Dexonex 5 mg/ml
- Brand:Square Pharmaceuticals Ltd.
- Product Code: Dexonex
- Availability: In Stock
-
21.00Tk.
Indications
Allergic states: Control of severe or incapacitating allergic
conditions intractable to adequate trials of conventional treatment in asthma,
atopic dermatitis, contact dermatitis, drug hypersensitivity reactions,
perennial or seasonal allergic rhinitis and serum sickness.
Collagen disease: Like lupus erythematosus, rheumatoid
arthritis etc.
Dermatologic diseases: Bullous dermatitis herpetiformis,
exfoliative erythroderma, mycosis fungoides, pemphigus and severe erythema
multiforme (Stevens-Johnson syndrome).
Endocrine disorders: Primary or secondary adrenocortical
insufficiency, congenital adrenal hyperplasia, hypercalcemia associated with
cancer and nonsuppurative thyroiditis.
Gastrointestinal
diseases: Regional enteritis
and ulcerative colitis.
Hematologic disorders: Acquired (autoimmune) hemolytic anemia,
congenital (erythroid) hypoplastic anemia (Diamond-Blackfan anemia), idiopathic
thrombocytopenic purpura in adults and selected cases of secondary
thrombocytopenia.
Neoplastic diseases: Leukemias and lymphomas.
Nervous system: Acute exacerbations of multiple sclerosis,
cerebral edema associated with primary or metastatic brain tumor, craniotomy or
head injury.
Ophthalmic diseases: Temporal arteritis, uveitis, and ocular
inflammatory conditions unresponsive to topical corticosteroids.
Renal diseases: To induce a diuresis or remission of
proteinuria in idiopathic nephrotic syndrome or that due to lupus
erythematosus.
Respiratory diseases: Berylliosis, fulminating or disseminated
pulmonary tuberculosis when used concurrently with appropriate antituberculous
chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis.
Rheumatic disorders: As adjunctive therapy for short-term
administration (to tide the patient over an acute episode or exacerbation) in
acute gouty arthritis, acute rheumatic carditis, ankylosing spondylitis,
psoriatic arthritis, rheumatoid arthritis, including juvenile rheumatoid
arthritis (selected cases may require low-dose maintenance therapy). For the
treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus.
Miscellaneous: Diagnostic testing of adrenocortical
hyperfunction, trichinosis with neurologic or myocardial involvement,
tuberculous meningitis with subarachnoid block or impending block when used
with appropriate antituberculous chemotherapy.
Pharmacology
Dexamethasone is a
synthetic glucocorticoid which decreases inflammation by inhibiting the
migration of leukocytes and reversal of increased capillary permeability. It
suppresses normal immune response.
Dosage & Administration
In general,
glucocorticoid dosage depends on the severity of the condition and the response
of the patient. If no favourable response is noted within a couple of days,
continuation of glucocorticoid therapy is undesirable. In chronic conditions
requiring long-term therapy the lowest dosage that provides adequate, but not
necessarily complete, relief should be used.
For tablet:
- In adult patients, daily oral
dosages vary from 1 mg to 10 mg and in children from 0.03-0.20 mg/kg body
weight,according to the individual response.
- In some patients higher dosages
may be temporarily required,to control the disease. As soon as
circumstances permit,dosage should be decreased.
- For a short dexamethasone
suppression test 1 mg dexamethasone is given at 11 p.m. and plasmacortisol
measured the next morning.
- Patients who do not show a
decrease in cortisol can be exposed to a longer test: 0.5 mg dexamethasone
is given at 6-hour intervals
- for 48 hours followed by 2 mg
every 6 hours for a further 48 hours. 24-hour urine collections are made
before, during and at the end of the test for the determination of 17
alpha-hydroxycorticoids.
For injection:
- Dexamethasone can be given by
intravenous (IV), intramuscular (IM) or local injection. Dexamethasone
injections can also be diluted with an infusion fluid or be injected
directly into the infusion line.
- Intravenous injections of
massive doses should be given slowly, over a period of several minutes.
- Intramuscular administration
should be given by deep intramuscular injection,to prevent atrophy of the
subcutaneous adipose tissues.
- Intra-articular injections
should be given under strictly aseptic conditions as glucocorticoids
decrease the resistance to infection. When diluted with these infusion
fluids, Dexamethasone will keep its potency for at least 24 hours (at room
temperature and in daylight conditions). As infusion fluids, Sodium
chloride 0.9%, Anhydrous glucose 5%, Invert sugar 10%, Sorbitol 5%,
Ringer's solution, Hartman's solution (Ringer-lactate) etc.can be used.
- The dosage of Dexamethasone
depends on the severity of the condition and the response of the patient.
- For systemic therapy in adults,
daily doses of 0.05-0.20 mg/kg body weight are usually sufficient. For
emergencies (e.g. anaphylaxis, acute severe asthma, cerebral edema)
substantially higher doses are required. An initial dose of 10-20 mg IV is
followed by 6 mg IV or IM every 6 hours,until a satisfactory result has
been obtained. Thereafter the dosage has to be tapered off gradually.
