Dexamethasone time of action after the injection. Dexamethasone for injection - instructions for use. Indications for the use of dexamethasone

19.07.2020 Recipes

Instructions for medical application Medicinal consumption

Dexametanone

International non-proprietary title

Dexametanone

Dosage form

Injection Solution 4 mg / ml

One ampoule contains

the active substance is 4.37 mg dexamethasame (equivalent to 4.00 mg phosphate dexamethane),

auxiliary substances: glycerin, dynatoryaedetate, sodium hydrophosphate dihydrate, water for injection.

Pharmacotherapeutic group

Corticosteroid tool for systematic generation, glucocorticosteroids.

PBX code H02AB02.

Pharmacological properties

Pharmacokinetics

After intravenous administration, the drug began to start quickly, and after intramuscular administration, the clinical effects in 8 hours. The effect of the drug prolonged and continues 17 to 28 days after intramusculosion and from 3 days to 3 weeks after local application (in the region proceedings). Dose of dexamethasone 0.75 mg is equivalent to a dose of 4 mg of methylprednisolonea of \u200b\u200btriamcinolone, 5 mg of prednisone and prednisolone, 20 mg of hydrocortisone and 25 MGCortizona. In the blood plasma, about 77% of dexamethasone binds to blood proteinamia, and mostly converted to albumin. Only minimality of dexamethasone binds to non-buminic proteins. Dexamethasone is a fat soluble compound. The drug is metabolized in the liver. Small quantities of dexamethasonmetabolized in the kidneys and other organs. The prevailing excretion occurred urine. The half-life (T1 \\ 2) is about 190 minutes.

Pharmacodynamics

Dexamethasone is the synthetic adrenal hormones (corticosteroid) with glucocorticoid effect. The drug translaimates a pronounced anti-inflammatory, anti-allergic and desensitizing effect, has immunosuppressive activity.

To date, adequateness of glucocorticoid mechanism has been accumulated, to submit, as it is on the cellular level. There are two clearly defined system-detectors detected in cytoplasm cells. By means of glucocorticoidreceptors, corticosteroids have anti-inflammatory immunosuppressive effects and regulate glucose homeostasis; Throughminexocuticoid receptors, they regulate sodium and potassium metabolism, and the water and electrolyte balance.

Indications for use

Dexamethasone is administered intravenously or substantially in acute cases Or with the impossibility of periolencepia.

Primary and secondary replacement therapy (pitpophized)

adrenal insufficiency

Congenital adrenal hyperplasia,

Subacute thyroiditis and heavy shapes-sellent thyroiditis.

Rheumatic fever

Acute rheumlock

Bubble, psoriasis, dermatitis (contact dermatitis by a smell

spring skin, Atopic, exfoliative, bullous

herpetyform, seborrheic, etc.), eczema

Toxidermy, Toxic epidermalnecrolesis (Layella syndrome)

Malignant Exudative Erythema (Stevens-Johnson syndrome)

Allergic reactions to LS and Food-Products

Whey disease, Dosage Exanthema

Urticaria, angioedema swelling

Allergic criny, Polleoz

Diseases threatening vision loss (acute central

chorioretinite, inflammation spectator nerve)

Allergic conditions (conjunctivitis, uveit, sclert, keratitis, iris)

Systemic immune diseases (sarcoidosis, temporal arteritis)

Proliferative change in orbit (endocrine ophthalmopathy,

pseudoovoli)

Sympathetic ophthalmia

Immunosuppressive therapy for the horn of the corneal.

The drug is used systemically or locally (VVID subconjunctive, retrobulbar or parabulbar injections)

Ulcerative colitis

Crohn's disease

Local enteritis

Sarcoidosis (symptomatic)

Acute toxic bronchiolitis

Chronic bronchitis and asthma (exacerbation)

Agranulocytosis, Päyelopathy, anemia (including autoimmune

hemolytic, congenital hypoplastic, erythroblasting)

Idiopathic thrombocytopenic purple

Secondary thrombocytopenia in adults, lymphoma (Hodgkinskaya,

nehodkzhkinskaya)

Leukemia, lympholoikosis (acute, chronic)

Kidney disease autoimmune genesis (W.Ch. acute glomer

lonephritis)

Nephrotic syndrome

Palliative therapy of leukemia and lymphoma

Acute leukemia in children

Hypercalcemia with malignant-based formations

Brain Out of Primary Tumor or Metastasis

wongwall brain, due to craniotomy or head injuries.

Shock of various origins

Shock not responding to standard therapy

Shock in patients with adrenal mining

Anaphylactic shock (intravenous, remove adrenaline)

Total characteristic of the drug

Dexamethasone refers to the group of glucocorticoid drugs. This is a synthetic hormone of adrenal cortex. The international non-proprietary name (short MNN) of his "dexamethasone", but it is possible to purchase a medicine with such a composition under the names of Dexazone, Metasic, Maxidge. These are all means from the glucocorticoid group. They are used in many pathologies, as they affect the organism at the cellular level.

Dexamethasone is the most popular tool from this group. The benefits of its relatives include a low price, a wide range of applications, the ability to use in the complex treatment of many diseases. In addition, its effectiveness is higher than from Cortisone 30 times. It costs this medicine cheap, the packaging price ranges from 35 to 100 rubles, depending on the form of release and dosage.

This drug is produced in ampoules, tablets and eye drops. In addition, it is added to some complex drugs for indoor and outdoor use. A solution for intravenous or intramuscular administration contains dexamethasone sodium phosphate, glycerin, phosphate diodriatium and water for injection.

Dexamethasone in ampoules

Dexamethasone injections are made in cases where for some reason it is impossible to use tablets. Usually this heavy conditions, severe pains, serious allergic reactions. Injections are made no longer than 3-5 days, then if necessary, go to oral administration.

Dexamethasone is injected intravenously or intramuscularly. It depends on the age of the patient and the severity of its condition. It is very important that the use of this drug passes under the supervision of a doctor, as it is possible to develop serious side effects. Therefore, this medicine is sold in pharmacies only by recipe.

Dexamethasone is packaged in 1 ml ampoules. The solution is usually transparent, slightly yellowish. Each ampoule is 4 mg active substance. Packaging includes 10 or 20 ampoules embedded in contour cells, as well as instructions for use. Each ampoule usually has a sticker with the title. Sometimes they have a point or ring denoting the place of the break. Otherwise, a scarifier is attached to the packaging to laminating the tip of the ampoule.

Store dexamethasone is required in place inaccessible for children. This is not necessarily a refrigerator, the main thing is that the temperature does not exceed 25 degrees, but it is impossible to freeze the drug too. It is necessary to protect the solution from the effects of sun rays, so the ampoules should always be in a closed packaging. After opening, the storage solution is not subject to, it is impossible to use it anymore.

Important: It is also impossible to apply the drug that has an expiration date, tightness or storage conditions have been broken.

