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

Excipients: methylparahydroxybenzoate 1.5 mg, propyl parahydroxybenzoate 0.2 mg, sodium disulfite 1.0 mg, disodium edetate 1.0 mg, sodium hydroxide to pH 7.0-8.5, water for injection up to 1.0 ml.

Description:

Transparent, from a colorless to light yellow solution.

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 glucocorticosteroids 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, that mediate 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.

Influence on 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.

Effect on 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.

Influence on 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.

Influence on 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 action is associated with the 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 development or prevention of edema of the mucous membranes, inhibition of eosinophilic infiltration of the submucosal layer of the bronchial epithelium, deposition of circulating immune complexes in the mucous membrane of 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 is associated with an increase in blood pressure (by increasing the concentration of circulating catecholamines and restoring the sensitivity of adrenoreceptors to them, as well as vasoconstriction), a decrease in the permeability of the vascular wall, membrane-protective properties, activation of liver enzymes involved in the metabolism of endo- and xenobiotics.

Immunosuppressive action is caused by inhibition of the release of cytokines (interleukin-1 and interleukin-2, gamma-interferon) from lymphocytes and macrophages.Suppresses the synthesis and release of pituitary adrenocorticotropic hormone (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. Doses of 1-1.5 mg / day inhibit the adrenal cortex; biological half-life (T_1/₂) - 32-72 h (the duration of oppression of the hypothalamic-pituitary-adrenal system).

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. The 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, a small amount of dexamethasone penetrates into breast milk.

Indications:

Substitution therapy for adrenal insufficiency (in combination with sodium chloride and / or mineralocorticosteroids): acute bark failure adrenal glands (Addison's disease, bilateral adrenalectomy); relative adrenal insufficiency, which develops after the cessation of treatment of 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, operational, 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 or computed tomography, caused by a brain tumor, brain 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; hypercalcemia 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): allergic conjunctivitis, keratitis, keratoconjunctivitis without damage to the epithelium, 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 (the need to reduce inflammatory phenomena and prevent cicatricial narrowing when poisoning with cauterizing fluids).

Contraindications:

- For short-term use according to "vital" indications, the only contraindication is hypersensitivity to the active substance or any other component of the drug;

- systemic fungal infections;

- the period of breastfeeding;

- simultaneous application of live and weakened vaccines with immunosuppressive doses of the drug.

Carefully:

With caution, the drug should be administered in the following conditions / conditions / risk factors:

Systemic parasitic and infectious diseases of a viral, fungal or bacterial nature (currently or recently transferred, including recent contact with a 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.

Diseases of the cardiovascular system, including the recently transferred myocardial infarction (in patients with acute and subacute myocardial infarction, it is possible to spread the focus of necrosis, slow the formation of scar tissue and, as a result, break the heart muscle), decompensated chronic heart failure (CHF) , arterial hypertension, hyperlipidemia.

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

Severe chronic renal and / or hepatic insufficiency, nephrourolythiasis.

Hypoalbuminemia and conditions predisposing to its occurrence.

Liver failure.

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

Acute psychosis, severe affective disorders (including in the anamnesis, 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 the growth period, the drug 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:

The dosage 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 formation) 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 glucose (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. Long-term treatment should be carried out at a dose not exceeding 0.5 mg / day. In / m in the same place is injected no more than 2 ml of solution.

In shock Enter strictly in / in the bolus in a dose of 2-6 mg / kg. If necessary, repeated doses are administered every 2 to 6 hours 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.

In acute edema of the brain, short-term intensive therapy is carried out: the adult 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 day - 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 exercise dose is 25 mg IV, then on day 1-3, 4 mg every 2 hours, on the 4th day - 4 mg every 4 hours, for 5-8 days - 4 mg every 6 hours, then the daily dose is reduced by 2 mg / day until it is completely canceled. For children weighing less than 35 kg, the loading dose is 20 mg IV, then on day 1 -3, 4 mg every 3 hours, on the 4th day - 4 mg every 6 hours, for 5-8 days - 2 mg every 6 hours, then the daily 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.

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, the drug Dexamethasone Enter 2-4 mg, if necessary, followed by a gradual withdrawal of the drug. To maintain a long-term effect, the drug is administered every 3-4 hours or as a prolongeddrip infusion. After relief of acute conditions, the patient is transferred to the drug Dexamethasone inside.

Doses of the drug for children (IM):

The dose of the drug during replacement therapy (with adrenal cortex deficiency) 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 0.833-5 mg / m² body surface area every 12-24 hours.

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

Side effects:

The frequency of development and severity of side effects depend on the duration of administration and the amount of dose used.

Disorders from the endocrine system: decrease in glucose tolerance, steroid diabetes mellitus or manifestation of latent diabetes mellitus, oppression of adrenal function, Itenko-Cushing syndrome (lunate face, pituitary-type obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, myasthenia gravis, steroid striae),delay in sexual development in children.

