Dexamethasone testimony. Guards Dexamethasone for intramuscular use

Dexamethasone is a drug that belong to glucocorticosteroids and is essentially a hormonal drug. The use of it in medicine is quite wide. Dexamethasone is produced in tablet forms or ointments, solutions for intramuscular and intravenous injections, in addition, it is part of many eye drops.

Pharmacology

Dexamethasone is a synthetic analog that normally produces adrenal bark. It affects glucocorticoid receptors, controls the exchanges of potassium, sodium, glucose and water exchange, affects production enzyme proteins and mediators Inflammation (reduces the formation of the latter). Due to the fact that the drug gives pronounced anti-shock, anti-inflammatory, immunosuppressive and antiallergic effects.

With intramuscular administration, the action appears after eight hours, with intravenous - much faster. Save effect From three days to three weeks or up to twenty-eight days during intravenous injection.

Dexamethasone effects are thirty-five times expressable than that.

Composition and form

Active substance in all forms is dexamethasone sodium phosphate. In addition to it, the preparation includes additional components: water, phosphate solution, glycerin and sodium edestat.

The form of the drug is as follows:

• Eye suspension;
• Offanta (drops of eye) 0.1%;
• Dexamethasone solution for injections (ampoules with a solution for intravenous or intramuscular infusion) 4mg / 1ml;
• Tablets 0.5 milligrams.

For what appoints

Diseases that require administration High-speed GCS, or when receiving tablet forms is impossible:

• Skocks of various genesis (toxic, operational, burn or traumatic). If other symptomatic therapy (plasma proceeds, vasoconstrictors and others) are ineffective;
• Anaphylactic shock or other severe manifestations of allergies;
• Blood diseases (thrombocytopenic purpura, agranulocytosis or hemolytic anemia);
• Endocrine pathologies (insufficiency of the adrenal cortex secondary or primary, congenital hyperplasia of the adrenal cortex, cerebral thyroiditis);
• With keloids, SLE, ring-shaped granuloma local (that is, the introduction into the field of education);
• Rheumatic diseases;
• In ophthalmology (parabulbar, retrobulbar or subconjunctival administration): with sympathetic ophthalmia, injuries and operations of eyes, episclerites, glorites, blepharoconjunctivitis, blufarites, iridocyclites, irites, keratoconjunctivitis, keratitis, allergic conjunctivitis, corneal transplantation;
• Heavy sharp dermatoses;
• Malignant pathologies: lymphomas and leukemia (as a paraliative treatment), leiba, hypercalcemia during tumors;
• Severe infections (in combination with antibiotics);
• Brain swelling (with tumors, CMT, neurosurgical operations, strokes, radiation lesions, meningitis, encephalitis);
• Systemic diseases of the connective tissue;
• Heavy bronchospasm, asthmatic status.

Dexamethasone: Tablets, instructions for use

Indications To use déxamethasone tablets are:

Indications for the use of eye drops

Dexamethasone Injection Solution - Indications

• Hemolytic anemia;
• Acute adrenal insufficiency;
• Asthmatic status;
• Brain swelling;
• Severe infections;
• Different shocks;
• Joint diseases;
• Thrombocytopenia;
• Severe allergies;
• Sharp croup;
• Agranulocytosis;
• Lymphoblast leukemia.

Contraindications

If necessary short-term The use of the drug due to life testimony, then the only contraindication will be hypersensitivity To dexamethane or additional components.

Intra-articular injections contraindicated With:

Intravenous / intramuscular injectations are contraindicated at:

• Active tuberculosis;
• Liver diseases (hepatitis or cirrhosis);
• Acute psychosis;
• Acute infections;
• Thrombocytopenic purple.

Children in periods of active growth of corticosteroids are prescribed purely by absolute (Life) indicators.

Toxic and therapeutic actions drug reduce barbiturates, phenythine, rifampicin, amidoglutetimide, ephedrine, rifabutin, somatotropin, antacids, and enhance - oral contraceptives. Joint reception with cyclosporin can provoke the appearance of cramps in children.

Increasing risks of hypokalemia and arrhythmias possible with a combination Corticosteroids and diuretics, heart glycosides. Edems and hypertension can appear with a combined reception of dexamethasone and nutritional supplements, sodium-containing agents. Severe hypokalemia, osteoporosis and CH - with amphotericin in, carbathyndase inhibitors; Ulcers and bleeding in the gastrointestinal tract - with NSAIDs.

Simultaneous application GKS with antiviral alive vaccines can lead to the activation of viruses and, as a result, the development of infection.

Dexamethasone weakens insulin and antidiabetic preparations, diuretics and kumarins, in addition, reception of the drug Reduces the portability of glycosides, reduces the concentration of the prazicvantel and salicylate, reduces the level of glucose.

Due to the fact that dexamethasone increases the clearance of salicylates, after its cancellation, the dose of salicylate is reduced. Combined reception with indomethacin can lead to a false negative result of the dexamethasone suppression test.

Doses and ways to use

Injection forms of the drug (injections of dexamethasone) are necessary for retrobulbar, periarticular, intra-articular, intramuscular and intravenous administrations. Dosage At the same time, purely individual and prescribed in accordance with the testimony, patient's condition and its reaction to treatment.

For the preparation of solutions for drip Intravenous infusion will need five percent dextrose or isotonic. High doses of the drug can be administered up to the status stabilization (that is, not more than 72 hours).

For adult patients With urgent or acute states, intravenous slow, inkjet or drip administration of the drug is also recommended, and intramuscular administration of four to twenty milligrams to four times a day. One dose (maximum) no more than eighty milligrams. Supporting - up to nine milligrams / day. The course of such therapy, as a rule, is four days, after which the patient is transferred to the tablet dexamethasone. Children are prescribed every twelve to twenty-four hours intramuscularly to 0.166 mg / kg.

• Tendons - one milligram;
• Nervous nodes (ganglia) - up to two milligrams;
• Small joints to one milligram;
• Shopping bags - three milligrams;
• Large joints - up to four milligrams;
• Soft fabrics - up to six milligrams.

For need a drug It may be prescribed again after a period of three days to three weeks, one-time dose in this case is no more than eighty milligrams / day. At shock states adult patients Twenty milligrams are introduced simultaneously, and then throughout the day continuous infusion three milligrams / kilograms or up to 6 mg per kg intravenously once, either by forty milligrams every six hours intravenously.

In the presence of brain edema, dexamethasone (for adults) is appointed by ten mg intravenously, after - four mg four times a day until the symptoms disappearance, after four days the dosage decreases and already on the fifth - the seventh day the therapy is stopped.

For children With adrenal failure, the daily dosage is 0.0233 milligrams / kilograms, this amount is divided into three receptions and administered intramuscularly every 72 hours or daily - to 0.01165 per day per day.

