Dexamethasone dosage, forms, and strengths

Dexamethasone is a glucocorticoid medication. Glucocorticoids are a group of corticosteroids (steroids) involved in the metabolism of carbohydrates, proteins, and fats. Corticosteroid therapy is primarily used to treat inflammatory and autoimmune conditions. It is also used in the management of severe allergic reactions, severe cases of nausea, cerebral and pulmonary edema, and several endocrine conditions. More recently, off-label use of dexamethasone in a clinical setting has been recommended for patients hospitalized with COVID-19.

Dexamethasone is manufactured under several brand names, which include Decadron, DexaBliss, and Dexamethasone Intensol. Dexamethasone is available in a tablet, \injection, solution, and eye drops.

RELATED: What is dexamethasone?

Dexamethasone forms and strengths

Dexamethasone is available in several formulations. 

• Tablet: 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg, 20 mg

• Solution: 0.5 mg/mL, 1 mg/mL

• Ocular solution: 0.1% 

Dexamethasone dosage for adults

The use of corticosteroids varies widely in clinical settings as there are many medical conditions that benefit from their strong anti-inflammatory properties. Healthcare professionals also use dexamethasone in clinical laboratory tests.

There is not enough clinical trial-based evidence to support a given optimal dose or duration of this medication for most conditions. Dosages and specific conditions listed are general guidelines and are based on manufacturer recommendations, actual clinical use, and expert advice. Many routine and safe uses of this medication are off-label and may not be listed here. Speak with your healthcare provider about specific dosing appropriate for your condition and baseline health status.

Other uses of dexamethasone apply, such as treatment for eye conditions, swimmer’s ear, acute asthma exacerbation, migraine, and more. Ask a healthcare professional about all possible indications.

Dexamethasone dosage for COVID-19

The National Institutes of Health (NIH) COVID-19 treatment guidelines panel recommends that the following individuals hospitalized with coronavirus infection receive dexamethasone:

• Those receiving supplemental oxygen, 

• Individuals receiving oxygen through a high-flow device, 

• Individuals receiving oxygen through non-invasive ventilation, 

• Those who are receiving intermittent mandatory ventilation (IMV), OR

• Extracorporeal membrane oxygenation (ECMO). 

The panel recommends against the use of dexamethasone in individuals with coronavirus infection who are not hospitalized OR who are hospitalized but do not require supplemental oxygen. These recommendations are made regardless of an individual’s vaccination status.

For some infections and in some circumstances, dexamethasone reduces lung inflammation. A review of how dexamethasone works in coronavirus infection can be found here. 

Data supporting the use of dexamethasone in the treatment of COVID-19 are continually emerging. As of the published date of this article, current guidance recommends a 6 mg daily dose of dexamethasone for up to 10 days. With any recommendation, it is important to use informed decision-making with your healthcare provider when determining which medications are appropriate for your condition. 

Dexamethasone dosage for adrenal insufficiency 

Adrenal insufficiency is a condition where the adrenal glands do not make enough of certain hormones. Adrenal insufficiency can be caused by several mechanisms:

• Suddenly stopping corticosteroids after taking them for a long time

• Addison’s disease, a condition where the immune system attacks the adrenal glands

• Tumors or disorders of the pituitary gland

Treatment depends on the reason why adrenal insufficiency occurred, but usually involves the replacement of the deficient hormones. A combination of corticosteroid replacement may be required.

• Dexamethasone for adrenal insufficiency: Determined by healthcare provider 

Dexamethasone dosage for multiple myeloma 

Multiple myeloma is a cancer of an immune system cell called a plasma cell. When plasma cells grow out of control, they create an abnormal protein called M protein. While the exact mechanism is unknown, dexamethasone causes apoptosis (programmed cell death) of plasma cells with mutant glucocorticoid receptors.

Dexamethasone is given as part of a chemotherapy regimen for multiple myeloma treatment. 

• Dexamethasone for multiple myeloma: 20-40 mg per cycle

Dexamethasone dosage for chemotherapy-associated nausea and vomiting 

Chemotherapy and radiotherapy can cause severe nausea and vomiting. These therapies can activate trigger and reflex centers for nausea in the brain, esophagus, stomach, and intestines. The antiemetic effects of dexamethasone work through multiple pathways that cause nausea.

• Dexamethasone for chemotherapy-associated nausea and vomiting: 4 mg daily or 8-12 mg on the day chemotherapy is received

Dexamethasone dosage for altitude sickness

When individuals travel from areas of low altitude to very high altitude (over 10,000 feet above sea level), they may experience headaches, nausea, vomiting, or shortness of breath from the reduced oxygen. In severe cases, the abrupt change in altitude can lead to cerebral or pulmonary edema. In these cases, dexamethasone can quickly reduce the pressure and alleviate symptoms. 

• Dexamethasone to treat altitude sickness: 4 mg dose taken every 6 hours

• Dexamethasone to prevent altitude sickness: 2 mg every 6 hours or 4 mg every 12 hours beginning on the day of ascent

Dexamethasone dosage for laboratory testing for Cushing’s syndrome 

Cushing’s syndrome is a condition where the body makes too much of the hormone cortisol. This can occur from taking steroids over a long period of time or from the adrenal glands secreting more cortisol than is needed. A dexamethasone suppression test is used to diagnose Cushing’s syndrome.