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

Heart Disease: arrhythmias, bradycardia (up to cardiac arrest), development (in predisposed patients) or worsening of the severity of CHF, changes in the electrocardiogram, characteristic of hypokalemia. 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.

Vascular disorders: increased blood pressure, hypercoagulation, thrombosis, with iv introduction: "tides" of blood to the face, vasculitis, increased fragility of capillaries.

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

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

Disturbances on the part of the organ of sight: Sudden loss of vision (when administered parenterally in the head, neck, nasal turbinate, the scalp may be the deposition of crystals of the drug in the blood vessels of the eye), posterior subcapsular cataracts, increased intraocular pressure with possible damage to the optic nerve, the propensity to develop secondary bacterial, fungal or viral eye infections, trophic changes cornea, exophthalmos, chemosis, ptosis, mydriasis, corneal perforation, central serous chorioretinopathy.

Disorders from the metabolism and nutrition: increased excretion of calcium, hypocalcemia, weight gain, negative nitrogen balance (increased protein breakdown), increased sweating, hypercholesterolemia, 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 musculoskeletal and connective tissue: slowing growth and ossification processes 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 the tendons of the muscles, 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.

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

General disorders and disorders at the site of administration: development or exacerbation of infections (the emergence of this side effect is facilitated by jointly used immunosuppressants and vaccination), withdrawal syndrome.

Local for parenteral administration: burning, numbness, pain, paresthesia and infection 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).

With iv introduction: arrhythmias, "tides" of blood to the face, seizures.

Overdose:

Symptoms: increased blood pressure, edema (peripheral), peptic ulcer, hyperglycemia, impaired consciousness.

Treatment: symptomatic, there is no specific antidote.

Interaction:

Dexamethasone is pharmaceutically incompatible with other drugs (LS) (can form insoluble compounds). It is recommended to administer it separately from other drugs (iv bolus, or via 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 excretion of acetylsacyl acid, reduces the content of its metabolites in the blood (with the dexamethasone abolition, the concentration of salicylates in the blood increases and the risk of side effects increases).

With simultaneous use with live antiviral vaccines and against the background of others.Types of immunizations increase 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 plasma concentrations.

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

Non-steroidal anti-inflammatory drugs (NSAIDs) and ethanol increase the risk of ulceration of the gastrointestinal mucosa 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.

The clearance of dexamethasone rises on the background of 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, lengthen T_1/2and 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 agents, oral contraceptives.

Tricyclic antidepressants can increase the severity of depression caused by the use of 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 the drug Dexamethasone (especially long) it is necessary to observe the oculist, monitor blood pressure and the state of water-electrolyte balance, as well as patterns of peripheral blood and blood glucose concentration.

In order to reduce side effects, you should increase the intake of potassium 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, the drug Dexamethasone in high doses prescribed under the strict supervision of a doctor.

It should be carefully monitored by the patient within a year after the end of long-term therapy with the drug Dexamethasone in connection with the possible development of a relative insufficiency of the adrenal cortex in stressful situations.

With a sudden withdrawal of the drug Dexamethasone, especially in the case of prior application of high doses, the development of acute adrenal insufficiency is possible; withdrawal syndrome (not caused by adrenal insufficiency): decreased appetite, nausea, vomiting, retardation, headache, generalized musculoskeletal pain, asthenia; as well as the aggravation of the disease, in connection with which the drug was prescribed Dexamethasone.

In patients with diabetes, 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 of dexamethasone, but it can also occur with short-term treatment.

Children who were in contact with sick measles or chickenpox during the treatment period prophylactically prescribe specific immunoglobulins. At children during long treatment by a preparation Dexamethasone it is necessary to closely monitor the dynamics of growth and development.

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 gastric and / or intestinal ulcer, 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.

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.

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

During the period of treatment, it is necessary to refrain from controlling vehicles and other mechanisms that require an increased concentration of attention and speed of psychomotor reactions.

Form release / dosage:

Solution for injection, 4 mg / ml.

Packaging:

By 1.0 ml of the drug in the ampoules of dark glass. For 25 ampoules in a cellular cardboard grid, 1 lattice together with instructions for use in a cardboard bundle.

5 ampoules in a plastic pallet, 5 pallets together with instructions for use in a cardboard pack.

Storage conditions:

Store in a dark place out of the reach of children, at a temperature of no higher than 25 ° C. Do not freeze.

Shelf life:

3 years.

Do not use after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:LP-001249

Date of registration:21.11.2011 / 24.01.2017

Expiration Date:Unlimited

The owner of the registration certificate:ELFA NPC, CJSC ELFA NPC, CJSC Russia

Manufacturer: & nbsp

ELFA LABORATORIES India

BIOCHEMIST, OJSC Russia

Information update date: & nbsp22.04.2017

Illustrated instructions

Instructions

Dexamethasone (Dexamethasone)