What action is rendered

The use of dexamethasone injections is justified with many diseases. It is prescribed when other therapy turns out to be ineffective. This glucocorticoid is a popular tool due to strong anti-inflammatory, anti-stress and anti-shock action. In addition, it has the ability to remove allergic reactions, activate metabolic processes and reduce abnormal activity. immune system.

Frequently applies dexamethasone in ampoules, it is usually injected intramuscularly or intravenously

The effect of the drug at intramuscular administration occurs after 6-8 hours, so in emergency cases is usually administered intravenously. And if it is impossible to use the drug orally, it is injected into soft tissues. With this method of admission to the body, the active substance quickly reacts with proteins of cell receptors, which allows it to penetrate the kernel.

It turns out that the effect of the drug is manifested at the cellular level. This explains its effectiveness in many pathological conditions. Dexamethasone is able to adjust exchange processes. It oppresses the production of some enzymes that can slow down the metabolism or accelerate the splitting of proteins. Due to this, the state of cartilage tissue and bones is improved.

In addition, the use of dexamethasone reduces the activity of leukocytes and the immune system. This helps to reduce the inflammatory process in autoimmune pathologies. And thanks to a decrease in vessel permeability, this medicine prevents the spread of inflammation.

Indications for use

The injections of this drug are used only on life indications usually after another treatment has been tried, which turned out to be unsolved. Claims of dexamethasone doctors "ambulance" at a shock state, impaired adrenal operations, rapidly increasing brain edema, for example, after a crank-brain injury.

The testimony for such treatment includes brain tumors, meningitis, radiation damage. Apply drug after injuries, surgical operations, with tumors, allergies or inflammatory diseases of the joints.

Artician pathology

The main indications of the use of dexamethasone are various articular diseases. Glucocorticoids are quickly removed inflammatory process and pain, so they are often prescribed when ordinary therapy does not bring positive results. And dexamethasone acts more efficiently than other drugs, so sometimes one injection is enough.

This drug improves the patient's condition when rheumatoid arthritis, diseases of Bekhtereva, sclerodermia, systemic red lolly, psoriasis. It accelerates recovery in various inflammatory diseases, for example, when ferursite, polyarthritis, epipidyl or synotte.

ATTENTION: Usually intramuscularly introduced it, but sometimes injections are made directly to the affected joint. In this case, you can repeat the injection only after 3 months. And you can enter from 0.4 to 4 mg.

Unacceptable long use Such injections or excess of the recommended dose. The active ingredient of this drug can negatively affect the state of cartilage tissues and even cause a weakening or breaking of tendons. Therefore, with such pathologies as osteoarthritis or osteochondrosis, it is rarely used and only under the supervision of a doctor.

Allergic reactions

Do not everyone know what dexamethasone prescribe, but many people suffering from allergies are familiar with him. This is one of the most common pathologies now. Typically, the correct behavior and the use of prescribed drugs makes it possible to normalize the state. But sometimes there are strong allergic reactions that can threaten health or even the life of the patient. Often in such cases, ordinary funds do not help remove strong edema or itching, so they are prescribed dexamethasone. It is able to quickly remove all the symptoms of allergies.

This drug is used most often in emergency cases: in the swelling of the quinque, angioedema edema or anaphylactic shock. But its use is also shown severe course Urban, dermatitis, eczema, conjunctivitis, half aulinosis. Usually, with these pathologies, it is recommended to prick dexamethasone for 4-8 mg 1-2 days. After removal acute symptoms It is better to go to the use of tablets.

Diseases of the respiratory system

This drug penetrates the bronchi and light, quickly removing swelling and inflammatory process. Therefore, it is often used in severe pathologies of respiratory organs, except for infectious. Dexamethasone is effective with asthmatic status, bronchial asthma or obstructive bronchitis. It significantly improves the patient's condition.

Such injections are used in emergency cases, for example, with a swelling of a quinque or bronchial asthma

This drug is especially used with similar pathologies. childhoodSince kids develop swells rapidly and respiratory function can be broken. Even acute laryngotrachite can give such complications, therefore comprehensive treatment Include glucocorticoid shots.

Contraindications

When appropriate, any drug is necessarily taken into account the presence of contraindications. This is especially important about dexamethasone. There are many pathologies in which it is impossible to apply the drug, as this may lead to the development of serious side effects.

ATTENTION: Such injections are not prescribed with some pathologies of the musculoskeletal system. Dexamethasone can slow down the processes of regeneration, as well as destroy the cartilage and bone tissue. High concentration It in the blood leads to the washing of calcium from the bones. Therefore, it is contraindicated to apply it during osteoporosis, the severe form of osteoarthrosis, after fractures.

It is very important not to apply such a medicine at various infectious diseases. Dexamethasone has an immunosuppressive effect, that is, inhibits immunity. If there are viruses, bacteria or fungi in the body, they begin to multiply quickly. Therefore, there are no such injections for tuberculosis.

In addition, such pathologies include contraindications:

diabetes;
ulcerative disease stomach;
heart attack;
the presence of bleeding;
psyche disorders;
renal or liver failure;
individual increased sensitivity to the drug.

Side effects

Instructions for use necessarily warns of possible side effects. Dexamethasone penetrates the cells and changes the metabolic processes. When using it in large doses, the immune system is oppressed, violation fat Exchange, Washing out calcium from bone tissue and accumulating fluid in the intercellular space. Because of this, a person after a course of such therapy may develop serious infectious diseases, edema appear, fat deposits accumulate and the risk of fractures increases.

This drug has a lot of side effects, so it is trying to prescribe it in the lowest possible doses. But still, many patients after the course of dexamethazone injections are developing such pathologies:

depression, hallucinations;
raising arterial pressure;
ulcer of the stomach, pancreatitis;
violation of blood composition;
insomnia;
impairment of the heart;
impotence;
dermatitis, urticaria;
slow healing of wounds;
convulsions;
reduction of vision, cataract;
muscle weakness.

Negative phenomena appear also at the injection site. It is often felt by pain, burning or numbness, a hematoma or a bump is formed. On the spot of the injection, the scar may appear, and skin covers are atrophy.

Instructions for use of injections

Injection use of glucocorticoids is possible only under the supervision of the doctor. In addition, the correct dosage is very important, there are certain rules for the introduction of such drugs. The main thing, dexamethasone needs to be introduced very slowly. Intravenous injections are better carried out in the form of a dropper. For this, the solution is diluted with glucose or sodium chloride. But with other drugs in one syringe mix this tool is prohibited.

It is desirable that the injection is done by a medical worker

But injections intramuscularly also need to do very slowly. With the rapid administration of the drug, it is possible to increase blood pressure and impairment of the heart.

Usually, the course of use of injections is 3-5 days. But it is not recommended to drastically discontinue treatment. Dexamethasone often leads to the development of cancellation syndrome, when the patient's condition of the patient is worsening after stopping the receipt of the medication into the body. Therefore, after the course of injection is transferred to the oral use of the drug. Moreover, its dosage gradually decreases under the guidance of the doctor.

Important: Prolonged use of glucocorticoids sometimes causes insufficiency of adrenal functions, which can manifest itself after a while after treatment.

