ICOS, LLC; 2018 Feb.4948 - Accolate (zafirlukast) package insert. Wilmington, DE: AstraZeneca; 2015 Dec.4997 - Lexapro (escitalopram) package insert. North Chicago, IL: Abbvie, Inc.; 2023 May.5023 - Methazolamide tablet package insert. Bridgewater, NJ: Bausch & Lomb Americas, Inc.; 2022 Mar.5070 - Kaletra (lopinavir; ritonavir) tablet and solution package insert. North Chicago, IL: AbbVie Inc; 2020 Oct.5112 - Lotronex (alosetron) package insert. San Diego, CA: Promethus Laboratories, Inc.; 2019 April.5137 - Propulsid (cisapride) package insert. Titusville, NJ; Janssen Pharmaceutica; 2006 Oct. NOTE: As of May 2000; Propulsid has only been available in the United States via an investigational limited access program to ensure proper patient screening and prescribing.5206 - Rescriptor (delavirdine) package insert. Research Triangle Park, NC: ViiV Healthcare; 2019 Aug.5213 - Priftin (rifapentine) package insert. Bridgewater, NJ: Sanofi-Aventis Pharmaceuticals Inc.; 2020 Jun.5259 - Provigil® (modafinil) package insert. West Chester, PA: Cephalon, Inc; 2004 Feb.5283 - Accutane (isotretinoin) package insert. Nutley, NJ: Roche Laboratories Inc.; 2008 Nov.5341 - Rapamune (sirolimus) package insert. Philadelphia, PA: Wyeth Pharmaceuticals Inc.; 2021 Jun.5442 - Isovue-M® (iopamidol) package insert. Princeton, NJ: Bracco Diagnostics, Inc.; 2002 Jul.5468 - Inapsine (Droperidol) Injection package insert. Lake Forest, IL: Akorn, Inc.; 2011 Oct.5504 - Purinethol® (Mercaptopurine) package insert. Sellersville, PA: Gate Pharmaceuticals, div of Teva Pharmaceuticals USA; 2003 Aug.5567 - Cuprimine (penicillamine) package insert. Lawrenceville, NJ: Atom Pharma; 2010 Mar.5946 - BiCNU (carmustine) injection package insert. Edison, NJ: Heritage Pharmaceuticals Inc.; 2013 Apr.6161 - Pegasys (peginterferon alfa-2a) package insert. South San Francisco, CA: Genentech Inc; 2021 Mar.6303 - Thymoglobulin (anti-thymocyte [antithymocyte] globulin-rabbit) package insert. Fremont, CA: SangStat Medical Corporation; 2002 Apr.6524 - Deltasone (prednisone) tablet package insert. Petaluma, CA: Oculus Innovative Sciences, Inc.; 2017 Nov.6625 - Photofrin (porfimer) package insert. Birmingham, AL: Axcan Scandipharm Inc.; 2003 Aug.6702 - Panhematin® (hemin for injection) package insert. Deerfield, IL: Ovation Pharmaceuticals, Inc.; 2006 Aug.6759 - Dexamethasone tablets USP, Dexamethasone oral solution, and Dexamethasone Intensol (oral solution concentrate) package insert. Eatontown, NJ: West-Ward Pharmaceuticals Corp; 2016 March.6807 - Humatrope (somatropin) package insert. Indianapolis, IN: Eli Lilly and Company; 2019 Oct.6968 - Raab W, Gmeiner B. Interactions between econazole, a broad-spectrum antimicrobic substance, and topically active glucocorticoids. Dermatologica 1976;153(1):14-22.7557 - Clolar (clofarabine) package insert. Cambridge, MA: Genzyme Corporation; 2010 Dec.7592 - Mier JW, Vachino G, Klempner MS, et al. Inhibition of interleukin-2-induced tumor necrosis factor release by dexamethasone: Prevention of an acquired neutrophil chemotaxis defect and differential suppression of interleukin-2 associated side effects. Blood 1990;76:1933-40.7714 - Schimmer B, Parker K. Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Hardman JG, Limbird LE, Molinoff PB, et al., eds. Goodman and Gilman's the Pharmacological Basis of Therapeutics, 10th edition. New York: McGraw Hill, 2001;1649-1674.7944 - Alkeran® injection (melphalan) package insert. Research Triangle Park, NC: GlaxoSmithKline; 2007 Jun.8083 - Ammonul® (sodium phenylacetate and sodium benzoate) package insert. Baltimore, MD: Chesapeake Biological Laboratories, Inc.; 2005 Feb.8255 - Actonel with Calcium (risedronate sodium with calcium carbonate) package insert. Rockaway, NJ: Warner Chilcott, LLC; 2015 Mar.8256 - Kumar R. Glucocorticoid-induced osteoporosis. Curr Opin Nephrol Hypertens 2001;10:585-9.8314 - Jux C, Leiber K, Hugel U, et al. Dexamethasone impairs growth hormone (GH)-stimulated growth by suppression of local insulin-like growth factor (IGF)-1 production and expression of GH- and IGF-1 receptor in cultured rat chondrocytes. Endocrinology 1998;139:3296-305.8315 - Allen DB. Inhaled corticosteroid therapy for asthma in preschool children: growth issues. Pediatrics 2002;109:373-80.8565 - Orencia (abatacept) package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2021 Dec.8844 - Dexamethasone tablets, USP, dexamethasone oral solution, and dexamethasone Intensol oral solution (concentrate) package insert. Columbus, OH: Roxane Laboratories; 2005 Oct.8888 - Fontaine F, de Sousa G, Burcham PC, et al. Role of cytochrome P450 3A in the metabolism of mefloquine in human and animal hepatocytes. Life Sci 2000;66:2193-212.9671 - Tyzeka (telbivudine) package insert. East Hanover, NJ: Novartis Pharmaceuticals, Corp.; 2018 Dec.10318 - Nuvigil (armodafinil) package insert. Frazer, PA: Cephalon Inc; 2017 Feb.10571 - Intelence (etravirine) package insert. Titusville, NJ: Janssen Pharmaceuticals, Inc.; 2019 July.10690 - Arcalyst (rilonacept) package insert. Tarrytown, NY: Regeneron Pharmaceuticals, Inc.; 2021 Mar.10783 - Cimzia (certolizumab pegol) subcutaneous injection package insert. Smyrna, GA: UCB Inc.; 2022 Dec.11334 - Kovarik JM, Purba HS, Pongowski M, et al. Pharmacokinetics of