Cardiovascular Bradycardia , cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure , fat embolism , hypertension , hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction see WARNINGS , pulmonary edema , syncope , tachycardia , thromboembolism , thrombophlebitis , vasculitis.

Dermatologic Acne, allergic dermatitis , cutaneous and subcutaneous atrophy , dry scaly skin, ecchymoses and petechiae , edema, erythema , hyperpigmentation , hypopigmentation, impaired wound healing, increased sweating, rash, sterile abscess , striae, suppressed reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria.

Endocrine Decreased carbohydrate and glucose tolerance, development of cushingoid state, glucosuria, hirsutism , hypertrichosis , increased requirements for insulin or oral hypoglycemic adrenocortical and pituitary unresponsiveness particularly in times of stress , as in trauma , surgery, or illness , suppression of growth in pediatric patients. Fluid And Electrolyte Disturbances Congestive heart failure in susceptible patients, fluid retention, hypokalemic alkalosis , potassium loss, sodium retention.

Metabolic Negative nitrogen balance due to protein catabolism. Musculoskeletal Aseptic necrosis of femoral and humeral heads, calcinosis following intra-articular or intralesional use , Charcot-like arthropathy , loss of muscle mass, muscle weakness, osteoporosis , pathologic fracture of long bones, postinjection flare following intra-articular use , steroid myopathy , tendon rupture, vertebral compression fractures.

Ophthalmic Exophthalmos , glaucoma , increased intraocular pressure , posterior subcapsular cataracts, rare instances of blindness associated with periocular injections. Other Abnormal fat deposits, decreased resistance to infection, hiccups , increased or decreased motility and number of spermatozoa, malaise , moon face, weight gain.

Amphotericin B Injection And Potassium-Depleting Agents When corticosteroids are administered concomitantly with potassium-depleting agents ie, amphotericin B, diuretics , patients should be observed closely for development of hypokalemia.

There have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure. Antibiotics Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance. Anticholinesterases Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy.

Anticoagulants, Oral Coadministration of corticosteroids and warfarin usually results in inhibition of response to warfarin, although there have been some conflicting reports. Therefore, coagulation indices should be monitored frequently to maintain the desired anticoagulant effect. Antidiabetics Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required. Antitubercular Drugs Serum concentrations of isoniazid may be decreased.

Cholestyramine Cholestyramine may increase the clearance of corticosteroids. Cyclosporine Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently.

Convulsions have been reported with this concurrent use. Digitalis Glycosides Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia.

Estrogens, Including Oral Contraceptives Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their effect. Hepatic Enzyme Inducers eg, barbiturates, phenytoin, carbamazepine, rifampin Drugs which induce hepatic microsomal drug-metabolizing enzyme activity may enhance the metabolism of corticosteroids and require that the dosage of the corticosteroid be increased.

Nonsteroidal Anti-inflammatory Agents NSAIDS Concomitant use of aspirin or other nonsteroidal anti-inflammatory agents and corticosteroids increases the risk of gastrointestinal side effects. Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia. The clearance of salicylates may be increased with concurrent use of corticosteroids.

Skin Tests Corticosteroids may suppress reactions to skin tests. Vaccines Patients on prolonged corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines due to inhibition of antibody response. Corticosteroids may also potentiate the replication of some organisms contained in live attenuated vaccines. Serious Neurologic Adverse Reactions With Epidural Administration Serious neurologic events, some resulting in death, have been reported with epidural injection of corticosteroids.

Specific events reported include, but are not limited to, spinal cord infarction , paraplegia , quadriplegia , cortical blindness , and stroke. Further data needed - historically set at 2 days.

Since infusion solutions generally do not contain preservatives, mixtures should be used within 24 hours. Single use vials—Store in container until time of use. Solution 09 16 15 Spinal cord compression: Use larger doses eg up to mg initially in patients with profound or rapidly progressive neurologic injury, and lower doses in patients with mild or equivocal signs. Dexamethasone Sodium Phosphate Injection can be given directly from the vial or it can be added to Sodium Chloride Injection or Dextrose Injection and administered by intravenous drip.

