Dexamethasone - instructions for use, dose, side effects, contraindications

Excipients: glycerol (glycerin distilled PK-94) - 22.5 mg, sodium hydrophosphate dodecahydrate (sodium phosphate disubstituted 12-water) - 0.8 mg; disodium edetate dihydrate [(disodium ethylenediamine-N,N,N’,N'- tetraacetic acid 2-water (Trilon B)] - 0.1 mg; water for injection - up to 1 ml.

Description:Pcolorless or with a yellowish tinge.

Pharmacotherapeutic group:Glucocorticosteroid

ATX: & nbsp

H.02.A.B.02 Dexamethasone

S.01.B.A.01 Dexamethasone

H.02.A.B Glucocorticoids

S.01.B.A Corticosteroids

Pharmacodynamics:

Dexamethasone is a synthetic hormone of the adrenal cortex, a glucocorticosteroid (GCS), a methylated derivative of fluoride prednisolone. Has anti-inflammatory, antiallergic, desensitizing, anti-shock, antitoxic and immunosuppressive action.

Interacts with specific cytoplasmic receptors of SCS with the formation of a complex,penetrating into the nucleus of the cell and stimulating the synthesis of matrix ribonucleic acid, the latter induces the formation of proteins, including lipocortin, mediating cellular effects. Lipocortin depresses phospholipase A2, inhibits the release of arachidonic acid and inhibits the synthesis of endoperoxides, prostaglandins, leukotrienes, which promote inflammation, allergies, etc.

Protein metabolism: reduces the amount of protein in the plasma (due to globulins) with an increase in the albumin / globulin ratio, increases the synthesis of albumins in the liver and kidneys; enhances protein catabolism in muscle tissue.

Lipid metabolism: increases the synthesis of higher fatty acids and triglycerides, redistributes fat (accumulation of fat occurs mainly in the area of the shoulder girdle, face, abdomen), leads to the development of hypercholesterolemia.

Carbohydrate metabolism: increases the absorption of carbohydrates from the gastrointestinal tract (GIT); increases the activity of glucose-6-phosphatase, which leads to an increase in the intake of glucose from the liver into the blood; increases the activity of phosphoenolpyruvate carboxylase and the synthesis of aminotransferases, which leads to the activation of gluconeogenesis.

Water-electrolyte exchange: delays sodium and water in the body, stimulates the excretion of potassium (mineralocorticoid activity), reduces the absorption of calcium from the digestive tract, "flushes" calcium from the bones, increases the excretion of calcium by the kidneys.

Anti-inflammatory effect is associated with inhibition of eosinophil release by inflammatory mediators; inducing lipocortin formation and reducing the number of mast cells producing hyaluronic acid; with a decrease in the permeability of capillaries; stabilization of cell membranes and membranes of organelles (especially lysosomal).

Antiallergic effect develops as a result of suppression of synthesis and secretion of mediators of allergy, inhibition of release from sensitized mast cells and basophils of histamine and other biologically active substances, decrease in the number of circulating basophils, suppression of lymphoid and connective tissue development, decrease in the number of T- and B-lymphocytes, mast cells, sensitivity of effector cells to mediators of allergy, inhibition of antibody formation, changes in the immune response of the body.

In chronic obstructive pulmonary disease, the action is mainly based on inhibition of inflammatory processes, inhibition of the development or prevention of edema of the mucous membranes, inhibition of eosinophilic infiltration of the submucosal layer of bronchial epithelium, deposition of circulating immune complexes in the mucosa of the bronchi, and inhibition of erosion and desquamation of the mucosa. Increases the sensitivity of beta-adrenergic receptors of bronchi of small and medium caliber to endogenous catecholamines and exogenous sympathomimetics, reduces the viscosity of bronchial secretions due to oppression or reduction of its production.

Anti-shock and antitoxic action associated with increased blood pressure (by increasing the concentration of circulating catecholamines and restore sensitivity thereto adrenoceptors and vasoconstriction), decreased vascular permeability, membrane-protective properties, activation of liver enzymes involved in the metabolism of endo- and xenobiotics.