In the case of acute allergic processes or exacerbations of chronic allergy, dexamethasone is used as follows:

• 1 day - an injection solution of 1-2 ml intramuscular administration or a tablet of dexamethasone at 0.75 mg;
• 2-4 days - four tablets divided into two receptions;
• 5-6 day - one tablet daily;
• 7 day - no therapy;
• 8 day - observed the patient.

Sideflines

As a rule, dexamethasone tolerated well. The drug has low mineralocorticoid activity, that is, the drug affects the exchange of water and electrolytes.

More often, medium and low dosages do not lead to a fluid and sodium delay, do not lead To strengthen the elimination of potassium.

The following side effects are possible:

• Regarding the senses: Cataract subcapsular rear, an increase in intraocular pressure, an increased risk of attaching fungal, viral, bacterial infections of the eye, changes in the trophic of the cornea, exophthalm, a sharp loss of vision (crystals of dexamethasone can be laid in the eye vessels in the case of its neck, head, nose, scalp);
• Regarding skin and mucous membranes: Stria, acne, impaired pigmentation, skin thinning, ekkimosis, petechia, slow healing of wounds, candidiasis, pyodermia;
• Regarding the endocrine system: Izsenko-Cushing syndrome, diabetes, reduced glucose tolerance, violation of puberty, depression of adrenal glands;
• Regarding metabolism: an increase in the withdrawal of calcium, hypokalemic syndrome, peripheral edema, increasing the decay of proteins, an increase in body weight, hypocalcemia;
• Regarding the musculoskeletal system: slowing down oases and growth, osteoprosis, tendons, steroid, muscle atrophy;
• Regarding vessels and hearts: thrombosis, arrhythmias, hypercoagulation, bradycardia, increase in pressure, heart failure, with heart attacks - the growth of the focus and the slowdown in the scarring, as a result, myocardial breaks;
• Regarding the gastrointestinal tract: IKOT, nausea, meteorism, vomiting, disorders of appetite, pancreatitis, esophagitis, bleeding;
• Regarding the nervous system: cramps, delirium, headaches, disorientation, pseudo-pumps of the cerebeller, euphoria, vertigo, hallucinations, psychosis, anxiety, paranoia, depression;
• Allergic manifestations: itching, rash, local manifestations, anaphylactic shock;
• Local manifestations in the case of parenteral administration: tingling, pain, numbness, burning, infection, less often - necrosis, with intramuscular injection: atrophy (especially deltoid muscle) subcutaneous fiber and skin;
• Among others: "Cancellation" syndrome, infections, leukocyturia, "chopping" blood to face.

Prices

Below are represented approach prices on various forms of the drug:

• Eye drops Dexamethasone about 82 rubles;
• Dexamethasone injection solution - 144 p.;
• Tablets Dexamethasone -45 r. ten pieces;
• Eye drops 0.1% with dexamethasone - 34 p.;
• Ampoules dexamethasone 1ml / 4 mg -202 p. For twenty-five pieces.

active substance: dexamethasone sodium phosphate;

1 ml of solution contains dexamethasone sodium phosphate, equivalent phosphate dexamethasone 4 mg;

excipients:methylparaben (E 218), Propilparaben (E 216), Dinatari Edetat, sodium metabisulphite (E 223), sodium dihydrophosphate dihydrate, sodium phosphate, sodium hydroxide, water for injection.

Dosage form. Injection.

Pharmacotherapeutic group

Corticosteroids for systemic use.

PBX code H02A B02.

Indications

Dexamethasone is administered intravenously or intramuscularly in urgent cases, as well as at the impossibility of oral administration of the drug in such states.:

Endocrine violations:

• replacement therapy of primary or secondary (hypophized) adrenal insufficiency (hydrocortisone or cortisone are selection drugs; if necessary, synthetic analogues can be used together with mineralocorticoids; in pediatric practice, combined use with mineralocorticoids is extremely important);
• acute adrenal insufficiency (hydrocortisone or cortisone are selection preparations; it may be necessary simultaneous use with mineralocorticoids, especially in the case of the use of synthetic analogues);
• before operations and in cases of serious injuries or diseases in patients with installed insufficiency or under an indefinite adrenocortical reserve;
• shock, resistant to traditional therapy, with the existing or suspected adrenal failure;
• congenital hyperplasia of adrenal glands;
• ungunny inflammation of the thyroid gland;
• hypercalcemia caused by cancer defeat.

Rheumatic diseases:as an auxiliary therapy for short-term use (to remove a patient from an acute state or with exacerbation of the disease) at:

• post-traumatic osteoarthritis;
• synoviti in osteoarthritis;
• rheumatoid arthritis, including juvenile rheumatoid arthritis (some cases may require low-cycling therapy);
• epipudiliti;
• acute gouty arthritis;
• psoriatic arthritis;
• ankylosing spondylitis.

Collagenoses: In the period of exacerbation or in some cases as supportive therapy at:

• systemic Red Volcanka;
• acute rheumatic carditi.

Skin diseases:

• pemphigus;
• heavy multiform erythema (Stevens-Johnson syndrome);
• exfoliative dermatitis;
• bullese herpetyiform dermatitis;
• severe seborrheic dermatitis;
• severe psoriasis;
• fungoїni mycosis.

Allergic diseases: Control of heavy or disabled allergic conditions that are not traditional treatment:

• bronchial asthma;
• contact dermatitis;
• atopic dermatitis;
• serum disease;
• chronic or seasonal allergic rhinitis;
• allergy to medication;
• urticaria after blood transfusion;
• acute noncommunicable larynx swelling (epinephrine is elected by the drug).

Eye diseases:heavy sharp and chronic allergic and inflammatory processes with eye damage:

• eye damage caused by Negro Zoster.;
• irit, iridocyclitis;
• chorioretinite;
• diffuse back will fly and choroiditis;
• neuritis optic nerve;
• sympathetic ophthalmia;
• inflammation of the front segment;
• allergic conjunctivitis;
• keratitis;
• allergic edge ulcer corneal.

Gastrointestinal diseases: To remove the patient from the critical period when:

• ulcerative colitis (systemic therapy);
• crown disease (system therapy).

Respiratory diseases:

• symptomatic sarcoidosis;
• beryallio;
• focal or disseminated pulmonary tuberculosis (together with the corresponding anti-tuberculosis chemotherapy);
• lefeler Syndrome, not amenable to therapy by other methods;
• aspiration pneumonite.

Hematological diseases:

• acquired (autoimmune) hemolytic anemia;
• idiopathic thrombocytopenic purpura in adults (only intravenous administration; intramuscular administration is contraindicated);
• secondary thrombocytopenia in adults;
• eritroblasting (erythrocyte anemia);
• nestra (Erotrojeva) hypoplastic anemia.

Oncological diseases:

• palliamentary treatment of leukemia and lymphoma in adults;
• acute leukemia in children.

States accompanied by edema:

• stimulation of the diurea or a decrease in proteinuria with an idiopathic nephlastic syndrome (without uremium) and a violation of the kidney function during systemic red lcanque.