dexamethasone and valspodar, a P-glycoprotein (mdr1) modulator: implications for coadministration. Pharmacother 1998;18:1230-6.11342 - Halotestin® (fluoxymesterone) package insert. New York, NY: Pharmacia and Upjohn Company a Division of Pfizer, Inc; 2002 May.24574 - Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. Ann Intern Med 1991;115:787-96.25398 - Melchart D, Linde K, Worku F, et al. Results of five randomized studies on the immunomodulatory activity of preparations of Echinacea. J Altern Complement Med 1995;1:145-60.26417 - Cohn JN, Kowey PR, Whelton PK, Prisant LM. New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice. Arch Intern Med 2000;160:2429-2436.27982 - Ketoconazole tablets package insert. Morgantown, WV: Mylan Pharmaceuticals, Inc.; 2017 Sept.27983 - Sporanox (itraconazole) capsules package insert. Titusville, NJ: Janssen Pharmaceuticals, Inc.; 2022 Dec.28001 - Hansten PD, Horn JR. Cytochrome P450 Enzymes and Drug Interactions, Table of Cytochrome P450 Substrates, Inhibitors, Inducers and P-glycoprotein, with Footnotes. In: The Top 100 Drug Interactions - A guide to Patient Management. 2008 Edition. Freeland, WA: H&H Publications; 2008:142-157.28003 - Mifeprex (Mifepristone, RU-486) package insert. New York, NY: Danco Laboratories, LLC.; 2023 Mar.28004 - Isuprel (isoproterenol) package insert. Bridgewater, NJ: Bausch Health US, LLC; 2022 Oct.28032 - McMahon M, Gerich J, Rizza R. Effects of glucocorticoids on carbohydrate metabolism. Diabetes Metab Rev 1988;4:17-30.28142 - Reyataz (atazanavir) package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2020 Sept.28158 - VFEND (voriconazole) tablets, suspension, and injection package insert. New York, NY: Pfizer Inc; 2022 Oct.28199 - Viagra (sildenafil citrate) package insert. New York, NY: Pfizer; 2017 Aug.28224 - Pacerone (amiodarone) tablets package insert. Maple Grove, MN: Upsher-Smith Laboratories, LLC.; 2018 Nov.28225 - CredibleMeds. Drugs to avoid in congenital long QT. Available on the World Wide Web at http://www.crediblemeds.org.28238 - Biaxin (clarithromycin) package insert. North Chicago, IL: AbbVie, Inc.; 2019 Sep.28251 - Ery-tab (erythromycin delayed-release tablets) package insert. Atlanta, GA: Arbor Pharmaceuticals, Inc.; 2018 Oct.28262 - Clozaril (clozapine) tablets package insert. Rosemont, PA: HLS Therapeutics (USA), Inc.; 2022 Dec.28267 - Acetazolamide package insert. Mahwah, NJ: Lifestar Pharma LLC; 2020 Mar.28279 - Falcoz C, et al. Effects of CYP4503A inhibition by ketoconazole on systemic activity of inhaled fluticasone propionate and budesonide. Eur Respir J 1997;10(suppl 25):175-6.28307 - Haldol (haloperidol) injection for immediate release package insert. Titusville, NJ: Janssen Pharmaceuticals, Inc.; 2020 Feb.28341 - Kaletra (lopinavir; ritonavir) tablet and solution package insert. North Chicago, IL: AbbVie Inc; 2020 Oct.28423 - Avelox (moxifloxacin) package insert. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc.; 2020 May.28424 - Factive (gemifloxacin mesylate) package insert. Toronto, ON: Merus Labs International, Inc.; 2019 May.28429 - Lasix (furosemide) package insert. East Brunswick, NJ: Strides Pharma Inc; 2022 Sept.28502 - Fiorinal (butalbital; aspirin; caffeine) capsules package insert. Madison, NJ: Allergan USA, Inc.; 2021 Apr.28549 - Coumadin (warfarin tablets) package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2017 Aug.28550 - Metformin HCl tablets package insert. Grand Cayman, Cayman Islands: Quallent pharmaceuticals Health LLC.; 2023 Feb.28761 - Albengres E, Le Louet H, Tillement JP. Systemic antifungal agents. Drug interactions of clinical significance. Drug Saf. 1998;18:83-97.28764 - Cipro (ciprofloxacin intravenous solution) package insert. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc.; 2022 Mar.28771 - Dilantin Kapseals (extended phenyotin sodium capsules, USP) package insert. Morris Plains, NJ: Parke Davis; 1999 Aug.28782 - Cancidas (caspofungin) for Injection package insert. Whitehouse Station, NJ: Merck and Co, Inc; 2021 Aug.28822 - Fareston (toremifene citrate) tablets package insert. Bedminster, NJ: Kyowa Kirin Inc.; 2017 May.28963 - Omnipaque (iohexol) package insert. Marlborough, MA: GE Healthcare, Inc.; 2023 Feb.28995 - Invirase (saquinavir) package insert. South San Francisco, CA: Genentech Inc.; 2020 Sept.29012 - Lexiva (fosamprenavir calcium) package insert. Research Triangle Park, NC: ViiV Healthcare; 2019 Mar29016 - Aldactone (spironolactone) package insert. New York, NY: G.D. Searle LLC; 2008 Jan.29088 - Sular (nisoldipine) package insert. Atlanta, GA: Shionogi Pharma, Inc.; 2017 Jun.29377 - Nanji AA. Drug-induced electrolyte disorders. Drug Intell Clin Pharm 1983;17:175-85.29524 - Nexium (esomeprazole) capsules, granules package insert. Wilmington, DE: AstraZeneca; 2022 March.29564 - Prilosec (omeprazole) package insert. Wilmington, DE: AstraZeneca; 2022 March.29611 - Mobic (meloxicam) package insert. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc.; 2021 Apr.29623 - Duragesic (fentanyl transdermal system) package insert. Titusville, NJ: Janssen Pharmaceuticals, Inc.; 2021 Mar.29763 - Actiq (oral transmucosal fentanyl citrate) package insert. Parsippany, NJ: Teva Pharmaceuticals USA, Inc.; 2022 Nov.29779 - Deltasone (prednisone) tablet package insert. Petaluma, CA: Oculus Innovative Sciences, Inc.; 2017 Nov.29818 - Noroxin (norfloxacin) tablets package insert. Whitehouse Station, NJ: Merck and C., Inc.; 2016 Jul.30011 - Dexamethasone tablets USP, Dexamethasone oral solution, and Dexamethasone Intensol (oral solution concentrate) package insert. Eatontown, NJ: West-Ward Pharmaceuticals Corp; 2016 March.30015 - Medrol (methylprednisolone) tablet package insert. New York, NY: Pfizer; Pharmacia and Upjohn Company LLC; 2019 Jan.30028 - Pediapred (prednisolone sodium phosphate) oral solution package insert. Manasquan, NJ: Royal Pharmaceuticals; 2018 Feb.30282 - Synalgos-DC (aspirin; caffeine; dihydrocodeine) capsules package insert. Atlanta, GA: Mikart, Inc.; 2019 Oct.30314 - Rifadin capsules and injection (rifampin) package insert. Bridgewater, NJ: Sanofi-Aventis, LLC; 2021 Dec.30379 - Hycodan (hydrocodone bitartrate; homatropine methylbromide) package insert. Malvern, PA: Endo Pharmaceuticals Inc.; 2018 Jun.30431 - Marinol (dronabinol, THC) package insert. Marietta, GA: Unimed Pharmaceuticals, Inc.; 2023 Jan.30470 - Tysabri (natalizumab) package insert. Cambridge, MA: Biogen Inc.; 2023 Apr.30555 - Tarceva (erlotinib) package insert. Northbrook, IL: OSI Pharmaceuticals, LLC; 2016 Sept.30571 - Lunesta (eszopiclone) tablets package insert. Marlborough, MA: Sunovion Pharmaceuticals Inc; 2019 Aug.30585 - Pandit MK, Burke J, Gustafson AB, et al. Drug-induced disorders of glucose tolerance. Ann Intern Med 1993;118:529-39.30676 - Emend (aprepitant oral products) package insert. Whitehouse Station, NJ: Merck & Co.,Inc.; 2019 Nov.30738 - Ofloxacin tablets package insert. Sacramento, CA: Nivagen Pharmaceuticals, Inc.; 2019 Feb.30742 - Abraxane (paclitaxel protein-bound particles) injection package insert. Summit, NJ: Celgene Corporation; 2020 Aug.30943 - Schimmer B, Parker K. Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Hardman JG, Limbird LE, Molinoff PB, et al., eds. Goodman and Gilman's the Pharmacological Basis of Therapeutics, 10th edition. New York: McGraw Hill, 2001;1649-1674.30966 - Sufenta (sufentanil citrate injection) package insert. Lake Forest, IL: Akorn Pharmaceuticals, Inc.; 2019 Oct31123 - Patten BM, Oliver KL, Engel WK. Adverse interaction between steroid hormones and anticholinesterase drugs. Neurology 1974;24:442-9.31327 - Abilify (aripiprazole) tablets, discmelt orally-disintegrating tablets, oral solution, and intramuscular injection. Rockville, MD: Otsuka America Pharmaceutical, Inc.; 2020 Feb.31807 - Exjade (deferasirox) package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2020 Jul.31832 - Nexavar (sorafenib) package insert. Wayne, NJ; Bayer HealthCare Pharmaceuticals Inc.; 2020 July.32073 - Lee AN, Werth VP. Activation of autoimmunity following use of immunostimulatory herbal supplements. Arch Dermatol 2004;140:723-7.32432 - Prezista (darunavir) package insert. Horsham, PA: Janssen Products, LP; 2023 Mar.32723 - Noxafil (posaconazole) package insert. Whitehouse Station, NJ: Merck & Co. Inc.: 2022 Jan.32731 - Fentora (fentanyl buccal tablet) package insert. Parsippany, NJ: Teva Pharmaceuticals USA, Inc.; 2022 Nov.32789 - Zolinza (vorinostat) capsules package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2018 Dec.32857 - Lidocaine hydrochloride and 5% dextrose injection package insert. Deerfield, IL: Baxter Healthcare Corporation; 2017 Feb.33192 - Tykerb (lapatinib) tablet package insert. Research Triangle Park, NC: GlaxoSmithKline; 2018 Dec.33473 - Selzentry (maraviroc) package insert. Research Triangle Park, NC: ViiV Healthcare; 2020 Oct.33528 - Metopirone (metyrapone) capsule package insert. Farmingdale, NJ: Direct Success, Inc; 2022 Sept.33654 - Codeine sulfate tablets package insert. Eatontown, NJ; West-Ward Pharmaceuticals Corp.: 2021 Mar.33698 - Androgel 1% (testosterone gel) package insert. North Chicago, IL: Abbott Laboratories; 2019 May.33718 - Intelence (etravirine) package insert. Titusville, NJ: Janssen Pharmaceuticals, Inc.; 2019 July.34253 - Regonol (pyridostigmine bromide injection, USP) package insert. Princeton, NJ: Sandoz, Inc.; 2019 Jan.34335 - Giao PT, de Vries PJ. Pharmacokinetic interactions of antimalarial agents. Clin Pharmacokinet 2001;40:343-73.34447 - Niwa T, Shiraga T, Takagi A. Effect of antifungal drugs on cytochrome P450 (CYP) 2C9, CYP2C19, and CYP3A4 activities in human liver microsomes. Biol Pharm Bull. 2005;28:1805-1808.34470 - Aczone (dapsone gel 5%) package insert. Irvine CA: Allergan Inc.; 2018 May.34477 - Kovarik JM, Purba HS, Pongowski M, et al. Pharmacokinetics of dexamethasone and valspodar, a P-glycoprotein (mdr1) modulator: implications for coadministration. Pharmacother 1998;18:1230-6.34535 - Zurcher RM, Frey BM, Frey FJ, et al. Impact of ketoconazole on the metabolism of prednisolone. Clin Pharmacol Ther 1989;45:366-72.34883 - Promethazine and codeine oral solution package insert. Baudette, MN: ANI Pharmaceuticals, Inc.; 2018 Jun.35401 - Coartem (artemether; lumefantrine) package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2019 Aug.35501 - Simponi (golimumab) injection package insert. Horsham, PA: Janssen Biotech, Inc.; 2019 Sept.35588 - Exforge HCT (amlodipine, valsartan, hydrochlorothiazide) tablets package insert. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2020 Aug.35591 - Cycloset (bromocriptine mesylate) package insert. Tiverton, RI: VeroScience LLC; 2020 Aug.35893 - Caldolor (ibuprofen) injection package insert. Nashville, TN: Cumberland Pharmaceuticals; 2023 May.36101 - Multaq (dronedarone) package insert. Bridgewater, NJ: Sanofi-aventis U.S. LLC; 2020 Nov.36250 - Sabril (vigabatrin) tablet/powder for oral solution package insert. Deerfield, IL: Lundbeck Inc.; 2021 Oct.36319 - Sandimmune (Cyclosporine) package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2013 May.37292 - Istodax (romidepsin) injection package insert. Summit, NJ: Celgene Corporation; 2021 July.37590 - Elewski B, Tavakkol A. Safety and tolerability of oral antifungal agents in the treatment of fungal nail disease: a proven reality. Ther Clin Risk Manag. 2005;1(4):299-306.39926 - OxyContin (oxycodone HCl extended-release) package insert. Stamford, CT: Purdue Pharma L.P.; 2021 Oct.40027 - Emend (fosaprepitant dimeglumine injection) package insert. Whitehouse Station, NJ: Merck & Co.,Inc.; 2022 May.40134 - Amphotericin B injection package insert. Big Flats, NY: X-Gen Pharmaceuticals, Inc.; 2009 Dec.40233 - Sporanox (itraconazole) oral solution package insert. Titusville, NJ: Janssen Pharmaceuticals, Inc.; 2022 Dec.40277 - Provenge (sipuleucel-T) package insert. Seattle, WA: Dendreon Co.; 2010 Apr.40596 - Prevacid (lansoprazole) capsules, tablets package insert. Deerfield, IL: Takeda Pharmaceuticals America, Inc.; 2022 March40862 - Prolia (denosumab) solution for injection package insert. Thousand Oaks, CA: Amgen, Inc.; 2023 Jan.40943 - Onsolis (fentanyl buccal soluble film) package insert. Raleigh, NC: BioDelivery Sciences, International, Inc.; 2021 Mar.41237 - Tegretol (carbamazepine) package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2018 Mar.41361 - Solu-Medrol (methylprednisolone sodium succinate for injection) package insert. New York, NY: Pharmacia and Upjohn Co; 2021 May.41569 - Ella (ulipristal 30 mg tablets) package insert. Paris, France: Laboratoire HRA Pharma; 2021 Jun.41853 - Proleukin (aldesleukin) package insert. San Diego, CA: Prometheus Laboratories Inc.; 2012 Jul.41934 - Lysodren (mitotane) package insert. Princeton, NJ: Bristol-Myers Squibb Oncology; 2021 June.41961 - Pancuronium injection package insert. Lake Forest, IL: Hospira, Inc; 2019 Jan.42031 - Rocuronium bromide package insert. Lake Zurich, IL: Fresenius Kabi; 2020 Apr.42227 - Latuda (lurasidone) package insert. Marlborough, MA: Sunovion Pharmaceuticals, Inc.; 2019 Dec.42295 - DDAVP (desmopressin acetate) injection package insert. Parsippany NJ: Ferring Pharmaceuticals, Inc.; 2022 Jul.42863 - Mytelase (ambenonium chloride tablets) package insert. Bridgewater, NJ:Sanofi-Aventis U.S. LLC; 2014 Nov.43236 - National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). General recommendations on immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011;60(2):1-64.43298 - Aplisol (tuberculin purified protein derivative, diluted) package insert. Chestnut Ridge, NY: Par Pharmaceuticals; 2016 Mar.43299 - Tubersol (tuberculin purified protein derivative, mantoux) package insert. Swiftwater, PA: Sanofi Pasteur, Inc.; 2020 Nov.43319 - Prednisone tablet package insert. Salisbury, MD: Cadista Pharmaceuticals Inc.; 2016 Mar.43463 - Orap (pimozide) package insert. Sellersville, PA: Teva Pharmaceuticals USA; 2014 Mar.43551 - Daliresp (roflumilast) package insert. Wilmington, DE: AstraZeneca Pharmaceuticals, LP; 2018 Jan.43566 - Intuniv (guanfacine extended-release tablets) package insert. Lexington, MA: Shire US Inc.; 2020 Aug.43880 - Lamisil (terbinafine oral granules) package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2019 Mar.43881 - Terbinafine tablets package insert. Princeton, NJ: Bionpharma Inc.; 2021 Nov.44094 - Zyban (bupropion sustained release tablets) package insert. Research Triangle Park, NC: GlaxoSmithKline; 2021 Mar.44376 - Edurant (rilpivirine) package insert. Titusville, NJ: Janssen Therapeutics; 2022 Oct.44854 - Xarelto (rivaroxaban) package insert. Titusville, NJ: Janssen Pharmaceuticals, Inc.; 2023 Feb.44913 - Mycamine (micafungin) for Injection package insert. Northbrook, IL: Astellas Pharma US, Inc; 2019 Dec.44951 - Brilinta (ticagrelor) package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2022 May.45238 - Synvisc (Hylan G-F 20) package insert. Ridgefield, NJ: Genzyme Biosurgery; 2014 Sep.45239 - Synvisc-One (Hylan G-F 20) package insert. Ridgefield, NJ: Genzyme Biosurgery; 2014 Sep.45335 - Zelboraf (vemurafenib) tablet package insert. South San Francisco, CA: Genentech USA, Inc.; 2020 May.45339 - Flo-Pred (prendisolone acetate) package insert. Hawthorne, NY: TaroPharma; 2021 July.45378 - Adcetris (brentuximab vedotin) injection package insert. Bothell, WA: Seagen Inc; 2022 Nov.45935 - Gefitinib (Iressa) package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2021 May.46782 - Jakafi (ruxolitinib) tablets package insert. Wilmington, DE: Incyte Corporation; 2022 Dec.48201 - US Department of Health and Human Services/Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep. 2016;65:1-103.48342 - ANADROL-50 (oxymetholone) package insert. Marietta, GA: Alaven Pharmaceutical; 2006 Nov.48494 - Inlyta (axitinib) package insert. New York, NY: Pfizer