Immunodepressive effect is caused by inhibition of the release of cytokines (interleukin-1 and interleukin-2,gamma-interferon) from lymphocytes and macrophages. Dexamethasone has a 30-fold more pronounced effect than endogenous cortisol. Therefore, it is a more potent inhibitor of secretion of corticotropin-releasing hormone and adrenocorticotropic hormone (ACTH). In pharmacological doses depresses the hypothalamic-pituitary-adrenal system, promotes the development of secondary adrenal insufficiency. Suppresses the synthesis and release of the pituitary ACTH and the second - the synthesis of endogenous GCS. Oppressing the secretion of thyroid-stimulating hormone and follicle-stimulating hormone. Suppresses the release of beta-lipotropin, but does not reduce the content of circulating beta-endorphin.

It inhibits connective tissue reactions during the inflammatory process and reduces the possibility of scar tissue formation.

Increases the excitability of the central nervous system.

Reduces the number of lymphocytes and eosinophils, increases erythrocytes (by stimulating the production of erythropoietins).

A feature of the action is a significant inhibition of the pituitary function and a virtually complete absence of mineralocorticoid activity.

Pharmacokinetics:

Absorption

The maximum concentration of dexamethasone in blood plasma is reached only 5 minutes after intravenous injection and 1 hour after intramuscular injection.

Distribution

The connection with plasma proteins (mainly with albumins) is 77%. Penetrates through blood-brain and placental barriers. Half-life (T_1/2) from the plasma is 190 min.

Metabolism

Metabolised in the liver. A small amount of dexamethasone is metabolized in the kidneys and other organs.

Excretion

Up to 65% of the dose is excreted by the kidneys within 24 hours.

The time of development of the clinical effect

With intravenous application, the effect develops rapidly; with intramuscular application, the clinical effect develops after 8 hours. The effect is long-lasting: from 17 to 28 days after intramuscular administration and from 3 days to 3 weeks after topical application. With local injection into the joints or soft tissues (in the lesion), absorption is slower than with intramuscular application.

Indications:

Substitution therapy for adrenocortical insufficiency (in combination with sodium chloride and / or mineralocorticosteroids): acute adrenocortical insufficiency (Addison's disease, bilateral adrenalectomy); relative insufficiency of the adrenal cortex,Developing after the abolition of treatment with SCS; primary or secondary insufficiency of the adrenal cortex.

Symptomatic and pathogenetic therapy of other diseases requiring the introduction of high-speed SCS, as well as in cases when oral administration of the drug is impossible:

- endocrine diseases (congenital hyperplasia of the adrenal cortex, subacute thyroiditis);

- shock (burn, traumatic, operating, toxic) - with ineffectiveness of vasoconstrictors, plasma-substituting drugs and other symptomatic therapy;

- cerebral edema (only after confirming the symptoms of increased intracranial pressure by the results of magnetic resonance imaging or computed tomography) due to a brain tumor in cases of head injury, neurosurgical intervention, cerebral hemorrhage, encephalitis, meningitis, radiation injury;

- asthmatic status; severe bronchospasm (exacerbation of bronchial asthma);

- severe allergic reactions, anaphylactic shock;

- rheumatic diseases;

- systemic connective tissue diseases;

- acute severe dermatoses;

- malignant diseases (palliative treatment of leukemia and lymphoma in adult patients, acute leukemia in children, hypercalicemia in patients with malignant tumors, with the impossibility of oral treatment);

- blood diseases (acute hemolytic anemia, agranulocytosis, idiopathic thrombocytopenic purpura in adults);

- in ophthalmic practice (subconjunctival, retrobulbar or parabulbar injection): keratitis, keratoconjunctivitis without epithelial damage, iritis, iridocyclitis, blepharitis, blepharoconjunctivitis, scleritis, episcleritis, inflammatory process after eye injuries and surgical interventions, sympathetic ophthalmia, immunosuppressive treatment after corneal transplantation;

- local application (in the area of pathological education): keloids, discoid lupus erythematosus, annular granuloma;

- poisoning with cauterizing fluids (reducing inflammation and preventing cicatricial narrowing).