Diagnostic test of adrenal hyperfunction

Brain swelling:

• brain swelling through the primary or metastatic brain tumor, craniotomy or head injury.

Application in the edema of the brain does not replace proper neurosurgical studies and finite appointments, such as neurosurgical intervention and other specific therapy.

Other readings:

• tuberculous meningitis with a subarachnoid blockade or a threat of blockade (together with the corresponding anti-tuberculosis therapy);
• trichinelles with neurological symptoms or trichinosis of myocardium.

Indications for intra-articular administration or introduction into soft fabrics: as auxiliary therapy for short-term use (in order to remove the patient from an acute state or with exacerbation of the disease) at:

• rheumatoid arthritis (severe inflammation of a single joint);
• synoviti with osteoarthritis;
• acute and subacute bursite;
• acute gouty arthritis;
• epipudiliti;
• acute nonspecific tendinei;
• post-traumatic osteoarthritis.

Local Introduction (Introduction to the Place):

• keloid lesions;
• localized hypertrophic, inflammatory and infiltrated lesions with lisp, psoriasis, ring-shaped granuloma;
• disk red wolf deprived;
• lipoid atrophic dermatitis Oppenheim;
• localized alopecia.

Application in cystic tumors of aponeurosis or tendon (ganglia) is also possible.

Contraindications.

Increased sensitivity to dexamethasone or to any other ingredient of the drug.

Acute viral, bacterial or systemic fungal infections (if appropriate therapy does not apply), Cushing syndrome, vaccination of live vaccine, as well as breastfeeding (except for urgent cases).

Method of use and dose.

Prescribe adults and children from the newborn period. Enter intravenously (in the form of injection or infusion), intramuscularly or locally using intra-articular injection or injection in place of lesion on the skin or in soft tissue infiltration.

As a solvent for intravenous infusion, a 0.9% sodium solution of chloride or a 5% glucose solution is used.

Solutions intended for intravenous administration or further dissolution of the drug should not contain preservatives when used for babies, especially premature.

When the drug is mixed with a solvent for infusion, sterile security measures should be followed. Since solutions for infusion usually do not contain preservatives, the mixture should be used for 24 hours.

Preparations for parenteral administration should be visually verified for the presence of extraneous particles and change color each time before administration to determine the shelf life of the solution and container.

The dose should be determined individually, in accordance with the disease of a particular patient, a prescribed period of treatment, tolerability of the GCS and the reaction of the body.

Intravenous and intramuscular administration

The recommended initial dose varies from 0.5 to 9 mg per day, depending on the diagnosis. In less severe cases, the dosage can be sufficient below 0.5 mg, while during severe diseases it may be necessary to dosage above 9 mg per day.

The initial doses of dexamethasone should be used before the appearance of a clinical reaction, and then the dose should be gradually reduced to the lowest clinically efficient. If high doses are prescribed for a period exceeding several days, then the dose should be gradually reduced over the next few days or even for a longer period.

If a satisfactory clinical reaction does not occur for the corresponding period of time, the injections of phosphate dexamethasone are stopped and another treatment is prescribed to the patient.

It is necessary to carefully monitor the symptoms that may require dosage correction, namely, changes in the clinical state as a result of remission or exacerbation of the disease, an individual response to the drug and the influence of stress (for example, surgery, infection, injury). During stress, it may be necessary to temporarily increase the dosage.

If the introduction of the drug is stopped after more than a few days of treatment, as a rule, cancellation should be carried out gradually.

With intravenous administration, the dosage is usually the same as when oral administration. However, with some urgent, sharp, life-threatening situations, the use of doses exceeding the usual can be justified and urgent with oral dosing. It should be taken into account that with intramuscular administration, the absorption speed is slower.

There is a tendency in current medical practice regarding the use of high (pharmacological) doses of corticosteroids for the treatment of shock, resistant to traditional therapy. Different authors offer the following dosing of phosphate dexamethasone injection:

Dosage

3 mg / kg body weight in 24 hours by constant intravenous infusion after an initial intravenous injection of 20 mg.

2-6 mg / kg body weight in the form of single intravenous injection

40 mg Initially, then repeated intravenous injections every 4-6 hours, while symptoms of shock are observed.

40 mg initially, then repeated intravenous injections every 2-6 hours, while symptoms of shock are observed.

1 mg / kg body weight in the form of one-time intravenous injection.

The use of highly dose corticosteroid therapy should be continued only before stabilizing the patient's condition and usually not more than 48-72 hours.

Motor's swelling

Dexamethasone, an injection solution is usually prescribed in the initial dose of 10 mg intravenously, then 4 mg every 6 hours intramuscularly before the disappearance of symptoms.

The treatment reaction is usually observed within 12-24 hours, the dosage can be reduced after 2-4 days of treatment, the drug is gradually canceled within 5-7 days. For palliative use in patients with repeated or non-cultural brain tumors, it can be effective supporting therapy in a dosage of 2 mg 2-3 times a day.

Heavy allergic diseases

With acute allergic diseases, which will also be stopped, or severe exacerbations of chronic allergic diseases are prescribed the following dosing scheme, which combines parenteral and oral therapy:

Descamethasone, injection solution, 4 mg / ml: first day - 1 or 2 ml (4 or 8 mg), intramuscularly.

Dexamethasone, tablets, 0.5 mg: second and third days - 6 tablets in two receptions every day; fourth day - 3 tablets in two receptions; fifth and sixth days - 1½ tablets every day; seventh day - no treatment; eighth day - Repeated visit to the doctor.

This scheme is designed to ensure adequate treatment throughout episodes of exacerbation to reduce the risk of overdose in chronic cases.

Local administration

Casting administration, introduction to the place of lesion or soft tissues is usually used in cases where the lesion is limited to one or two joints (sections). The dosage and frequency of injection depends on the conditions and location of the introduction. The usual dose is 0.2-6 mg. The frequency of use usually ranges from one introduction of 3-5 days to one introduction in 2-3 weeks. Frequent intra-articular administration can damage the articular cartilage.

Intrachnosuglobova The injection of corticosteroids can lead to systemic effects in addition to local.

The intra-articular introduction of corticosteroids in infected joints should be avoided.

Corticosteroids should not be introduced into unstable joints.

Some of the usual disposable doses are shown below:

Dexamethasone, an injection solution is especially recommended for use in combination with one of the less soluble extensive steroids for intra-articular administration and introduction into soft tissues.

For all other indications, the initial dose range is 0.02-0.3 mg / kg / day in three or four injections (0.6-9 mg / m 2 of the body surface area / day).

In order to compare, the following are equivalent doses in milligrams for various corticosteroids:

Dose 0.75 mg of dexamethasone is equivalent to a dose of 2 mg of parametazone or 4 mg of methylprednisolone and triamcinolone, or 5 mg of prednisone and prednisone, or 20 mg of hydrocortisone, or 25 mg of cortisone, or 0.75 mg of betamethazone.

