Description of the dosage form

Release form, composition and packaging

10 pieces. - Packaging cell contour (1) - packs cardboard.
10 pieces. - Dark glass vials (1) - packs cardboard.

Clinical and Pharmacological Group

pharmachologic effect

Glucocorticosteroid (GKS) is a methylated fluoroprednisolone derivative, inhibits the release of interleukin-1 and interleukin-2, interferon gamma from lymphocytes and macrophages. It has anti-inflammatory, anti-allergic, desensitizing, anti-shock, antitoxic and immunosuppressive effect.

Suppresses the release of the hypophysia of the adrenocorticotropic hormone (ACTH) and beta-lipotropin, but does not reduce the content of the circulating beta-endorphine. Depresses secretion thyreotropic hormone (TSH) and follicle-sufficient hormone (FSH).

Increases the excitability of the central nervous system (CNS), reduces the number of lymphocytes and eosinophils, increases - erythrocytes (stimulates the production of erythropoietins).

Interacts with specific cytoplasmic receptors, forms a complex penetrating into the cell core, stimulates the synthesis of mRNA, which induces the formation of proteins, incl. Lipocortin, which mediate cell effects. Lipocortine inhibits phospholipase A2, suppresses the release of arachidonic acid and suppresses the synthesis of endoperosis, Pg, leukotrienes that contribute to the processes of inflammation, allergies, etc.

Protein exchange: Reduces the amount of protein in plasma (due to globulin) with an increase in albumin / globulin coefficient, increases albumin synthesis in liver and kidney; Enhances catabolism protein in muscle tissue.

Lipid sharing: Enhances the synthesis of higher education fatty acids and triglycerides (TG), the fat redistributes (the accumulation of fat is predominantly in the field of shoulder belt, facial, abdomen) leads to the development of hypercholesterolemia.

Carbohydrate: Increases the absorption of carbohydrates from the gastrointestinal tract (gastrointestinal tract); increases the activity of glucose-6-phosphatase, leading to an increase in the admission of glucose from the liver into blood; Increases activity
phosphoenolpiruvatatkoxylase and aminotransferase synthesis leading to glukegenesis activation.

Water and electrolyte exchange: It delays Na + and water in the body, stimulates the removal of K + (ISS activity), reduces the absorption of Ca2 + from the gastrointestinal gastrointestinal absorption.

The anti-inflammatory effect is associated with the oppression of the release of inflammation mediators by eosinophils; induction of lipocortin formation and a decrease in the number of fat cells producing hyaluronic acid; with a decrease in permeability of capillaries; Stabilization of cell membranes and organelle membranes (especially lysosomal).

The antiallergic effect develops as a result of suppressing the synthesis and secretion of allergy mediators, braking releases from sensitized fat cells and histamine basophils, and other biologically active substances, reduce the number of circulating basophils, the reduction of the development of lymphoid and connective tissue, reducing the amount of T-and B-lymphocytes, fat cells, reduce the sensitivity of effector cells to allergy mediators, oppression of antibody formation, changes in the body's immune response.

With chronic obstructive pulmonary disease (COPD), the action is based mainly on the braking of inflammatory processes, the inhibition of the development or prevention of edema of mucous membranes, the braking of the eosinophilic infiltration of the submembraty layer of the epithelium of the bronchi, sediments in the mucous membrane of the bronchi circulating immune complexes, as well as braking erosion and desquamation of the mucous membrane . Increases the sensitivity of beta-adrenoreceptors of bronchi small and medium caliber to endogenous catecholamines and exogenous sympathomimetics, reduces the viscosity of the mucus due to the oppression or reduction of its products.

Anti-shock and antitoxic effects are associated with an increase in blood pressure (due to an increase in the concentration of circulating catecholamines and the restoration of the sensitivity to adrenoreceptors, as well as vasoconstrictions), a decrease in the permeability of the vascular wall, membranctotective properties, activation of liver enzymes involved in the metabolism of endo and xenobiotics.

The immunosuppressive effect is due to the braking of the release of cytokines (interleukin1, interleukin2; interferon gamma) from lymphocytes and macrophages.

Suppresses the synthesis and secretion of ACTG, and the secondary - synthesis of endogenous GKS. Inhibits the connective tissue reactions during the inflammatory process and reduces the possibility of forming scar tissue.

Action feature is a significant inhibition of the pituitary function and the almost complete absence of an ISS activity. Doses 1-1.5 mg / day depress the adrenal bark; Biological T 1/2 - 32-72 h (duration of the oppression of the hypothalamus-pituitary-cortical layer of adrenal glands).

Approximately 3.5 mg of prednisone (or prednisone), 15 mg of hydrocortisone or 17.5 mg of cortisone correspond to 0.5 mg of dexamethasone.

Pharmacokinetics

Dexamethasone is quickly and virtually completely absorbed after receiving inside. The bioavailability of dexamethasone tablets is approximately 80%. C MAX in blood plasma and the maximum effect after receiving inside are achieved after 1-2 hours; After receiving a single dose, the effect is maintained for about 2.75 days.

In the blood plasma, approximately 77% of dexamethasone binds to proteins, mainly with albumin. A minor amount of dexamethasone binds to non-Buman proteins. Dexamethasone is a fat soluble substance that can penetrate out and intracellular spaces. In the central nervous system (hypothalamus, pituitary gland), its effects are due to binding with membrane receptors. In peripheral tissues, it binds to cytoplasmic receptors. His decay occurs at its place of its action, i.e. in a cage. Metabolized mainly in the liver before the formation of inactive metabolites. Excreted by the kidneys.

Indications for the use of the drug

The replacement therapy of the primary and secondary (pitpofizar) adrenal insufficiency, congenital hyperplasia of adrenal glands, subacute thyroiditis and heavy forms of village-coolant thyroiditis. Rheumatic diseases: rheumatoid arthritis (including juvenile chronic arthritis) And embracing lesions with rheumatoid arthritis (lung, heart, eyes, skin vasculitis).

Systemic diseases of connective tissue, vasculitis and amyloidosis (as part of combined therapy): Systemic Red Volchanka (treatment of polyporosites and lesions of internal organs), SHEGREEN syndrome (treatment of lesions of light, kidney and brain), systemic sclerosis (treatment of mositeitis, pericarditis and alveolitis), polyimositis, dermatomyositis, systemic vasculites, amyloidosis (replacement therapy for adrenal insufficiency ), sclerodermia.

Skin diseases: pemphigoid, buggy dermatitis, herpetyiform dermatitis, exfoliative dermatitis, exudative erythema (heavy forms), nodular erythema, seborrheic dermatitis (heavy forms), psoriasis (heavy forms), deprive, fantoide myoses, schoq quinque, bronchial asthma, contact dermatitis, atopic dermatitis, serum disease, allergic rhinitis, dosage disease (increased sensitivity to medicinal preparations), urticaria after blood transfusion, systemic immune diseases (sarcoidosis, temporal arteritis).

Eye diseases: Proliferative changes in orbit (endocrine ophthalmopathy, pseudo-turn), sympathetic ophthalmia, immunosuppressive therapy for corneal transplantation.

Ulcerative colitis (heavy exacerbations), Crohn's disease (heavy aggravations), chronic autoimmune hepatitis, reaction reaction after liver transplantation.

Blood Diseases: Congenital or acquired acute pure aplastic anemia, autoimmune hemolytic anemia, secondary thrombocytopenia in adults, erythroblasting, acute lymphoblastic leukemia (induction therapy), myelodsplastic syndrome, angioimmunoblastic malignant T-cell lymphoma (in combination with cytostatics), plastocytoma (in combination with cytostatics) , anemia after myelofibrosis with myeloid metaplasia or lymphoplasmacitoid immunocyte, systemic histiocytosis (system process).

Diseases of the kidneys: Primary and secondary glomerulonephritis (Hoodpasher syndrome), kidney lesions in systemic diseases of the connective tissue (system red lupus, SHEGREEN syndrome), systemic vasculites (usually in combination with cyclophosphamide), glomerulonephritis with nodule polyarteritis, CHARGA-Strauss syndrome, Purple Purple GranuoMatosis Genoha, mixed cryoglobulinemia, kidney lesions in the arterity of such asus, interstitial nephritis, immunosuppressive therapy after kidney transplantation, induction of diurea or a decrease in proteinhemia with an idiopathic nephlastic syndrome (without uremiya) and with kidney damage against the system of system red lupus.

Malignant diseases: Palliamentary therapy of leukemia and lymphoma in adults, acute leukemia in children, hypercalcemia with malignant neoplasms.

Other readings: Tuberculosis meningitis with a subarachnoid blockade (in combination with adequate anti-tuberculosis therapy), trichoinosis with neurological or myocardial manifestations.

Dosing mode

Doses are established individually for each patient, depending on the nature of the disease, expected duration of treatment, tolerance of the drug and the patient's reaction to the therapy conducted.

Normal support Dose - from 0.5 mg to 3 mg / day.

Minimally efficient Daily dose - 0.5-1 mg.

Maximum daily Dose - 10-15 mg.

The daily dose can be divided into 2-4 admission.

After reaching the therapeutic effect, the dose is gradually reduced (usually by 0.5 mg every 3 days before the maintenance dose is achieved).

For long use High doses inside, the drug is recommended to take during meals, and in the intervals between hazards, the reception of antacids is necessary. The duration of the application of dexamethasone depends on the nature of the pathological process and the effectiveness of treatment and ranges from several days to several months or more. Treatment is stopped gradually (at the end several corticotropin injections are prescribed).

- Ply bronchial asthma, rheumatoid arthritis, ulcerative colitis - 1.5-3 mg / day;

- Ply system Red Volchanka. - 2-4.5 mg / day;

- Ply oncohematological diseases - 7.5-10 mg.

For the treatment of acute allergic diseases, it is advisable to combine parenteral and oral administration: 1 day - 4-8 mg parenterally; 2 day - inside, 4 mg 3 times a day; 3, 4 days - inside, 4 mg 2 times a day; 5, 6 day - 4 mg / day, inside; 7 day - cancellation of the drug.

Dosing in children

Children (depending on age) are prescribed 2.5-10 mg / m 2 of the body surface area / day., Dividing the daily dose by 3-4 receptions.

Diagnostic samples in hyperfunction of adrenal cortex

Short 1 mg dexamethasone test: 1 mg of dexamethasone inside at 11.00; Blood fence to determine serum cortisol at 8.00 the next day.

Special 2-day test with 2 mg of dexamethasone: 2 mg of dexamethasone inside every 6 hours for 2 days; Daily urine is assembled to determine the concentration of 17-hydroxycorticosteroids.