Contraindications:

For short-term use of "vital" indications, the only contraindication is hypersensitivity to any of the components of the drug.

Breastfeeding period, systemic mycoses.

Simultaneous use of live or diluted vaccines with immunosuppressive doses of the drug Dexamethasone.

Carefully:

Systemic parasitic and infectious diseases of viral, fungal or bacterial nature (currently or recently transferred, including recent contact with the patient) - herpes simplex, herpes zoster (viremic phase), chicken pox, measles; amoebiasis, strongyloidiasis (or suspected); active or latent tuberculosis. Application in severe infectious diseases is permissible only against the background of specific antimicrobial therapy.

The vaccination period (8 weeks before and 2 weeks after vaccination), lymphadenitis after BCG vaccination. Immunodeficiency conditions (including AIDS or HIV infection).

Diseases of the gastrointestinal tract: peptic ulcer of stomach and duodenum, esophagitis, gastritis, acute or latent peptic ulcer, newly created intestinal anastomosis, ulcerative colitis with perforation or abscessing, diverticulitis.

Liver failure.

Hypoalbuminemia and conditions predisposing to its occurrence.

Diseases of the cardiovascular system, including the recently transferred myocardial infarction, decompensated chronic heart failure, arterial hypertension, hyperlipidemia.

Endocrine diseases - diabetes (including impaired tolerance to carbohydrates), thyrotoxicosis, hypothyroidism, Itenko-Cushing's disease, obesity III-IV degree.

Severe chronic renal failure, nephrourolythiasis.

Systemic osteoporosis, myasthenia gravis gravis, poliomyelitis (except for the form of bulbar encephalitis), epilepsy, "steroid" myopathy.

Acute psychosis, severe affective disorders (including in the history, especially "steroid" psychosis).

Open and closed angle glaucoma, herpes of the eye (risk of corneal perforation).

Pregnancy.

Elderly patients - in connection with a high risk of osteoporosis and hypertension.

In children during growth dexamethasone It should be used only under absolute indications and under very careful supervision of the attending physician.

Pregnancy and lactation:

Dexamethasone penetrates the placenta and can reach high concentrations in the fetus.During pregnancy (especially in the first trimester) or in women planning pregnancy, taking the drug Dexamethasone is shown if the expected therapeutic effect of the use of the drug exceeds the risk of negative effects on the body of the mother or fetus. SCS should be prescribed during pregnancy only on absolute indications. With prolonged therapy during pregnancy, the possibility of impaired fetal growth is not ruled out. In case of application at the end of pregnancy, there is a risk of atrophy of the adrenal cortex in the fetus, which may require replacement therapy in the newborn.

A small amount of dexamethasone penetrates into breast milk.

If treatment with the drug is necessary during breastfeeding, breastfeeding should be discontinued, as this may delay the growth of the baby and reduce the secretion of its endogenous corticosteroids.

Dosing and Administration:

Dosing regimen is individual and depends on the indications, the patient's condition and his reaction to therapy. The drug is administered intravenously (iv) slowly struino or drip (with acute and urgent conditions); intramuscularly (intramuscularly); possibly also local (in pathological education) and subconjunctival,retrobulbar or parabulbar injection.

In order to prepare a solution for intravenous infusion, an isotonic solution of sodium chloride or a 5% solution of dextrose should be used.

The drug is administered intravenously and / or in a dose of 0.5-24 mg / day in 2 divided doses (equivalent to 1 / 3-1 / 2 oral dose) as short as possible in the lowest effective dose, and the treatment is gradually withdrawn. If high doses are used for more than a few days, the dose should gradually decrease over the next few days or longer. Long-term treatment should be carried out at a dose not exceeding 0.5 mg / day. Intramuscularly, no more than 2 ml of solution is injected into the same place.