In addition, large doses of dexamethasone lead to strong losses of potassium, which negatively affects the work of the heart muscle. Perhaps also development mental disorders, Therefore, it is sometimes recommended to introduce the necessary dose once a day in the morning.

Proper dosage

In order for the treatment of dexamethasone to be effective, but the possibility of the appearance of side effects has decreased, it is important to introduce it in certain doses, which are usually defined individually, depending on the age of the patient, the severity of its condition and availability chronic pathologies. Adult patients at once are administered from 4 to 20 mg. Sometimes one injection is enough, since the effect of the drug is felt up to 3 weeks. But in severe cases, they make 3-4 injections per day. The maximum dosage per day is 80 mg.

The dosage of the dexamethasone solution depends not only on the individual characteristics of the patient, but also on the purpose of use. For example, at the edema of the brain, 16 mg of the drug is first introduced, the following injection is carried out after 6 hours, but already 5 mg. In such a dosage, injections are made every 6 hours.

Application during pregnancy

Any medicine for women during a child tooling can be applied only according to the testimony of the doctor. And the dexamethasone solution easily penetrates through the placental barrier, as it acts at the cellular level. Therefore, the drug can negatively influence the child who has not yet born, causing various violations in its development. Then the baby may develop adrenal dysfunction.

This drug is used only when the state of a woman is severe and benefit from such treatment exceeds the risk of side effects.

Features of applications in children

Apply this tool from birth. Children make only intramuscular injections strictly according to the testimony of the doctor. The dosage at the same time should be calculated very carefully to prevent the appearance of side effects. Depending on the severity of the state, 0.2 to 0.4 mg is injected per kg of the child's weight. This is a daily dose that can be divided into 3-4 applications. It is advisable to use the minimum possible dosage and the duration of treatment.

Medicinal interaction

Usually dexamethasone is used as part of a comprehensive treatment. But it is very important to take into account its compatibility with other medicines. Some of them can reduce the efficiency of the drug or increase the risk of development. side effects. It is unacceptable to engage in self-medication and you need to warn your doctor before the start of treatment about the medications taken.

It is impossible to take the drug in conjunction with other glucocorticoids or non-steroidal anti-inflammatory means. The risk of severe side effects also increases when using it together with contraceptives or ritodrine.

conclusions

The solution of dexamethasone for injections is a fairly common means of treating various emergency states. Despite the possibility of the appearance of side effects, this drug is used quite often. But it is necessary to be prescribed by the doctor. The dosage is also selected individually. Failure to comply with medical recommendations during therapy may result in serious consequences.

Video on the topic

Dexamethasone - hormonal medicinal substance For systemic use, the main active substance of which is a sodium dexamethasone phosphate.

It is used for disease therapy that can be influenced by glucocorticoids. The main form of release is injection solutions.

In this article, we will consider for what doctors prescribe the drug dexamethasone, including instructions for use, analogues and prices for this medicinal product in pharmacies. If you have already used dexamethazone, leave feedback in the comments.

Composition and form of release

List of components this drug Depends on the form in which it is produced. Dexamethasone comes in the pharmacy network as follows:

Pills. They are produced at 50 and 100 pieces in cardboard packaging, a dosage of 0.5 mg.
Solution for injections (injections). Produced in ampoules. Main component - Sodium dexamethasone phosphate, water, sodium hydroxide, preservatives, etc. are used as auxiliary.
Eye drops. They consist of sodium dexamethasone phosphate, water, borants and additional components. Drops in bottles or tubes are supplied, in dosage 1, 1.5, 2, 5, 10 ml.
Suspension for eyes. The active ingredient - dexamethasone, with the addition of the following substances: water, ethanol, sodium chloride, sodium hydrophosphate, polysorbate, sodium dihydrophosphate, chloride benzalconium. It is produced in bottles, a dose of 5 ml.

Clinical and Pharmacological Group: GCS for injections.

What are they prescribed dexamethasone?

The use of dexamethasone is shown in replacement therapy of adrenal cortex deficiency, including acute or relative, primary and secondary, and also developed after the abolition of glucocorticosteroids (GKS).

According to the instructions, dexamethasone can also be included in the scheme of pathogenetic and symptomatic therapy at:

Hematological diseases (including idiopathic thrombocytopenic purpura in adults and acute leukemia in children);
Metabolic disorders (including hyperkalemia caused by a malignant tumor);
Diseases of the joints (incl. With osteoarthritis or rheumatoid arthritis);
Diseases of the digestive tract (including with crown disease, ulcerative colitis);
Edema syndrome;
Ophthalmic diseases;
Diseases of allergic nature;
Systemic diseases of the connective tissue;
Lung diseases (including sarcoidosis, aspiration pneumonite, etc.);
Infantile spasms;
Dermatological diseases (including neutrophilic, contact, exfoliative dermatitis; multiform entry, toxic epidermal necroliz, etc.).

As part of combination therapy, dexamethasone is used with a shock of different genes. In combination with antimicrobial agents, the drug is often used in infectious diseases.

pharmachologic effect

Dexamethasone - a powerful immunosuppressant, has an anti-inflammatory and antiallergic effect. In the presence of an active substance, the receptor sensitivity of β-adrenoreceptors to the adrenaline and noraderennaline produced by the brain layer of adrenal glands is enhanced.

One ampoule of dexamethasone causes the oppression of the operation of the hypothalamic-pituitary-glkocortical system for 3 days. In an equivalent ratio of 0.5 mg of dexamethasone correspond to the action of 3.5 mg of prednisolone, 15 mg of hydrocortisone or 17.5 mg of cortisone.

Instructions for use

Dosing mode is individual and depends on the indications, the state of the patient and its reaction to therapy. The drug is introduced into / in slowly inkjet or drip (with sharp and urgent states); per / m; Local (in pathological education) is also possible. 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.

In difficult cases and at the beginning of treatment, up to 10-15 mg of the drug per day, the supporting dose can be 2-4.5 mg and more than a day.
With asthmatic status and sharp allergic diseases, 2-3 mg of dexamethasone per day for a short time can be used for a short time.
In the treatment of adrenogenital syndrome (violation of the function of the adrenal cortex, accompanied by the strengthened secretion of male genital hormones), the dose is selected depending on the release of 17-ketosteroids with urine. Usually the effect is achieved when appointing 1-1.5 mg. The average daily dose of 2-3 mg is divided into 2-3 receptions. When treating small doses, the drug is prescribed once in the morning.

In the acute period of the disease and at the beginning of treatment, the drug is used in higher doses. When the effect is reached, the dosage decreases with an interval of several days before the maintenance dose is achieved or before discontinuation of treatment. Dosing mode individual.

Contraindications

The drug is contraindicated in individual intolerance and severe hepatic insufficiency. With extreme caution and emergency control of the attending physician, the drug dexamethasone is introduced to women in pregnancy, children and adults with:

pathologies digestive system ulcerative nature;
infectious diseases;
HIV - infected and patient AIDS;
chronic liver and kidney diseases;
cardiovascular pathologies, especially during the period of the acute myocardial infarction;
violations of hormonal secretion;
period before and after vaccination of lymphadenitis and brucellosis;
osteoporosis, glaucoma.