Side effect

Classification of the frequency of side effects (WHO): Very often\u003e 1/10, often from\u003e 1/100 to< 1/10, нечасто от > 1/1000 BC< 1/100, редко от >1/10000 BC< 1/1000, очень редко от < 1/10000, включая отдельные сообщения.

From side immune system: Infrequently - reactions of increased sensitivity, reducing the immune response and an increase in susceptibility to infections.

From side endocrine system: Often - transient adrenal insufficiency, growth slowdown in children and adolescents, insufficiency and adrenal atrophy (reducing the response to stress), Izsenko-Cushing syndrome, imagination of the menstrual cycle, girsuitism, the transition of latent diabetes in clinically manifestation, increasing the need for insulin or oral administration hypoglycemic drugs in patients with diabetes, sodium and water delay, strengthening potassium loss; Very rarely - hypokalemic alkalosis, negative nitrogen balance due to catabolism proteins.

Violations of metabolism and nutrition: Often - a decrease in carbohydrate tolerance, an increase in appetite and weight gain, obesity; Infrequently - hyperitriglyceridemia.

From the nervous system: often - mental disorders; Infrequently - the edema of the papillary of the optic nerve and an increase in intracranial pressure (pseudo-turn of the brain) after the cancellation of therapy, dizziness, headache; Very rarely - convulsions, euphoria, insomnia, irritability, hyperkinosis, depression; Rarely - psychosis.

From side digestive system: infrequently - peptic ulcers, acute pancreatitis, nausea, hiking, stomach ulcers or a 12-rosewoman; Very rarely - esophagitis, perforation of ulcers and bleeding of the gastrointestinal tract (hematomesis, melan), pancreatitis, perforations of the gallbladder and intestines (especially in patients with chronic inflammatory diseases of the colon).

From the senses: infrequently - rear subcapsular cataract, an increase in intraocular pressure, a tendency to the development of secondary bacterial, fungal or viral infections eye, trophic changes cornea, Exophthalm.

From the side of the cardiovascular system: infrequently arterial hypertension, hypertensive encephalopathy; Very rarely - polyphocal ventricular extrasystoles, transient bradycardia, heart failure, myocardial break after a newly transferred acute heart attack.

From the side of the skin: often - erythema, thinning and fragility of the skin, slow wound healing, strry, petechia and ekkimosis, increased sweating, steroid acroy, suppression of the skin reaction during allergological tests; very rare - angineurotic edema, allergic dermatitis, urticaria.

From the musculoskeletal system: Often - muscle atrophy, osteoporosis, muscle weakness, steroid myopathy (muscle weakness due to the catabolism of muscle tissue); infrequently - aseptic necrosis bones; Very rarely - compression fractures of vertebrae, tendons breaks (especially with the joint use of some quinolones), damage to the articular cartilage and necrosis of bones (are associated with frequent intra-articular injections).

From the hematopopitation system: Rarely, thromboembolic complications, a decrease in the number of monocytes and / or lymphocytes, leukocytosis, eosinophilia (as in other glucocorticosteroids), thrombocytopenia and lowcomitoenic purpura.

Allergic reactions: Rarely - skin rash, itching, angioedema, bronchospasm, anaphylactic shock.

From the urogenital system: Rarely impotence.

Symptoms and symptoms of glucocorticosteroids

If a patient, long-term taking glucocorticosteroids, quickly reduce the dose of the drug, may develop signs of adrenal insufficiency, arterial hypotension, death.

In some cases, the symptoms of cancellation may be similar to the symptoms and signs of exacerbation or recurrence of the disease, over which the patient receives treatment. In the development of heavy undesirable phenomena treatment with the drug Dexametanone must be discontinued.

Contraindications for the use of the drug

For short-term use on "life" indications, the only contraindication is increased sensitivity to active substance or the auxiliary components of the drug.

A drug Dexametanone Contraindicated patients with galactosemia, lactase deficiency and glucose-galactose maleabsorption syndrome, due to the fact that lactose is included in the drug.

Diseases of the gastrointestinal tract: Ulcery disease of the stomach and 12-rosewood, esophagitis, gastritis, acute or latent peptic ulcers, recently created anastomosis of the intestine, ulcerative colitis with a threat of perforation or abscess, diverticulitis.

Cardiovascular diseases, including The recently suffered myocardial infarction (in patients with acute and subacted myocardial infarction, it is possible to spread the focus of necrosis, the slowdown in the formation of scar tissue and as a result - the gap of the heart muscle), decompensated chronic heart failure, arterial hypertension, hyperlipidemia.

Endocrine diseases: Sugar diabetes (including violation of carbohydrate tolerance), thyrotoxicosis, hypothyroidism, Incenko-Cushing disease.

Severe chronic renal and / or liver failure, nephrowolithiasis; hypoalbuminemia and states predisposing to its occurrence; Systemic osteoporosis, Miasthenia GRAVIS, acute psychosis, obesity (III-IV Art.), Poliomyelitis (except for the shape of bulbar encephalitis), open-dectorial and closed-coronal glaucoma, lactation period.

Application of the drug during breastfeeding and breastfeeding

During pregnancy (especially in the first trimester) the drug Dexametanone It can only be applied when the expected therapeutic effect exceeds the potential risk to the fetus. With long-term therapy with dexamethasone during pregnancy, the possibility of breach of fetal growth is not excluded. In the case of drug Dexametanone In the last trimester of pregnancy, there is a danger of atrophy of the adrenal cortex at the fetus, which may require substantive therapy in a newborn.

If the woman during pregnancy received glucoroids, in the process of childbirth, additional use of glucocorticosteroids is recommended. If the generic activity is delayed or a caesarean section is planned, during the period period, it is recommended to intravenously to introduce 100 mg of hydrocortisone every 8 hours. In case of need for therapy by the drug Dexametanone Breastfeeding should be stopped.

special instructions

In patients who need long-term therapy with dexamethasone, after discontinuation of therapy, the abolition syndrome may develop (also without clear signs of adrenal insufficiency): fever, discharge from the nose, conjunctiva hyperemia, headache, dizziness, drowsiness and irritability, muscle pain and joints , vomiting, weight loss, weakness, cramps. Therefore, dexamethasone must be canceled by a gradual reduction in the dose. Fast abolition of the drug may be fatal.

In patients who received long-term therapy with dexamethasone and underwent stress after its cancellation, it is necessary to resume the use of dexamethasone, due to the fact that induced adrenal failure can be maintained within a few months after canceling the drug.

Dexamethazone therapy can mask signs of existing or new infections and signs of intestinal perforation in patients with ulcerative colitis. Dexamethasone can exacerbate the course of systemic fungal infections, latent amoebiasis or tuberculosis of lungs.

Patients with acute tuberculosis lung dexamethasone can be prescribed (together with anti-tuberculosis drugs) only in the case of a fulminant or heavy disseminated process. Patients with inactive tuberculosis of lungs, receiving therapy with dexamethasone, or patients with positive tuberculin tests must be prepared in parallel to obtain anti-tuberculosis chemoprophylaxis.

Special attention and careful medical observation is necessary to patients with osteoporosis, arterial hypertension, heart failure, tuberculosis, glaucoma, liver or renal failure, diabetes, active peptic ulcers, fresh intestinal anastomoses, ulcerative colitis and epilepsy. Carefully The drug is appointed in the first weeks after an acute myocardial infarction, patients with thromboembolism, with miastenia, glaucoma, hypothyroidism, psychosis or psychoneurosis, as well as patients older than 65 years.

During dexamethazone therapy, sugar diabetes is made or the transition of latent in clinically manifelic diabetes.

With long-term treatment, control of serum potassium is needed.

During therapy, dexamethazone is contraindicated vaccination with alive vaccines.

Immunization killed viral or bacterial vaccines does not give the expected growth of the titer of specific antibodies and therefore does not provide the necessary protective effect. Dexamethasone is usually not prescribed for 8 weeks before vaccination and within 2 weeks after vaccination.

Patients taking high doses of dexamethasone for a long time should avoid contact with cortal patients; When random contact occurs, it is recommended preventive treatment Immunoglobulin.

Care must be taken in the treatment of patients who have recently carrying surgical interference or bone fracture, since dexamethasone can slow down the healing of wounds and fractures.

The action of glucocorticosteroids is enhanced in patients with liver cirrhosis or hypothyroidism.

Dexamethasone applies in children and adolescents only by strict indications. In the course of treatment, strict control of the growth and development of a child or a teenager is necessary.

Special information about some components of the drug

The drug dexamethasone includes lactose, and therefore, the use of it in patients with galactosemia, lactase deficiency and glucose-galactose maleabsorption syndrome is contraindicated.

Impact on the ability to control vehicles and other complex mechanisms

Dexamethasone does not affect the ability to manage vehicles and work with technical devices that require the concentration of attention and speed of psychomotor reactions.

Overdose

The one-time use of a large number of tablets does not lead to clinically significant intoxication.

Symptoms: It is possible to strengthen dose-dependent side effects. In this case, the dose of the drug should be reduced.

Treatment: Supporting and symptomatic.

Specific antidote does not exist.

Hemodialysis is ineffective.

Medicinal interaction

The simultaneous use of dexamethasone and non-steroidal anti-inflammatory drugs (NSAIDs) increases the risk of developing and forming an umber of the gastrointestinal tract.

The effect of dexamethasone decreases while using the CYPZ4 isoenzyme inducers simultaneously (for example, phenytoin, phenobarbitone, carbamazepine, prison, rifabutin, rifampicin) or drugs that increase the metabolic clearance of glucocorticoids (ephedrine and aminogllutetimide); In such cases, it is necessary to increase the dose of dexamethasone.

The interaction between dexamethasone and the above preparations can distort the results of dexamethasone suppression samples. If samples with dexamethazone should be carried out during therapy with one of the above drugs, this interaction must be taken into account when interpreting sample results.

The simultaneous use of dexamethasone and inhibitors of the CYPZ4 isoenzyme (for example, ketoconazole, macrolide antibiotics) can lead to an increase in the concentration of dexamethasone in the blood.

The simultaneous use of drugs that are metabolized by Cyppz4 (for example, Indinavir, erythromycin) can increase their clearance, which can be accompanied by a decrease in their serum concentrations.

Dexamethasone reduces the effectiveness of hypoglycemic drugs, hypotensive drugs, a praziquantener and sodiumuretics (it is necessary to increase the dose of these drugs); Increases the activity of heparin, albendazole and potassium-saving diuretics (if necessary, the dose of these drugs decrease).

