Clinical Conundrum
Can the intravenous solution of Dexamethasone be given orally?
Background
Respiratory illnesses like asthma, croup, and bronchiolitis account for a large number of annual emergency department visits.
Steroids are often used as part of the treatment course. However, many times commercial products may be unavailable or unsuitable for patients creating the need to compound these medications.
Dexamethasone is commonly used for those listed indications in many pediatric and adult cases because it is inexpensive and has a longer duration of action compared to the other steroids.
Answer
The IV formulation of dexamethasone can be administered via the oral route at the same dose when mixed with a small amount of syrup or juice for palatability.
This eliminates the need to crush tablets and can decrease adverse effects that may be caused by excipients found in the standard dexamethasone oral solutions.
The final product will be rapidly absorbed orally and is as efficacious as the parenteral route for both pediatrics and adults.
References
Corneli HM, Zorc JJ, Mahajan P, et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis [published correction appears in N Engl J Med. 2008 Oct 30;359(18):1972.. Majahan, Prashant [corrected to Mahajan, Prashant]]. N Engl J Med. 2007;357(4):331-339. doi:10.1056/NEJMoa071255
McCallister A, So TY, Stewart J. Evaluation of the efficacy of a onetime injectable dexamethasone administered orally in the pediatric emergency department for asthma exacerbation. J Pediatr Pharmacol Ther. 2017;22(5):326-331.
Toledo A, Amato CS, Clarke N, Reitz RE, Salo D. Injectable dexamethasone sodium phosphate administered orally? A pharmacokinetic analysis of a common emergency department practice. J Pediatr Pharmacol Ther. 2015;20(2):105-111. doi:10.5863/1551-6776-20.2.105.
Written by:
GeMiracle F Lee, P4 Pharmacy Student
Doctor of Pharmacy Candidate, Class of 2022
Reviewed By:
Joanne C. Routsolias, PharmD, RN, BCPS
Clinical PharmD Specialist - Emergency Medicine/Toxicology