• Dexamethasone suppression test: 1 mg dose of dexamethasone is administered at bedtime, cortisol levels are checked the following morning

Dexamethasone dosage for children

Dexamethasone has several pediatric uses, including the treatment of croup, bronchopulmonary dysplasia, adrenal insufficiency, and hospitalized patients with COVID-19 who require oxygen. It is typically given by tablet or in solution form, with dosing based on the condition it is being used to treat.

Dexamethasone dosage restrictions

For certain individuals, the benefits of treatment with corticosteroids do not outweigh the adverse effects associated with their use. In these individuals, dexamethasone should be avoided.

Women who are pregnant or breastfeeding 

Caution is advised in the first trimester of pregnancy or if dexamethasone is taken for a long time. The risks and benefits for breastfeeding mothers should be discussed with a healthcare provider, as there is no human data available to assess the risk to the infant or on breast milk production. Safer alternatives may be available.

Systemic fungal infections

Dexamethasone is contraindicated for use in individuals with systemic fungal infections. Corticosteroids increase the risk of infection.

Cerebral malaria 

Corticosteroids should not be used in cerebral malaria. Dexamethasone may reduce the ability to clear the infection.

Ocular HSV

Ophthalmic corticosteroids should not be used to treat ocular herpes simplex keratitis as they can prolong the course of the disease. 

Dexamethasone dosage for pets

Dexamethasone is used to treat and reduce pain from a variety of conditions in dogs including:

• Allergies and autoimmune conditions 

• Colitis and the gastrointestinal disorders 

• Liver, kidney, blood, respiratory, and nervous system conditions 

• Tumors

For most conditions, 0.1-3 mg per pound of the dog’s body weight is given two to three times per day.

Corticosteroids are generally not used in cats as they can cause hyperglycemia (elevated blood glucose) and diabetes.

How to take dexamethasone

Corticosteroid use is associated with serious side effects. It is important to take dexamethasone exactly as prescribed.

• It is important to follow all medical advice while taking this medication. Read and follow all patient instructions that come with this medication. 

• This medication should be taken on exactly the days and/or times it is recommended.

• This medication should not be used for longer than is prescribed. 

• Taking this medication with a small meal or snack may help reduce short-term side effects. It is ok to crush this medication and mix it into the food you are eating.

• Store this medication in a closed container at room temperature, away from heat, moisture, and direct light.

Dexamethasone dosage FAQs

What happens if I miss a dose of dexamethasone?

If you have a missed dose, take your dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose. If you forget to take this medicine for several days in a row, talk to your healthcare provider before you start taking it again.

How do I stop taking dexamethasone?

Corticosteroids can cause steroid withdrawal syndrome when they have been taken over a period of time and are stopped suddenly. When you stop taking corticosteroids, it takes time for the adrenal glands to start making hormones again.

Withdrawal symptoms can be avoided by tapering the medication (slowly decreasing the dose over a period of time) as well as taking this medication exactly as is prescribed. 

What is the maximum dosage for dexamethasone?

The typical maximum dosage of dexamethasone is 40 mg per day. 

Corticosteroids can alter cardiovascular and renal function leading to heart failure; deplete potassium, sodium, and calcium; cause water retention and weight gain; lead to mood changes; weaken bones causing osteoporosis; cause delayed wound healing; and worsen myasthenia gravis and glaucoma. These adverse reactions generally worsen at a high dose that’s taken over longer periods of time.

Can you overdose on dexamethasone?

Taking too much dexamethasone will increase the risk of side effects. While immediate death is unlikely, corticosteroid overdose can result in severe problems with electrolytes and metabolism. If you believe you have taken too much medication, seek medical attention right away.

What interacts with dexamethasone?

There are several medications that should not be used with dexamethasone. Using these medications while taking dexamethasone could result in very severe adverse events from undesirable drug interactions. It is important to notify your healthcare provider about all medications you are taking prior to beginning therapy with this medication. 

Avoid all live vaccines:

• Adenovirus vaccine

• BCG intravesical vaccine

• Cholera vaccine

• Influenza nasal vaccine 

• MMR vaccine

• Rotavirus vaccine 

• Smallpox vaccine 

• Typhoid vaccine 

• Varicella (chickenpox) vaccine 

• Yellow fever vaccine 

Other medications that should not be taken with dexamethasone:

• Desmopressin increases the risk of hypertension (high blood pressure) 

• Mifepristone is associated with a life-threatening risk of low potassium 

• Rilpivirine efficacy is reduced with dexamethasone

• Talimogene laherparepvec increases risk of disseminated herpes infection

Related resources for dexamethasone dosages:

• Adult dosing, Epocrates

• Corticosteroids for COVID-19, National Institutes of Health

• Dexamethasone for the treatment of coronavirus disease, SN Comprehensive Clinical Medicine

• Pediatric dosing, Epocrates

• Dexamethasone for dogs, Dogtime

• Drug interactions, Epocrates