Side effects

The frequency of development and severity of side effects depend on the duration of use, the value of the dose used and the possibility of compliance with the circadian rhythm of the destination. Usually dexamethasone is well tolerated. As a rule, low and medium doses of dexamethasone do not cause sodium delays and water in the body, an increased excretion of potassium.

Nevertheless, such side effects are possible:

vomiting, nausea. steroid ulcer, pancreatitis, erosive esophagitis (surface inflammation of the esophagus), IKOT, meteorism;
exophthalm (offset eyeball forward or to the side), trophic changes of the cornea, a tendency to the development of eye infections, an increase in intraocular pressure, the rear subcapsular cataract (clouding of the lens);
reduction of glucose tolerance, inhibition of adrenal function, steroid diabetes mellitus, Izeno-Cushing syndrome (adrenal cortex hyperfunction);
hypocalcemia, hypokalemia, hyponatremia, increased calcium excretion, increase body weight, increased sweating;
bradycardia, arrhythmia, increase blood pressure;
slowing down in children, breaking muscle tendons, osteoporosis, reduced muscle mass, steroid myopathy;
an increase in intracranial pressure, anxiety, depression, paranoia, dizziness, headache, convulsions;
dermatological and allergic reactions.

Overdose

Symptoms: In the case of the use of the drug in high doses for several weeks, the majority of the side effects listed above the side effects and syndrome of Cushing is possible.

Treatment: a reduction in the dose or temporary cancellation of the drug, the conduct of symptomatic therapy. There is no special antidote. Hemodialysis is not effective.

Pregnancy and lactation

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

If it is necessary to carry out treatment with a drug during breastfeeding, then breastfeeding should be stopped.

Analogs

Currently, there are a large number of dexamethasone substitutes. This is Dexazazone, Decamed, Dexapos, Deckon D, Maxidge, Forthetortin, Dexafar and many others. In this case, dexametosone has a tangible price advantage.

Prices

The average price of dexamethasone injections in pharmacies (Moscow) 138 rubles.

Terms and Storage Terms

List B. Store at a temperature not higher than 25 ° C in an inaccessible place for children. Do not freeze. Shelf life - 3 years. Do not apply after the expiration date indicated on the package.

Dexamethasone instructions for use (injections in ampoules, eye drops, pills). DexameThasone is a powerful synthetic glucocorticoid (containing adrenal cortex hormones and their synthetic analogs) with a drug intended for the regulation of protein, carbohydrate and mineral exchange.

Dexamethasone instructions for use, reviews, analogues and forms of release (0.5 mg tablets, injections in ampoules (injection solution), drops of eye offang) medicines for the treatment of inflammation in adults, children and during pregnancy.

Structure

Active substance - dexamethasone sodium phosphate (in terms of phosphate dexamethasone) - 4.0 mg / 8.0 mg;
Auxiliary substances - glycerin, dynatory phosphate dihydrate, Dinatari Edetat, water for injection.

Forms of release

Tablets 0.5 mg.;
Solution in ampoules for intravenous and intramuscular administration (injections for injections) 4mg / ml.;
Drops eye offang 0.1%;
Suspension Eye 0.1%

Dexamethasone instructions for the use of the drug

The oral use of dexamethasone in the form of tablets implies the prescription of 10-15 mg of the drug per day at the initial stage of treatment, followed by a decrease in the daily dose to 2-4.5 mg with supporting therapy. Daily dose of the drug dexamethasone instruction recommends dividing 2-3 receptions (after or during meals).

Supporting small doses should be taken once a day, preferably in the morning. Dexamethasone in ampoules is designed for intravenous (drip or inkjano), intramuscular, perarticular and intra-articular administration. Recommended daily dose of dexamethasone with such methods of administration - 4-20 mg. Dexamethasone in ampoules is usually used 3-4 times a day for 3-4 days, followed by the transition to the tablet.

Dexamethasone drops are used in ophthalmology: with acute states of 1-2 drops of the drug, they are injected into a conjunctival bag every 1-2 hours, while improving the state - every 4-6 hours. Chronic processes involve the use of dexamethasone drops 2 times a day.

The duration of treatment depends on clinical flow Diseases, therefore, dexamethasone drops can be used from several days to four weeks.

Indications for the use of dexamethasone

Diseases requiring the introduction of high-speed GCS, as well as cases where oral administration is impossible:

Shock (burn, traumatic, operational, toxic) - with the ineffectiveness of vasoconstrictor means, plasma-substituting drugs and other symptomatic therapy;
Severe allergic reactions, anaphylactic shock;
Blood Diseases: Sharp hemolytic anemia, agranulocytosis, idiopathic thrombocytopenic purpura in adults;
Endocrine diseases: acute insufficiency of adrenal cortex, primary or secondary failure, congenital hyperplasia, subacute thyroiditis;
Local use (in the area of \u200b\u200bpathological education): keloids, discoomed red lupus, ring-shaped granuloma;
Rheumatic diseases - dexamethasone instructions for use;
IN ophthalmological practice (Subconjunctive, retrobulbar or parabulbar administration): Allergic conjunctivitis, keratitis, keratoconjunctivitis without damage to the epithelium, irrit, iridocyclitis, blepharitis, blefaroconjunctivitis, sclerites, episclerite, inflammatory process after injuries of the eye and operational interventions, sympathetic ophthalmia, immunosuppressive treatment after cornea transplantation;
Sharp heavy dermatoses;
Malignant diseases: palliative treatment of leukemia and lymphoma in adult patients; acute leukemia in children; hypercalcemia in patients suffering malignant tumors, if impossible oral treatment;
Severe infectious diseases (in combination with antibiotics);
Cerebral edema (with a tumor, cranial and brain injury, neurosurgelic intervention, hemorrhage, encephalitis, meningitis, radiation lesion);
Systemic diseases of the connective tissue;
Asthmatic status; Heavy bronchospasm (exacerbation bronchial asthma, chronic obstructive bronchitis).

For what appoints Tablets Dexamethasone

Under hypothyroidism (condition with a disqual deficiency of thyroid hormones);
With rheumatoid arthritis in the exacerbation phase;
With congenital adrenogenital syndrome (hyperfunction of adrenal cortex and increased content Androgen in the body);
In the illness of Addison-Burmer (loss of adrenalities of the ability to produce hormones in sufficient quantity);
With pemphigus (skin disease, manifested in the form of bubbles in hand, genitalia, mouth, etc.);
With acute and subacute thyroidity (inflammation of the thyroid gland);
With acute erythrodermia (redness of the skin);
With progressive ophthalmopathy (increase in the volume of eye tissues) associated with thyrotoxicosis (intoxication of thyroid hormones);
With acute eczema;
For diseases of the connective tissue;
With malignant tumors (symptomatic therapy);
With autoimmune hemolytic anemia;
Under the edema of the brain;
In agranulocytosis (reducing the level of neutrophils in the blood);
With bronchial asthma;
Under serum disease (immune response to alien sera proteins).