At urgent conditions are used in higher doses: the initial dose is 4-20 mg, which is repeated until the desired effect is achieved, the total daily dose rarely exceeds 80 mg. After achieving a therapeutic effect dexamethasone Enter 2-4 mg, if necessary, followed by a gradual withdrawal of the drug. To maintain a long-term effect, the drug is injected every 3-4 hours or as a continuous drip infusion. After relief of acute conditions, the patient is transferred to dexamethasone intake.

In shock Enter strictly in / in the bolus in a dose of 2-6 mg / kg.If necessary, repeat doses are administered every 2-6 h or in the form of a prolonged IV infusion at a dose of 3 mg / kg / day. Treatment with dexamethasone should be performed as part of a complex therapy of shock. The use of pharmacological doses is permissible only in life-threatening conditions, and, as a rule, this time does not exceed 48-72 hours.

With edema of the brain the initial dose of 10 mg is given IV, then 4 mg every 6 hours until relief of symptoms (usually within 12-24 hours). After 2-4 days, the dose is reduced and the drug is gradually stopped for 5-7 days.

Patients with malignant neoplasms may require maintenance treatment - 2 mg IM or iv 2-3 times a day.

With acute edema of the brain short-term intensive therapy: adults, the loading dose is 50 mg IV, then on day 1-3, 8 mg are administered every 2 hours, on the 4th day - 4 mg every 2 hours, for 5-8 days - 4 mg every 4 hours, then the daily dose is reduced by 4 mg / day until it is completely canceled.

Children with a body weight of more than 35 kg the loading dose is 25 mg IV, then on day 1-3, 4 mg every 2 hours, on the 4th day - 4 mg every 4 hours, on 5-8 days - 4 mg every 6 hours, then daily The dose is reduced by 2 mg / day until it is completely canceled.

Children with body weight less than 35 kg the loading dose is 20 mg IV, then on day 1-3, 4 mg are administered every 3 hours, on the 4th day - 4 mg every 6 hours, for 5-8 days - 2 mg every 6 hours, then daily The dose is reduced by 1 mg / day until it is completely canceled.

In acute self-limiting allergic reactions or exacerbation of chronic allergic diseases Combine parenteral and oral use of dexamethasone: 1st day - iv 4-8 mg, 2-3 day - inside 1 mg 2 times a day, 4-5 day - inside 0.5 mg 2 times a day, 6- 7 day - inside 0.5 mg once. On the 8th day, the effectiveness of therapy is evaluated.

Doses of the drug for children (IM): the dose of the drug during replacement therapy (with adrenal cortex insufficiency) is 0.0233 mg / kg body weight or 0.67 mg / m² body surface area, divided into 3 doses, every 3rd day or 0.00776-0.01165 mg / kg body weight or 0.233-0.335 mg / m² body surface area daily.

With other indications, the recommended dose is from 0.02776 to 0.1666 mg / kg body weight or 0.833 to 5 mg / m² body surface area every 12-24 hours.

Side effects:

The frequency of development and severity of side effects depend on the duration of application, the amount of dose used and the possibility of observing the circadian rhythm of the appointment.

Disorders from the endocrine system: reduced glucose tolerance, "steroid" diabetes or a manifestation of latent diabetes mellitus, adrenal suppression, Cushing's syndrome (moon face, obesity, pituitary type, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, myasthenia gravis, "steroid" striae), delay sexual development in children.

Violations of the blood and lymphatic system: moderate leukocytosis, lymphopenia, eosinopenia, polycythemia.

Disorders from the gastrointestinal tract: nausea, vomiting, pancreatitis, steroid ulcer of stomach and duodenum, erosive esophagitis, bleeding and perforation of the stomach or intestines, increase or decrease in appetite, flatulence, hiccough, abdominal pain, discomfort in the stomach. In rare cases - increased activity of "liver" transaminases and alkaline phosphatase.