Such ratios of dosages refer only to oral or intravenous use of these drugs. When these drugs or their derivatives are introduced intramuscularly or intrastand, their relative properties can change significantly.

Adverse reactions

The frequency of manifestations of side effects depends on the dose and duration of treatment. The most common side effects of short-term treatment is the temporary insufficiency of adrenal glands, intolerance of glucose, an increased appetite and an increase in body weight, mental disorders; More rare side effects are allergic reactions, hyperitriglyceridemia, ulcerative disease of the stomach and duodenum and acute pancreatitis.

Long-term treatment most often leads to a long disturbance of adrenal function, slow-down growth of children, central obesity, skin vulnerability, muscle atrophy, osteoporosis, less commonly - to reduce immune protection and increased susceptibility to infectious diseases, cataracts, glaucoma, arterial hypertension, aseptic bone necrosis.

Side reactions by organ systems

From the side of the hematopoietic and lymphatic systems: cases of thromboembolism, a decrease in the number of monocytes and / or lymphocytes, leukocytosis, eosinophilia (as well as when using other glucocorticoids); Rarely thrombocytopenia and low-level purple.

From the immune system:rarely - rash, urticaria, angioedema swelling, bronchospasm and anaphylactic reactions.

From the heart-vascular system: Polytopna ventricular extrasystole, paroxysmal bradycardia, heart failure, arterial hypertension and hypertensive encephalopathy; Very rarely - the gap of the heart in patients who recently moved myocardial infarction.

From the central nervous system:after treatment, the appearance of swelling of the optic nerve disc and increased intracranial pressure (pseudo-turn) is possible. Such neurological side effects may also be observed as dizziness, convulsions and headache.

Mental disorders: Changes in personality and behavior that are most often manifested as euphoria; There were also about such side effects: insomnia, irritability, hyperkinosis, depression and (rarely) psychosis.

From the endocrine system and metabolism: The oppression of the function and atrophy of the adrenal glands (decrease in the reaction to stress), the Cushing syndrome, the slowdown in the growth of children, the impairment of the menstrual cycle, girsutism, the transition of latent diabetes in a clinically active form, reducing carbohydrate tolerance, increased needleness of insulin or oral medications against diabetes in patients with diabetes, Negative nitrogen balance due to catabolism proteins, hypokalemic alkalosis, delay in the body of sodium and water, increased loss of potassium.

From the digestive system: Ezophagitis, nausea, IKOT; Rarely - peptic ulcers of the stomach and duodenal intestine are also possible ulcerative perforations and bleeding in the digestive tract (bloody vomiting, melan), pancreatitis and perforation of the gallbladder and intestines (especially in patients with chronic intestinal inflammation).

From the side of the musculoskeletal system and connective tissue: Muscular weakness, steroid myopathy (muscular weakness causes muscular catabolism), osteoporosis (increased calcium removal) and spinal compression fractures, aseptic osteonecosis (more often - aseptic necrosis bones heads of hips and shoulders), tendons breaks (especially with parallel use of some quinolones), Damage to the articular cartilage and necrosis of bones (due to intra-articular infection).

From the side of the skin and subcutaneous fabrics: Slowed healing of wounds, thinned and vulnerable skin, petechia and hematoma, erythema, increased sweating, acne, reaction to skin tests is suppressed. Allergic dermatitis, urticaria and angioedema swelling are also possible.

From the body of the vision: Increased intraocular pressure, glaucoma, cataract or pucheglasie.

From the reproductive system: Occasionally - impotence.

Violations during pregnancy, postpartum and perinatal periods: Corner paralysis in premature babies, retrolental fibroplasia.

General violations:edema, hyper - or hypopigmentation of the skin, skin atrophy or subcutaneous layer, sterile abscess and redness of the skin.

Signs of glucocorticoid cancellation syndrome

In patients who were treated for a long time with dexamethasone, during a too fast reduction in the dose can be observed by the abolition syndrome and occur cases of insufficiency of adrenal glands, arterial hypotension or death.

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

If severe undesirable reactions happen, treatment must be discontinued.

Overdose

There are rare messages about acute overdose or death due to acute overdose.

Overdose, usually only after a few weeks of applying excessive doses, can cause most of the undesirable effects specified in the section "Adverse Reactions", primarily Cushing Syndrome.

No specific antidote. Treatment should be supportive and symptomatic. Hemodialysis is not an effective method of accelerated elimination of dexamethasone from the body.

Application during pregnancy or breastfeeding

Glucocorticoids pass through the placenta and reach high concentrations in the fruit. According to some data, even the pharmacological doses of glucocorticoids can increase the risk of placenta deficiency, oligohydramniosis, slow motion development or its intrauterine death, increasing the number of leukocytes (neutrophils) in the fetus and adrenal failure.

During pregnancy, the introduction of dexamethasone is permissible only on life indications.

Children born to mothers who were prescribed glucocorticoids during pregnancy should be carefully checked for the presence of adrenal failure.

Small amounts of glucocorticoids are found in breast milk. Therefore, breastfeeding is not recommended during dexamethazone therapy. A possible influence is to slow down the growth of the child and reduce the secretion of endogenous glucocorticoids.

Children

Apply children from a newborn period. During treatment with dexamethasone, careful observation of the growth and development of children is necessary.

Special security measures

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

Features of application

During parenteral treatment with Corticites, in rare cases, hypersensitivity reactions may be observed, therefore it is necessary to take appropriate measures before starting treatment with dexamethasone, despite the possibility of allergic reactions (especially in patients with allergic reactions to any other medications in history).

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

Patients who were injected with dexamethasone for a long time and experience heavy stress after the cessation of therapy should be resumed the use of dexamethasone, since the insufficiency of the adrenal glands may continue within a few months after the cessation of treatment.

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

Patients with pulmonary tuberculosis in active form should receive dexamethasone (along with means against tuberculosis) only with a quick or highly scattered pulmonary tuberculosis. Patients with an inactive form of pulmonary tuberculosis, which are treated with dexamethasone, or patients who react to tuberculin should receive chemical preventive tools.

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

During treatment, there may be an exacerbation of diabetes or transition from the latent phase to clinical manifestations of diabetes.

With long-term treatment, serum potassium levels should be monitored.

Vaccination of the live vaccine is contraindicated during the treatment of dexamethasone. The vaccination of the killed viral or bacterial vaccine does not lead to the expected synthesis of antibodies and does not have the expected protective effect. Dexamethasone is usually not prescribed for 8 weeks before vaccination and do not begin to apply earlier than 2 weeks after vaccination.

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

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

The intra-design destination of dexamethasone can lead to system effects. Frequent use can cause damage to cartilage or bone necrosis.

