Prescribing Guides
Dexamethasone Prescribing Guide for Indian Clinical Practice
Dexamethasone prescribing guide for Indian clinicians covering glucocorticoid potency, dosing across indications, adrenal suppression and NEET PG points.
MedNext Editorial Team | 2026-08-01 | 9 min read
Dexamethasone Prescribing Guide for Indian Clinical Practice
Dexamethasone prescribing guide for Indian clinicians covering glucocorticoid potency, dosing across indications, adrenal suppression and NEET PG points.
Dexamethasone is a potent, long-acting synthetic glucocorticoid with no mineralocorticoid activity. It is indispensable in Indian clinical practice for cerebral oedema, CINV, bacterial meningitis, and numerous inflammatory and autoimmune conditions.
Clinical Pharmacology Overview
Dexamethasone is a fluorinated glucocorticoid that binds intracellular glucocorticoid receptors, modulating gene transcription to suppress inflammation, immune responses, and allergic reactions. It inhibits phospholipase A2 (via lipocortin), reduces prostaglandins and leukotrienes, decreases capillary permeability, and stabilises lysosomal membranes.
Pharmacokinetics: Oral bioavailability is approximately 80-90%. Protein binding is 77% (less than cortisol). Metabolised in the liver. Half-life is 36-54 hours (biological half-life 36-72 hours, the longest among commonly used corticosteroids). Excreted renally.
Equipotent doses: 0.75 mg dexamethasone = 5 mg prednisolone = 4 mg methylprednisolone = 20 mg hydrocortisone.
Indian Brand Names
- Dexona (Zydus Cadila)
- Decdan (Organon)
- Wysolone DM (Pfizer) -- note: Wysolone alone is prednisolone
- Dexamethasone IP (multiple manufacturers)
- Decadron (MSD -- largely replaced by generic brands in India)
Approved Indications in Indian Clinical Practice
- Cerebral oedema (tumour-associated, traumatic)
- Bacterial meningitis (adjunct with antibiotics)
- Chemotherapy-induced nausea and vomiting (CINV)
- Anaphylaxis (adjunct to adrenaline)
- Croup (single dose in children)
- Severe acute asthma exacerbation
- COVID-19 with hypoxia (RECOVERY trial protocol)
- Preterm labour (foetal lung maturation)
- Raised intracranial pressure
- Congenital adrenal hyperplasia (suppression therapy)
- Diagnostic use: overnight dexamethasone suppression test for Cushing syndrome
Dosing in Adults
Cerebral oedema: 10 mg IV loading dose, then 4 mg IV/IM every 6 hours. Taper over days to weeks.
Bacterial meningitis: 0.15 mg/kg IV every 6 hours for 4 days (start with or before first antibiotic dose).
CINV: 8-20 mg IV before chemotherapy (varies by emetogenicity).
COVID-19 (hospitalised, requiring O2): 6 mg once daily (oral or IV) for up to 10 days.
Preterm foetal lung maturation: 6 mg IM every 12 hours for 4 doses (total 24 mg).
Overnight DST: 1 mg orally at 11 PM, measure 8 AM cortisol.
Low-dose DST: 0.5 mg every 6 hours for 48 hours.
Important Drug Interactions
- CYP3A4 inducers (phenytoin, rifampicin, carbamazepine): accelerate dexamethasone metabolism, reducing efficacy
- NSAIDs: increased GI bleeding risk
- Oral hypoglycaemics and insulin: corticosteroids cause hyperglycaemia
- Warfarin: may alter anticoagulant effect (monitor INR)
- Diuretics: enhanced hypokalaemia
- Live vaccines: contraindicated during immunosuppressive corticosteroid therapy
- Fluoroquinolones: increased tendon rupture risk
Side Effects and Monitoring
Short-term high-dose: hyperglycaemia, insomnia, mood changes, increased appetite, fluid retention (minimal with dexamethasone), GI irritation.
Long-term: Cushing syndrome, osteoporosis, adrenal suppression, immunosuppression, myopathy, cataracts, glaucoma, growth retardation (children), avascular necrosis of femoral head, peptic ulceration, thin skin and poor wound healing.
Adrenal suppression: courses longer than 2-3 weeks at supraphysiological doses suppress the HPA axis. Taper gradually; abrupt withdrawal can cause adrenal crisis.