Dexamethasone can change the effect of kumarine anticoagulants, so during therapy, more frequent control of prothrombin time is recommended. Antacids reduce the suction of dexamethasone in the stomach. Smoking does not affect the pharmacokinetics of dexamethasone.

With the simultaneous use of oral contraceptives, T 1/2 of glucocorticosteroids may increase, with the corresponding enhancement of them biological effects and an increase in the frequency of adverse side effects.

The simultaneous use of riteodine and dexamethasone in the period of generic activity is contraindicated, as this may lead to the death of the mother because of the eighty edema. The joint use of dexamethasone and thalidomide can cause toxic epidermal necroliz.

Potential, therapeutically favorable interactions:the simultaneous use of dexamethasone and methoclopramid, diphenhydraminamine, coolness of 5-NT 3 receptors (serotonin or 5-hydroxytripetamine type 3), such as ondansetron or ripps, are effective in preventing nausea and vomiting caused by chemotherapy (cisplatin, cyclophosphamide, methotrexate, fluorouracyl ).

Conditions of vacation from pharmacies

The drug is released by the prescription.

Terms and Storage Terms

The drug is stored at a temperature not higher than 25 ° C, in the original packaging. Keep out of the reach of children.

Shelf life - 5 years. Do not use the drug after the expiration date.

Dexamethasone - instructions for the use of the drug is not a benefit for self-study. This document contains information that only a person with medical education can understand and objectively appreciate.

Dexamethasone - Pharmacological group

In the instructions for use it is written that dexamethasone is hormonal drug (Pharmacological group - glucocorticosteroids). The medicine is obtained by synthetic. When introduced into the body, it has an action similar to the hormones of the adrenal cortex.

The instruction on the use of dexamethasone compares it with hydrocortisone (cortisol), hormone, which is produced by the body. By nature, dexamethasone is a hydrocortisone homolog - it has a similar structure and structure, but its molecule composition is supplemented with fluorine atoms. In some instructions, the name fluoroprednisolone is used. Based on the chemical structure, hydrocortisone and dexamethasone possess similar properties.

However, the instructions for the drug indicate that the use of dexamethasone is recommended in smaller quantities, compared with other medications of this group. Dexamethasone has a much greater efficiency when introduced into the human body than its natural prototypes.

Note! The official instruction does not indicate this, but dexamethasone, only a doctor can be prescribed its use and dosage. The medicine is 35 times more active than the cortisone and is 7 times stronger than prednisone!

2 mg of dexamethasone in terms of prednisone will be already 14 mg, and in terms of hydrocortisone it will already be 60 mg of the active substance.

Forms of dexamethasone release

The dixamethasone substance is a poorly soluble powder with a crystal structure, white or yellowish color, without a pronounced smell. According to the instructions for use, the most common form of release is a solution for parenteral administration. Methods of administration: to Vienna, in the muscle, to the joint, in the near-hand fabrics. Subcutaneously dexamethasone is used in veterinary medicine.

In the pharmacy network you can buy dexametosone in the following pharmacy forms:

• Tablets dexamethasone in the dosage of 0.5 mg of the active substance.
• Solution for injections, in ampoules of 4 mg and 8 mg.
• Eye drops in solution or suspension, concentration of 0.1%.
• Spray decksocort with dexamethasone (and neomycin) for the treatment of dermatological pathologies.

Accumulating information from the instructions for the use of dexamethasone for different dosage forms, the drug produces several domestic producers, the German Bayer AG and Wiimer Pharma, Polish pharmacists, Slovenia Krka and pharmaceutical company In Thailand. The price depends on the manufacturer and form of release. Approximate cost from 60 to 100 rubles per packaging of ampoules.

pharmachologic effect

The instructions for use of the drug lists the testimony for the purpose. The use of dexamethasone varies depending on the pathology. Deksametazon, when introduced inside, acts at the cellular level, forcing the react of cytoplasmic receptors.

Since transmembrane receptors are in all organs and tissues, the synthetic glucocorticosteroid acts systemically.

Desoximetasone application instructions contains information that the drug effectively eliminates:

• inflammatory processes in organs and tissues, including liver, kidneys, eyes, skin;
• acts as an immunosuppressant;
• suppresses allergic reactions;
• displays the patient from the state of the shock;
• contributes to the removal of toxins in poisoning;
• displays excess fluid from the body.

In general, dexamethasone and its analogs change the organism metabolism in all systems, so it is so important to follow the instructions. When taking inside or injections, the medicine is quickly and fully absorbed by the body.

Note! Instructions for use warns not only the strong effects of dexamethasone on the body, but also on the effect of prolongation. Incorrect dosage will cause side effects.

The half-life (half-life) of the active substance is from one and a half to two and a half days. The drug dexamethazole in the liver is processed, excreted from the body through the urinary system.

Lipid exchange

The use of dexamethasone (or its analogs) provokes stimulation of the formation of triglycerides and fatty acids. In this case, triglycerol concentrates the deposition of subcutaneous fat at the top of the body. The patient acquires a characteristic view, a man who sits on hormones. " The patient increases the shoulder belt, face and belly. Hands and legs, as a rule, are completely incorrect, but are subject to edema.

Note! The use of the drug without a clear instruction of the attending physician, is fraught with an increase in the content of poor cholesterol in the blood. This, in turn, threatens with vascular complications in the legs, ischemic disease Hearts, the development of hypertension.

Carbohydrate exchange

The use of dexamethasone enhances the digestibility of carbohydrates from the intestine. At the same time, it stimulates the flow of glucose gas from the liver into the blood, which increases the content of glucose blood supplying to hyperglycemia.

Protein exchange

According to the instructions, in terms of the effect on protein metabolism in the body, the use of dexamethasone shifts the equilibrium of globular albumin towards the predominance of albumin in the blood. Enhances the intensity of the breakdown of protein in muscle tissue, at the same time reducing the formation of complex protein molecules (globulins). Stimulates the synthesis of albumin in the liver and kidneys.

Water salt balance

Reception of dexamethasone, even subject to the instruction, can contribute to the delay in the body of sodium and water ions. The glucocorticosteroid is washing potassium. Weakens the bone, preventing the absorption of calcium from food. With long-term reception of dexamethasone, patients have a sacred view, pronounced pastosity of tissues.

Thus, stimulation of the absorption of carbohydrates, change water salt balance When receiving a dexetasone, leads to the accumulation of adipose tissue (Izhenko-Cushing syndrome) and the development of osteoporosis. These two effects according to the instructions are the most common contraindication to long-term therapy.

Note! The effect of dexamethasone on metabolism is a dose-dependent (method of use, dosage, duration of treatment). As follows, the instructions for receiving the drug are expressed in a minimum.

The instruction warns that the use of the drug in children is fraught with a slowdown in their growth. This is due to the ability of glucocorticosteroids to strengthen the processes of decay in the tissues of the body. Cheaps can be: bone, connecting, muscular, adipose tissue, as well as a dermis.

The anti-inflammatory effect is explained by the ability of dexamethasone to suspend the production of inflammation mediators. Initiates the production of more lipocartine. Reception of the drug prevents lysosa destruction, which is especially important in inflammatory pathologies of the joints. In the treatment of arthritis, the instruction recommends the use of rings, compresses with a solution of dexamethasone. The local form of application effectively removes inflammation, narrows the vessels in the area of \u200b\u200bthe solution or ointment.

Note! The success of anti-inflammatory therapy with the use of dexamethasone depends on comprehensive treatment.

In parallel, the patient is prescribed a course of antimicrobial therapy (for example, ciprofloxacin), antibiotics (for example, Tobramycin, with pneumonia of ciprofloxacin hydrochloride, in gynecology gentamicin). Women with inflammatory diseases. Stone.

The immunosuppressive effect is explained by the ability of dexamethasone to suppress the activity of lymphocytes and macrophages.

The anti-allergic effect is made of complex action. medication on the body. Reduces the manifestation of allergies to the oppression of the production of histamines, the anti-inflammatory effect, which provides dexamethasoni on the composition of the blood.

The instruction warns that in high doses, dexamethasone actively acts on the brain, increasing the activity of synapse. This may manifest a epileptic attack or convulsive syndrome. Need control of condition and blood indicators.

Indication to Application - Instructions for dexamethasone

The use of glucocorticosteroids is shown in a number of diseases. According to the instructions, dexamethasone is used: inside in a tablet form; Injection (intravenous, dropper, intramuscular injections); locally local (appliques, compresses, rubbing).

Purpose in tablets do under the following diseases:

• Pathology in the work of the thyroid gland - hypoteriosis, thyroiditis in acute and smoothed form. Eye disease arising against thyrotoxicosis.
• Inflammatory diseases of the joints.
• Endocrine disorders.
• Bronchial asthma in the stages of exacerbation, heavy bronchitis with an asthmatic component, pneumonia, COPD.
• Blood diseases, bleasting disorders.
• Dermatosis, eczema.
• Oncological pathology. Here, dexamethasone is shown in the complex of supportive treatment, when the disease is in the last stages of development (palliative therapy).

How to take in tablets? The instruction indicates that oral dexamethasone is used as a continuation of treatment, when canceling injections or droppers.

The dexamethasone solution is prescribed in the form of intramuscular injections, intravenously drip in difficult conditions that require immediate or extremely intensive medical care.

Take the drug in the following cases:

• Shock conditions various etiology (for example, during injury).
• Heavy allergic reactions: anaphylactic shock, swelling of quinque, dermatosis, eczema with a large area of \u200b\u200blesion.
• Brain swelling caused: traumatic damage (including operating intervention); infection (meningitis, encephalitis); hemorrhage, etc.
• Comprehensive treatment heavy infections, including tuberculosis.
• Breathing disorders, asthmatic status.
• Hormonal insufficiency with bad adrenal work.
• The pathology of the joints of inflammatory, traumatic, autoimmune genesis.
• The acute states of neurological etiology.
• Oncopathology.

The instructions also indicate the use of dexamethasone not only in its pure form, but also as part of complex drugs of local destination. Indications for use can be in dentistry in ophthalmic treatment, with the treatment of ENT organs.

In ophthalmology with inflammatory, degenerative diseases, eye damage (including operating), dexamethasone is prescribed in the form of droplets. This may be a special solution of dexamethasone without additives or in a multicomponent medication.

Locally, dexamethasone (ointment, solution, aerosol) is shown in a red lolly, heavy dermatoses (including granulomatous), eczema, keloid formations.

