Dexamethasone administration route

If an i.v. line cannot be placed, the intraosseous drug administration route can be used for pediatric patients during, for example, cardiopulmonary resuscitation (CPR) because drug delivery by this route is similar to that for i.v. administration. If drug or fluid delivery by this route is sluggish, a saline flush can be used to clear the needle. Intraosseous administration is used to deliver medications such as epinephrine, atropine, sodium bicarbonate, dopamine, diazepam, isoproterenol, phenytoin, phenobarbital, dexamethasone, and various antibiotics. ... 

Effects on growth occur early in treatment with sensitive testing methods they can be detected in growing children within a few weeks of starting therapy. The effects can be produced by any route of administration, including even inhalation therapy (at least with dexamethasone) (SEDA-18, 391). Comparisons of attained heights with expected heights in children who have used inhaled or oral... 

One study compared vitreous and serum concentrations after 7.5-mg oral doses of dexamethasone with peribulbar injections of 5 mg dexamethasone phosphate. Peribulbar administration of the agent resulted in 3.9% higher intravitreal than vitreous concentrations, but serum dexamethasone levels were approximately equal with both routes of administration. 

Posterior subcapsular cataracts (PSCs) can occur with all routes of administration (Figure 12-2), including systemic, topical, cutaneous, nasal aerosols, and inhalation corticosteroids. In a study of 44 rheumatoid arthritis patients treated with various steroids, including prednisone and dexamethasone, 17 (39%) developed bilateral PSCs. Dosage and duration of therapy appeared to be correlated with the incidence of cataract development. Patients who received prednisone therapy for 1 to 4 years showed an 11% incidence if the dose range was less than 10 mg/day a 30% incidence if the dose was... 

When used in combination with corticosteroids, cyclophosphamide is dosed at 1-3 mg/kg for oral therapy and 0.5-1.0 g/m of body surface area for intravenous therapy. The most common route of cyclophosphamide administration is intravenous, although there is little evidence that this is better than oral administration. Likewise, there is no evidence to suggest the optimal duration of treatment. Based on empirical experience, cyclophosphamide generally is dosed monthly for 6 months and then every 3 months for a period of either 2 years or for 1 year after the nephritis is in remission." " Of course, cyclophosphamide therapy is not without risk. Serious toxic effects include suppression of hematopoiesis, opportunistic infections, bladder complications (e.g., hemorrhagic cystitis and cancer), sterility, and teratogenesis. White blood cell counts must be monitored during cyclophosphamide therapy, and if the nadir is less than 1500/mm, the dose must be adjusted to keep the white cell count above 1500/mm. Nausea and vomiting associated with cyclophosphamide can be controlled with oral ondansetron plus dexamethasone. ... 

The incidence and severity of vomiting depends on the dosage and route of administration of antineoplastic agents. Intravenous ondansetron (Zof-ran) plus dexamethasone and lorazepam is the most effective treatment available for prevention of severe vomiting due to antineoplastic agents (see also Figure 73). 

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