Violations from the heart and blood vessels: arrhythmias, bradycardia (up to cardiac arrest); development (in predisposed patients) or worsening of the course of chronic heart failure; changes in the electrocardiogram,characteristic of hypokalemia; increased blood pressure, hypercoagulation, thrombosis; with intravenous administration: "hot flashes" to the face, vasculitis, increased fragility of capillaries. In patients with acute and subacute myocardial infarction - the spread of the focus of necrosis, slowing the formation of scar tissue, which can lead to rupture of the heart muscle.

Disorders of the psyche: nervousness or anxiety, insomnia, emotional lability, delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, suicidal tendencies.

Disturbances from the nervous system: increased intracranial pressure, dizziness, headache, vertigo, pseudotumor, cerebral cramps, convulsions.

Disturbances on the part of the organ of sight: sudden loss of vision (with parenteral administration in the head, neck, nasal concha, scalp may precipitate crystals of the drug in the vessels of the eye), posterior subcapsular cataracts, increased intraocular pressure with possible damage to the optic nerve, propensity to develop secondary bacterial, fungal or viral infections eye, trophic corneal changes, exophthalmos, chemosis, ptosis, mydriasis, corneal perforation, central serous chorioretinopathy.

Disorders from the metabolism and nutrition: hypercholesterolemia, increased excretion of calcium, hypocalcemia, weight gain, negative nitrogen balance (increased protein breakdown), increased sweating, epidural lipomatosis.

Caused by mineralocorticoid activity - fluid retention and sodium (peripheral edema), hypernatremia, hypokalemic syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue).

Disturbances from the musculoskeletal and connective tissue: slowing the growth and processes of ossification in children (premature closure of epiphyseal growth zones), osteoporosis, (very rarely - pathological bone fractures, aseptic necrosis of the head of the humerus and thigh bone), rupture of muscle tendons, steroid myopathy, muscle loss (atrophy).

Disorders from the kidneys and urinary tract: leukocyturia.

Disturbances from the skin and subcutaneous tissues: delayed healing of wounds, petechiae, ecchymosis, thinning of the skin, hyper- or hypopigmentation, "steroid" acne, steroid striae, propensity to develop pyoderma and candidiasis, rosace-like perioral dermatitis, suppression of reactions during skin tests, telangiectasia, hypertrichosis.

Immune system disorders: generalized (skin rash, skin itching, anaphylactic shock), local allergic reactions.

Infectious and parasitic diseases: development or exacerbation of infections (the emergence of this side effect is facilitated by jointly used immunosuppressants and vaccination).

General disorders and disorders at the site of administration: withdrawal syndrome, local with parenteral administration: burning, numbness, pain, paresthesia and infections at the injection site, rarely - necrosis of surrounding tissues, scar formation at the injection site; atrophy of the skin and subcutaneous tissue with the / m introduction (especially dangerous is the introduction to the deltoid muscle).

Overdose:

Symptoms: increased arterial pressure, peripheral edema, peptic ulcer, hyperglycemia, impaired consciousness.

Treatment: symptomatic, there is no specific antidote.

Interaction:

Dexamethasone is pharmaceutically incompatible with other drugs (LS) (may form insoluble compounds). It is recommended to inject it separately from other drugs (iv bolus, or through another dropper, as a second solution).

When a solution of dexamethasone is mixed with heparin, a precipitate forms.

Dexamethasone increases the toxicity of cardiac glycosides (because of the resulting hypokalemia, the risk of arrhythmias increases).

Accelerates the removal of acetylsalicylic acid, reduces the content of its metabolites in the blood (with the abolition of dexamethasone, the concentration of salicylates in the blood increases and the risk of side effects increases).

With simultaneous use with live antiviral vaccines and against other types of immunizations, increases the risk of virus activation and the development of infections.

Increases the metabolism of isoniazid, mexiletine (especially in "fast acetylators"), which leads to a decrease in their concentrations in the blood plasma.