Contraindications of dexametazone

In the instructions for the use of dexamethasone, contraindications are separated into absolute and relative. To absolutely, when dexamethasone is forbidden to apply even a short-term course, the individual intolerance of the medication.

The description of the drug contains a list of relative contraindications.

Dexamethasone should not be prescribed in the following states and pathologies:

• glaucoma;
• obesity 3 stages;
• viral lesions, including: Herpes, HIV;
• systemic myoses;
• glice invasion;
• inflammatory diseases (without the use of antibiotics in the complex);
• diseases of the gastrointestinal tract (colitis, ulcerative disease, enteritis);
• recent infarction in history;
• diabetes;
• the pathology of the liver, kidneys, which are expressed in a sharp decline in the performance of these bodies;
• osteoporosis;
• inflammation of lymph nodes;
• some forms of mental pathologies;
• polio;
• pregnancy.

Note! The body's reaction to the introduction of a potent corticosteroid is impossible to predict. According to the instructions, the use of dexamethasone requires an individual approach, this applies to the dosage and duration of treatment.

Pregnancy is a relative contraindication. The instruction allows the use of dexamethasone in cases where the risk of its negative effect on the fruit is compensated by a severe condition of the mother.

Breastfeeding is contraindicated to apply dexamethasone and its analogues. According to the guv instructions, it should be discontinued if effective therapy Impossible without dexamethasone. To maintain the lactation process milk to decrease until the end of the treatment.

Dosage

About how the dexamethasone should be dosed, the instruction definitely indicates that the dosage is selected individually. Corticosteroid treatment starts with a low dose, the mid-therapy is an intensive course, the final stage - a gradual decline in dosage

Note! The introduction of a synthetic hormone into the body will inevitably provoke a slowdown in the production of its own corticosteroidal analogues. Unjustified use of a potent hormonal medication can undermine your health.

IN official instruction For the use of dexamethasone, the classic diagram of the drug dosing in injections looks like this:

• the beginning of therapy is from 2 to 4 mg of the drug per day;
• in the area of \u200b\u200bthe therapeutic effect (2-3 days of treatment) - maximum dosage;
• the final stage of treatment is a gradual decrease in the daily dose to 0.5 mg.

The instruction warns that the initial reception of the doximetazone inside in the maximum dose can provoke a hormonal shock in a patient. The same effect occurs when a sharp abolition of the drug.

According to the instructions, not only the dosage varies, but also the form of applying dexamethasone. At the intensive stage of therapy, dexteroson is introduced into the vein inkjano, drip or intramuscularly. For supporting therapy, it is enough to receive tablets.

In the treatment of joints, dexamethasone is introduced locally, directly in the affected joint.

Treatment instructions Next:

• from 0.2 to 8 mg of dexamethasone are injected into the joint once, once every 3 days;
• full course - 3 weeks.

Children dose doksimetaison according to their age. It is minimally allowed to apply 0.25 mg per day, the maximum - 2.5 mg of the active substance per day.

Note! The dosage varies not only from age or individual reactions, but also from its diagnosis, anamnesis. Children daily dose are divided by 3-4 receptions.

Instructions for ophthalmologic use of drugs with dexamethasone:

• the initial stage of treatment is 1-2 drops after 1-2 hours;
• after the development of a persistent therapeutic effect - the time interval increases to 4-6 hours.

The duration of the use of medicines with dexamethasone varies depending on the severity of the state. According to the instructions not more than 3 weeks.

In dermatology, the use of drugs containing dexamethasone, according to the instructions for appropriate medicines.

Note! The uncontrolled use of hormonal drugs under skin allergic reactions leads to exacerbation of the disease. One of the consequences of non-compliance of the instruction - necrosis of tissues.

Side Effects of Dexametazone

Since dexamethasone is a potent hormonal preparation, its use can be negatively affected by any of the organism systems. Side effects can be called systemic, since the work of the whole organism is disturbed.

Endocrine system:

• incenko-Cushing syndrome;
• increase glucose levels, diabetes;
• violation of the production of adrenal hormones;
• in children - growth delay;
• teenagers have a delay in puberty.

Violations in the metabolic system:

• reduction in calcium level, potassium;
• improving sodium content;
• increasing protein decay processes, increased sweating.

The cardiovascular system:

• violation heart Rhythm with the predominance of bradycardia (in severe cases of the heart stop);
• increasing arterial indicators, blood thickening, vessel thrombosis;
• in patients with infarction - the delay in the processes of scarring, necrosis, the gap of the heart;

Bone-muscular system:

• amyotrophy;
• osteoporosis;
• moopathy.

Neurology and psyche:

• hallucinations, euphoria, depression, nervousness, insomnia;
• cramps, epileptic seizures;
• headache, disorientation, failures in memory.

Digestive system:

• nausea, vomiting;
• sprinkling ulcers;
• acute colitis;
• inflammation of the esophagus;
• inflammation of the pancreas.

The instruction on the drug indicates possible changes from the senses. Organic defeat Eye, the development of inflammatory processes, reducing visual acuity.

In connection with the metabolic disorder, pathological changes in internal organsThe use of dexamethasone is not according to the instructions are fraught with the following manifestations:

• acne;
• strya;
• changing pigmentation;
• inflammatory processes.

From the side of dermatological complications, the use of dexamethasone can lead to allergic reactions in the form of dermatitis, eczema, rashes of different types.

Note! To reduce the effect of the side effect of dexamethasone and its analogues on the body, during the use of glucocorticosteroids are prescribed by concomitant symptomatic therapy.

For example, according to the instructions for stabilizing the operation of the digestive system, omeprazole is prescribed.

A balanced diet is very important during dexamethasone. Food should be rich in proteins, be easy to assimilate. The advantage should be given to products rich in potassium. Milk products are important because the body requires an increased amount of calcium. Salt should be minimized. However, it is not necessary to completely exclude from meals.

Analogs of dexamethasone and price

Similar preparations, which can be replaced with dexamethasone, the instructions for use usually do not specify. The use of generic drugs is possible according to the instructions for dexamethane, since the active ingredient in these medicines is one. Exact information on dosage and application is indicated in the annotation to the drug.

List of drugs with different trade names, but with one active substance - dexamethasone:

• Decadron
• Deca-Allvoran
• SUPERTENDIN
• Forthert.
• Dexacrort
• Sondex
• Dexaben
• Detoon
• Maksidek

Table of preparations that are analogues of dexamethasone. Their use regulates individual instructions, since having a similar effect, preparations contain other active hormonal substances.

The instruction indicates that all drugs with a doximetazone can not be applied without the appointment of a doctor. When buying a pharmacist, you will need to present a recipe on Latin.

Conditions for storage ampoules: at room temperature, in the original packaging. Store no more than 5 years since the release.

Video

Pharmacodynamics: Dexamethasone - synthetic hormone of adrenal cortex with glucocorticosteroid effect (GKS). It has anti-inflammatory and immunosuppressive effects, and also affects energy metabolism, glucose homeostasis and (by negative feedback) on the secretion of the hypothalamic activating factor and the adrenocorticotropic hormone of the pituitary gland. GCS are fat soluble substances and therefore, easily penetrate the target cells through cell membranes. The binding of the hormone with the receptor causes conformational changes in the receptor and increases its affinity for DNA. The complex hormone receptor penetrates the core of the cell and is associated with the regulatory portion of the DNA molecule, also known as the glucocorticoid response element (GRE). The activated receptor binds to GRE or specific genes and regulates the transcription of matrix RNA (mRNA). The newly formed mRNA is transported to ribosomes, which then participate in the formation of new proteins. Depending on the type of target cells and cellular processes, the formation of new proteins can both amplify (for example, tyrosine-transaminase synthesis in liver cells) and suppressible (for example, IL-2 synthesis in lymphocytes). Since receptors to GCS are found in all tissues, the implementation of their action is carried out in most organism cells. The effect on the metabolism of energy and homeostasis glucose: dexamethasone, along with insulin, glucagon and catecholamines, adjusts the accumulation and consumption of energy. In the liver, it stimulates the formation of glucose from pyruvate and amino acids and the formation of glycogen. In peripheral, fabrics, in particular, in muscles, reduces glucose consumption and mobilizes amino acids (proteins), which are a substrate gluconeogenesis in the liver. The immediate effects on fat metabolism are manifested by the central redistribution of adipose tissue, and the enhancement of lipolysis in response to the effects of catecholamines. Through the receptors in the proximal channels of the kidneys, dexamethasone stimulates the renal blood flow and glomerular filtration, suppresses the formation and secretion of vasopressin and improves the kidney ability to excrete acids. Increases the sensitivity of the vessels to pressor agents. In high doses, dexamethasone suppresses the formation of fibroblasts of collagen I and III type and the formation of glycosaminoglycans; Due to the oppression of the formation of extracellular collagen and matrix, they slow down wound healing. Long, taking high doses causes progressive resorption of bone tissue as mediated effect, and directly reduces its formation (stimulates the secretion of the pararathgamon and suppresses the secretion of calcitonin). In addition, it leads to a negative balance of calcium - reduces calcium absorption in the intestine and enhances its kidney removal. This usually leads to secondary hyperparathyroidism and phosphatia. Action on the hypothalamus and pituitary gland: dexamethasone is 30 times more pronounced action than endogenous cortisol. Therefore, it is a more powerful inhibitor of the secretion of corticotropin-rilizing factor (CRF) and adrenocorticotropic hormone (ACTH). In pharmacological doses, the hypothalamic-pituitary-adrenal system is oppressed, contributes to the development of secondary adrenal insufficiency. The lack of adrenal cortex can develop already on 5-7. The day of administration of dexamethasone in daily doses equivalent to the 20-30 mg of prednisone or after 30 days therapy with small doses. After canceling a short course of therapy (up to 5 days) with high doses, the function of the adrenal cortex can recover one week; After a long course, normalization comes later, usually this process takes up to 1 year. Some patients may develop irreversible atrophy of the adrenal cortex. The anti-inflammatory and immunosuppressive effect of glucocorticosteroids is connected both by their molecular and biochemical effects. The molecular anti-inflammatory effect is the result of the interaction of glucocorticosteroids with glucocorticoid receptors and changes in the expression of a number of genes governing the formation of a plurality of information molecules, proteins and enzymes involved in the process of inflammation. This leads to a decrease in or preventing a tissue response to inflammation: the oppression of the cumulation of macrophages and leukocytes, the suppression of phagocytosis and the release of lysosomal enzymes, the synthesis of inflammation mediators, blocking the macrophage inhibitory factor. Dexamethasone reduces the expansion and permeability of capillaries, reduces the adhesion of leukocytes to the endothelium, inhibits the synthesis of Pg, leukotriene, thromboxanes. Dexamethasone reduces the formation of leukotrienes by reducing the release of arachidonic acid of their cell phospholipids, which is the result of suppressing the activity of phospholipase A2. The effect on phospholipase is mediated by an increase in lipocortin concentration (macrortine), which is an A2 phospholipase inhibitor. The overwhelming effect of dexamethasone on the synthesis of prostaglandins and thromboxane is the result of a decrease in the synthesis of specific MDNA encoding the formation of cyclooxygenase. Dexamethasone warns or depresses cellular immune reactions (slow motion hypersensitivity reactions) reduces the amount of T-lymphocytes. (Type I), monocyte and eosinophilov, binding to immunoglobulins with their receptors, inhibits synthesis of interleukins: reduces T-lymphocytic blastogenesis and reduces the primary immune response. Activates humoral immunity by stimulating T-helpers II type II - enhances the production of antibodies. The meaningful effect is to reduce the formation of a tumor necrosis factor (FNO) and IL-1. Pharmacokinetics: The maximum concentration of dexamethasone is achieved in the blood plasma already 5 minutes after intravenous administration (in / c) and 1h after intramuscular administration (in / m). Under the local introduction to joints or soft tissues (in the lesion foci), suction occurs more slowly than at a / m application. When in / in application, the action develops quickly, with a / m use of the clinical effect develops after 8h. The action is long: from 17 to 28 days after a / m application and from 3 days to 3 weeks after local application. The transition of phosphate dexamethasone in dexamethasone in the blood plasma and the synovial fluid occurs quickly. In the blood plasma, approximately 77% of dexamethasone binds to proteins, mainly with albumin. Only a slight amount of dexamethasone binds to non-buminic proteins. Penetrates outside and intracellular spaces. In the central nervous system (hypothalamus, pituitary gland), its effects are due to binding with membrane receptors. In peripheral tissues, binds to cytoplasmic receptors. The decay occurs at its place of its action, i.e. in the cell. Metabolized mainly in the liver (mainly by conjugation with glucuronic and sulfuric acids) to inactive metabolites, as well as in kidney and other tissues. Available mainly by the kidneys. Half-life (T1 / 2) -190 min.