Before intra-articular administration, a synovial liquid should be removed from the joint and investigate it (check for the presence of infection). The introduction of GCS in infected joints should be avoided. If the joint infection is developing after injection, the antibiotics should begin with proper therapy.

Patients need to be reported that they avoid physical burden on the affected joints until time when inflammation is cured.

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

Corticoids can distort the results of skin allergic tests.

Special information about some ingredients.

The drug contains less than 1 mmol (23 mg) sodium in a dose, that is, practically "sodium free".

The ability to influence the reaction rate when managing vehicles or working with other mechanisms.

No data.

Interaction with other medicines and other types of interactions

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

The effectiveness of dexamethasone decreases, if at the same time take rifampicin, carbamazepine, phenobarbon, phenytoin (diphenylhydantoin), prison, ephedrine or aminoglutortimide, so the dose of dexamethasone in such combinations should increase.

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

Ketoconazole can suppress the adrenal synthesis of glucocorticoids, thus, due to a decrease in dexamethasone concentration, adrenal insufficiency may be observed.

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

Dexamethasone can change the effect of kumarine anticoagulants, so when applying such a combination of drugs, the prothrombin time should be checked more often.

Parallel use of dexamethasone and high doses of other glucocorticoids or agonists  2 -adrenoreceptors increases the risk of hypokalemia. In patients with hypokalemia, heart glycosides contribute to the violation of the rhythm and have greater toxicity.

Glucocorticoids enhance the kidney clearance of salicylate, so it is sometimes difficult to obtain therapeutic concentrations of serum salicylate. It is necessary to be careful to patients who gradually reduce the dose of corticosteroids, since it may be observed an increase in the concentration of serum salicylate and intoxication.

If there are oral contraceptives in parallel, the half-life of glucocorticoids can fond, which enhances their biological effect and can increase the risk of side effects.

The simultaneous use of riotradin and dexamethasone is contraindicated during childbirth, as it can lead to a lung edema. It has been reported on the death of the worine due to the development of such a state.

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

Types of interaction that have therapeutic advantages: parallel appointment of dexamethasone and metoclopramid, diphenhydramide, stubpeasine or antagonists 5-NT 3 (serotonin receptors or 5-hydroxy-tripatin receptor, type 3, such as ondansetron or rivzetron) efficient for the prevention of nausea and vomiting caused by cisplatin chemotherapy, cyclophosphamide, methotrexate , Formuracyl.

Pharmacological properties.

Pharmacodynamics.

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

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

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

Pharmacokinetics.

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

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

Pharmaceutical characteristics

Basic Physics and Chemicals properties: Transparent, from colorless to pale yellow solid, virtually no mechanical inclusions.

Incompatibility

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

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

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

Some medications, such as Lorazepam, must be mixed with dexamethasone in glass vials, and not in plastic bags (the concentration of the Laureza-Ma drops to values \u200b\u200bbelow 90% in 3-4 hours of storage in polyvinyl chloride packages at room temperature).

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

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

Shelf life

Storage conditions

Store in a dark place at a temperature not higher than 30 ° C. Do not freeze.

Keep out of the reach of children.

Packaging

1 ml in ampoule; 5 ampoules in a cardboard box.

Category of vacation

On prescription.

Manufacturer

Skill of PVT PVT Ltd., India.

Location

Serves No. 110 / a / 2 Amit Farm, Jane Packs, near the Coca Cola, N.Kh. № 8, Kajipura-387411, Khedya, India.

MNN: Dexametanone

Manufacturer: Krka, D.D., Novo Place

Anatomy-therapeutic-chemical classification: DexameThasone

Registration number in Kazakhstan: № RK-LS-5№003394

Registration period: 05.08.2016 - 05.08.2021

Instruction

• russian

Tradename

Dexametanone

International non-proprietary title

Dexametanone

Dosage form

Injection solution, 4 mg / ml

Composition

One ampoule contains

active substance - 4.37 mg phosphate sodium dexamethasone (equivalent to 4.00 mg phosphate dexamethane),

inspromational substances: Glycerin, Dinatari Edetat, sodium hydrophosphate dihydrate, water for injection.

Description

Transparent, colorless to light yellow solid

Pharmacotherapeutic group

Corticosteroids for system use. Glucocorticosteroids. Dexamethasone.

ATH code H02AB02.

Pharmacological properties

Pharmacokinetics

After intravenous administration, the drug begins to act quickly, and after intramuscular administration, the clinical effect is achieved after 8 hours. The effect of the drug prolonged and continues from 17 to 28 days after intramuscular administration and from 3 days to 3 weeks after local application (in the area of \u200b\u200bthe lesion). Dose of dexamethasone 0.75 mg is equivalent to a dose of 4 mg of methylprednisolone and triamcinolone, 5 mg of prednisone and prednisolone, 20 mg of hydrocortisone and 25 mg of cortisone. In the blood plasma, about 77% of dexamethasone binds to blood plasma proteins, and mostly converted into albumin. Only the minimum amount of dexamethasone binds to non-albumin proteins. Dexamethasone is a fat soluble compound. The drug is initially metabolized in the liver. Small amounts of dexamethasone metabolized in the kidneys and other organs. The prevailing excretion occurs through the urine. The half-life (T1 \\ 2) is about 190 minutes.

Pharmacodynamics

Dexamethasone is a synthetic hormone of adrenal cortex (corticosteroid) with glucocorticoid effect. The preparation has a pronounced anti-inflammatory, anti-allergic and desensitizing effect, has immunosuppressive activity.

To date, sufficient information about the mechanism of glucocorticoid mechanism is accumulated to imagine how they act at the cellular level. There are two clearly defined receptor systems detected in cytoplasm cells. Through glucocorticoid receptors, corticosteroids have anti-inflammatory and immunosuppressive effects and regulate glucose homeostasis; By means of mineralocorticoid receptors, they regulate sodium and potassium metabolism, as well as aqueous and electrolyte balance.

Indications for use

Dexamethasone is administered intravenously or intramuscularly in acute cases or at the impossibility of oral therapy:

replacement therapy for primary and secondary (pitpofizar) adrenal insufficiency

congenital hyperplasia of adrenal glands

subacute thyroiditis and hard forms of village-coolant thyroiditis

rheumatic fever

acute rheumlock

bubble, psoriasis, dermatitis (contact dermatitis with a lesion of a large skin surface, atopic, exfoliative, bullous herpetyform, seborrheic, etc.), eczema

toxidermy, toxic epidermal necroliz (Lylel syndrome)

malignant Exudative Erythema (Stevens-Johnson syndrome)

allergic reactions to LS and food products

whey disease, Dosage Exanthema

urticaria, angioedema swelling

allergic rhinitis, pollinosis

diseases threatening vision loss (acute central chorioretinite, inflammation of the visual nerve)

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

systemic immune diseases (sarcoidosis, temporal arteritis)

proliferative change in orbit (endocrine ophthalmopathy, pseudo-turn)

sympathetic ophthalmia

immunosuppressive therapy for corneal transplantation

The drug is used systemically or locally (in the form of subconjunctive, retrobulbar or parabulbar injections):

ulcerative colitis

crohn's disease

local enteritis

sarcoidosis (symptomatic)

acute toxic bronchiolitis

chronic bronchitis and asthma (exacerbation)

agranulocytosis, Päilyopathy, anemia (including autoimmune hemolytic, congenital hypoplastic, erythroblasting)

idiopathic thrombocytopenic purple

secondary thrombocytopenia in adults, lymphoma (Hodgkinskaya, Nevatzhkinskaya)

leukemia, lympholoikosis (acute, chronic)

diseases of kidney autoimmune genesis (incl. acute glomerulonephritis)

nephrotic syndrome

palliative therapy of leukemia and lymphoma in adults

acute leukemia in children

hypercalcemia with malignant neoplasms

the head of the brain due to primary tumors or metastases in the brain, due to craniotomy or head injuries.

