Before Taking This Medicine
You should not use Decadron if you are allergic to it, or if you have:
a fungal infection anywhere in your body.
Tell your doctor if you have ever had:
Steroid medication affects your immune system. You may get infections more easily. Steroids can also worsen or reactivate an infection you’ve already had. Tell your doctor about any illness or infection you have had within the past several weeks.
It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.
You should not breastfeed while using Decadron.
Oral Steroids Are Useful
- Asthma is a chronic inflammatory disorder of the airways.
- Corticosteroids reduce airway hyperresponsiveness, inhibit inflammatory cell migration and activation, and block late-phase reaction to allergens.
- Inhaled Steroids improve control of asthma and are safe and well tolerated by children.
- Inhaled Steroids do not improve acute exacerbations.
Sensitivity Analysis And Power Of Studies
There was no change in direction of effect size on sensitivity analysis for the variables: relapse rate, hospital readmission, and vomiting at home. However, when the results of Qureshi et al. and Cronin et al. were eliminated individually the pooled analysis demonstrated no difference between dexamethasone and prednisone for vomiting in ED .
Figure 7. Sensitivity analysis for vomiting at home with elimination of trials of Qureshi et al. Cronin et al. .
The calculated power of individual studies based on the weighted mean effect size at = 0.05 is presented in Table 2 . For the outcome variables, relapse rate and hospital readmission rate, all studies were underpowered. The weighted mean effect size for relapse rate was 0.0316 and for hospital readmission rate was 0.0132. Based on these values, a total sample size of 8,162 participants and 45,041 participants are required for detecting difference in relapse rate and hospital readmission rate, respectively . The power of our meta-analysis for detecting significant difference in relapse rate was 25.8% and for hospital readmission was 7.92%. For the variables, vomiting at ED and vomiting at home, the weighted mean effect sizes were 0.1156 and 0.0944, respectively. The power of our meta-analysis at = 0.05 was 96.9% for both these variables.
Table 2. Power analysis of included studies for different outcome variables.
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Systemic Corticosteroids In Asthma Exacerbations
The Cochrane Collaboration maintains numerous ongoing systematic reviews of randomized controlled trials of systemic steroids versus placebo in acute exacerbations of asthma in children and adults. In one Cochrane Review, patients who were treated with short courses of steroids required significantly less care as defined by relapse to additional care within 7 to 10 days , fewer hospitalizations , and less need of -agonist use . In addition, patient symptom scores improved with steroid therapy however, no significant comparisons could be made owing to a lack of standardization in the use and reporting of scores between the studies. The overall incidence of side effects, such as vomiting and headache, was reported as rare, with no significant differences between the groups this might be partly due to the limited information provided in these studies. No significant differences were identified between different routes of administration. The review concludes that a short course of systemic steroids is beneficial in moderate to severe asthma exacerbations. Mild exacerbations can be treated with -agonist therapy and inhaled corticosteroids, with the addition of systemic steroids if a patients symptoms do not improve.8
Taking Oral Steroids Can Be Challenging
Aside from the known side effects of steroids, convincing a child to take oral steroids can be difficult.
- Giving patients families prescriptions to get filled adds one more, potentially difficult, step to their management of the patient.
- Some will have financial limitations.
- Some will have transportation limitations.
- Some will have memory limitations .
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Amphotericin B Injection And Potassium
When corticosteroids are administered concomitantly with potassium-depleting agents , patients should be observed closely for development of hypokalemia. 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.
Risk Of Bias Assessment
The authors’ judgment of the risk of bias is presented in Figure 8. Randomization was adequately described in five studies . An appropriate method of allocation concealment was utilized in four trials . Only three studies provided sufficient information on blinding of participants and personnel while only two trials reported blinding of outcome assessment. Attrition bias was found to be high in two studies .
Figure 8. Risk of Bias assessment. Green, low risk of bias Yellow, unclear risk of bias Red, high risk of bias.
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What Other Drugs Will Affect Decadron
Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.