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Structure

1 ml of the drug contains

active substance - Sodium dexamethasone phosphate 4 mg in terms of dexamethasone phosphate 100% substance

excipients: sodium chloride, sodium hydrophosphate dodecahydrate, Dinatari Edetat, injection water

Pharmacotherapeutic Group

Corticosteroids for system use. Glucocorticosteroids. Dexametanone

ATX Code H02A B02

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Pharmacological properties

Pharmacokinetics

After intravenous administration, the maximum concentrations of dexamethasone phosphate in blood plasma are achieved in just 5 minutes, and after intramuscular administration - after 1 hour. When local use in the form of injections in joints or soft tissues, suction takes place slower. The effects of drugs begins quickly after intravenous administration. With intramuscular administration, the clinical effect is observed 8 hours after administration. The drug is valid for a long time: from 17 to 28 days after intramuscular administration and from 3 days to 3 weeks after local applications. The biological period of the semi-anniversary of dexamethasone is 24-72 hours. In plasma and synovial fluid, dexamethasone phosphate quickly turns into dexamethasone.

In the blood plasma, approximately 77% of dexamethasone binds to proteins, mainly with albumin. Only a minor amount of dexamethasone binds to other blood plasma proteins. Dexamethasone is a fat soluble substance, so it penetrates between and intracellular space. It has its effect in the central nervous system (hypothalamus, pituitary gland) by binding to membrane receptors. In the peripheral tissues binds and acts through the cytoplasm receptors. Dexamethasone disintegrates at the place of its action, i.e. in a cage. Dexamethasone is metabolized mainly in the liver. A small amount of dexamethasone is metabolized in kidneys and other tissues. The main ways are the kidneys.

Pharmacodynamics

Dexamethasone - synthetic hormone of adrenal cortex (corticosteroid), which has glucocorticoid action. It has an anti-inflammatory and immunosuppressive effect, and also affects energy metabolism, glucose exchange and (due to negative feedback) on the secretion of the activation factor of the hypothalamus and trophic hormone adenogipophies.

The mechanism of action of glucocorticoids is still not fully clarified. Now there is a sufficient number of messages about the mechanism of glucocorticoids to confirm that they act at the cellular level. In the cytoplasm of cells there are two well-defined receptor systems. Due to the binding with receptors of glucocorticoid corticidates, anti-inflammatory and immunosuppressive effects have an anti-inflammatory and immunosuppressive effect and regulate the glucose exchange, and due to the binding to mineralocorticoid receptors, they regulate sodium metabolism, potassium and water-electrolyte equilibrium.

Glucocorticoids dissolve in lipids and easily penetrate the target cells through the cell membrane. The binding of the hormone with the receptor leads to a change in the conformation of the receptor, which contributes to an increase in its affinity from DNA. The hormone / receptor complex falls into the core of the cell and is associated with the regulatory center of the DNA molecule, which is also called the glucocorticoid response element (GRE). Activated receptor associated with GRE or with specific genes adjusts the transcription of M-RNA, which can be increased or reduced. The newly formed M-RNA is transported to the ribosome, after which the formation of new proteins occurs. Depending on the target cells and processes that occur in cells, protein synthesis can be enhanced (for example, the formation of tyrosineransaminase in liver cells) or reduced (for example, the formation of IL-2 in lymphocytes). Since glucocorticoid receptors are in all types of tissues, we can assume that glucocorticoids act on most organism cells.

Indications for use

• shock of various origins
• heat brain edema (with brain tumors, cranial injury, neurosurgical operations, brain hemorrhage, meningitis, encephalitis, radiation lesions)
• bronchial asthma, asthmatic status, heavy allergic reactions (otinka, bronchospasm, dermatosis, acute anaphylactic reaction to drugs, serum and antibiotics), pyrogenic reactions
• acute hemolytic anemia, thrombocytopenia, acute lymphoblastic leukemia, agranulocytosis, severe infectious diseases (in combination with antibiotics)
• acute insufficiency of adrenal cortex
• acute stenling laryngotrachite in children
• shoulder-painting periatritis, epicondylitis, bursitis, tendovaginitis, osteochondrosis, arthritis of different etiology, osteoarthritis
• rheumatic diseases, collagenoses

Dexamethasone, an injection solution, 4 mg / ml, is used in sharp and urgent statesin which parenteral administration is vital. The drug is intended for short-term application for life indications.

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Method of application and dose

Appoint adults and children from birth.

The dosing mode is individual and depends on the testimony, the severity of the disease and the patient's reaction to therapy. The drug is injected intramuscularly, intravenously slowly inkjet or drip, it is also possible periarticular or intra-articular administration. In order to prepare a solution for in / in drip infusion, an isotonic solution of sodium chloride should be used, a 5% glucose solution or a ringer solution.

Adults intravenously, intramuscular Enter from 4 to 20 mg 3-4 times / day. The maximum daily dose is 80 mg. With sharply dangerous situations, high dosages may be needed. The duration of parenteral use is 3-4 days, then transfer to the supporting therapy of the oral form of the drug. When the effect is reached, the dose is reduced over several days before the maintenance dose (an average of 3-6 mg / day, depending on the severity of the disease) or to the cessation of treatment with continuous patient observation. The rapid intravenous administration of massive doses of glucocorticoids can cause a cardiovascular collapse: the injection is produced slowly for several minutes.

Brain swelling (adult): The initial dose of 8-16 mg intravenously, subsequently 5 mg intravenously or intramuscularly every 6 hours until a satisfactory result is achieved. With surgical operations on the brain, these dosages may be needed a few more days after surgery. After that, the dosage should gradually decrease. Continuous treatment can counteract the increase in intracranial pressure associated with the brain tumor.

Children Prescribed injections of dexamethasone intramuscular. The dose of the drug is usually from 0.2 mg / kg to 0.4 mg / kg per day. Treatment should be reduced to minimal doses in the shortest period of time.

For intra-articular administration The dose depends on the degree of inflammation, size and location of the affected area. The drug is introduced once every 3-5 days (for a synovial bag) and once every 2-3 weeks (for joint).

In the same joint to introduce no more than 3-4 times and no more than 2 joints at the same time. More frequent administration of dexamethasone may damage the articular cartilage. Casting injections should be carried out in strict sterile conditions.

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Side effects

• thromboembolism, reducing the number of monocytes and / or lymphocytes, leukocytosis, eosinophilia (as well as when using other glucocorticoids), thrombocytopenia and lowcomytopenic purpura
• hypersensitivity reactions, rash, allergic dermatitis, urticaria, angioedema, bronchospasm and anaphylactic reactions, reducing the immune response and an increase in susceptibility to infections
• polytonian ventricular extrasystole, paroxysmal bradycardia, heart failure, cardiac arrest, heart break in patients recently undergoing myocardial infarction
• arterial hypertension, hypertensive encephalopathy
• after treatment, the appearance of swelling of the optic nerve disc and increased intracranial pressure (pseudo-turn) is possible. Such neurological side effects may also be observed as dizziness (vertigo), cramps and headache, sleep disorders, confusion, nervousness, concern
• change of personality and behavior that are most often manifested as euphoria; There are also reported on such side effects: insomnia, irritability, hyperkinosis, depression and psychosis, as well as manico-depressive psychosis, delirium, disorientation, hallucinations, paranoia, mood lability, suicide thoughts, worsening schizophrenia, amnesia, deterioration of epilepsy
• inhibition of adrenal functions and atrophy (reaction to stress), Cushing syndrome, growth slowdown in children and adolescents, menstrual disorders, amenorrhea, girsutism, transition of latent diabetes in a clinically active form, reduce carbohydrate tolerance, an increase in appetite and an increase in body weight, Hypertriglyceridemia, obesity, increased need of insulin or oral administration against diabetes in patients with diabetes, negative nitrogen balance due to protein catabolism, hypokalemic alkalosis, sodium and water delay, increased loss of potassium, hypocalcemia
• esophagitis, dyspepsia, nausea, vomiting, hiking, peptic stomach ulcers and duodenal gutPossible ulcerative perforations and bleeding in the digestive tract (vomiting with blood admissions, melena), pancreatitis and perforation of the gallbladder and intestines (especially in patients with chronic intestinal inflammation)
• muscular weakness, steroid myopathy (muscle weakness causes muscle catabolism), osteoporosis (increased calcium removal) and compression spinal fractures, fractures of tubular bones, aseptic osteonosis (more often - aseptic necrosis bones of hips and shoulders), tendons breaks (especially with parallel The use of some quinolones), damage to the articular cartilage and necrosis of bones (due to intra-articular infection), premature closure of epiphyseal growth zones
• slowed healing of wounds, itching, thinning and improving skin sensitivity, strlica, petechia and bruises, acne, teleangioectasia, erythema, increased sweating, oppressed reaction to skin tests
• increased intraocular pressure, glaucoma, cataract or exophthalm, thinning of the cornea, exacerbation of bacterial, fungal or viral eye infections
• development of opportunistic infections, recurrence of inactive tuberculosis
• impotence
• swelling, hyper- or hypopigmentation of the skin, skin atrophy or subcutaneous layer, sterile abscess and redness of the skin, transient sensation of burning and pinching in the crotch with intravenous administration or when introducing high doses
• with intramuscular administration of changes at the place of administration, including swelling, burning, numbness, pain, paresthesia and infections at the injection site, rarely necrosis of the surrounding tissues, the formation of scars at the injection site, skin atrophy and subcutaneous fiber, with intramuscular administration (especially dangerous introduction to deltoid muscle)

With intravenous administration: arrhythmias, tides blood to face, cramps.