Solutions used for intravenous administration or further dilution of this product should be preservative-free when used in the neonate, especially the premature infant. When it is mixed with an infusion solution, sterile precautions should be observed. In less severe diseases doses lower than 0. Avoid contact with people who have recently received oral polio vaccine or flu vaccine inhaled through the nose. Avoid contact with people who have chickenpox or measles unless you have previously had these diseases e.

If you are exposed to one of these infections and you have not previously had it, seek immediate medical attention. Consult your doctor or pharmacist for more details. If you have diabetes , this drug may make it harder to control your blood sugar levels. Monitor your blood sugar levels regularly and inform your doctor of the results.

Your medicine, exercise plan , or diet may need to be adjusted. Eighth Day Follow-up visit This schedule is designed to ensure adequate therapy during acute episodes, while minimizing the risk of overdosage in chronic cases. In cerebral edema, Dexamethasone Sodium Phosphate injection, USP is generally administered initially in a dosage of 10 mg intravenously followed by 4 mg every six hours intramuscularly until the symptoms of cerebral edema subside.

Response is usually noted within 12 to 24 hours and dosage may be reduced after two to four days and gradually discontinued over a period of five to seven days.

Blood is drawn for plasma cortisol determination at 8: For greater accuracy, give 0. Twenty-four hour urine collections are made for determination of hydroxycorticosteroid excretion. They are available as follows: NDC bottles of Allergic Reactions Anaphylactoid reaction, anaphylaxis , angioedema. Cardiovascular Bradycardia , cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure , fat embolism , hypertension , hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction see WARNINGS , Cardio-Renal , edema, pulmonary edema , syncope , tachycardia , thromboembolism , thrombophlebitis , vasculitis.

Dermatologic Acne, allergic dermatitis , dry scaly skin, ecchymoses and petechiae , erythema , impaired wound healing, increased sweating, rash, striae, suppression of reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria.

Endocrine Decreased carbohydrate and glucose tolerance, development of cushingoid state, hyperglycemia , glycosuria, hirsutism , hypertrichosis, increased requirements for insulin or oral hypoglycemic agents in diabetes , manifestations of latent diabetes mellitus , menstrual irregularities, secondary adrenocortical and pituitary unresponsiveness particularly in times of stress , as in trauma , surgery, or illness , suppression of growth in pediatric patients.

Fluid And Electrolyte Disturbances Congestive heart failure in susceptible patients, fluid retention, hypokalemic alkalosis , potassium loss, sodium retention, tumor lysis syndrome. Gastrointestinal Abdominal distention, elevation in serum liver enzyme levels usually reversible upon discontinuation , hepatomegaly , increased appetite, nausea, pancreatitis , peptic ulcer with possible perforation and hemorrhage , perforation of the small and large intestine particularly in patients with inflammatory bowel disease , ulcerative esophagitis.

Metabolic Negative nitrogen balance due to protein catabolism. Musculoskeletal Aseptic necrosis of femoral and humeral heads, loss of muscle mass, muscle weakness, osteoporosis , pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures.

Ophthalmic Exophthalmos , glaucoma , increased intraocular pressure , posterior subcapsular cataracts. Other Abnormal fat deposits, decreased resistance to infection, hiccups , increased or decreased motility and number of spermatozoa, malaise , moon face, weight gain. Amphotericin B Injection And Potassium-Depleting Agents When corticosteroids are administered concomitantly with potassium-depleting agents e.

In addition, there have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure. Anticholinesterases Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy.

Anticoagulants, Oral Co-administration of corticosteroids and warfarin usually results in inhibition of response to warfarin, although there have been some conflicting reports. Therefore, coagulation indices should be monitored frequently to maintain the desired anticoagulant effect. Antidiabetics Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required.

Antitubercular Drugs Serum concentrations of isoniazid may be decreased. Cholestyramine Cholestyramine may increase the clearance of corticosteroids. Cyclosporine Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. Convulsions have been reported with this concurrent use. Thus, results of the DST should be interpreted with caution in these patients. Digitalis Glycosides Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia.

Ephedrine Ephedrine may enhance the metabolic clearance of corticosteroids, resulting in decreased blood levels and lessened physiologic activity, thus requiring an increase in corticosteroid dosage.

Estrogens, Including Oral Contraceptives Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their effect.

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