Tell your doctor about all your current medicines. Many drugs can affect Decadron, especially:
an antibiotic or antifungal medicine
What Should I Avoid While Taking Decadron
Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chickenpox or measles. These conditions can be serious or even fatal in people who are using steroid medicine.
Avoid drinking alcohol while you are taking Decadron.
Do not receive a “live” vaccine while using Decadron. The vaccine may not work as well during this time, and may not fully protect you from disease. Live vaccines include measles, mumps, rubella , polio, rotavirus, typhoid, yellow fever, varicella , and zoster .
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Are Prednisone And Other Oral Steroids Safe For Asthma
While a two-week course or “short burst” of oral steroids like prednisone is relatively safe, itâs important to avoid steroids on a long-term basis as there are potential serious side effects. Taking supplemental calcium may help to prevent osteoporosis or thinning of the bones, which is one of the side effects of long-term steroid use.
Current Treatment Of Acute Asthma
Acute asthma exacerbations are defined as episodes of progressive increase in shortness of breath, cough, wheezing, or chest tightness, or some combination of these symptoms. Most recently, an expert group formed by the National Institutes of Health agreed to define acute asthma as a worsening of asthma requiring the use of systemic corticosteroids to prevent a serious outcome. Acute exacerbation of asthma symptoms is a common complication of the disease. The frequency in which exacerbations happen vary widely depending on the severity of disease, the degree of control with prophylactic medications, and exposure to triggers. In a multicenter study from the US, the admission rate of all comers to the emergency department with acute asthma was 23%. On the other hand, a European study showed that only about 7% of all patients with acute asthma exacerbation required hospitalization. We have a similar experience in Saudi Arabia where about 8% of all asthmatics with acute exacerbation are hospitalized, but if we look at only the severe group the rate goes up to 40%. These epidemiological data underscores the importance of effective treatment of asthma exacerbations and their prevention.
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How Should I Take Decadron
Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.
Your dose needs may change due to surgery, illness, stress, or a medical emergency. Tell your doctor about any such situation that affects you.
Do not stop using Decadron suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.
In case of emergency, wear or carry medical identification to let others know you use Decadron.
Store at room temperature away from moisture and heat.
Hepatic Enzyme Inducers Inhibitors And Substrates:
Drugs which induce cytochrome P450 3A4 enzyme activity may enhance the metabolism of corticosteroids and require that the dosage of the corticosteroid be increased. Drugs which inhibit CYP 3A4 have the potential to result in increased plasma concentrations of corticosteroids. Dexamethasone is a moderate inducer of CYP 3A4. Co-administration with other drugs that are metabolized by CYP 3A4 may increase their clearance, resulting in decreased plasma concentration.
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Oral Dexamethasone Vs Oral Prednisone For Children With Acute Asthma Exacerbations: A Systematic Review And Meta
- 1Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying, China
- 2Department of Hematology, Shengli Oilfield Central Hospital, Dongying, China
Background: This systematic review and meta-analysis was conducted to compare relapse rates and adverse effects with oral dexamethasone vs. oral prednisone for acute asthma exacerbations in pediatric patients.
Methods: A computerized literature search of PubMed, Embase, Scopus, CENTRAL and Google scholar databases was carried out till 1st August 2019. Six Randomized controlled trials and 1 quasi-RCT were included. Dosage of dexamethasone and prednisone varied across studies. Studies were grouped based on the follow-up period and duration of dexamethasone administration.
Results: There was no significant difference in the relapse rate between dexamethasone and prednisone at 15 days and 1015 days of follow up . Pooled analysis found no significant difference in relapse rates with 1-day and 2-day dosage of dexamethasone compared to prednisone. Hospital readmission rates after initial discharge were not significantly different between the two drugs . Frequency of vomiting at ED and at home was significantly higher with prednisone as compared to dexamethasone.
How To Use Decadron 4 Mg Tablet
Take this medication by mouth as directed by your doctor. Take with food or milk to prevent stomach upset. Take the tablet form of this medication with a full glass of water unless your doctor directs you otherwise. If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.
If you take this medication once daily, take it in the morning before 9 AM. If you are taking this medication every other day or on another schedule besides a daily one, it may help to mark your calendar with a reminder.
