Difference between revisions of "Dexamethasone"
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{{Infobox drug reference | {{Infobox drug reference | ||
| trade_names = | | trade_names = Decadron | ||
| drug_class = | | drug_class = Steroid | ||
| drug_class_color = | | drug_class_color = | ||
| uses = | | uses = PONV, analgesia | ||
| contraindications = | | contraindications = Relative: Diabetes/hyperglycemia, altered mental status, lymphoma, infection | ||
| routes = | | routes = IV | ||
| dosage = | | dosage = PONV: 4-8mg | ||
}} | Analgesia: 0.1mg/kg | ||
| dosage_calculation = | |||
| mechanism = Unclear but likely related to steroidal anti-inflammatory action | |||
| adverse_effects = Hyperglycemia, altered mental status, delayed wound healing | |||
| time_onset = 1-2 hrs | |||
| duration = 36-72 hrs | |||
}}'''Dexamethasone''' is a corticosteroid commonly used in anesthetic practice for management of PONV and pain. While the mechanism of action of steroids is well known, the mechanism of dexamethasone in prevention of PONV is not well understood. | |||
== Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. --> == | |||
== | * PONV: DREAM study found that inclusion of dexamethasone (8mg IV) at the time of induction reduced PONV and PRN anti-emetic usage across patient groups<ref>{{Cite journal|last=DREAMS Trial Collaborators and West Midlands Research Collaborative|date=2017-04-18|title=Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial)|url=https://pubmed.ncbi.nlm.nih.gov/28420629/|journal=BMJ (Clinical research ed.)|volume=357|pages=j1455|doi=10.1136/bmj.j1455|issn=1756-1833|pmc=5482348|pmid=28420629}}</ref> | ||
** Given its longer onset, most effective when given at induction | |||
** Typical dose 4-8mg IV | |||
* Analgesia: meta-analysis found that dexamethasone effective at reducing pain scores and opioid consumption post op<ref>{{Cite journal|last=De Oliveira|first=Gildàsio S.|last2=Almeida|first2=Marcela D.|last3=Benzon|first3=Honorio T.|last4=McCarthy|first4=Robert J.|date=2011-09|title=Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials|url=https://pubmed.ncbi.nlm.nih.gov/21799397/|journal=Anesthesiology|volume=115|issue=3|pages=575–588|doi=10.1097/ALN.0b013e31822a24c2|issn=1528-1175|pmid=21799397}}</ref> | |||
** Dose: 0.1mg/kg | |||
** Found to have most consistent effect when given at time of induction | |||
== Contraindications<!-- List contraindications and precautions for use of the drug. --> == | == Contraindications<!-- List contraindications and precautions for use of the drug. --> == | ||
=== Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. --> === | === Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. --> === | ||
* systemic fungal infection | |||
=== Precautions<!-- List precautions for use of the drug. If none, this section may be removed. --> === | === Precautions<!-- List precautions for use of the drug. If none, this section may be removed. --> === | ||
See below for adverse effects | |||
* In cases of adrenal insufficiency, consider using hydrocortisone as dexamethasone has minimal mineralocorticoid effect | |||
== Pharmacology == | == Pharmacology == | ||
=== Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system --> === | === Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system --> === | ||
Dexamethasone is a corticosteroid associated with all the typical side effects seen with most steroids used in practice. | |||
==== Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. --> ==== | ==== Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. --> ==== | ||
As a steroid, it is thought to exert its clinical effects through anti-inflammatory action<ref>{{Cite journal|last=Holte|first=Kathrine|last2=Kehlet|first2=Henrik|date=2002-11|title=Perioperative Single-Dose Glucocorticoid Administration: Pathophysiologic Effects and Clinical Implications|url=https://journals.lww.com/journalacs/citation/2002/11000/perioperative_single_dose_glucocorticoid.14.aspx|journal=Journal of the American College of Surgeons|language=en-US|volume=195|issue=5|pages=694|doi=10.1016/S1072-7515(02)01491-6|issn=1879-1190}}</ref> | |||
* inhibits both cyclooxygenase and lipoxygenase pathways <ref>{{Cite web|url=https://academic.oup.com/edrv/article/21/1/55/2423840|access-date=2024-02-13|website=academic.oup.com}}</ref> | |||
* inhibits of spinal cord nociceptive processing<ref>{{Cite journal|last=Svensson|first=Camilla I.|last2=Yaksh|first2=Tony L.|date=2002-04|title=The Spinal Phospholipase-Cyclooxygenase-Prostanoid Cascade in Nociceptive Processing|url=https://www.annualreviews.org/doi/10.1146/annurev.pharmtox.42.092401.143905|journal=Annual Review of Pharmacology and Toxicology|language=en|volume=42|issue=1|pages=553–583|doi=10.1146/annurev.pharmtox.42.092401.143905|issn=0362-1642}}</ref> | |||
* inhibits release of bradykinin<ref>{{Cite journal|last=Hargreaves|first=Kenneth M|last2=Costello|first2=Ann|date=1990-08|title=Glucocorticoids suppress levels of immunoreactive bradykinin in inflamed tissue as evaluated by microdialysis probes|url=http://doi.wiley.com/10.1038/clpt.1990.132|journal=Clinical Pharmacology and Therapeutics|volume=48|issue=2|pages=168–178|doi=10.1038/clpt.1990.132|issn=0009-9236}}</ref> | |||
==== Adverse effects<!-- Describe any potential adverse effects of the drug. --> ==== | ==== Adverse effects<!-- Describe any potential adverse effects of the drug. --> ==== | ||