In case of intracranial administration - nasal bleeding.

With intra-articular administration, the system of pain in the joint.

Signs of glucocorticoid cancellation syndrome

In patients who were treated for a long time with dexamethasone, during a rapid decline in the dose may be observed by the abolition syndrome and cases of adrenal insufficient, arterial hypotension or death.

In some cases, signs of cancellation syndrome may be similar to signs of deterioration or relapse of the disease, from which the patient was treated.

If severe undesirable reactions happen, treatment must be discontinued.

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Contraindications

• increased sensitivity to dexamethasone or to any other ingredient of the drug
• acute viral, bacterial or systemic fungal infections (if proper therapy does not apply)
• cushing syndrome
• vaccination of live vaccine
• intramuscular Introduction is contraindicated in patients with severe blood coagulation disorders
• gastric ulcer and duodenal ulcer
• osteoporosis
• pregnancy and lactation period
• acute psychosis
• viral and fungal eye diseases, corneal diseases combined with epithelium defects
• trachoma, glaucoma
• active shape of tuberculosis
• renal failure
• cirrhosis of the liver I. chronic hepatitis
• epilepsy
• local administration is contraindicated in bacteriamia, systemic fungal infections, in patients with unstable joints, infections at the site of use, including septic arthritis due to gonorrhea or tuberculosis.

Medicinal interactions "Type \u003d" Checkbox "\u003e

Medicinal interactions

The parallel use of dexamethasone and non-steroidal anti-inflammatory means increases the risk of gastrointestinal bleeding and the formation of an ulcer.

The effectiveness of dexamethasone decreases, if at the same time take rifampicin, rifambutin, carbamazepine, phenobarbon, phenytoine (diphenyl hydrogen), prison, ephedrine or aminoglutortimide, so the dose of dexamethasone in such combinations should be increased.

Interaction between dexamethasone and all the above drugs Can distort the test oppression of dexamethasone. This must be considered when evaluating the test results.

Crims of dexamethasone reduces therapeutic effect Anticholinesterase agents used for miastic.

The joint use of dexamethasone and drugs inhibiting CYP 3A4 enzyme activity, such as ketoconazole, antibiotics-macrolides, can cause an increase in the concentration of dexamethasone in serum and blood plasma. Dexamethasone is a moderate inducer CYP 3A4. Co-use with preparations that are metabolized by CYP 3A4, such as indinavir, erythromycin, can increase their clearance, causing a decrease in serum concentrations.

Ketoconazole can coagulate the adrenal synthesis of glucocorticoids, thus, due to the decrease in the concentration of dexamethasone, adrenal insufficiency may develop.

Dexamethasone reduces the therapeutic effect of drugs for the treatment of diabetes mellitus, arterial hypertension, kumarian anticoagulants, prazicvantel and sodium-student (therefore the dose of these drugs should be increased); It increases the activity of heparin, albendazole and kaliuretics (the dose of these drugs needs to be reduced if necessary).

Dexamethasone can change the effect of kumarine anticoagulants, so when applying such a combination of drugs, it is necessary to check the prothrombin time.

The parallel use of dexamethasone and high doses of other glucocorticoids or agonists of β2-adrenoreceptors increases the risk of hypokalemia. In patients with hypokalemia, heart glycosides contribute to the violation of the rhythm and have greater toxicity.

Antacids reduce the suction of dexamethasone in the stomach. The effect of dexamethasone, with simultaneous intake with food and alcohol, is not investigated, but the simultaneous use of drugs and food with high sodium content is not recommended. Smoking does not affect the pharmacokinetics of dexamethasone.

Glucocorticoids are reinforced by the kidney clearance of salicylate, therefore it is sometimes difficult to obtain therapeutic concentrations of serum syliattes. Care should be taken to patients who gradually reduce the dose of corticosteroid, since it may be observed an increase in the concentration of salicylate in blood serum and intoxication.

If it is possible to use oral contraceptives in parallel, the half-life of glucocorticoids may increase, which enhances their biological effect and can increase the risk of side effects.

The simultaneous use of riteodine and dexamethasone is contraindicated during childbirth, as this can lead to a lung edema. Fatheel has been reported due to the development of such a state.

The simultaneous use of dexamethasone and thalidomide can cause toxic epidermal necroliz.

Types of interaction that have therapeutic advantages: The parallel purpose of dexamethasone and metoclopramid, diphenhydramide, strokesine or antagonists of 5-HT3 recipes (serotonin or 5-hydroxytriptamine receptors, type 3, such as nausetron or rivzetron) efficient for the prevention of nausea and vomiting caused by cisplatin chemotherapy, cyclophosphamide, methotrexate, fluorouracyl.

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special instructions

During parenteral treatment with corticoids, hypersensitivity reactions are rare, so it is necessary to take appropriate measures before the treatment of dexamethasone, given the possibility of allergic reactions (especially in patients with allergic reactions to any other medicines in history).

In patients who have been treated with dexamethasone for a long time, cancellation syndrome (also without visible signs of adrenal failure) with discontinuation of treatment (elevated body temperature, runny nose, redness of conjunctivations, headache, dizziness, drowsiness, or irritability, pain in muscles and joints, vomiting , reduction of body weight, weakness, often convulsions). Therefore, the dose of dexamethasone should be reduced gradually. Sudden cessation of treatment may have fatal consequences.

If the patient is in a state of severe stress (due to injury, operation or severe disease) over the therapy, the dose of dexamethasone should be increased, and if this occurs during the cessation of treatment, hydrocortisone or cortisone should be used.

Patients who were injected with dexamethasone for a long time and which are experiencing severe stress after discontinuation of therapy, it is necessary to restore the use of dexamethasone, since the insufficiency of the adrenal glands can last for several months after the cessation of treatment.

The treatment with dexamethasone or natural glucocorticoids may disguise the symptoms of an existing or new infection, as well as the symptoms of intestinal perforation. Dexamethasone can exacerbate systemic fungal infection, latent amebiasis and pulmonary tuberculosis.

Caution and medical observation are recommended by osteoporosis patients, with arterial hypertension, heart failure, tuberculosis, glaucoma, hepatic or renal failure, diabetes, active peptic ulcers, recent intestinal anastomy, ulcerative colitis and epilepsy. Special care requires patients during the first weeks after myocardial infarction, patients with thromboembolism, severe miastenia, hypothyroidism, psychosis or psychoneurosis, as well as elderly patients .

During treatment, sugruy diabetes can occur or the transition from the latent phase to clinical manifestations Sugar diabetes.

With prolonged treatment, you need to control the level of potassium in serum.

Vaccination of the live vaccine is contraindicated during the treatment of dexamethasone. Vaccination inactivated viral or bacterial vaccine does not lead to the expected synthesis of antibodies and has no expected protective effect. Dexamethasone phosphate is usually not prescribed for 8 weeks before vaccination and do not begin to apply earlier than 2 weeks after vaccination.

Patients who have long been treated with high doses of dexamethasone and have never been sick, should avoid contact with infected persons; Random contact recommended prophylactic treatment with immunoglobulin.

The glucocorticoid effect is enhanced in patients with cirrhosis of the liver or hypothyroidism.

Heavy mental reactions may accompany the systemic use of corticosteroids. Usually symptoms appear in a few days or weeks after the start of treatment. The risk of developing these symptoms increases with high doses. Most of the reactions passes with a decrease in the dose or when canceling the drug. It is necessary to observe and detect changes in mental state in time, especially depressive mood, suicidal thoughts and intentions. With special caution, you need to use corticosteroids in patients with affective disorders in the presence or a history of the nearest relatives. The appearance of undesirable effects can be prevented by using minimal effective doses for the shortest period or applying the necessary daily dose of the drug 1 time in the morning.

The intra-articial use of dexamethasone can lead to system effects.

Frequent use can cause damage to cartilage or bone necrosis.

Before intra-articular administration, it is necessary to remove the synovial fluid from the joint and explore it (check for the presence of infection). It is necessary to avoid the introduction of corticidals in infected joints. If the joint infection is developing after injection, it is necessary to begin the appropriate antibiotic therapy.

Patients should report that they avoid exercise On the affected joints until inflammation is cured.

The introduction of the drug into unstable joints should be avoided.

Corticoids can distort the results of skin allergic tests.

Special warnings regarding the aid. The preparation contains 1 mmol (23 mg) sodium at a dose, which is a very small amount.

Incompatibility. The drug should not be mixed with other drugs, besides the following: 0.9% sodium solution of chloride or 5% glucose solution.

When mixing dexamethasone with chlorpromazine, diphenhydronamine, doxaphram, doxorubicin, doweunubicin, udarubicin, hydromorphon, ondansetron, noitrérasezine, potassium is formed by a nitrate and vancomycin.

Approximately 16% of dexamethasone is dissolved in a 2.5% glucose solution and 0.9% solution of sodium chloride with amiccin.

Some drugs such as Lorazepam should be mixed with dexamethazone in glass vials, and not in plastic bags (the concentration of the Lorazepam drops to values \u200b\u200bbelow 90% in 3-4 hours of storage in polyvinyl chloride packets at room temperature).

Some drugs, such as metapaminol, have the so-called "incompatibility that develops slowly" is developing during the day when mixed with dexamethasone.

