Dexamethasone

Chemical name

(11бета,16альфа)-9-Фтор-11, 17,21-тригидрокси-16-мети лпрегна- 1,4-dien-3 ,20-dion

Gross

C22-H29-F-O5

Characteristics

Fluorinated homologs hydrocortisone. White or almost white crystalline powder odourless. Virtually nerastvorim water, it is difficult soluble in alcohol.

Of drugs

Drugs, the anti-inflammatory, protiwallergicescoe, desencibilizirutee, protivosokowoe, immunodepressivne. Interacts with specific receptors zitoplazmaticakimi to form complex enters the nucleus of the cell and catalytic synthesis Mrnk; Last education produces proteins, including lipokortina, oposreduth cell effects. Lipokortin oppressing fosfolipazu A_2, suppresses liberatiou arahidonova acid and ingibiruet biosynthesis endoperekisey, NG, lakotrienov contributing to the processes of inflammation, allergies, etc. Prevents release of mediators of inflammation Eosinophils and fat cells. Stops gialuronidasy activity, and kollagenaza protease, normalizes the skin matrix cartilage and bone. Reduces the permeability of capillaries, stabilize cell membranes, including lizosomaiona, oppressing release Cytokines (interleukin 1 and 2, gamma-interferon) from the cells and macrophages was involution limfoidna tissue. Restores adrenoretseptorov sensitivity to kateholaminam. Makes catabolised proteins, reduces glucose disposal perifericescimi tissues and glukoneogenez increases in the liver. Decreases skin and increases the removal of calcium; Delaying sodium (and water), the secretion of Aktg.posle inside rapidly and completely absorbed. The blood linked (60-70%) to a specific protein vector-transkortinom. Easily passes through gistogematicalkie barriers, including GEB and placental. Biotransformiroetsa in the liver (mainly by conjugation with glukuronova and sulphuric acids) to inactive metabolites. T_1/2 - 36-54 hours Return with urine (a fraction - lactoirutmi disorders). The damage to skin absorption is determined by many factors : product formulation (auxiliary substances), the integrity of the skin, the availability of occluzionna bandages, etc.

Indications

Addison disease, congenital gipoplasia napochechnikov, napochechnikovaya deficiency (usually in combination with mineralokortikoidami) adrenoguenitalny syndrome, tireoidit (acute, podostry), hypothyroidism, opujoleva gipercalziemia, shock (anaphylactic, post, posleoperazionny, cardiogenny, gemotransfuzionny etc.), rheumatoid arthritis Phase worsening, acute revmocardit, kollagenozy (rheumatic disease; Disseminirovannaya red lupus, etc.) inflammatory and degenerative diseases of joints (arthritis, tendowaginit, bursitis, epikondilit, stiloidit, disorders, osteoarthritis, acute illness, etc.), myofasciitis, �нфекционно-аллергиче ская bronchial asthma, asthma status (in / in, in / m), and allergic reactions anaphylactoidnye, including by drugs, dermatitis (Contact, atopic, эксфолиативный, пузырчатый, герпетиформный, себорейный etc.), psoriasis, eczema, многоформная экссудативная erythema, vesicular disease, Mycobacterium shaped, эритродермия and other skin diseases, swelling the brain (with tumors, head trauma, Neurosurgery intervention кровоизлиянии the brain, энцефалите, meningitis, ray eyes light (on / in, in / m), Baby Ulcerative Colitis, hepatitis, саркоидоз, berillios, disseminated tuberculosis (only in combination with �ротивотуберкулезным�� means), illness Leffler and other severe respiratory diseases, anaemia (Autoimmune, Hemolytic, disease, gipoplastical, idiopathic, eritroblastopenia) trombozitopenica idiopathic purpura (adults), the secondary anaemia, lymphoma (hodgkinskaya, lymphoma), leukaemia, lymphoblastic (acute, chronic), agranulozitos, plazmotsytoma and other diseases of the blood, principally syndrome, severe infectious diseases (with the necessary combination with antibiotics), multiple sclerosis, negnanye and allergic diseases of the eye (conjunctivitis, keratit, irit, iridotsyklit, blefarit, blefarokongunguit, episclerit, sclerit) infections after eye injuries and operations, sympathetic oftalmia detected adrenakorticalna failure and Pensions stunting (children), affective disorders, including with depression.

Restrictions on the use of

Пептические ulcer syndrome, a disease hospital of stomach and duodenal ulcers, эзофагит, gastritis, intestinal whales (in the near history), long heart failure, arterial hypertension, thrombosis, diabetes, osteoporosis, a disease-Иценко Кушинга, acute kidney and / or liver failure, psychoses, apnoea condition, infants, открытоугольная glaucoma (inwards parenteral), AIDS, pregnancy, breast-feeding.

Contraindications

Hypersensitivity, systemic mikozy, amebnye sexually active form of TB infections joints and okolosustaveh soft tissue, before and after inoculation (especially antiviral), obesity III extent (inside); Eye drops, viral, such as a simple zoster, wind smallpox, fungal and tuberculosis defeat eye truly acute eye infection (in the absence of antimicrobial therapy), of the cornea epithelial defects, trachoma, glaucoma.