* Hyperglycemia | |||
* Altered mental status | |||
* Short term use not associated with surgical site infection<ref>{{Cite journal|last=Corcoran|first=Tomás B.|last2=Myles|first2=Paul S.|last3=Forbes|first3=Andrew B.|last4=Cheng|first4=Allen C.|last5=Bach|first5=Leon A.|last6=O’Loughlin|first6=Edmond|last7=Leslie|first7=Kate|last8=Chan|first8=Matthew T.V.|last9=Story|first9=David|last10=Short|first10=Timothy G.|last11=Martin|first11=Catherine|date=2021-05-06|title=Dexamethasone and Surgical-Site Infection|url=http://www.nejm.org/doi/10.1056/NEJMoa2028982|journal=New England Journal of Medicine|language=en|volume=384|issue=18|pages=1731–1741|doi=10.1056/NEJMoa2028982|issn=0028-4793}}</ref>, but anesthesiologists and surgeons may often choose to avoid dexamethasone if concerned about pre-existing infection | |||
* Impaired post op wound healing | |||
=== Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. --> === | === Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. --> === | ||
Latest revision as of 23:12, 23 February 2024
Dexamethasone
| Trade names |
Decadron |
|---|---|
| Clinical data | |
| Drug class |
Steroid |
| Uses |
PONV, analgesia |
| Contraindications |
Relative: Diabetes/hyperglycemia, altered mental status, lymphoma, infection |
| Routes of administration |
IV |
| Dosage |
PONV: 4-8mg Analgesia: 0.1mg/kg |
| Pharmacodynamics | |
| Mechanism of action |
Unclear but likely related to steroidal anti-inflammatory action |
| Adverse effects |
Hyperglycemia, altered mental status, delayed wound healing |
| Pharmacokinetics | |
| Onset of action |
1-2 hrs |
| Duration of action |
36-72 hrs |
| Physical and chemical data | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Dexamethasone is a corticosteroid commonly used in anesthetic practice for management of PONV and pain. While the mechanism of action of steroids is well known, the mechanism of dexamethasone in prevention of PONV is not well understood.
Uses
- PONV: DREAM study found that inclusion of dexamethasone (8mg IV) at the time of induction reduced PONV and PRN anti-emetic usage across patient groups[1]
- Given its longer onset, most effective when given at induction
- Typical dose 4-8mg IV
- Analgesia: meta-analysis found that dexamethasone effective at reducing pain scores and opioid consumption post op[2]
- Dose: 0.1mg/kg
- Found to have most consistent effect when given at time of induction
Contraindications
Absolute contraindications
- systemic fungal infection
Precautions
See below for adverse effects
- In cases of adrenal insufficiency, consider using hydrocortisone as dexamethasone has minimal mineralocorticoid effect
Pharmacology
Pharmacodynamics
Dexamethasone is a corticosteroid associated with all the typical side effects seen with most steroids used in practice.
Mechanism of action
As a steroid, it is thought to exert its clinical effects through anti-inflammatory action[3]
- inhibits both cyclooxygenase and lipoxygenase pathways [4]
- inhibits of spinal cord nociceptive processing[5]
- inhibits release of bradykinin[6]
Adverse effects
- Hyperglycemia
- Altered mental status
- Short term use not associated with surgical site infection[7], but anesthesiologists and surgeons may often choose to avoid dexamethasone if concerned about pre-existing infection
- Impaired post op wound healing
Pharmacokinetics
Chemistry and formulation
History
References
- ↑ DREAMS Trial Collaborators and West Midlands Research Collaborative (2017-04-18). "Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial)". BMJ (Clinical research ed.). 357: j1455. doi:10.1136/bmj.j1455. ISSN 1756-1833. PMC 5482348. PMID 28420629.
- ↑ De Oliveira, Gildàsio S.; Almeida, Marcela D.; Benzon, Honorio T.; McCarthy, Robert J. (2011-09). "Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials". Anesthesiology. 115 (3): 575–588. doi:10.1097/ALN.0b013e31822a24c2. ISSN 1528-1175. PMID 21799397. Check date values in:
|date=(help) - ↑ Holte, Kathrine; Kehlet, Henrik (2002-11). "Perioperative Single-Dose Glucocorticoid Administration: Pathophysiologic Effects and Clinical Implications". Journal of the American College of Surgeons. 195 (5): 694. doi:10.1016/S1072-7515(02)01491-6. ISSN 1879-1190. Check date values in:
|date=(help) - ↑ academic.oup.com https://academic.oup.com/edrv/article/21/1/55/2423840. Retrieved 2024-02-13. Missing or empty
|title=(help) - ↑ Svensson, Camilla I.; Yaksh, Tony L. (2002-04). "The Spinal Phospholipase-Cyclooxygenase-Prostanoid Cascade in Nociceptive Processing". Annual Review of Pharmacology and Toxicology. 42 (1): 553–583. doi:10.1146/annurev.pharmtox.42.092401.143905. ISSN 0362-1642. Check date values in:
|date=(help) - ↑ Hargreaves, Kenneth M; Costello, Ann (1990-08). "Glucocorticoids suppress levels of immunoreactive bradykinin in inflamed tissue as evaluated by microdialysis probes". Clinical Pharmacology and Therapeutics. 48 (2): 168–178. doi:10.1038/clpt.1990.132. ISSN 0009-9236. Check date values in:
|date=(help) - ↑ Corcoran, Tomás B.; Myles, Paul S.; Forbes, Andrew B.; Cheng, Allen C.; Bach, Leon A.; O’Loughlin, Edmond; Leslie, Kate; Chan, Matthew T.V.; Story, David; Short, Timothy G.; Martin, Catherine (2021-05-06). "Dexamethasone and Surgical-Site Infection". New England Journal of Medicine. 384 (18): 1731–1741. doi:10.1056/NEJMoa2028982. ISSN 0028-4793.
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