The dosage and length of treatment are based on your medical condition and response to treatment. Take this medication exactly as prescribed. Follow the dosing schedule carefully. Your doctor may attempt to reduce your dose slowly from time to time to minimize side effects.
Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as nausea, dizziness, weakness, or muscle/joint pain. To prevent these symptoms while you are stopping treatment with this drug, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details. Report any new or worsening symptoms right away.
Tell your doctor if your condition does not improve or if it worsens.
How To Use Decadron Injection
Depending on your product, this medication is given by injection into a vein, muscle, joint, or skin area as directed by your doctor. Follow your doctor’s directions carefully. The dosage is based on your medical condition and response to treatment. Your doctor may attempt to reduce your dose slowly from time to time to minimize side effects.
If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.
Do not stop using this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as nausea, dizziness, weakness, or muscle/joint pain. To prevent these symptoms while you are stopping treatment with this drug, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details. Report any new or worsening symptoms right away.
Tell your doctor if your condition does not improve or if it worsens.
Systemic Steroids For Treating Asthma
Oral prednisone and dexamethasone are the currently recommended systemic steroids for moderate to severe asthma exacerbations. Formulations such as hydrocortisone and methylprednisolone can be given parenterally. Studies have found these routes to be equally effective, with the oral route being less painful and invasive.10,11 Prednisone is given for 5 days at a dose of 1 to 2 mg/kg daily . Dexamethasone can be given for 1 to 5 days at a dose ranging from 0.3 to 0.6 mg/kg daily. Dexamethasone is a long-acting glucocorticoid with a half-life of 36 to 72 hours, and is 6 times more potent than prednisone. Prednisone is shorter acting, with a half-life of 18 to 36 hours.12
Recognizing the debate in choice and dose of corticosteroids, the Cochrane Database generated a protocol to investigate this issue in hospitalized patients with asthma, but a review has not yet been published.13
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Criteria For Study Inclusion
The guidelines of the PRISMA statement and the Cochrane Handbook for Systematic Reviews of Intervention were followed during the conduct of this review . Only quasi-randomized controlled trials and RCTs were included in our study. Utilizing the PICOS outline for selecting studies, we included trials conducted in pediatric patients with acute asthmatic exacerbation treated in either an ambulatory or ED setting comparing oral dexamethasone with oral prednisone and assessing relapse rates and adverse events . Studies including adult asthma patients and utilizing the parenteral route of administration of dexamethasone or prednisone were excluded. We also excluded non-randomized studies, retrospective studies, case-series, and non-English language studies.
Dexamethasone May Offer A Better Option
- Dexamethasone Pharmacodynamics
- Potency Dexamethasone is 5-6 times more potent than prednisone.
- Half-life Dexamethasone has 4-5 longer 1/2 life than prednisone.
So the next time you are ordering oral steroids for your patients with acute asthma exacerbations, consider utilizing either a single dose or two-doses of dexamethasone as a way to improve compliance and lead to beneficial results.
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What Happens If I Overdose
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
An overdose of dexamethasone is not expected to produce life threatening symptoms. Long term use of high doses can lead to thinning skin, easy bruising, changes in body fat , increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.
Comparison Of Oral Dexamethasone Doses In Asthma Exacerbation
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|First Posted : July 20, 2009Last Update Posted : July 20, 2009|
These previous studies show similar efficacy of dexamethasone when compared to the standard 5-day prednisone/prednisolone treatment. . Within the institution, the investigators have incorporated the use of dexamethasone in the management of acute asthma exacerbations. However, practices vary as to the use of a single dose, two-day dosing and the timing of the second dose for those patients receiving two doses of dexamethasone.
The purpose of this study was to determine if single dose oral dexamethasone is as effective as a 2 dose course of oral dexamethasone in preventing relapse within 7 days for pediatric asthma patients managed in the ED. Given the long half life of dexamethasone, the investigators hypothesized that 2 doses given on days 1 and 3 are superior to single dose in improving symptoms and preventing relapse in the ED management of mild to moderate asthma exacerbations.
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