Increases the risk of hepatotoxic effects of paracetamol (induction of liver enzymes and the formation of a toxic metabolite of paracetamol).

Increases (with prolonged therapy) the content of folic acid.

Hypokalemia caused by dexamethasone may increase the severity and duration of muscle blockade against the background of muscle relaxants.

In high doses reduces the effect of somatropin.

Dexamethasone reduces the effect of hypoglycemic drugs; enhances the anticoagulant effect of coumarin derivatives.

Weaken the influence of vitamin D on the absorption of calcium in the lumen of the intestine.

Ergocalciferol and parathyroid hormone interfere with the development of osteopathy caused by dexamethasone.

Reduces the concentration of praziquantel in the blood.

Cyclosporine (inhibits metabolism) and ketoconazole (reduces clearance) increase toxicity.

Thiazide diuretics, carbonic anhydrase inhibitors, other glucocorticosteroids and amphotericin B increase the risk of hypokalemia, Na-containing drugs - edema and increased blood pressure.

Non-steroidal anti-inflammatory drugs (NSAIDs) and ethanol increase the risk of developing the appearance of the mucous membrane of the gastrointestinal tract and bleeding, in combination with NSAIDs for the treatment of arthritis, it is possible to reduce the dose of GCS due to the summation of the therapeutic effect.

Indomethacin, displacing dexamethasone from association with albumin, increases the risk of developing its side effects.

Amphotericin B and carbonic anhydrase inhibitors increase the risk of osteoporosis.

The therapeutic effect of dexamethasone decreases under the influence of phenytoin, barbiturates, ephedrine, theophylline, rifampicin and other inducers of microsomal liver enzymes (an increase in metabolic rate).

Mitotane and other inhibitors of the adrenal cortex function may necessitate an increase in the dose of dexamethasone.

TOlirens dexamethasone increases with the use of drugs of thyroid hormones.

Immunosuppressants increase the risk of infection and lymphoma or other lymphoproliferative disorders caused by the Epstein-Barr virus.

Estrogens (including oral estrogen-containing contraceptives) reduce the clearance of dexamethasone, prolong the half-life and their therapeutic and toxic effects.

The emergence of hirsutism and acne is facilitated by the simultaneous use of other steroid hormone drugs, androgens, estrogens, anabolic, oral contraceptives.

Tricyclic antidepressants can increase the severity of depression caused by dexamethasone (not shown for the therapy of these side effects).

The risk of developing cataracts increases when used against other SCS, antipsychotic drugs (neuroleptics), carbutamide and azathioprine.

Simultaneous appointment with m-holinoblokatorami (including antihistamines, tricyclic antidepressants), nitrates contributes to the development of increased intraocular pressure.

With simultaneous use with fluoroquinolones, the risk of tendonitis (predominantly Achilles tendon) increases in elderly patients and in patients with tendon diseases.

Antimalarial drugs (chloroquine, hydroxychloroquine, mefloquine) in combination with dexamethasone may increase the risk of myopathy, cardiomyopathy.

Angiotensin converting enzyme inhibitors with concomitant administration with dexamethasone may alter the composition of peripheral blood.

Special instructions:

During treatment with dexamethasone (especially long-term) it is necessary to observe the oculist, control blood pressure and condition of the water-electrolyte balance, as well as patterns of peripheral blood and blood glucose levels.

In order to reduce side effects, it is necessary to increase the intake of K⁺ in the body (diet, potassium preparations). Food should be rich in proteins, vitamins, with a restriction of fat, carbohydrates and table salt.

The effect of the drug is enhanced in patients with cirrhosis of the liver. It should be noted that in patients with hypothyroidism, the clearance of dexamethasone decreases, and in patients with thyrotoxicosis - increases.

The drug may enhance existing emotional instability or psychotic disorders. When referring to a psychosis in an anamnesis dexamethasone in high doses prescribed under the strict supervision of a doctor.

With caution should be used in acute and subacute myocardial infarction - possibly spreading the focus of necrosis, slowing the formation of scar tissue and rupture of the heart muscle.