For what the drops of dexamethasone are prescribed

With scarpets (inflammation of the deep layers of the eye sclera);
With keratitis (inflammation of the cornea of \u200b\u200bthe eye);
With sympathetic ophthalmia (inflammatory eye lesions);
With unmarried and allergic conjunctivitis (inflammation of the mucous membrane of the eye);
With iris (inflammation of the iris eye);
With bluffy (inflammation of the edges of the age);
With inflammatory processes after injuries of the eye or operations;
With iridocyclite (inflammation of the iris and ciliary body);
With episclerite (inflammation of the connective tissue between the conjunctiva and scler);
When keratoconjunctivitis (simultaneous inflammation of the conjunctivations and cornea of \u200b\u200bthe eye) without damage to the epithelium.

What is prescribed injections in ampoules dexamethasone

With acute hemolytic anemia;
With acute insufficiency of adrenal cortex;
With asthmatic status;
Under acute lymphoblastic leukemia (malignant disease, affecting the bone marrow, spleen, lymph nodes, forklock gland and other organs). Dexamethasone instructions for use;
Under the edema of the brain;
With severe infectious diseases;
With a shock of different genes;
For diseases of the joints;
During thrombocytopenia;
With severe allergic reactions;
With acute croup (inflammation of the larynx and the top respiratory tract);
With agranulicitosis.

Contraindications

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

In children during the growth period, GCS should be applied only in absolute indications and under particularly thorough observation of the attending physician.

Carefully The drug should be prescribed under the following diseases and states:

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. Dexamethasone instructions for use.

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, furosemide, etcrinic acid, carboanhydrase inhibitors, amphotericin B 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.

Method of application and dose

Designed for intravenous, intramuscular, 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 for a / in drip infusion, an isotonic solution of sodium chloride or a 5% dextrose solution 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 single 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. Children - in / m in a dose of 0.02776-0.16665 mg / kg every 12-24 hours.

Soft fabrics: from 2 to 6 mg;
Large joints (for example, knee joint): from 2 to 4 mg;
Articular bags: from 2 to 3 mg;
Small joints (for example, interphalating, temporal joints): from 0.8 to 1 mg;
Nervous ganglia: from 1 to 2 mg;
Tendons: from 0.4 to 1 mg.

The drug is prescribed again with an interval from 3 days to 3 weeks as needed; maximum dose For adults - 80 mg per day. With a shock, adults - in / in 20 mg once, then according to 3 mg / kg for 24 hours in the form of a continuous infusion or to / in one-time 2-6 mg / kg, or in / in 40 mg each 2- 6 o'clock.

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. In case of insufficiency of the adrenal corthes (children) in terms of 0.0233 mg / kg (0.67 / mg / m2) per day in 3 injections every third 24 hours, or daily at 0.00776-0.01165 mg / kg ( 0.233- 0.335 mg / m2) per day.

With acute allergic reaction or exacerbation of chronic allergic disease, dexamethasone must be assigned to the following graph, taking into account the combination of parenteral and oral application: Dexamethasone Instructions for use The injection solution 4 mg / ml: 1 day, 1 or 2 ml (4 or 8 mg) intramuscularly; Dexamethasone Tablets 0.75 mg: second and third days, 4 pieces in 2 receptions per day, fourth - 2 pieces in 2 reception, fifth and sixth days - 1 pcs. Daily, on the seventh - without treatment, 8 day-observation.

Side effects

Usually dexamethasone instructions for use are well tolerated. It has low mineralocorticoid activity, i.e. His influence on water-electrolyte exchange Nightly. As a rule, low and medium doses of dexamethasone do not cause sodium delays and water in the body, an increased excretion of potassium.

The following side effects are described:

From the sides of the senses: the rear subcapsular cataract, an increase in intraocular pressure with possible damage to the optic nerve, a tendency to the development of secondary bacterial, fungal or viral infections, trophic changes of the cornea, exophthalm, sudden loss of vision (with parenteral administration in the head, neck, nasal Shells, scalp skin is possible deposition of drug crystals in eye vessels);
From the side of the skin and mucous membranes: slow down healing of wounds, petechia, ekkimosis, thinning of skin, hyper- or hypopigmentation, steroid eels, strry, tendency to the development of pyodermia and candidiasis;
From side endocrine system: Reducing glucose tolerance, steroid diabetes mellitus or manifestation of latent diabetes mellitus, oppression of adrenal functions, Izsenko-Cushing syndrome (moon-shaped face, hypophized obesity, hirsutism, enhancement of blood pressure, dysmenorrhea, amenorrhea, muscle weakness, strry), penal delay in children;
From the metabolism: increased elimination of calcium, hypocalcemia, increasing body weight, negative nitrogen balance (increased protein decay), strong sweating. Conditioned by mineralocorticoid activity - fluid delay and sodium (peripheral edema), plasternatrhythmia, hypocalaminessindrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue);
On the side of the musculoskeletal system: slowdown in the growth and processes of ossification in children (premature closure of epiphyseal growth zones), osteoporosis (very rarely - pathological fractures of bones, aseptic necrosis heads of the brachial and femur), tenders of muscle tendons, steroid myopathy, reduced muscle mass (atrophy). Dexamethasone instructions for use;
From the side of the cardiovascular system: arrhythmia, bradycardia (up to a heart stop); Development (in predisposed patients) or strengthening the severity of heart failure, changes on the electrocardiogram characteristic of hypokalemia, an increase in blood pressure, hypercoagulation, thrombosis. In patients with sharp and subacted myocardial infarction - the spread of the focus of necrosis, slowing down the formation of scar tissue, which can lead to a rupture of the heart muscle;
On the part of the digestive system: nausea, vomiting, pancreatitis, steroid ulcer of the stomach and duodenum, erosive esophagitis, gastrointestinal bleeding and perforation of the gastrointestinal tract, increase or decrease the appetite, digestion disruption, flatulence, ICOT. In rare cases - an increase in the activity of hepatic transaminases and alkaline phosphatase;
From side nervous system: Delia, disorientation, euphoria, hallucinations, manico-depressive psychosis, depression, paranoia, increase in intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, pseudogo cerebellum, headache, cramps.

Allergic reactions: Skin rash, itching, anaphylactic shock, local allergic reactions.

Local with parenteral administration: burning, numbness, pain, tingling and infection at the injection site, rarely - necrosis of the surrounding tissues, the formation of scars; Atrophy of the skin and subcutaneous tissue at a per / m administration (it is especially dangerous to prick in the deltoid muscle).

Others: Development or aggravation of infections (the appearance of this by-effect The jointly used immunosuppressants and vaccination), leukocyturia, "rings" of blood to the face, "Cancellation" syndrome are promoted.

