dexamethasone

the heavy hitter

A long-acting, highly potent fluorinated glucocorticoid with zero mineralocorticoid activity (no salt retention). Potency: 0.75 mg Dex $\approx$ 5 mg Prednisone.

key internal medicine indications

1. CNS Oedema:
   • Mechanism: Reduces vasogenic oedema (tumours, abscesses).
   • Dose: 4 mg to 10 mg IV/PO q6h.
   • Emergency: Spinal Cord Compression (10 mg IV STAT).
2. Bacterial Meningitis:
   • Evidence: Reduces hearing loss/neurologic sequelae (S. pneumoniae).
   • Timing: Must give BEFORE or WITH first antibiotic dose. (10 mg IV q6h x 4 days).
3. Oncology:
   • Myeloma therapy (direct apoptosis of plasma cells).
   • Antiemetic (CINV).
4. COVID-19:
   • RECOVERY trial (6 mg daily) for hypoxic patients.

adverse effects (acute)

• Hyperglycaemia: Significant spikes (pm).
• Psychosis/Insomnia: “Steroid rage” or mania.
• Perineal Pruritus: Intense burning if pushed too fast IV.