One should carefully monitor the patient within a year after the end of long-term therapy with dexamethasone in connection with the possible development of a relative insufficiency of the adrenal cortex in stressful situations.

Long-term use of high doses of the drug requires a gradual dose reduction in order to prevent the development of acute adrenocortical insufficiency.

When using dexamethasone, there is a risk of developing severe anaphylactic reactions, bradycardia.

On the background of therapy with the drug, the risk of activation of strongyloidiasis is increased.

The dose of dexamethasone should be temporarily increased in case of stressful situations during therapy (surgery, trauma). Temporary increase in the dose of the drug in stressful situations is necessary both before and after stress.

Against the background of treatment with dexamethasone, it is necessary to use specific antibacterial therapy for the therapy of latent tuberculosis, lymphadenitis after BCG vaccination, poliomyelitis, acute and chronic bacterial, parasitic infections and specific therapy in patients with peptic ulcer and osteoporosis.

During therapy with the drug, careful monitoring of the condition of patients with chronic heart failure, uncontrolled arterial hypertension, trauma and ulcerative lesions of the cornea, glaucoma is necessary.

May worsen myasthenia flow.

With sudden withdrawal of the drug, especially in the case of previous use of high doses, it is possible to develop acute adrenal insufficiency; withdrawal syndrome (not caused by adrenal insufficiency): decreased appetite, nausea, vomiting, retardation, headache, generalized musculoskeletal pain, asthenia; as well as exacerbation of the disease, which was appointed dexamethasone.

In patients with diabetes mellitus, blood glucose concentrations should be monitored and if necessary, dosages of hypoglycemic drugs should be corrected.

Dexamethasone may increase susceptibility or mask the symptoms of infectious diseases. Veterinary pox, measles and other infections can be more severe and even fatal in non-immune individuals. Immunosuppression often develops with prolonged use, but it can also occur with short-term treatment with dexamethasone.

Taking the drug may mask the symptoms of "irritation of the peritoneum" in patients with perforation of the wall of the stomach or intestine.

Against the background of the use of GCS, a change in the mobility and the number of spermatozoa is possible.

Children who were in contact with sick measles or chickenpox during the treatment period prophylactically prescribe specific immunoglobulins.

Children during prolonged treatment with dexamethasone need careful monitoring of the dynamics of growth and development.

Effect on the ability to drive transp. cf. and fur:

During treatment, it is not recommended to drive vehicles, as well as to engage in potentially dangerous activities that require speed of psychomotor reactions and increased concentration of attention.

Form release / dosage:

Solution for injection, 4 mg / ml.

Packaging:

For 1 or 2 ml of the drug in the ampoules of light-protective glass.

10 ampoules are placed in a box of cardboard.

5 or 10 ampoules are placed in a contour mesh box made of a polyvinylchloride film and aluminum foil printed lacquered, or without foil.

1, 2 or 5 contour packs of 5 ampoules, 1 or 2 contour packs of 10 ampoules are placed in a pack of cardboard.

In each pack, the box is attached instructions for use, the ampullar scarifier.

Ampoule scapper does not invest in case of using ampoules with a kink ring or with an incision and a point.

Storage conditions:

In the dark place at a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

2 years.

Do not use the product after the expiration date printed on the package.

Terms of leave from pharmacies:On prescription

Registration number:LP-003597

Date of registration:04.05.2016

Expiration Date:04.05.2021

The owner of the registration certificate:SYNTHESIS, OJSC SYNTHESIS, OJSC Russia

Manufacturer: & nbsp

SYNTHESIS, OJSC Russia

Representation: & nbspSYNTHESIS JSC Joint-Stock Kurgan Society of Medical Preparations and Products SYNTHESIS JSC Joint-Stock Kurgan Society of Medical Preparations and Products Russia

Information update date: & nbsp21.03.2017

Illustrated instructions

Instructions

Dexamethasone (Dexamethasone)