Price of dexametazone drug

Dexamethasone, Tablets 0.5 mg, 10 pcs. - 45 rubles;
Dexamethasone, eye drops 0.1%, 5 ml - 34 rubles;
Dexamethasone, ampoules 4 mg, 1 ml, 25 pcs. - 202 rubles;
Dexamethasone PR for injection 4 mg / ml 1 ml ampoule, 25 pcs. 144 rub.;
Dexamethasone Eye drops, 10 ml - 82 rubles.

special instructions

With caution should be used in acute and subacute myocardial infarction - it is possible to spread the focus of necrosis, slowing the formation of scar tissue and the gap of the heart muscle;
During treatment with dexamethasone, vaccination should not be carried out in connection with the decline in its effectiveness (immune response).
Assigning dexamethasone at interpurrente infections, septic conditions and tuberculosis, it is necessary to simultaneously carry out antibiotics of bactericidal action;
In patients with latent infectious diseases of the kidneys and urinary tract Dexamethasone is able to cause leukocyturia, which may be diagnostic;
With a sudden cancellation, especially in the case of the previous use of high doses, the development of "Cancellation" syndrome (anorexia, nausea, inhibition, generalized muscular-skeletal pain, general weakness), as well as the aggravation of the disease, was appointed dexamethane;
During treatment with dexamethasone (especially long), observation of the eyepiece, control of the blood pressure and state of the water and electrolyte balance, as well as the pattern of peripheral blood and blood glucose levels are necessary;
In children during long-term treatment, dexamethasone needs careful monitoring of growth and development dynamics. Children, which during the treatment period were in contact with sick cute or chickenpasses, prophylactically prescribe specific immunoglobulins.
Due to a weak mineralocorticoid effect for replacement therapy in adrenal insufficiency, dexamethasone is used in combination with mineralocorticoids;
Dexamethasone increases the content of metabolites of 11- and 17-oxytocorticosteroids;
In order to reduce side phenomena Antacids can be prescribed, and also should be increased admission to + to the body (diet, potassium preparations). Food should be rich in proteins, vitamins, with limiting the content of fats, carbohydrates and table salt;
In patients with diabetes mellitus, the content of blood glucose should be monitored and corrected therapy if necessary.
X-ray control over the bone-articular system (spinal shots, brushes) are shown;
The effect of the drug is enhanced in patients with hypothyroidism and cirrhosis of the liver. The drug can strengthen existing emotional instability or psychotic disorders. When specifying psychosis, a history of dexamethasone in high doses is prescribed under the strict control of the doctor;
In stressful situations during supportive treatment (for example, surgical operations, injury or infectious diseases), a dose correction should be corrected due to the increase in glucocorticosteroid need. It should be carefully observed for patients during the year after the end of long-term therapy with dexamethasone due to the possible development of the relative failure of the adrenal cortex in stressful situations. Dexamethasone instructions for use.

Video Review DEXAMETHASONE (DexameThasone)

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GKS for injection

Active substance

Dexamethasone phosphate (in shape sodium salt) (DexameThasone)

Release form, composition and packaging

Injection Transparent, colorless or pale yellow.

Auxiliary substances: methylparaben, propylparaben, sodium metabisulfite, Dinatari Edetat, sodium hydroxide, water d / and.

2 ml - dark glass ampoules (25) - cardboard boxes.
2 ml - dark glass vials (25) - cardboard boxes.

pharmachologic effect

Synthetic glucocorticoid (GKS), methylated fluoroprednisolone derivative. It has an anti-inflammatory, immunosuppressive effect, increases the sensitivity of beta-adrenoreceptors to endogenous catecholaminam.

Interact with specific cytoplasmic receptors (receptors for GCS are in all tissues, especially there are many of them in the liver) with the formation of a complex inducing proteins (including enzymes that regulate vital processes in cells.)

Protein exchange: Reduces the number of globulins B, increases the synthesis of albumin on the liver and kidney (with an increase in albumin / globulin coefficient), reduces the synthesis and enhances the catabolism of the protein in muscle tissue.

Lipid exchange: increases the synthesis of higher fatty acids and triglycerides, redistribute fat (the accumulation of fat occurs mainly in the field of shoulder belt, facial, abdomen), leads to the development of hypercholesterolemia.

Carbohydrate: Increases carbohydrate absorption from the gastrointestinal tract; increases the activity of glucose-6-phosphatase (increasing the flow from the liver into blood); Increases the activity of phosphoenolpiruwatkarboxylase and the synthesis of aminotransferase (activation of gluconeogenesis); Promotes the development of hyperglycemia.

Water-electrolyte exchange: delays Na + and water in the body, stimulates the removal of K + (mineralocorticoid activity), reduces the absorption of Ca + from the gastrointestinal tract, reduces the mineralization of bone tissue.

The anti-inflammatory effect is associated with the oppression of release of eosinophils and fat cells of inflammation mediators; induction of lipocortion formation and reducing the number of fat cells producing hyaluronic acid; with a decrease in permeability of capillaries; Stabilization of cell membranes (especially lysosomal) and organelle membranes. Acts on all stages of the inflammatory process: inhibits the synthesis of prostaglandins (PG) at the level of arachidonic acid (lipocortine inhibits phospholipase A2, suppresses the liberation of arachidonic acid and inhibits the biosynthesis of endoperosis, leukotrienes, contributing to the processes of inflammation, allergies, etc.), synthesis of "pro-inflammatory cytokines" ( Interleukin 1, factor of necrosis of the Alpha tumor, etc.); Increases the stability of the cell membrane to the action of various damaging factors.

The immunosuppressive effect is due to the resulting lymphoid tissue involution, the inhibition of lymphocyte proliferation (especially T-lymphocytes), suppressing the migration of B cells and the interaction of T- and limfocytes, the braking of the release of cytokines (interleukin-1, 2; gamma interferon) from lymphocytes and macrophages and a decrease in antibody formation.

The antiallergic effect develops as a result of a decrease in the synthesis and secretion of allergy mediators, inhibition of release of the release of sensitized fat cells and basophils of histamine and other biologically active substances, reducing the number of circulating basophils, t- and deformphocytes, fat cells; suppressing the development of lymphoid and connective tissue, reducing the sensitivity of effector cells to allergy mediators, inhibition of antibody formation, changes in the immune response of the body.

With obstructive diseases of the respiratory tract, the action is due mainly to the braking of inflammatory processes, the prevention or decrease in the severity of edema of mucous membranes, a decrease in the eosinophilic infiltration of the submembrance layer of the epithelium of the bronchi and sediments in the mucous membranes of the circulating immune complexes, as well as the braking of erosion and deskvamation of the mucous membrane. Increases the sensitivity of beta-adrenoreceptors of bronchi small and medium caliber to endogenous catecholamps and exogenous sympathomimetics, reduces the viscosity of the mucus by reducing its products.

Suppresses the synthesis and secretion of ACTH 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 almost complete absence of mineralocorticosteroid activity.

Doses 1-1.5 mg / day depress the function of the adrenal cortex; The biological half-life - 32-72 h (the duration of the oppression of the hypothalamus-pituitary-hypophy-cortical substance of the adrenal glands).