Monitoring: blood glucose (especially in diabetics), blood pressure, electrolytes (potassium), signs of infection. Bone density for long-term use. Ophthalmology review for prolonged courses.
Special Populations
Pregnancy: Category C. Used for foetal lung maturation (24-34 weeks gestation). Crosses placenta minimally compared to prednisolone (lacks 11-beta-HSD2 protection). Prolonged use carries risk of foetal adrenal suppression and IUGR.
Renal impairment: No dose adjustment required.
Hepatic impairment: Metabolism may be reduced. Monitor for enhanced effects.
Elderly: Higher risk of osteoporosis, hyperglycaemia, and myopathy. Use lowest effective dose for shortest duration.
Children: Growth monitoring essential with prolonged use.
NEET PG High-Yield Points
- Most potent commonly used glucocorticoid (25-30x hydrocortisone)
- No mineralocorticoid activity -- does not cause sodium retention
- Longest biological half-life (36-72 hours) -- long-acting steroid
- Dexamethasone suppression test: screening for Cushing syndrome
- Used in bacterial meningitis BEFORE or WITH first antibiotic dose
- RECOVERY trial: mortality benefit in COVID-19 with hypoxia only
- Foetal lung maturity: betamethasone or dexamethasone at 24-34 weeks
- Crosses placenta (unlike prednisolone, which is inactivated by 11-beta-HSD2)
- Adrenal crisis risk on abrupt withdrawal after prolonged use
- Equipotent dose calculation is a high-frequency exam question
Indian Regulatory Status
Dexamethasone is a Schedule H drug under the Drugs and Cosmetics Act. It is included in the NLEM of India for multiple indications. Injectable and oral formulations are widely available and affordable. The CDSCO mandates that corticosteroid prescriptions include adequate counselling on the risks of prolonged use. It is not a controlled substance but its immunosuppressive potential demands responsible prescribing.
Frequently Asked Questions
What is the glucocorticoid potency of dexamethasone?
Dexamethasone is approximately 25-30 times more potent than hydrocortisone as a glucocorticoid. It has virtually no mineralocorticoid activity. 0.75 mg of dexamethasone is equivalent to 20 mg hydrocortisone, 5 mg prednisolone, or 4 mg methylprednisolone.
Why is dexamethasone used in bacterial meningitis?
Dexamethasone (0.15 mg/kg IV every 6 hours for 4 days, started before or with the first antibiotic dose) reduces mortality and neurological sequelae in bacterial meningitis, particularly pneumococcal meningitis, by suppressing the inflammatory cascade triggered by bacterial lysis. This is a well-established practice in Indian paediatric and adult medicine.
How does dexamethasone differ from prednisolone?
Dexamethasone has a longer duration of action (36-72 hours vs 12-36 hours), higher glucocorticoid potency (25-30x hydrocortisone vs 4x), and negligible mineralocorticoid activity (no sodium/water retention). Prednisolone is preferred for chronic inflammatory conditions; dexamethasone for acute/high-potency needs and diagnostic tests.
Why was dexamethasone important in COVID-19?
The RECOVERY trial demonstrated that dexamethasone 6 mg daily for up to 10 days reduced 28-day mortality in hospitalised COVID-19 patients requiring supplemental oxygen or mechanical ventilation. It did not benefit (and potentially harmed) those not requiring oxygen. This became standard of care in Indian COVID-19 protocols.
Continue reading
Prescribing GuidesMetformin Prescribing Guide for Indian Clinical Practice
Evidence-based metformin prescribing for Indian clinicians covering dosing, brands, interactions, monitoring and NEET PG high-yield points.
Prescribing GuidesCeftriaxone Prescribing Guide for Indian Clinical Practice
Complete ceftriaxone prescribing reference for Indian clinicians covering indications, dosing, reconstitution, drug interactions and NEET PG points.
Prescribing GuidesAmoxicillin Prescribing Guide for Indian Clinical Practice
Comprehensive amoxicillin prescribing reference for Indian doctors covering dosing, brands, resistance patterns and NEET PG high-yield pharmacology.
Continue with Prescribing Guides
Apply what you have read with clinical prescribing MCQs that test real decision-making: drug choice, dose selection, interactions and monitoring.
Try prescribing questionsBrowse all prescribing guides