This medicine is a corticosteroid used to treat swelling in a number of different disorders such as arthritis, bursitis, or tendonitis.
Synthetic GCS in the molecule which includes a fluorine atom. Has a marked anti-inflammatory, antiallergic and desensitizing effect, and antishock and anti-toxic effect, has immunosuppressive activity. Slight delays sodium and water in the body. These effects are associated with inhibition of eosinophils release inflammatory mediators, induction, education lipokortinov and reduce the number of mast cells that produce hyaluronic acid, a decrease in capillary permeability, stabilization of cell membranes (especially the lysosomal) membranes and organelles. Immunosuppressive effect is caused by inhibition of the release of cytokines (interleukin 1,2, gamma-interferon) of lymphocytes and macrophages. The main influence on the metabolism associated with protein catabolism, increased gluconeogenesis in the liver and decreased glucose utilization by peripheral tissues.
The drug inhibits the activity of vitamin D, which leads to a decrease in calcium absorption and increase its excretion. Dexamethasone inhibits the synthesis and secretion of ACTH and the second - the synthesis of endogenous steroids. A special feature of the drug is a significant inhibition of pituitary function and the complete lack of mineralocorticoid activity.
For oral administration. Biermer's disease. Acute and subacute thyroiditis, hypothyroidism, progressive ophthalmopathy associated with thyrotoxicosis. Bronchial asthma, rheumatoid arthritis exacerbation, UC, connective tissue disorders. Autoimmune hemolytic anemia, thrombocytopenia, aplasia and hypoplasia of hemopoiesis, agranulocytosis, serum sickness. Acute erythroderma, pemphigus (normal), acute eczema (at the beginning of treatment). Malignant tumors (as a palliative therapy). Congenital adrenogenital syndrome. Swelling of the brain (usually after a preliminary parenteral GCS).
For parenteral administration. The shock of various origins. Swelling of the brain (with brain tumors, craniocerebral trauma, neurosurgical intervention, brain hemorrhage, encephalitis, meningitis, radiation injury). Asthmatic status. Severe allergic reactions: Quincke's edema, bronchospasm, dermatitis, acute anaphylactic reaction to medication, transfusion of serum and antibiotics, pyrogenic reactions. Acute hemolytic anemia, thrombocytopenia, acute lymphoblastic leukemia, agranulocytosis. Severe infections (in combination with antibiotics), acute adrenal insufficiency. Acute infections in children (acute croup, etc.). Joint diseases (humeroscapular periarthritis, epicondylitis, styloiditis, bursitis, abscess, compression neuropathy, low back pain, arthritis of different etiologies, osteoarthritis).
For ophthalmology. Negnoyny and allergic conjunctivitis, keratitis, keratoconjunctivitis without damage to the epithelium, iritis, iridocyclitis, blefarokonyunktivit, blepharitis, episcleritis, scleritis, inflammatory process after trauma eye and surgical interventions, sympathetic ophthalmia.
Solo. Inside severe disease at the beginning of treatment prescribed to 10-15 mg of the drug in the day, maintenance dose may be 2 - 4.5 mg or more per day. The average daily dose of 2-3 mg divided into 2-3 reception. In the treatment of small doses of medication prescribed once in the morning.
When parenteral application of a drug is introduced into / in the slow jet or drip (acute and urgent situations) in / m, possibly also periarticular and intraarticular injection. During the day, you can enter from 4 to 20 mg of dexamethasone 3-4. Duration of parenteral use is usually 3-4 days, then move on to maintenance therapy of oral forms of the drug. In the acute period in various diseases and early treatment of the drug is used in higher doses. When the effect of decreasing the dosage every few days until a maintenance dose or to stop treatment.
For ophthalmology. In acute conditions instilled into the conjunctival sac of 1-2 drops every 1-2 hours, then, with a decrease in inflammation after every 4-6 h. In the remaining cases - 1-2 drops 3-4 times a day. The duration of treatment ranging from 1-2 days to several weeks depending on the clinical course of disease.