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

Pharmacokinetics

Blood binds (60-70%) with a specific protein-transceiver - transcertine. Easily passes through histohematic barriers (including through hematophephalic and placental).

Metabolized in the liver (mainly by conjugation with glucuronic and sulfuric acids) to inactive metabolites.

Excreted by kidneys (small part - lactating glands). T 1/2 dexamethasone from plasma - 3-5 h.

Indications

Diseases requiring the introduction of high-speed GCS, as well as cases where oral administration is impossible:

- endocrine diseases: acute insufficiency of adrenal cortex, primary or secondary insufficiency of adrenal cortex, congenital hyperplasia of adrenal cortex, subacute thyroiditis;

- shock (burn, traumatic, operational, toxic) - with the ineffectiveness of vasoconstrictor means, plasma-substituting drugs and other symptomatic therapy;

- edema of the brain (with a brain tumor, cranial and brain injury, neurosurgical intervention, hemorrhage in the brain, encephalitis, meningitis, radiation lesion);

- asthmatic status; Heavy bronchospasm (aggravation of bronchial asthma, chronic obstructive bronchitis);

- severe allergic reactions, anaphylactic shock;

- rheumatic diseases;

- systemic connecting tissue diseases;

- sharp heavy dermatoses;

- malignant diseases: palliative treatment of leukemia and lymphoma in adult patients; acute leukemia in children; hypercalcemia in patients suffering from malignant tumors, with impossibility of oral treatment;

- blood diseases: acute hemolytic anemia, agranulocytosis, idiopathic thrombocytopenic purpura in adults;

- severe infectious diseases (in combination with antibiotics);

- in ophthalmologic practice (subconjunctive, retrobulbar or parabulbar administration): allergic conjunctivitis, keratitis, keratoconjunctivitis without damage to the epithelium, irrit, iridocyclite, blepharitis, blepharoconjunctivitis, scarce, episclerite, inflammatory process after eye injury and surgery, sympathetic ophthalmia, immunosuppressive treatment after corneal transplantation;

- Local use (in the area of \u200b\u200bpathological education): keloids, discoomed red lupus, ring-shaped granuloma.

Contraindications

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

FROM caution The drug should be prescribed under the following diseases and states:

- Diseases of the tract - ulcerative ulcer of the stomach and duodenum, esophagitis, gastritis, acute or latent peptic ulcer, recently created intestinal anastomosis, nonspecific ulcerative colitis with a threat of perforation or abscess, diverticulitis;

- pre- and post accuming period (8 weeks before and 2 weeks after vaccination), lymphadenitis after the BCG vaccination;

- immunodeficiency states (including AIDS or HIV infection);

- diseases of the cardiovascular system (incl. Recently suffered myocardial infarction - in patients with acute and subacted myocardial infarction possible, the focus of necrosis is possible, slowing down the formation of scar tissue and, as a result, is the gap of the heart muscle), severe chronic heart failure, arterial hypertension, hyperlipidemia);

- endocrine diseases - diabetes mellitus (including violation of the tolerance for carbohydrates), thyrotoxicosis, hypothyroidism, the disease of Izeno-Custine, obesity (III-IV Art.)

- severe chronic renal and / or liver failure, nephrowolithiasis;

- hypoalbuminemia and states predisposing to its occurrence;

- systemic osteoporosis, Miasthenia gravis, acute psychosis, poliomyelitis (except for the shape of the bulbar encephalitis), open and closed-coronal glaucoma;

- Pregnancy.

Dosage

Dosing mode is individual and depends on the indications, the state of the patient and its reaction to therapy. The drug is introduced into / in slowly inkjet or drip (with acute and urgent states); per / m; Local (in pathological education) is also possible. In order to prepare a solution for in / in drip infusion, an isotonic solution should be used or a 5% dextrose solution.

In the acute period various diseases And at the beginning of therapy, dexamethasone is used in higher doses. During the day, you can enter from 4 to 20 mg of dexamethasone 3-4 times.

Dose drug for children (in / m):

The dose of the drug during substitution therapy (in case of insufficiency of the adrenal cortex) is 0.0233 mg / kg of body weight or 0.67 mg / m 2 of the body surface area, divided by 3 doses, every 3rd day or 0.00776 - 0.01165 mg / kg body weight or 0.233 - 0.335 mg / m 2 body surface area daily. With other indications, the recommended dose is from 0.02776 to 0.16665 mg / kg of body weight or 0.833 - 5 mg / m 2 of the body surface area every 12-24 hours.

When the effect is reached, the dose is reduced to supporting or before discontinuation. The duration of parenteral use is usually 3-4 days, then go to the supporting therapy with dexamethasone in tablets.

The long-term use of high doses of the drug requires a gradual reduction in the dose in order to prevent the development of acute insufficiency of adrenal cortex.

Side effects

Usually dexamethasone is well tolerated. It has low mineralocorticoid activity, i.e. Its influence on water-electrolyte exchange is small. As a rule, low and medium doses of dexamethasone do not cause sodium delays and water in the body, an increased excretion of potassium. The following side effects are described:

From the endocrine system:reducing glucose tolerance, steroid diabetes or manifestation of latent diabetes mellitus, inhibition of adrenal functions, Izsenko-Cushing syndrome (moon-like face, hypophized type obesity, girsutism, enhancement of blood pressure, dysmenorrhea, amenorrhea, muscle weakness, strry), latency of sexual development Children.

From the digestive system:nausea, vomiting, pancreatitis, steroid ulcer of the stomach and duodenum, erosive esophagitis, gastrointestinal bleeding and perforation of the walls of the gastrointestinal tract, an increase or decrease in appetite, disruption of digestion, flatulence, ICOT. In rare cases - an increase in the activity of hepatic transaminases and alkaline phosphatase.

From the side of the cardiovascular system:arrhythmias, bradycardia (up to a heart stop); Development (in predisposed patients) or strengthening the severity of heart failure, changes on the electrocardiogram characteristic of hypokalemia, an increase in blood pressure, hypercoagulation, thrombosis. In patients with acute and subacted myocardial infarction - the spread of the focus of necrosis, slowing down the formation of scar tissue, which can lead to the rupture of the heart muscle.

From the nervous system:delium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increasing intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, pseudogo cerebellum, headache, convulsions.

From the senses:rear subcapsular cataract, an increase in intraocular pressure with possible damage to the optic nerve, a tendency to the development of secondary bacterial, fungal or viral eye infections, trophic changes of the cornea, exophthalm, sudden loss of vision (with parenteral administration in the head, neck, nasal shells, the skin of the head is possible Deposition of drug crystals in eye vessels).

From the metabolism:increased excretion of calcium, hypocalcemia, body weight increase, negative nitrate balance (increased protein decay), increased sweating.

Conditioned mineralocorticoid activity- Liquid delay and sodium (peripheral edema), plasternatrhythmia, hypocalaminessindrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue).