Shock of various origins

shock not responding to standard therapy

shock in patients with adrenal insufficiency

anaphylactic shock (intravenously, after the introduction of adrenaline)

Other readings

Indications for intra-articular administration of dexamethasone or introduction into soft fabrics:

rheumatoid arthritis (severe inflammation in a separate joint)

ankylosing spondylitis (when the inflamed joints do not mislead the standard therapy)

psoriatic arthritis (oligoarthicular defeat and tendosyovitis)

monoarthritis (after removal of intra-articular fluid)

osteoarthritis (only with exudate and synovitis)

emailing rheumatism (epicondylitis, tendineisitis, bursitis)

Local introduction (injections in the lesion center):

• hypertrophic, inflamed and infiltrated foci depriving, psoriasis, ring-shaped granules, sclerosing folliculite, discoomed lupus and skin sarcoidosis

  localized alopecia

Method of application and dose

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

Parenteral application

The injection solution is introduced intravenously or intramuscularly, as well as in the form of intravenous injections (with glucose or saline).

The recommended average initial daily dose with intravenous or intramuscular administration varies from 0.5 mg to 9 mg and, if necessary, more. The initial dose of dexamethasone must be applied until the clinical effect is reached; The dose is then gradually decreased to the minimum efficient. During the day, you can enter from 4 to 20 mg of dexamethasone 3-4 times. The duration of parenteral administration is usually 3-4 days, then transfer to the supporting therapy of the oral form of the drug.

Local administration

The recommended single dose of dexamethasone for intra-articular administration ranges from 0.4 mg to 4 mg. Intrautic administration can be repeated in 3-4 months. Injections in the same joint can be carried out only 3-4 times in life, and it is impossible to make injections in more than two joints at the same time. More frequent administration of dexamethasone can lead to damage to intra-articular cartilage and bone necrosis. The dose depends on the size of the striking joint. The usual dose of dexamethasone is from 2 mg to 4 mg for large joints and from 0.8 mg to 1 mg for small joints.

The usual dose of dexamethasone for administration inside the articular bag is from 2 mg to 3 mg, for the introduction of the tendon in the vagina - from 0.4 mg to 1 mg, and for tendons - from 1 mg to 2 mg.

When administered to limited foci of lesions, the same doses of dexamethasone are used as for intra-articular administration. The drug can be administered simultaneously, the maximum, in two hearths.

Dosing in children

With intramuscular administration of the dose for replacement therapy is 0.02 mg / kg of body weight or 0.67 mg / m2 of the body surface area, which is divided into 3 injections with an interval of 2 days, or from 0.008 mg to 0.01 mg / kg of mass Body or from 0.2 mg to 0.3 mg / m2 body surface area daily. For other indications, the recommended dose is from 0.02 mg to 0.1 mg / kg of body weight or from 0.8 mg to 5 mg / m2 of the body surface area, every 12-24 hours.

Side effects

reducing glucose tolerance, "steroid" diabetes or manifestation of latent diabetes mellitus

itsenko-Cushing syndrome, increase in body weight

ikota, nausea, vomiting, raising or decreased appetite, flatulence, increase in the activity of "liver" transaminase and alkaline phosphatase, pancreatitis

"Steroid" ulcer of the stomach and duodenum, erosive zoophagit, bleeding and perforation of the gastrointestinal tract

arrhythmias, bradycardia (up to a heart stop), development (in predisposed patients) or increased severity of chronic heart failure, an increase in blood pressure

hypercoagulation, thrombosis

delia, disorientation, euphoria, hallucinations, manico- depressive psychosis, depression, paranoia

increased intracranial pressure, nervousness, anxiety, insomnia, headache, dizziness, cramps, vertigo

pseudo-turn cerebellum

sudden loss of vision (with parenteral administration It is possible to deposition of the drug crystals in the vessels of the eye), the rear subcapsular cataract, an increase in intraocular pressure with possible damage to the visual nerve, trophic changes in the cornea, exophthalm, the development of secondary bacterial, fungal or viral eye infections

negative nitrogen balance (increased disintegration of proteins), hyperlipoproteinemia

increased sweating

liquid delay and sodium (peripheral swelling), hyperkilimic syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue)

slowdown in the growth and processes of ossification in children (premature closure of epiphyseal growth zones)

elevated calcium removal, osteoporosis, pathological fractures of bones, aseptic necrosis of the head of the shoulder and femoral bone, tenders

"steroid" myopathy, muscle atrophy

slowed healing of wounds, a tendency to the development of pyodermia and candidiasis

petechia, ekkimoza, skin thinning, hyper- or hypopigmentation,

steroid acne

generalized and local allergic reactions

reducing immunity, development or aggravation of infections

leukocyturia

violation of the secretion of genital hormones (violation of the menstrual cycle, girsutism, impotence, delay in sexual development in children

syndrome "Cancellation"

burning, numbness, pain, paresthesia and infections, necrosis of surrounding tissues, the formation of scars at the injection site, skin atrophy and subcutaneous tissue at intramuscular administration (the introduction into the deltoid muscle), arrhythmias, "tides" of blood to the face, convulsions (with intravenous administration), collapse (with rapid introduction of large doses)

Contraindications

increased sensitivity to active substance or auxiliary components of the drug

gastric ulcer and duodenal ulcer

osteoporosis

acute viral, bacterial and systemic fungal infections (when appropriate therapy does not apply)

cushing syndrome

pregnancy and lactation period

renal failure

liver cirrhosis or chronic hepatitis

acute psychosis

intramuscular administration is contraindicated in patients with severe hemostasis impairment (idiopathic thrombocytopenic

for use in ophthalmological practice: viral and fungal eye diseases

acute form of purulent eye infection in the absence of a specific

therapies, corneal diseases combined with epithelial defects, trachoma, glaucoma

active shape of tuberculosis

Medicinal interactions

The effectiveness of dexamethasone decreases while receiving rifampicin, carbamazepine, phenobarbiton, phenytoin (diphenylhydantoin), prison, ephedrine or aminoglytetimide. Dexamethasone reduces the therapeutic effect hypoglycimizing drugs, hypotensive drugs, prasikvantel and sodium; Dexamethasone increases activity heparin, albendazole and kaliuretikov. Dexamethasone can change the action antosverting drugs of the kumarine series.