In case of brief therapy: possible nausea, vomiting, bradycardia, hypotension, collapse (especially with the rapid introduction of large doses), arrhythmias, heart failure, and the development of steroid ulcers of the stomach, decrease glucose tolerance and reduced immunity.
With long-term therapy: a syndrome Itsenko-Cushing, hyperglycemia until steroid diabetes, hyperlipoproteinaemia, hepatomegaly, erosive and ulcerative lesions gastrointestinal tract, pancreatitis, myocardial dystrophy, mood disorders, psychoses, increased intracranial pressure, dizziness, headaches, cramps. Erythema face, thinning and vulnerability of the skin, petechiae, ecchymosis, striae, cellulitis, slow wound healing, excessive sweating. Increased intraocular pressure, posterior subcapsular cataract, exophthalmos. Increased thrombosis. More frequent occurrence of infections and exacerbation of the severity of their flow. Adrenal insufficiency, especially during times of stress (in trauma, surgery, concomitant diseases).
With prolonged use of dexamethasone for ophthalmology may increase intraocular pressure. If thinning of the cornea there is a risk of perforation. Very rarely - distribution Herpes simplex.
Hypersensitivity to dexamethasone. Systemic mycoses. Infectious lesions of joints and periarticular soft tissues. Obesity III-IV degree (with the appointment of the drug inside).
For use in ophthalmology. Viral and fungal diseases of the eye, an acute form of purulent eye infection in the absence of specific therapy, diseases of the cornea, combined with defects in the epithelium, trachoma, glaucoma.
Appointing dexamethasone with intercurrent infections, septic conditions and tuberculosis, must be treated simultaneously appropriate antibiotics. With daily use for the 5 th month of treatment may develop atrophy of the adrenal cortex. The drug can mask some symptoms of infection. During treatment should not immunize.
Precautions assign patients with UC, with diverticulitis, a newly established intestinal anastomosis, gastric ulcer and duodenal ulcer, renal failure, systemic osteoporosis, myasthenia gravis, arterial hypotension. Caution is also needed in the appointment of dexamethasone in patients with severe arterial hypertension, diabetes, mental illness, glaucoma, and hypoalbuminemia. In hypothyroidism, as well as liver cirrhosis drug effect can be amplified. When the initial emotional instability or psychotic tendencies of these phenomena may be amplified. In the appointment of the drug to patients with herpes cornea should be borne in mind the possibility of perforation. In the course of treatment necessary to control intraocular pressure and condition of the cornea.
With the sudden cancellation of the drug, especially in the case of prior use of high doses of a so-called withdrawal syndrome GKS (not due gipokortitsizmom): anorexia, nausea, lethargy, generalized musculoskeletal pain, general weakness. After discontinuation of the drug for several months can be maintained relative insufficiency of the adrenal cortex. If during this period there are stressful situations, prescribe (if indicated) at the time of GCS, if necessary in conjunction with the mineralocorticoid.
During pregnancy (especially in the I trimester) and lactating prescribe the drug, taking into account the expected therapeutic effect and adverse effect on the fetus. With long-term therapy during pregnancy did not exclude the possibility of violations of fetal growth. In the case of the drug in late pregnancy there is a danger of atrophy of the adrenal cortex of the fetus, which may require replacement therapy in the newborn.
In children during long-term treatment requires careful monitoring of the dynamics of growth and development. Children who during the treatment period were in contact with measles or chickenpox prophylactic specific immunoglobulins.
When the joint application of dexamethasone with cardiac glycosides may be worsening tolerability past due to lack of potassium with diuretics - may be increased excretion of potassium, with anti-diabetic control - possible hyperkalemia; with coumarin derivatives - possibly weakening the effect of anticoagulation, with rifampicin, phenytoin, barbiturates - possibly weakening effect of dexamethasone, with hormonal contraceptives - may strengthen action of dexamethasone, with NSAIDs - may strengthen the risk of erosive-ulcerative lesions and bleeding from the gastrointestinal tract, with atsetilsalitsilatami - the level of salicylates in the blood decreases; with praziquantel - may reduce its concentration in the blood.