Inc; 2022 Sept.48640 - Dexycu (dexamethasone intraocular suspension) package insert. Watertown, MA: EyePoint Pharmaceuticals US, Inc.; 2020 Jun.48697 - Korlym (mifepristone) tablet package insert. Menlo Park, CA: Corcept Therapeutics; 2019 Nov.48902 - Von Moltke LL, Greenblatt DJ, Granda BW, et al. Zolpidem metabolism in vitro: responsible cytochromes, chemical inhibitors, and in vivo correlations. Br J Clin Pharmacol 1999;48:89—97.49489 - Cortisone acetate tablet package insert. Eatontown, N.J.: Hikma Pharmaceuticals USA Inc.; 2016 July49773 - Rituxan (rituximab) injection package insert. South San Francisco, CA: Genentech, Inc.; 2018 Apr.49823 - Afinitor (everolimus) tablets package insert. East Hanover, NJ:Novartis Pharmaceuticals Corporation; 2022 Feb.49829 - Votrient (pazopanib) tablet package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2021 Sept.49866 - Stendra (avanafil) package insert. Freehold, NJ: Metuchen Pharmaceuticals, LLC.; 2022 Oct.49903 - Zortress (everolimus) package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2018 Aug.50586 - Torisel (temsirolimus) injection package insert. Philadelphia, PA: Wyeth Pharmaceuticals Inc; 2018 March.50623 - Ulipristal (Esmya 5 mg tablets) European package insert. London UK; Gedeon Richter (UK) Ltd: 2017 Aug.51002 - Chan JC, Cockram CS, Critchley JA. Drug-induced disorders of glucose metabolism. Mechanisms and management. Drug Saf 1996;15:135—57.51027 - Ifex (ifosfamide) package insert. Deerfield, IL: Baxter Healthcare Corp; 2018 Jul51324 - Rayos (prednisone) delayed-release tablets package insert. Deerfield, IL: Horizon Pharma USA, Inc.; 2019 Dec.51432 - Marqibo (vincristine sulfate liposome) injection package insert. East Windsor, NJ: Acrotech Biopharma LLC; 2022 Mar.51664 - Stribild (elvitegravir; cobicistat; emtricitabine; tenofovir disoproxil fumarate) package insert. Foster City, CA: Gilead Sciences, Inc; 2021 Sept.51727 - Xtandi (enzalutamide) capsule and tablet package insert. Northbrook, IL:Astellas Pharma US, Inc.; 2022 Sept.51834 - Food and Drug Administration (FDA): Drug development and drug interactions. Retrieved Sep 19, 2012. Available on the World Wide Web http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/DrugInteractionsLabeling/ucm093664.htm#transporter.52140 - Perampanel (Fycompa) tablets and oral suspension package insert. Woodcliff Lake, NJ: Eisai Inc.; 2019 May.52506 - Cometriq (Cabozantinib) capsules package insert. South San Francisco, CA:Exelixis, Inc.; 2020 Jan52746 - Sirturo (bedaquiline) tablet package insert. Titusville, NJ: Janssen Therapeutics; 2021 Sept.53022 - Ravicti (Glycerol phenylbutyrate) package insert. Lake Forest, IL: Horizon Pharma USA, Inc.; 2021 Sept.53394 - Abilify Maintena (aripiprazole) extended-release intramuscular injection package insert. Rockville, MD:Otsuka America Pharmaceutical, Inc.; 2020 June.54049 - Solu-cortef (hydrocortisone sodium succinate) injection package insert. New York, NY: Pharmacia & Upjohn Co.; 2021 May.54278 - Solu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY: Pharmacia and Upjohn Co.; 2021 May.54285 - Dexamethasone sodium phosphate injection solution. Schaumburg, IL: APP Pharmaceuticals, LLC; 2008 Apr.54286 - Dexamethasone tablets USP, Dexamethasone oral solution, and Dexamethasone Intensol (oral solution concentrate) package insert. Eatontown, NJ: West-Ward Pharmaceuticals Corp; 2016 March.54374 - Phenylephrine hydrochloride injection. Eatontown, NJ: West-Ward Pharmaceuticals; 12 Dec.54557 - Dexamethasone sodium phosphate injection package insert. Schaumburg IL: APP Pharmaceuticals; 2008 Jan.54802 - Tafinlar (dabrafenib) capsules package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2023 Mar.54891 - Bloxiverz (neostigmine methylsulfate injection) package insert. Lenoir, NC: Exela Pharma Sciences, LLC; 2020 Nov.55362 - Elspar (asparaginase) injection package insert. Deerfield, IL: Lundbeck; 2013 July.56146 - Kenalog-40 (triamcinolone acetonide) injection package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2019 April.56233 - Singh JA, Furst DE, Bharat A, et al. 2012 Update of the 2008 American College of Rheumatology Recommendations for the Use of Disease-Modifying Antirheumatic Drugs and Biologic Agents in the Treatment of Rheumatoid Arthritis. Arthritis Care & Research 2012;64(5):625-639.56303 - Zohydro ER (hydrocodone extended-release capsules) package insert. Morristown, NJ: Currax Pharmaceuticals LLC; 2021 Mar.56410 - Imbruvica (ibrutinib) capsules, tablets, and oral suspension package insert. Sunnyvale, CA: Pharmacyclics, Inc.; 2023 May.56471 - Olysio (simeprevir) capsule package insert. Titusville, NJ: Janssen Therapeutics; 2017 Nov.56538 - Vickers AE, Sinclair JR, Zollinger M. Multiple cytochrome P-450s involved in the metabolism of terbinafine suggest a limited potential for drug-drug interactions. Drug Metab Dispos. 