Side-Effects

Delay sodium and water, the loss of potassium and calcium, oedema, erosivno-azwenne shock syndrome (with the increase of ulcers until perforation, bleeding), haemorrhagic pancreatitis, atony blood, increasing appetite, nausea and vomiting, gepatomegalia, muscle weakness, miopatia, osteoporosis, pathological fractures, tendon ruptures, incredible, aetiology, the AD female heart failure, heart and liver diseases, syndrome Itsenko - Kushinga, giperglikemia, hyperlipoproteinemy, nitrogenous negative balance dismenorea, stunting among children, girsutizm, reduced immunity, the repression of regenerative and sh processes, dizziness, headaches, mood violations, psychoses, the vnutricerepnogo pressure, convulsions, and the thinning enthusiasm skin petehii, ekhimozy, nurturing, erythema and changing pigmentation person increased sweating, increased vnutriglaznogo pressure exofthalm, thrombosis and embolism, the syndrome (malaise, pain : headaches, in the abdomen, joints and muscles), depression, secondary napochechnikovaya deficiency; rarely allergic reaction (rash, itching of the skin).

Patient interaction

Older therapeutic and toxic effects of barbiturates, phenytoin, rifampicin (faster metabolism), somatotropin, antatsida (reduced intake), make-estrogensoderjaschie oral contraceptives, the risk of arrhythmias and gipokaliemii heart-glycosides and dioretiki likelihood of oedema and hypertension - sodium products or additives, heavy gipokaliemii, heart failure and osteoporosis, amphotericin B and carboangidraza inhibitors, the risk of losses erosivno-yazvennah and bleeding from the stomach-Npvs.pri simultaneous application living antiviral vaccines, and in the face of other kinds of immunization increases the risk of activation of viruses and infections. Ters gipoglikemicescuu activity of insulin and oral protivodiabeticakih funds antikoagulyazionnuu - kumarinov, dioreticescuu - mochegonnah, immunotroponuu-vaccination (suppresses antiteloobrazovanie). Poor tolerance of cardiac glycosides (a deficit of potassium), reduces the concentration salicilatov prazikvantela and in the blood.

Overdosing

Treatment : with the development of undesirable phenomena is symptomatic, acquired Itsenko - Kushinga-appointment aminoglutetimida.

Precautions

Be wary when using nonspecific yazvennom kolite, divertikulite bowel gipoalbuminemii. Appointment if interkurrentnykh infections, tuberculosis, septic conditions requires pre - and post-simultaneous antimicrobial therapy. There is a need to take into account an increase in the gipotireoze and cirrhosis of the liver, aggravaciu psihoticescoy symptoms and emotional lability in their original high-level masking Some of the symptoms of infection, the likelihood that within a few months (to a year) relative napochechnikova failure after the dexamethasone (particularly in the case of long term use). Breast-feeding at the end of treatment. In the long course carefully watching the dynamics of growth and development of children, systematically optical survey of control гипоталамо-гипофизар��о-надпочечниковой system, the level of glucose in the blood. Cease therapy only gradually. Recommended caution in any type of operation, the re-emergence of infectious diseases, injuries, avoid immunization that alcohol consumption. The children, in order to avoid an overdose of dose calculations are based on the surface area of the body. In the case of contact with diseased measles, smallpox wind and other infections appoint a preventive therapy.

Dosing and Administration

Inside, parenteral Local. Dose set individually, depending on the disease and the patient. Inside (during or after delivery), one in the morning (a small dose) or reception 2-3 (large dose) : 2-3 mg to 4-6 mg (10-15 mg) a day, after reaching effect dose gradually reduced to a supporting-0.5-1 mg (2-4.5 mg or more) per day; treatment to stop (at the end of a designated kortikotropina injection. For children 0,25-25 mg, or 0,0833-0,3333 mg / kg or 0,0025-0,0001 mg / m ^ 2 per day in 3-4 admission on the basis of age. dropped : in / in, struino slow or drip (with pressing conditions), or / m 4-20 mg (80 mg) three times a day supporting dose 0,2-9 mg / day, the course of 3-4 days, and then ingesting. Children in / m 0,02776-0,16665 mg / kg every 24 hours Vnutrisustavno (a hotbed of defeat), or periartikulyarno (soft tissue) : adults and adolescents - 0,2-6 mg (2-8 mg), repeated at intervals of 3 days to 3 weeks, as appropriate; the maximum dose for adults-80 mg per day. When she (adults), in / in, 20 mg once, and then to 3 mg / kg within 24 hours of continuous infusions or / with a single 2-6 mg / kg or / in the 40 mg every 2-6 (4-6) at the отеке brain (adult), 10 mg in / in and then on the 4 mg every 6 h in / m to the symptoms; lower dose of 2-4 days and gradually, within 5-7 days longer treatment. In the absence of crust napochechnikov (children), in / m 0.0233 mg / kg (0.67 mg / m ^ 2) / day in 3 injections every third day, or every day, 0,00776-0,01165 mg / kg (0,233-0,335 mg / m ^ 2) a day. Kongungualno : in acute conditions for the 1-2 drops every 1-2 hours, and then four to six hours; in the remaining cases, 1-2 drops 3-4 times a day; course, from 1-2 days to a few weeks.

Directory → Antimicrobials, and protivoparazitarnae protivoglistnae funds → Antibiotics → Other antibiotics → Dexamethasone