Dexamethasone with glycopyrolate: the pH value of the final solution is 6.4, which goes beyond the range of stability.

Application during pregnancy or breastfeeding

Drug is contraindicated in pregnancy or during breastfeeding

Application in pediatrics . Apply children from birth only in case of extreme need. During treatment with dexamethasone, careful observation of the growth and development of children is necessary.

Features of the effect of the drug on the ability to control transport or potentially hazardous mechanisms

Given that sensitive patients with the use of the drug may occur by adverse reactions (dizziness, confusion, etc.), for the period of use of the drug, it should be refrained from managing vehicles and performing other works that require concentration.

Solution for injection 4 mg / ml 1 MLSOK storage "Type \u003d" CheckBox "\u003e

Storage term

Do not apply the drug after the expiration date indicated on the package.

Conditions of vacation from pharmacies

On prescription

Manufacturer

PJSC "Pharmak", Ukraine, 04080, Kiev, ul. Frunze, 63.

Owner registration certificate

PJSC "Pharmak", Ukraine

Description

Transparent colorless or yellowish solution.

Structure

On one ampoule: active substance - phosphate dexamethasone (in the form of dexamethasone sodium phosphate) - 4.0 mg (ampoule 1 ml) and 8.0 mg (ampoule 2 ml); excipients: Glycerin, Dinatarium Phosphate Dihydrate, Dinatari Edetat, water for injection.

Pharmacotherapeutic group

Corticosteroids for systemic use. Glucocorticoids.
PBX code: H02Av02.

pharmachologic effect

Dexamethasone - synthetic fluorinated glucocorticosteroid, has an anti-inflammatory, anti-allergic, immunosuppressive effect, has anti-acudative and antifibroblast properties, practically does not have a mineralocorticosteroid effect. Interacts with specific cytoplasmic receptors and shares the complex penetrating the cell core and stimulating the synthesis of mRNA; The latter induces the formation of proteins encouraging cell effects, including lipocortin, which inhibits phospholipase A2, suppresses the liberation of arachidonic acid and inhibits the biosynthesis of endoperosis, prostaglandins, leukotrienes that contribute to the processes of inflammation, allergies, etc. Dexamethasone inhibits the expellation of protein genes participating in the development of inflammatory reactions. Prevents the release of inflammation mediators from eosinophils and fat cells. The activity of hyaluronidase, collagenase and proteases inhibits. Suppresses the activity of fibroblasts and the formation of collagen. Reduces the permeability of capillaries, stabilizes cell membranes, including lysosomal, inhibits the release of cytokines from lymphocytes and macrophages.

Indications for use

Diseases requiring the introduction of high-speed glucocorticosteroid, as well as cases where oral administration is impossible. Addison's disease, congenital hyperplasia of adrenal glands, adrenal insufficiency (usually in combination with mineralocorticoids), adrenitoenital syndrome, subacute thyroiditis, tumor hypercallesemia, shock (anaphylactic, post-tramatic, postoperative, cardiogenic, hemotransphusion, etc.), rheumatoid arthritis in the aggravation phase, sharp rheumokard , collagenoses (rheumatic diseases - as additional therapy for short-term treatment of the exacerbation of the disease, disseminated red lupus, etc.), diseases of the joints (post-trap osteoarthritis, acute gouty arthritis, psoriatic arthritis, synotic under osteoarthritis, acute nonspecific tendosyne, bursitis, epicondylitis, illness Bekhtereva et al.), Bronchial asthma, asthmatic status, anaphylactoid reactions, incl. induced drugs; cerebral edema (with tumors, cranial and brain injury, neurosurgical intervention, brain hemorrhage, encephalitis, meningitis); Nonspecific ulcerative colitis, sarcoidosis, beryllio, disseminated tuberculosis (only in combination with anti-tuberculosis means), lefflera disease, etc. Heavy respiratory diseases; Aenemia (autoimmune, hemolytic, congenital, hypoplastic, idiopathic, erythroblasting), idiopathic thrombocytopenic purpura (in adults), secondary thrombocytopenia, lymphoma (Hodgkinskaya and non-Khodgkinskaya), leukemia, lympholoicosis (acute, chronic), serum disease, allergic reactions when overflowing blood , acute infection swelling of the larynx (adrenaline is a preparation of first selection), trichinosis with damage to the nervous system or the involvement of myocardium, nephrotic syndrome, heavy inflammatory processes after injuries of eye and operations, skin diseases: bubble, Stevens-Johnson syndrome, exfoliative dermatitis, bullous herpes dermatitis , severe seborrheic dermatitis, heavy flow Psoriasis, atopic dermatitis.

Method of application and dose

Designed for intravenous (V / B), intramuscular (in / m), intra-articular, periarticular and retrobulbar administration. Dosing mode is individual and depends on the indications, the state of the patient and its reaction to therapy. In order to prepare a solution for in / in drip infusion, an isotonic solution of sodium chloride or a 5% solution of dextrose should be used. The introduction of high doses of dexamethasone can be continued only before stabilizing the patient's condition, which usually does not exceed 48 to 72 hours. Adults in acute and urgent states are introduced into / in slowly, inkidino or drip, or in / m in a dose of 4-20 mg 3-4 times a day. Maximum daily dose - 80 mg. Supporting dose - 0.2-9 mg per day. The course of treatment is 3-4 days, then go to oral administration of dexamethasone.
With a shock, adults, - in / in 20 mg once, then 3 mg / kg for 24 hours in the form of a continuous infusion or to / in one-time 2-6 mg / kg, or to / in 40 mg each 2-6 hours.
At the edema of the brain (adults) - 10 mg in / c, then 4 mg every 6 hours per / m to eliminate symptoms; The dose is reduced after 2-4 days and gradually - for 5-7 days - cease treatment.
With acute allergic reaction Or exacerbation chronic allergic disease Dexamethasone should be appointed according to the following schedule, taking into account parenteral and oral administration: 1 day - intravenous solution for injection 4 mg / ml in a dose of 1-2 ml (4-8 mg); 2 and 3 days - inside 1 mg (2 tablets of 0.5 mg) 2 times a day; 4 and 5 days - inside 0.5 mg (1 tablet of 0.5 mg) 2 times a day; 6 and 7 day - inside once 1 tablet of 0.5 mg; On the 8th day, evaluate the effectiveness of therapy.
For the introduction into the joint, the recommended doses range from 0.4 mg to 4 mg. The dose depends on the size of the affected joint:
- large joints (for example, knee joint): 2-4 mg;
- Small (for example, interphalangeal, temporal joint): 0.8-1 mg. In case the re-administration is needed, it is possible not earlier than in 3-4 weeks.
Introduction to the same joint can be completed three or four times throughout life. A more frequent intra-articular administration can damage the articular cartilage and cause necrosis.
The dose of dexamethasone, which is introduced into the synovial bag, is usually 2-3 mg, in the sheath of the tendon - 0.4-1 mg. Dexamethasone can be simultaneously entering no more than two locations of damage. Doses for introducing into soft tissues (around the joint) are 2-6 mg.
Children
In case of insufficiency of the adrenal bark of the dose of children during replacement therapy, 0.0233 mg / kg (0.67 mg / m 2 of the surface of the body surface) in / m, divided into 3 injections every 3rd day, or 0.00776 - 0, 01165 mg / kg (0.233 - 0.335 mg / m 2 body surface area) daily.
When applying for other indications, the recommended dose is 0.02776 - 0.16665 mg / kg (0.833 - 5 mg / m 2 of the body surface area) every 12-24 hours.

Side effect

The frequency of development of side effects is given in the following gradation: very frequent (≥1 / 10); frequent (≥1 / 100,<1/10); нечастые (≥1/1000, <1/100); редкие (≥1/10000, <1/1000); очень редкие (<1/10000); неизвестные (по имеющимся данным определить частоту встречаемости не представляется возможным). Частота нежелательных эффектов зависит от дозы и продолжительности лечения.
Side effects associated with short-term treatment with dexamethasone include:
From the immune system: Infrequent - hypersensitivity reactions.
: Frequent - transient adrenal insufficiency.
: Frequent - reduction of tolerance to carbohydrates, increase in appetite and weight gain; Infertuous - hyperitriglyceridemia.
Psychiatric violations: Frequent - mental disorders.
: Infrequent - peptic ulcers and acute pancreatitis.
Side effects associated with long-term treatment of dexamethasone include:
From the immune system: Infrequent - Reducing the immune response and an increase in susceptibility to infections.
From the endocrine system: Frequent - long-term adrenal insufficiency, growth slowdown in children and adolescents.
Violation of metabolism and nutrition: Frequent - upper type of obesity.
Violation: infrequent - cataract, glaucoma.
: Infrequent - arterial hypertension.
: Frequent - thinning and fragility of the skin.
: frequent - muscle atrophy, osteoporosis; Infrequent - aseptic necrosis of bones.
The following side effects associated with the treatment of dexamethasone may occur (they are presented in order to reduce significance).
From the lymphatic system and blood formation system: Rare - thromboembolic complications, a decrease in the number of monocytes and / or lymphocytes, leukocytosis, eosinophilia (as well as other glucocorticoids), thrombocytopenia and lowcomitoenic purpura.
From the immune system: Rare - rash, bronchospasm, anaphylactic reactions; Very rare - angioedema edema.
From sidehearts: Very rare - polyphocal ventricular extrasystoles, transient bradycardia, heart failure, myocardial break after a recently suffered acute infarction.
From the vascular system: Infrequent - hypertensive encephalopathy.
Psychiatric violations: infrequent - change in personality and behavior that are most often manifested by Euphoria, insomnia, irritability, hyperkinesia, depression; Rarely - psychosis.
From the endocrine system: Often - insufficiency and adrenal atrophy (decrease in stress response), Incenko Cushing syndrome, violation of the regularity of the menstrual cycle, girsutism.
Violation of metabolism and nutrition: Rarely - the transition of latent diabetes in clinically manifestyle, increasing the need for insulin or oral saccharination drugs in patients with diabetes, sodium and water delay, strengthening of potassium loss; Very rarely - hypokalemic alkalosis, negative nitrogen balance due to catabolism proteins.
From the digestive system: infrequent - nausea, hiking, stomach ulcers or a 12-rosewoman; Very rarely - esophagitis, perforation of ulcers and bleeding of the gastrointestinal tract (hematomesis, melon), pancreatitis, perforation of the gallbladder and intestines (especially in patients with chronic inflammatory diseases of the large intestine).
From the musculoskeletal system and connective tissue: Frequent - muscle weakness, steroid myopathy (muscular weakness due to catabolism of muscle tissue); Very rare - compression fractures of vertebrae, tendons breaks (especially with the joint use of some quinolones), necrosis of the cartilage tissue of the joint and bones (with frequent intra-artic injections).
From the skin and subcutaneous fiber: Frequent - slowing down wound healing, strlicie, petechia and ekkimosis, increased sweating, acne, leather reaction suppression during allergological tests; Very rarely - allergic dermatitis, urticaria.
Violation by the body of the vision: infrequent - an increase in intraocular pressure; Very rarely - Exophthalm.
From the reproductive system and the mammary glands: rarely - impotence.
General disorders and disorders in the place of introduction: Very rare - swelling, hyper- and hypopigmentation of the skin, skin atrophy, or subcutaneous fiber, sterile abscess and redness of the skin.
Signs and symptoms of glucocorticosteroids cancellation syndrome.
If a patient, long-term glucocorticosteroids, quickly reduce the dose of the drug, may develop signs of adrenal insufficiency, arterial hypotension, death.
In some cases, the symptoms of cancellation may be similar to the symptoms and signs of exacerbation or recurrence of the disease, over which the patient has received treatment. When developing severe undesirable phenomenon, treatment must be discontinued.
In the event of the above adverse reactions or adverse reactions not specified in this manual for medical use of the drug, it is necessary to consult a doctor.