1999;27(9):1029-1038.56575 - Adrenalin (epinephrine) 1 mg/mL injection package insert. Chestnut Ridge, NJ: Par Pharmaceutical Companies, Inc.; 2022 Jun.56665 - Hetlioz (tasimelteon) package insert. Washington, D.C.: Vanda Pharmaceuticals, Inc.; 2020 Dec.56853 - Hemangeol (propranolol hydrochloride) oral solution package insert. Parsippany, NJ: Pierre Fabre Pharmaceuticals, Inc.; 2021 Jun.57053 - Food and Drug Administration (US FDA) Drug Medwatch-FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. Retrieved April 23, 2014. Available on the World Wide Web at http://www.fda.gov/downloads/Drugs/DrugSafety/UCM394286.pdf.57094 - Zykadia (ceritinib) package insert. Indianapolis, IN: Novartis; 2021 Oct.57151 - Zontivity (vorapaxar) package insert. Parsippany, NJ: Aralez Pharmaceuticals US Inc.; 2019 Nov.57578 - Vazculep (phenylephrine) injection package insert. Chesterfield, Mo: Avadel Legacy Pharmaceuticals, LLC; 2019 Oct.57675 - Zydelig (idelalisib) tablet package insert. Foster City, CA:Gilead Sciences, Inc.; 2022 Feb.57685 - Buphenyl (sodium phenylbutyrate) oral tablet and powder package insert. South San Francisco, CA: Hyperion Therapeutics, Inc.; 2013 Jun.57713 - K Phos Neutral (potassium phosphate; sodium phosphate) tablets package insert. Tampa, FL: Beach Pharmaceuticals; 2005 Jun.57714 - Virt Phos 250 Neutral (potassium phosphate; sodium phosphate) tablets package insert. Tampa, FL: Virtus Pharmaceuticals; 2014 Mar.57715 - Phospha 250 Neutral (potassium phosphate; sodium phosphate) tablets package insert. Columbus, OH: Rising Pharmaceuticals, Inc.; 2011 Feb.57741 - Orbactiv (oritavancin) package insert. Lincolnshire, IL: Melinta Therapeutics, LLC; 2022 Jan.57789 - Ambien (zolpidem immediate-release tablets) package insert. Bridgewater, NJ: Sanofi-Aventis U.S. LLC; 2022 Feb.57803 - Cerdelga (eliglustat) capsules. Waterford, Ireland: Genzyme Ireland, Ltd.;2018 Sept.58000 - Tybost (cobicistat) package insert. Foster City, CA: Gilead Sciences, Inc; 2021 Sept.58001 - Vitekta (elvitegravir) package insert. Foster City, CA: Gilead Sciences, Inc; 2015 Jul.58167 - Harvoni (ledipasvir; sofosbuvir) tablet and oral pellets package insert. Foster City, CA: Gilead Sciences, Inc; 2020 Mar.58171 - Akynzeo (fosnetupitant; palonosetron injection and netupitant; palonosetron capsules) package insert. Lugano, Switzerland: Helsinn Healthcare; 2023 February.58220 - Bachmakov I, Werner U, Endress B, et al. Characterization of beta-adrenoceptor antagonists as substrates and inhibitors of the drug transporter P-glycoprotein. Fundam Clin Pharmacol 2006;20:273-82.58461 - Lemtrada (alemtuzumab) injection package insert. Cambridge, MA: Genzyme Corporation; 2022 Sep.58662 - Lynparza (olaparib) tablets package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2022 Aug.58664 - Viekira Pak (ombitasvir; paritaprevir; ritonavir; dasabuvir) tablet package insert. North Chicago, IL: AbbVie, Inc; 2019 Dec.58766 - Tasigna (nilotinib) package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2021 Sept.58770 - Gleevec (imatinib mesylate) tablet package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2022 Mar.59042 - Cresemba (isavuconazonium) package insert. Northbrook, IL: Astellas Pharma US, Inc; 2022 Feb.59438 - Trisenox (arsenic trioxide) injection package insert. Parsippany, NJ: Teva Pharmaceuticals USA, Inc.; 2020 Oct.59891 - Orkambi (lumacaftor; ivacaftor) tablet package insert. Boston, MA: Vertex Pharmaceuticals, Inc. 2022 Sept59949 - Rexulti (brexpiprazole) tablets package insert. Rockville, MD: Otsuka America Pharmaceutical Inc; 2023 May.60000 - Odomzo (sonidegib) capsules package insert. Cranbury, NJ: Sun Pharmaceutical Industries, Inc.; 2017 Sept.60001 - Daklinza (daclatasvir) package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2019 Oct.60099 - Addyi (flibanserin tablets) package insert. Raleigh, NC: Sprout Pharmaceuticals, Inc.; 2021 Sept.60164 - Vraylar (cariprazine capsules) package insert. Madison, NJ:Allergan USA, Inc.; 2022 Dec.60269 - Genvoya (elvitegravir; cobicistat; emtricitabine; tenofovir alafenamide) package insert. Foster City, CA: Gilead Sciences, Inc; 2022 Jan.60281 - Cotellic (cobimetinib) tablets package insert. San Francisco, CA: Genentech USA, Inc; 2022 Oct.60523 - Zepatier (elbasvir; grazoprevir) tablet package insert. Whitehouse Station, NJ: Merck, Inc; 2021 Dec.60612 - Aczone (dapsone gel 7.5%) package insert. Exton, PA: Almirall, LLC; 2019 Sept.60706 - Venclexa (venetoclax) tabs package insert. South San Francisco, CA: Genentech, Inc.; 2020 Nov.60738 - Cabometyx (Cabozantinib) tablets package insert. Alameda, CA: Exelixis, Inc.; 2022 July.60748 - Nuplazid (pimavanserin) package insert. San Diego, CA: Acadia; 2020 Nov.60760 - Dexamethasone sodium phosphate injection package insert. Eatontown, NJ:West-Ward Pharmaceuticals;2014 Sept.60852 - Netspot (gallium Ga 68 dotatate) injection package insert. Millburn, NJ: Advanced Accelerator Applications USA, Inc. 2021 Dec.60911 - Epclusa (sofosbuvir; velpatasvir) tablet and oral pellets package insert. Foster City, CA: Gilead Sciences, Inc; 2022 Apr.60951 - Syndros (dronabinol) oral solution package insert. Chandler, AZ; Insys Therapeutics, Inc. 2022 Sept.61087 - Leukine (sargramostim) injection package insert. Bridgewater, NJ: Sanofi-Aventis U.S. LLC; 2022 May.61310 - Oncaspar (pegaspargase) injection package insert. Boston, MA: Servier Pharmaceuticals LLC; 2022 Dec.61750 - Emflaza (deflazacort) tablets and oral suspension. South Plainfield, NJ: PTC Therapeutics; 2021 Jul.61806 - Noctiva nasal spray (desmopressin acetate) package insert. Milford, PA: Serenity Pharmaceuticals LLC; 2017 Mar.61816 - Kisqali (ribociclib) tablets