For local therapy, the
following doses are recommended:
- Intra-articularly: 2-4 mg in
large and 0.8-1 mg in small joints
- Intrabursally: 2-4 mg;in tendon
sheaths:0.4-1 mg
- The frequency of these
injections may vary from every 3-5 days to every 2-3 weeks
* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন'
Interaction
- Diuretics and/or cardiac
glycosides, since potassium loss may be enhanced.This is a particular risk
in patients using cardiac glycosides; since hypokalaemia increases the
toxicity of these drugs.
- Antidiabetics, since
glucocorticoids may impair glucose tolerance, thereby increasing the need
for antidiabetic drugs.
- Non-steroidal anti-inflammatory
drugs, since the incidence and/or severity of gastro-intestinal ulceration
may increase.
- Oral anti-coagulants since
glucocorticoids may alter the need for these drugs.
- Glucocorticoids may be less
effective when used concomitantly with liver enzyme inducing drugs,such as
rifampicin, ephedrine, barbiturates, phenytoin and primidone.
- If patients undergoing
long-term therapy with glucocorticoids are concomitantly given salicylates,
any reduction in glucocorticoid dosage should be made with caution, since
salicylate intoxication has been reported in such cases.
- Antacids;especially those
containing magnesium trisilicate,have been reported to impair the
gastro-intestinal absorption of glucocorticoids. Therefore, doses of one
agent should be spaced as far as possible from the other.
Contraindications
- Gastric and duodenal ulcers.
- Systemic and ophthalmic fungal
infections.
- Viral infections, e.g.
varicella and herpes genitalis infections. Viral infections of the eye.
- Glaucoma.
- Hypersensitivity to
corticosteroids
Side Effects
The following adverse
reactions have been associated with prolonged systemic glucocorticoid therapy.
Endocrine and
metabolic disturbances:
Cushing-like syndrome, hirsutism, menstrual irregularities, premature
epiphyseal closure, secondary adrenocortical and pituitary unresponsiveness,
decreased glucose tolerance, negative nitrogen and calcium balance.
Fluid and electrolyte
disturbances: Sodium and fluid
retention, hypertension, potassium loss, hypokalaemic alkalosis.
Musculo-skeletal
effects: Myopathy, abdominal
distension, osteoporosis, aseptic necrosis of femoral and humeral heads.
Gastro-intestinal
effects: Gastric and duodenal
ulceration, perforation and haemorrhage.
Dermatological effects: Impaired wound healing, skin atrophy,
striae, petechiae and ecchymoses, bruising, facial erythema, increased
sweating, acne.
Central Nervous System
effects: Psychic disturbances
ranging from euphoria to frank psychotic manifestations,convulsions,in children
pseudotumor cerebri (benign intracranial hypertension) with vomiting and
papilloedema.
Ophthalmic effects: Glaucoma, increased intraocular pressure,
posterior subcapsular cataracts.
Immunosuppressive
effects: Increased
susceptibility to infections, decreased responsiveness to vaccination and skin
tests.
Pregnancy & Lactation
Pregnancy Category
C.There are no adequate and well-controlled studies in pregnant women.
Corticosteroids should be used during pregnancy only if the potential benefit
justifies the potential risk to the fetus. Glucocorticoids appear in breast
milk.Mothers taking high dosages of corticosteroids should be advised not to
breast-feed
Precautions & Warnings
General: The lowest possible dose of corticosteroids
should be used to control the condition under treatment.The reduction should be
gradual.
Cardio-renal: These agents should be used with caution in
patients with congestive heart failure,hypertension, or renal insufficiency.
Endocrine: Drug-induced secondary adrenocortical
insufficiency may be minimized by gradual reduction of dosage.
Gastrointestinal: Steroids should be used with caution in
active or latent peptic ulcers, diverticulitis, intestinal anastomoses, and
nonspecific ulcerative colitis, since they may increase the risk of a
perforation.
Musculoskeletal: Special consideration should be given to
patients at increased risk of osteoporosis (e.g.,postmenopausal women) before
initiating corticosteroid therapy.
Neuro-psychiatric: An acute myopathy has been observed with the
use of high doses of corticosteroids, most often occurring in patients with myasthenia
gravis or in patients receiving concomitant therapy with neuromuscular blocking
drugs (e.g., pancuronium). Psychic derangements may appear ranging from
euphoria, insomnia, mood swings, personality changes, and severe depression, to
frank psychotic manifestations.
Use in Special Populations
In order to minimize
the potential growth effects of corticosteroids, pediatric patients should be
titrated to the lowest effective dose.
Overdose Effects
Overdosage is
unlikely, however, treatment of overdosage is by supportive and symptomatic
therapy
Therapeutic Class
Glucocorticoids
Storage Conditions
Tablet: Store in a cool & dry place, protected
from light & moisture.
Injection: Store below 30° C, protected from light.Do
not freeze. Keep medicines out of the reach of children
Tags: Dexonex