Contraindications

Hypersensitivity to the active substance or other ingredients of the drug, acute viral, bacterial and systemic fungal infections (without appropriate treatment), amoebic infections, infectious lesions of joints and eye-shaped soft tissues, active forms of tuberculosis, period before and after preventive vaccinations (especially antiviral), Glaucoma, an acute purulent eye infection (retrobulbar administration), Cushing syndrome, vaccination of a living vaccine, intramuscular administration is contraindicated to patients with severe violations of the blood coagulation system.

Overdose

There are isolated messages about cases of acute overdose or death due to acute overdose. Overdose is usually manifested only in a few weeks of applying excessive doses and can cause most of the unwanted effects specified in the section "Side Reactions", primarily Cushing syndrome.
There is no known specific antidote. Treatment supporting and symptomatic. Hemodialysis is ineffective to accelerate the removal of dexamethasone from the body.

Precautions

Limited to use when: peptic gastric ulcers, ulcerative ulcer of the stomach and duodenum, esophagitis, gastritis, intestinal anastomosis (in the nearest history); Stagnation of heart failure, arterial hypertension, thrombosis, diabetes, osteoporosis, Incenco-Cushing diseases, acute renal and / or liver failure, psychosis, convulsive states, miastic, open-hearted glaucoma, AIDS, pregnancy, breastfeeding. With long-term treatment (more than 3 weeks) in high doses (more than 1 mg of dexamethasone per day) for the prevention of secondary adrenal insufficiency, the cancellation of dexamethasone is gradually produced. This state can last for several months, so when stressing (including on the background of general anesthesia, surgical intervention or injury), an increase in dose or administration of dexamethasone is necessary. Local use of dexamethasone can lead to system effects. When intra-articular administration, local infectious processes should be eliminated (septic arthritis). Frequent intra-articular administration can damage the articular tissues and osteonosis. Patients are not recommended to overload the joints (despite the decrease in symptoms, inflammatory processes in the joint are continuing).
Care should be taken when appointed against the backdrop of non-specific ulcerative colitis, the intestinal diverticult, hypoalbuminemia. Purpose in the case of intercurrent infections, tuberculosis, septic conditions requires preliminary and then simultaneous antibacterial therapy. GCS can increase susceptibility or mask symptoms of infectious diseases. Shedsh, cortex and other infections can proceed more hard and even lead to a fatal outcome in non-immunized persons. Immunosuppression is more often developing with prolonged use of GCS, but may occur during short-term treatment. Against the background of the concomitant tuberculosis, it is necessary to carry out adequate antimicobacterial chemotherapy. The simultaneous use of dexamethasone in high doses with inactivated viral or bacterial vaccines may not give the necessary result. Immunization against the background of GCS replacement therapy is permissible. It is necessary to take into account the strengthening of the hypothyroidism and cirrhosis of the liver, the aggregation of psychotic symptoms and emotional lability at their high initial level, the disguise of some symptoms of infection, the probability of conservation for several months (up to 1 year) relative adrenal insufficiency after the cancellation of dexamethasone (especially in the case of long-term use ). With a long course, it is carefully observed over the dynamics of growth and development of children, systematically conduct an ophthalmic survey, control the condition of the hypothalamic-pituitary-adrenal system, the blood glucose level. Terminate therapy only gradually. It is recommended to be careful when carrying out any kind of operations, the occurrence of infectious diseases, injuries, avoid immunization, eliminate the use of alcoholic beverages. In the case of contact with sick cute, wind inspiration and other infections, prescribe concomitant prophylactic therapy.
In rare cases in patients receiving parenteral corticosteroids, anaphyactoid reactions may occur. Before introducing patients, appropriate precautions should be taken, especially if the patient has an allergy to any drug.
Corticosteroids can be aggravated by the course of systemic fungal infections and, therefore, should not be used in the presence of such infections.
Corticosteroids can activate Latent Amebiaz. Therefore, it is recommended to exclude hidden or active Amebiaz before the start of corticosteroid therapy.
The average and high doses of cortisone or hydrocortisone can cause an increase in blood pressure, the holding of salt and water and an increase in the excretion of potassium. It may be necessary to limit salt and potassium. All corticosteroids increase calcium excretion.
Apply corticosteroids with great care in patients with a recently suffered myocardial infarction due to risk of gastroincing wall.
Corticosteroids should be used with caution in patients with eye infection caused by a simple herpes due to the risk of developing cornea perforations.
Aspirin should be used with caution in combination with corticosteroids due to the risk of hypoprothrombinemia.
In some patients, steroids can increase or decrease the mobility and the amount of spermatozoa.
May be observed:
- loss of muscle mass;
- pathological fractures of long tubular bones;
- compression vertebral fractures;
- Aseptic necrosis heads of the femur and shoulder bone.
During the treatment of dexamethasone, it is possible to deteriorate a drainage of diabetes mellitus or the transition of latent diabetes in a form with clinical manifestations.
The preparation contains 0.0196 mmol (0.045 mg) sodium at a dose.
Children
In children, in order to avoid overdose, the dose calculation is based on the surface area of \u200b\u200bthe body. Dexamethasone applies in children and adolescents only by strict indications. During treatment with dexamethasone, it is necessary to carefully monitor the growth and development of children and adolescents.
Premature children: there are data indicating the negative impact on the subsequent neurological development of early use (<96 часов) в начальных дозах 0,25 мг/ кг два раза в день у недоношенных детей с бронхолегочной дисплазией.
Elderly patients
Unwanted effects of systemic corticosteroids, such as hypokalemia, osteoporosis, hypertension, diabetes, increased susceptibility to infections and skin thinning may have more serious consequences in elderly patients. In order to avoid dangerous unwanted reactions, clinical observation is recommended.

Application during pregnancy and lactation

Glucocorticoids penetrate the placenta, and can achieve high concentrations in the body of the fetus. Dexamethasone is less intensively metabolized in the placenta, compared, for example, with prednisone, so the fetus can determine the high concentrations of dexamethasone. Therapeutic doses of glucocorticoids can increase the risk of placental insufficiency, lowland, growth delays and fetal development or intrauterine death, increase the number of leukocytes (neutrophils) in a child, as well as the risk of adrenal insufficiency. Application during pregnancy is allowed if the expected effect of therapy exceeds the potential risk to the fetus. At the time of treatment, breastfeeding should be stopped. Infants born from mothers who received significant doses of corticosteroids during pregnancy should be carefully observed to identify signs of adrenal hypofunction.

Impact on the ability to control the car and other potentially dangerous mechanisms

During treatment, it should not be controlled by vehicles and engage in potentially hazardous activities that require increased attention and start psychomotor reactions.

Interaction with other medicines

Therapeutic and toxic effects of dexamethasone reduce barbiturates, phenytoin, rifabutin, carbamazepine, ephedrine and aminoglutetimide, rifampicin (accelerate metabolism); somatotropin; Antacids (reduce suction), reinforce - estrogen-containing oral contraceptives. Simultaneous use with cyclosporin increases the risk of savoring in children. The risk of arrhythmias and hypokalemia increases cardiac glycosides and diuretics, the likelihood of edema and arterial hypertension - sodium-containing drugs and nutritional supplements, heavy hypokalemia, heart failure and osteoporosis - amphotericin in and carbonic henching inhibitors; The risk of erosive-ulcerative lesions and bleeding from the gastrointestinal tract - non-steroidal anti-inflammatory means. With simultaneous use with alive antiviral vaccines and against the background of other types of immunization, increases the risk of activation of viruses and the development of infection. Simultaneous use with thiazide diuretics, furosemeid, etcrinic acid, carbonic henhydrate inhibitors, amphotericin in can lead to severe hypokalemia, which can enhance the toxic effects of cardiac glycosides and non-polarizing muscle relaxants. Weakens the hypoglycemic activity of insulin and oral antidiabetic agents; anticoagulant - kumarins; Diuretic - diuretic diuretics; Immunotropic - vaccination (suppresses antibody). It worsens the tolerance of cardiac glycosides (causes potassium deficiency), reduces the concentration of salicylates and the prazicvantel in the blood. It may increase blood glucose concentration, which requires a dose correction of hypoglycemic drugs, sulfonylurea derivatives, asparaginases. GCS increases the clearance of salicylate, so after the cancellation of dexamethasone, it is necessary to reduce the dose of salicylate. With simultaneous use with an indomethacin, a dexamethasone suppression test may produce false-negative results.
The joint use of dexamethasone and drugs inhibiting the activity of the CYP enzyme (ketoconazole, macrolides) can cause an increase in serum dexamethasone concentration. Dexamethasone is a moderate CYP inducer. Co-use with preparations that are metabolized by CYP 4 (Indinavir, erythromycin) can increase their clearance, which leads to a decrease in serum concentration.
The simultaneous use of dexamethasone and thalidomide can cause toxic epidermal necroliz.
The simultaneous use of riteodine and dexamethasone is contraindicated during childbirth, as this can lead to a fatal outcome of the fever, due to the edema of the lungs.
During the period of treatment, the simultaneous use of drugs and foods with a high sodium content is not recommended.

Storage conditions

In the light-protected place at a temperature not higher than 25 ° C.
Keep out of the reach of children.