package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2022 Oct.61838 - Ocrevus (ocrelizumab) injection package insert. South San Francisco, CA: Genentech, Inc.; 2022 Aug.61902 - Stimpel M, Proksch A, Wagner H, et al. Macrophage activation and induction of macrophage cytotoxicity by purified polysaccharide fractions from the plant Echinacea purpurea. Infect Immun 1984;46:845-961905 - Chavez ML, Jordan MA, Chavez PI. Evidence-based drug-herbal interactions. Life Sci 2006;78:2146-57.61909 - Alunbrig (brigatinib) tablet package insert. Cambridge, MA: Ariad Pharmaceuticals Inc.; 2022 March.61937 - Millipred (prednisolone) oral tablet package insert. Research Triangle Park, NC: Zylera Pharmaceuticals, LLC; 2015 Nov.62028 - Baxdela (delafloxacin) package insert. Lincolnshire, IL: Melinta Therapeutics, Inc.; 2019 Oct.62127 - Nerlynx (neratinib) package insert. Los Angeles, CA: Puma Biotechnology, Inc; 2021 June.62131 - Vosevi (sofosbuvir; velpatasvir; voxilaprevir) tablet package insert. Foster City, CA: Gilead Sciences, Inc; 2019 Nov.62201 - Mavyret (glecaprevir; pibrentasvir) tablets package insert. North Chicago, IL: AbbVie Inc.; 2021 Sept.62264 - National Clinical Guideline Centre (UK). Multiple Sclerosis: Management of Multiple Sclerosis in Primary and Secondary Care. London: National Institute for Health and Care Excellence (UK); (NICE Clinical Guideline No 186). 2014 Oct. Accessed: August 25 2017. Available at: www.ncbi.nlm.nih.gov/pubmedhealth/PMH0068954/pdf/PubMedHealth_PMH0068954.pdf62393 - Verzenio (abemaciclib) tablets package insert. Indianapolis, IN: Lilly USA, LLC; 2023 March.62611 - Prevymis (letermovir) package insert. Whitehouse Station, NJ: Merck and Co, Inc.; 2020 Mar.62723 - Macrilen (macimorelin) package insert. Frankfurt am Main, Germany: Aeterna Zentaris GmbH; 2018 Jan.62853 - Amin M, Suksomboon N. Pharmacotherapy of type 2 diabetes mellitus: an update on drug-drug interactions. Drug Saf. 2014;37:903-919.62874 - Erleada (apalutamide) tablets package insert. Horsham, PA: Janssen Products, LP; 2023 Feb.62889 - Apadaz (benzhydrocodone; acetaminophen) tablets package insert. Newton, PA: KVK-Tech, Inc.; 2021 Mar.63317 - Braftovi (encorafenib) capsules package insert. Boulder, CO: Array BioPharma Inc.; 2022 Feb.63328 - Aristada Initio (aripiprazole lauroxil extended-release injectable suspension) package insert. Altham, MA:Alkermes, Inc.; 2020 Feb.63387 - Orilissa (elagolix) tablets package insert. North Chicago, IL: AbbVie Inc.; 2021 Feb.63484 - Pifeltro (doravirine) package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2022 Jan.63571 - Copiktra (duvelisib) capsules package insert. Las Vegas, NV: Secura Bio, Inc.; 2021 Dec.63731 - Dsuvia (sufentanil) sublingual tablets package insert. Redwood City, CA: AcelRx Pharmaceuticals, Inc.; 2019 Oct.63732 - Lorbrena (lorlatinib) tablets package insert. New York, NY: Pfizer Labs; 2021 March.63777 - Daurismo (glasdegib) tablets package insert. New York, NY: Pfizer Labs; 2023 Mar.63780 - Vitrakvi (larotrectinib) capsules and oral solution package insert. Stamford, CT: Loxo Oncology, Inc.; 2022 Nov.63790 - Firdapse (amifampridine) tablets package insert. Coral Gables, FL: Catalyst Pharmaceuticals, Inc.; 2023 May.63923 - The American Geriatrics Society 2019 Beers Criteria Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019;00:1-21.64002 - Pyridostigmine Bromide oral solution package insert. East Windsor, NJ: Novitium Pharma LLC; 2019 Mar.64031 - Mayzent (siponimod) tablets package insert. East Hanover, NJ: Novartis Pharmaceutical Corporation; 2023 Jan.64064 - Balversa (erdafitinib) tablets package insert. Horsham, PA: Janssen Products, LP; 2023 Jan.64165 - Dexamethasone (Decadron) tablets package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2019 May.64535 - Turalio (pexidartinib) capsules package insert. Basking Ridge, NJ: Daiichi Sankyo, Inc.; 2022 Oct.64561 - Pretomanid tablet package insert. Hyderabad, India: Mylan, Laboratories Limited; 2022 Dec.64567 - Rozlytrek (entrectinib) package insert. South San Francisco, CA: Genentech Inc.; 2022 July64568 - Inrebic (fedratinib) capsules package insert. Summit, NJ: Celgene Corporation; 2021 Dec.64576 - Xenleta (lefamulin) package insert. Dublin, Ireland: Nabriva Therapeutics US, Inc.; 2021 Mar.64748 - Brukinsa (zanubrutinib) capsules package insert. San Mateo, CA: BeiGene USA, Inc; 2023 Apr.64768 - Xcorpi (cenobamate) tablets package insert. Paramus, NJ: SK Life Science, Inc.; 2022 Jun.64778 - Oxbryta (voxelotor) tablets package insert. South San Francisco, CA: Global Blood Therapeutics, Inc.; 2021 Dec.64870 - Dayvigo (lemborexant) tablets package insert. Nutley, NJ: Eisai Inc.; 2023 Apr.64874 - Ubrelvy (ubrogepant) tablets package insert. Madison, NJ: Allergan USA, Inc.; 2023 Feb.64885 - Caplyta (lumateperone) capsules package insert. New York, NY; Intra-Cellular Therapies, Inc.; 2022 Apr.64922 - Ayvakit (avapritinib) tablets package insert. Cambridge, MA: Blueprint Medicines Corporation; 2023 Mar.64952 - Tazverik (tazemetostat) tablet package insert. Cambridge, MA: Epizyme, Inc.; 2020 June.65052 - Nurtec ODT (rimegepant) orally disintegrating tablet package insert. New Haven, CT: Biohaven Pharmaceuticals, Inc.; 2022 Apr.65107 - Kroger A, Bahta L, Hunter P. General Best Practice Guidelines for Immunization. Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP).Available on the world wide web at https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf. Revised April 27, 2022. Accessed on July 14, 2022.65169 - Ozanimod (Zeposia) capsules package insert. Summit, NJ: Celgene Corporation; 2022 Sept.65246 - Koselugo (selumetinib) capsules package insert. Wilmington, DE: AstraZeneca Pharmaceuticals, LP; 2021 Dec.65295 - Tukysa (tucatinib) tablets package insert. Bothell, WA: Seattle Genetics, Inc.; 2023 Jan65307 - Pemazyre (pemigatinib) tablets package insert. Wilmington, DE: Incyte Corporation: 2021 Feb.65377 - Tabrecta (capmatinib) tablets package insert. Novartis Pharmaceuticals Corporation;East Hanover, NJ:2023 March.65387 - Retevmo (selpercatinib) capsules package insert. Indianapolis, IN: Eli Lilly and Company; 2022 Sept.65431 - Qinlock (ripretinib) tablets package insert. Waltham, MA: Deciphera Pharmaceuticals, LLC; 2022 Dec.65562 - Levofloxacin tablets package insert. Livonia, MI; Major Pharmaceuticals: 2019 Nov.65576 - Uplizna (inebilizumab-edon) injection package insert. Gaithersburg, MD: Viela Bio, Inc.; 2020 Jun.65593 - Zepzelca (lurbinectedin) injection package insert. Palo Alto, CA: Jazz Pharmaceuticals, Inc.; 2022 April.65685 - Dooley KE, Bliven-Sizemore EE, Weiner M, et al. Safety and pharmacokinetics of escalating daily doses of the antituberculosis drug rifapentine in healthy volunteers. Clin Pharmacol Ther 2012; 91:565850 - Kesimpta (ofatumumab) injection package insert. East Hanover, NJ: Novartis Pharmaceutical Corporation; 2022 Sep.66080 - Food and Drug Administration (FDA). Fact Sheet for Healthcare Providers Administering Vaccine: Emergency Use Authorization (EUA) of Pfizer-BioNTech COVID-19 Vaccine to Prevent Coronavirus Disease 2019 (COVID-19) for 12 years and older. Purple cap and purple border. Retrieved November 22, 2022.66129 - Zokinvy (lonafarnib) capsules package insert. Palo Alto, CA: Eiger BioPharmaceuticals, Inc.; 2020 Nov.66336 - Lupkynis (voclosporin) capsules package insert. Rockville, MD: Aurinia Pharma U.S., Inc.; 2021 Jan.66527 - Ponvory (ponesimod) tablet package insert. Titusville, NJ: Janssen Pharmaceuticals, Inc.; 2021 Oct.66702 - Truseltiq (Infigratinib) capsules package insert. Brisbane, CA: QED Therapeutics, Inc.; 2021 May.66705 - Brexafemme (ibrexafungerp) package insert. Jersey City, NJ: Scynexis, Inc; 2022 Nov.66793 - Kerendia (finerenone) tablets package insert. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc.; 2022 Sept.66990 - Exkivity (mobocertinib) capsules package insert. Lexington, MA: Takeda Pharmaceuticals America, Inc.; 2023 March.67011 - Qulipta (atogepant) tablet package insert. Dublin, Ireland: Forest Laboratories Ireland Ltd.; 2023 Apr.67036 - Tavneos (avacopan) capsules package insert. Cincinnati, OH; ChemoCentryx, Inc.: 2021 Oct.67203 - Food and Drug Administration (FDA). Fact sheet for healthcare providers: emergency use authorization for Paxlovid. Retrieved May 25, 2023. Available on the World Wide Web at https://www.fda.gov/media/155050/download?utm_medium=email&utm_source=govdelivery67248 - Quviviq (daridorexant) tablet package insert. Radnor, PA: Idorsia Pharmaceuticals US Inc; 2023 Mar.67403 - Pyrukynd (mitapivat) tablets package insert.Cambridge, MA: Agios Pharmaceuticals, Inc.; 2022 Feb.67427 - Vonjo (pacritinib) capsules package insert. Seattle, WA: CTI BioPharma Corp; 2022 Feb.67478 - Ztalmy (ganaxolone) package insert. Radnor, PA: Marinus Pharmaceuticals, Inc.; 2022 Nov.67543 - Camzyos (mavacamten) package insert. Princeton, NJ: Bristol-Myers Squibb; 2022 Sept.67585 - Voquezna Triple Pak (vonoprazan, amoxicillin, clarithromycin) and Voquezna Dual Pak (vonoprazan, amoxicillin) package insert. Buffalo Grove, IL: Phathom Pharmaceuticals, Inc.; 2022 May.68242 - Rezlidhia (olutasidenib) capsules package insert. Greenville, NC; Metrics Contract Services; 2022 Dec.68325 - Krazati (adagrasib) tablets package insert. San Diego, CA: Mirati Therapeutics, Inc.; 2022 Dec.68383 - Sunlenca (lenacapavir) package insert. Foster City, CA: Gilead Science, Inc.; 2022 Dec.68520 - Jaypirca (pirtobrutinib) tablets package insert. Indianapolis, IN: Lilly USA, LLC; 2023 Jan.68530 - Orserdu (elacestrant) tablets package insert. New York, NY; Stemline Therapeutics, Inc: 2023 Jan.68644 - Skyclarys (omaveloxolone) capsules package insert. Plano, TX: Reata Pharmaceuticals, Inc.; 2023 Feb.68778 - Joenja (leniolisib) package insert. Saint Quentin Fallavier, France; Skyepharma Production SAS. 2023 Mar.

    Monitoring Parameters

    • blood glucose
    • blood pressure
    • intraocular pressure
    • ophthalmologic exam
    • pulmonary function tests (PFTs)
    • serum cortisol
    • serum potassium

    US Drug Names

    • AK-Dex
    • Baycadron
    • Dalalone
    • Dalalone D.P
    • Dalalone L.A
    • Decadron
    • Decadron-LA
    • Dexabliss
    • Dexacort PH Turbinaire
    • Dexacort Respihaler
    • DexPak Jr TaperPak
    • DexPak TaperPak
    • Dextenza
    • DEXYCU
    • DoubleDex
    • Dxevo
    • Hemady
    • HiDex
    • Maxidex
    • Ocu-Dex
    • Ozurdex
    • ReadySharp Dexamethasone
    • Simplist Dexamethasone
    • Solurex
    • TaperDex
    • ZCORT
    • Zema-Pak
    • ZoDex
    • ZonaCort 11 Day
    • ZonaCort 7 Day
    ;