From the musculoskeletal system:the slowdown in the growth and processes of ossification in children (premature closure of epiphyseal growth zones), osteoporosis (very rarely pathological fractures of bones, aseptic necrosis of the head of the shoulder and femur), the gap of the muscle tendons, steroid myopathy, a decrease in muscle mass (atrophy).

From the side of the skin and mucous membranes:slowed healing of wounds, petechia, ekkimosis, skin thinning, hyper- or hypopigmentation, steroid eels, strry, tendency to the development of pyodermia and candidiasis.

Allergic reactions:skin rash, itching, anaphylactic shock, local allergic reactions.

Local with parenteral administration:burning, numbness, pain, tingling at the place of administration, infection at the injection site, rarely - necrosis of the surrounding tissues, the formation of scars at the injection site; Atrophy of the skin and subcutaneous tissue at a per / m administration (the introduction into the deltoid muscle is especially dangerous).

Others:the development or aggravation of infections (jointly used immunosuppressants and vaccination and vaccination), leukocyturia, "tides" of blood to the face, "cancellation" syndrome contribute to the appearance of this side effect.

Overdose

It is possible to strengthen the side phenomena described above.

It is necessary to reduce the dose of dexamethasone. Treatment is symptomatic.

Medicinal interaction

Pharmaceutical incompatibility of dexamethasone with others in / in the injected drugs is possible - it is recommended to be administered separately from other drugs (in / in bolus, or through Dr. dropper, as a second solution). When mixing a solution of dexamethasone, a sediment is formed with heparin.

Simultaneous purpose of dexamethasone C:

- Inductors of hepatic microsomal enzymes(phenobarbital, rifampicin, phenytoin, theophylline, ephedrine) leads to a decrease in its concentration;

— diuretics(especially tiazide and carboanhydrase inhibitors) and amphotericin in - It may lead to an increase in the elimination of the K + organism and an increase in the risk of developing heart failure;

— with sodium-containing drugs- to the development of edema and an increase in blood pressure;

— cardiac glycosides -their portability deteriorates and the likelihood of the development of ventricular extrasytoly increases (due to the caused hypokalemia);

— indirect anticoaguppy- weakens (less often enhanced) their action (dose correction is required);

— anticoagulants and thrombolitics -rises the risk of developing bleeding from ulcers in the gastrointestinal tract;

— ethanol and npvp - the risk of erosive-ulcer lesions in the gastrointestinal tract and the development of bleeding is increasing (in combination with NSAIDs in the treatment of arthritis it is possible to reduce the dose of glucocorticosteroids due to the summation of the therapeutic effect);

— paracetamol- the risk of hepatotoxicity is increasing (induction of hepatic enzymes and the formation of toxic paracetamol metabolite);

— - accelerates its elimination and reduces blood concentration (when dexamethasone cancels, the level of salicylates in the blood increases and the risk of developing side effects) is increasing);

— insulin and oral hypoglycemic drugs, hypotensive means -their effectiveness decreases;

— vitamin D -it decreases its effect on the suction of CA 2+ in the intestine;

— somatotropic hormone -reduces the effectiveness of the latter, and with praziquantel -its concentration;

— M-cholinoblocators(including antihistamines and tricyclic antidepressants) and nitrates -contributes to an increase in intraocular pressure;

— isoniazid and Mexylethine- increases their metabolism (especially in "slow" acetylastors), which leads to a decrease in their plasma concentrations.

Carboangeerase and "loop" diuretics inhibitors can increase the risk of osteoporosis.

Indomethacin, ousting dexamethasone due to albumin, increases the risk of developing its side effects.

ACTH enhances dexamethasone action.

Ergocalciferol and pararathgamon prevent the development of osteopathy caused by dexamethasone.

Cyclosporine and ketoconazole, slowing down dexamethasone metabolism, can in some cases increase its toxicity.

The simultaneous purpose of androgens and steroidal anabolic preparations with dexamethasone contributes to the development of peripheral edema and girsutism, the appearance of acne.

Estrogens and oral estrogen-containing contraceptives reduce dexamethasone clearance, which can be accompanied by an increase in the severity of its action.

Mitanka and other inhibitors of the adrenal cortex functions can determine the need to increase the dose of dexamethasone.

With simultaneous use with alive antiviral vaccines and against the background of other types of immunization increases the risk of activating viruses and the development of infections.

Antipsychotic means (neuroleptics) and azathioprine increase the risk of cataracts when appointing dexamethasone.

With simultaneous use with antihydride preparations, decreases, and with thyroid hormones - the clearance of dexamethasone increases.

special instructions

During treatment with dexamethasone (especially long), observation of the eyepiece, control of the blood pressure and state of the water and electrolyte balance, as well as the pattern of peripheral blood and blood glucose levels is necessary.

In order to reduce side effects, antacids can be prescribed, and also to increase the admission to + in the body (diet, potassium preparations). Food should be rich in squirrels, vitamins, with limiting the content of fats, carbohydrates and cooking salts.

The effect of the drug is enhanced in patients with hypothyroidism and cirrhosis of the liver. The drug can strengthen existing emotional instability or psychotic disorders. When specifying psychosis, a history of dexamethasone in high doses is prescribed under the strict control of the doctor.

With caution, it should be used in acute and subacted myocardial infarction - it is possible to spread the focus of necrosis, slowing down the formation of scar tissue and the gap of the heart muscle.

In stressful situations during supportive treatment (for example, surgical operations, injury or infectious diseases), a dose correction should be corrected due to the increase in glucocorticosteroid need. It should be carefully observed for patients during the year after the end of long-term therapy with dexamethasone due to the possible development of the relative failure of the adrenal cortex in stressful situations.

With a sudden cancellation, especially in the case of the preceding use of high doses, the development of the "Cancellation" syndrome (anorexia, nausea, inhibition, generalized muscular-skeletal pain, general weakness), as well as the aggravation of the disease, was assigned to the dexamethasone.

During treatment with dexamethasone, vaccination should not be carried out in connection with the decline in its effectiveness (immune response).

Assigning dexamethasone at intercurrent infections, septic conditions and tuberculosis, it is necessary to simultaneously carry out antibiotics of bactericidal action.

In children during long-term treatment, dexamethasone needs careful monitoring of growth and development dynamics. Children, which during the treatment period were in contact with sick cute or chickenpasses, prophylactically prescribe specific immunoglobulins.

Due to the weak mineralocorticoid effect for substitution therapy with adrenal insufficiency, dexamethasone is used in combination with mineralocorticoids.

In patients with diabetes mellitus, the content of blood glucose should be monitored and corrected therapy if necessary.

X-ray control over the bone-articular system (spinal shots, brushes) are shown.

In patients with latent infectious diseases of the kidneys and urinary tract, dexamethasone is able to cause leukocyturia, which may have a diagnostic value.

Dexamethasone increases the content of metabolites of 11- and 17-oxytocorticosteroids.

Pregnancy and lactation

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

If it is necessary to carry out treatment with a drug during breastfeeding, then breastfeeding should be stopped.

Childcare

In children during the growth period, GCS should be applied only in absolute indications and under particularly thorough observation of the attending physician.