Simultaneous use of dexamethasone and large doses glucocorticoids or agonists 2 receptorsincreases the risk of hypokalemia. Higher arrhythmogenicity and toxicity of cardiac glycosides are noted in patients suffering from hypokalemia.

With the simultaneous use of oral contraceptives, the half-life of glucocorticoids may increase, which leads to an increase in their action and an increase in the number of side effects.

The simultaneous use of riteodine and dexamethasone in the period of generic activity is contraindicated, as this may lead to the death of the mother because of the eighty edema.

The simultaneous purpose of dexamethasone and methoclopramid, diphenhydraminamine, coolness of 5-HT3 receptors (serotonin or 5-hydroxitriptamine type 3), such as ondansetron or rippsome, effectively for the prevention of nausea and vomiting caused by chemotherapy using cisplatin, cyclophosphamide, methotrexate, fluorouracyl .

special instructions

Application in pediatrics

In children during long-term treatment, it is necessary to carefully monitor the dynamics of growth and development. In children during the growth period, glucocorticosteroids should be used only on life indications and under particularly careful observation of the doctor. To prevent violation of growth processes with long-term treatment of children under the age of 14, it is desirable every 3 days to make a 4-day break in treatment.

Children, during treatment in contact with sick cute, wind inspaid, prescribe specific immunoglobulins.

In diabetes mellitus, tuberculosis, bacterial and amoebic dysentery, arterial hypertension, thromboembolis, cardiac and renal failure, non-specific ulcerative colitis, diverticulite, recently educated intestinal anastomose, apply dexamethasone is needed very carefully and, subject to adequate treatment for the underlying disease. If the patient has a history of psychosis, then the treatment of glucocorticosteroids is carried out only on life indications.

With a sudden abolition of the drug, especially in the case of high doses, it occurs, the abolition syndrome of glucocorticosteroids: anorexia, nausea, inhibition, generalized muscular-skeletal pains, general weakness. After the discharge of the drug for several months, the relative failure of the adrenal cortex may be maintained. If in this period there are stressful situations, temporarily glucocorticoids are prescribed, and, if necessary, mineralocorticoids.

Before the use of the drug, it is desirable to conduct a patient examination for the presence of ulcerative pathology of the gastrointestinal tract. Patients with predisposition to the development of this pathology must be appointed with the preventive purpose of antacid funds.

During treatment with the drug, the patient must adhere to a diet with rich in potassium, proteins, vitamins, with a reduced content of fats, carbohydrates and sodium.

If the patient has intercurent infections, the septic state treatment with dexamethasone must be combined with antibacterial therapy.

If the treatment of dexamethazone is carried out for 8 weeks to and 2 weeks after active immunization (vaccination), then in this case the effect of immunization will be reduced or completely neutralized.

Patients with heavy cranial injuries and violation of cerebral circulation on ischemic type Glucocorticoids are necessary with caution.

Features of influenceon the ability to control the vehicle or potentially hazardous mechanisms

Since dexamethasone can cause dizziness and headache, when driving vehicles or working with other mechanisms, it is recommended to refrain from driving a car and control other potentially hazardous mechanisms.

Overdose

Symptoms: It is possible to aggravate side effects.

Treatment: cancel and assign symptomatic therapy. No specific antidote.

After the disappearance of symptoms of overdose, the reception is renewed.

Form release and packaging

1 ml into dark glass ampoules with a white point and a green ring for opening ampoules. A self-adhesive label is glued on the ampoule.

Dexamethasone is a drug that refers to a group of corticosteroids. There are quite a lot of pathologies in which the use of this medicinal product is required.

It is sometimes used to treat even infants, but only in cases if it is necessary to conduct urgent activities that will preserve the child life (for example, when, or when other drugs did not provide a proper therapeutic effect. At the same time, it is imperative constantly under the supervision of a doctor.

Features of the drug

The medicine is produced in several dosage forms: in the form of injections, tablets and drops. Dexamethasone children are usually assigned in an injection or tablet form.

The active substance is the dexamethasone phosphate. In relation to additional ingredients of the drug, it must be said that the composition of the drug depends on its shape:

1. In the composition of the injection form There are 4 mg of active substance per 1 ml of solution, and a small amount of glycerol, propylene glycol, buffer phosphate solution, and water, is observed as the accompanying components.
2. In tablet form There are 0.5 mg of active substance, as well as lactose, silicon and residual amounts of magnesium stearate.
3. In eye drops There is a basic active substance with a mass of 1 mg per milliliter of solution, as well as minor quantities of boric acid, sodium tetraborate, water and preservatives.

The active ingredient can pass inside the cells and increase the synthesis of ribonucleic acid. Due to the oppression of phospholipase, an increase in the production of arachidone acids is increased, as well as the biosynthesis of endoperexies, mediators of the inflammatory allergic reaction and pain syndrome.

As a result of the drug, there is a decrease in the amount of protease, hyaluronidase and collagenase in small quantities or with the complete absence, which leads to the following:

1. Improving the functioning of bone and cartilage tissues.
2. Reducing the permeability of the capillary bed.
3. Corrigation of stabilization of cell membranes.
4. Water and sodium delay in the body.
5. An increase in protein catabolism, glucose disposal, as well as increased glycogen release from the liver.

When taking a tablet forms of dexamethasone for children, there is almost complete absorption of the drug into the blood from the stomach. At the same time, the percentage of binding to blood proteins is not too high, it reaches an average of no more than 80%, and bioavailability is no more than 70%. The active ingredient can affect inside the cells.

The effect may appear after a few minutes from the moment of reception, but the maximum effect is achieved on average after 2 hours. The duration of therapeutic effects The drug can be 3 days.

When using an injection form, the effect of the drug may occur much faster. This is largely due to the lack of time required for the absorption of the drug. The medicine penetrates through the hematostephalic barrier, thereby affecting the organs of the central nervous system.
The removal of the drug is carried out with urine through the urinary system.

Dexamethasone is incompatible with other drugs.

Indications and contraindications

Dexamethasone can be used in various pathologies, but due to possible side effects, as well as the presence of a large number of contraindications, including childhood, it is not used so often. It is basically its application justified only in cases where the threat to life arises. And children's age here is no exception.

Among the testimony in which the sharp threat of life is distinguished:

1. Anaphylactic shockmanifested by a sharp drop in blood pressure, violation of the work of the heart and other vital organs.
2. Heavy allergic reaction in the form.
3. Sweet brain edemaAs the result of the transferred cranial injury, the infectious process, the presence of a tumor process in the skull area.
4. Toxic stateassociated with a massive burn, the consequence of pain or traumatic shock, acute blood loss.
5. Acute insufficiency adrenal apparatus.

Dexamethasone in children also applied for the following chronic diseases:

• severe flow, clinic of pronounced bronchospasm;
• severe autoimmune pathologies, such as rheumatoid arthritis or systemic red lupus;
• pronounced;
• crohn's disease or nonspecific ulcerative colitis with a pronounced disorder function of the digestive tract;
• hemolytic anemia or other pathology of the blood system;
• glomerulonephritis;
• severe infectious processes;
• malignant lesions.

Among the contraindications, in which even sharp processes will not be an indication for the purpose of this drug, it is necessary to allocate:

• increased body sensitivity to drug components;
• allergy to dexamethasone;
• acute diseases that can be caused by bacterial, viral, as well as fungal infections;
• the state associated with the direct vaccination, especially after the BCG vaccination;
• the pathology of the cornea, accompanied by a violation of its integrity;
• incenko-Cushing syndrome;
• inflammatory diseases of the digestive tract, especially associated with the presence of erosive-ulcerative defects (gastritis, stomach or duodenal ulcers);
• tuberculosis and other chronic infectious processes;
• pathology of the nervous system, accompanied by convulsions, epilepsy;
• diseases of the endocrine system, especially the thyroid gland (hypothyroidism or thyroiditis).

Caution should be taken dexamethasone with violations of the liver function.

To treat children a strong nasal congestion, difficulty breathing due to allergies are sometimes prescribed drops of dexamethasone to instill them in the nose. Such an unusual use of the drug is well relieved by swelling, eliminates inflammation, makes it easier to breathe kid.

Possible side effects

Side effects are a common problem when applying dexamethasone by children. Among the most common reactions can be allocated:

1. Allergic reaction In response to the introduction of the means, which most often has the kind of urticaria, eczema or rashes of various character.
2. Violation of the nervous system, such as headache, dizziness, neuropathy, etc.
3. Defeat operation of the digestive tract. It can manifest itself to the appearance or complication of pancreatitis, gastritis, as well as ulcerative disease of the stomach and duodenum.
4. In children, the wrong or long-term reception of dexamethasone can lead to slowdown the growth of both the whole organism and individual systems. That is why the babies accepting dexamethasone are found acquired heart defects, serious violations in the work of internal organs, underdevelopment or backlog in the development of germ and reproductive system organs.
5. Appearance of a specific appearanceassociated with an increase in body weight, water delay in the body, muscle atrophy.
6. Mental disorders.
7. Changes of skin With their exhaustion and the appearance of Striy and scar changes.
8. Development of cataracts and glaucoma.

Instructions for the use of dexamethasone Children in the form of injections, tablets and drops

The dosage of the drug in children and not only should be calculated only by a specialist based on the patient's pathological condition, the severity of the process, as well as the age of the patient and its body weight.
The method of application and dose of dexamethasone for children depends on the form of the drug and testimony.

Using injection form The drug appointment of a doctor may be as follows: when developing an acute state, which is urgent, is calculated from 0.02 mg per 1 kg of body weight. In some cases, the dosage can be increased to 0.16 mg per 1 kg. At the same time, it is necessary to take into account the dosing mode and the multiplicity of reception. The minimum duration between the introductions is 12 hours. In some cases, a single introduction of dexamethasone intramuscularly or intravenously is used. In acute adrenal insufficiency, an increase in dosage to 0.2-0.3 mg per kilogram of body mass is allowed to stabilize the state.

In the form of tablets With inflammatory, allergic or other chronic pathologies, dexamethasone, a dosage of 0.25 mg, divided into three or four receptions per day. The maximum daily dosage can reach 2 mg.

In the form of eye drops Dexamethasone is allowed to take in the amount of one drop to 3 times a day. The duration of therapy can reach the week. In the event of a severe or chronic process, an individual increase in the duration of use of this drug is possible.

The drug in liquid form in ampoules is often used to conduct inhalation children with inflammation of the respiratory tract (for example, with bronchitis, laryngitis, broncho-construction). For children, the following dosage is used: 0.5 ml of the preparation is mixed with 2-3 ml of saline. Inhalations are made 3 times a day for 3-7 days.

How much is it and how to store

The price of dexamethasone depends not only on the type of pharmacy and the manufacturer's plant, but also the dosage form. The average cost of tableted form is about 50 rubles. Injection form can reach about 200 rubles in price. The cost of eye drops is about 70 rubles. The drug is released from the pharmacy only in the presence of a doctor's prescription.

The drug can be stored in the form of tablets and injections for five years from the moment of manufacture, and the shelf life for droplets is three years, but only provided that the bottle is sealed. After opening, it is necessary to use drops for 3 weeks.
The optimal temperature regime should not exceed 25 degrees of heat. It is necessary to protect the drug from the effects of sun rays.

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.

Composition

• 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

1. Tablets 0.5 mg.;
2. Solution in ampoules for intravenous and intramuscular administration (injections for injections) 4mg / ml.;
3. Drops eye offang 0.1%;
4. 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 the clinical course of the disease, 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: acute hemolytic anemia, agranulocytosis, idiopathic thrombocytopenic purple 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 an ophthalmological practice (subconjunctive, retrobulbar or parabulbar administration): Allergic conjunctivitis, keratitis, keratoconjunctivitis without damage to the epithelium, irrit, iridocyclite, blepharitis, blepharoconjunctivitis, sclerites, episclerite, inflammatory process after eye injury and surgery, sympathetic ophthalmia, immunosuppressive treatment after transplantation cornea;
• 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;
• 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 (aggravation of 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 advanced androgen content 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 upper 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.

1. Soft fabrics: from 2 to 6 mg;
2. Large joints (for example, knee joint): from 2 to 4 mg;
3. Articular bags: from 2 to 3 mg;
4. Small joints (for example, interphalating, temporal joints): from 0.8 to 1 mg;
5. Nervous ganglia: from 1 to 2 mg;
6. 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 an acute allergic reaction or exacerbation of chronic allergic disease, dexamethasone must be appointed according to the following graph, taking into account the combination of parenteral and oral administration: dexamethasone instruction for use for injection 4 mg / ml solution: 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. 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:

1. 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);
2. 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;
3. From the endocrine system: reduction of glucose tolerance, steroid diabetes mellitus 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) , delay in sexual development in children;
4. 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);
5. 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;
6. 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;
7. 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;
8. From the nervous system: delirium, disorientation, euphoria, hallucinations, manico-depressive psychosis, depression, paranoia, increasing intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, pseudo-turn 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 exacerbation of infections (jointly used immunosuppressants and vaccination, leukocyturia, "tides" of blood to the face, "Cancellation", contribute to the emergence of this side effect).

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 capable of causeing 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 effects, antacids can be prescribed, and also to increase the admission to + in 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)