Deksametazo-Darnitsa solution

General characteristics. Structure:

Acting veshchestvo:dexamethasone;

1 ml of solution contains phosphate sodium dexamethasone in terms of 100% anhydrous, free from ethanol, substance – 4,0 mg;

excipient: sodium hydrophosphate, dodecahydrate; potassium dihydrophosphate; glycerin; benzyl alcohol; dinatrium эдетат; water for injections.

Pharmacological properties:

Pharmacodynamics. DEKSAMETAZON-DARNITSA – the semi-synthetic fluorinated glucocorticosteroid which slows down release interleykina-1 and interleykina-2, gamma interferon from lymphocytes and macrophages. Renders the antiinflammatory, antiallergic, desensibilizing, antishock, anti-toxic and immunosuppressive action.

Suppresses release by a hypophysis of AKTG and beta липотропина, but does not reduce the level of the circulating beta endorphine. Oppresses secretion of thyritropic and follicle-stimulating hormones.

Increases excitability of the central nervous system, reduces quantity of lymphocytes and eosinophils, increases quantity of erythrocytes (stimulates production of erythropoetin).

Interacts with specific cytoplasmatic receptors and forms the complex getting into a kernel of a cell and stimulates synthesis of MRNK, the last induces formation of proteins, including the lipokortin mediating cellular effects. Lipokortin oppresses a phospholipase And, suppresses release of arachidonic acid and suppresses synthesis of endoperoxides, prostaglandins, the leukotrienes promoting processes of an inflammation, an allergy.

Protein metabolism: reduces amount of protein in plasma (at the expense of globulins) with increase in coefficient albumine/globulin, increases synthesis of albumine in a liver and kidneys; strengthens a protein catabolism in muscular tissue.

Lipidic exchange: increases synthesis of higher fatty acids and triglycerides, redistributes fat (accumulation of fat is preferential in the field of a shoulder girdle, the person, a stomach), leads to development of a hypercholesterolemia.

Carbohydrate metabolism: increases absorption of carbohydrates from a digestive tract; increases activity of the glyukozo-6-phosphatase leading to increase in intake of glucose from a liver in blood; increases activity of a fosfoenolpiruvatkarboksilaza and synthesis of the aminotransferases leading to activation of a gluconeogenesis.

Water and electrolytic exchange: Na + and water in an organism detains, stimulates removal of K+ (mineralokortikosteroidny activity), reduces absorption of Ca2 + from a digestive tract, "washes away" Ca2 + from bones, increases removal of Ca2 + kidneys.

The antiinflammatory effect is connected with release oppression by eosinophils of mediators of an inflammation; induction of formation of a lipokortin and reduction of quantity of the mast cells producing hyaluronic acid; reduction of permeability of capillaries; stabilization of cellular membranes and membranes of organellas (especially lizosomalny).

The antiallergic effect develops as a result of suppression of synthesis and secretion of mediators of an allergy, braking of release from sensitized mast cells and basophiles of a histamine and other biologically active agents, reduction of number of the circulating basophiles, suppression of development of adenoid and connecting tissue, decrease in quantity of T-and B-lymphocytes, mast cells, decrease in sensitivity of effector cells to mediators of an allergy, oppression of antibodyformation, change of an immune response of an organism.

At chronic obstructive diseases of lungs action is based mainly on braking of inflammatory processes, oppression of development or the prevention of hypostasis of mucous membranes, braking of eosinophilic infiltration of a submucosal layer of an epithelium of bronchial tubes, adjournment in a mucous membrane of bronchial tubes of the circulating cell-bound immune complexes, and also braking of an erozirovaniye and desquamation of a mucous membrane. Increases sensitivity of beta adrenoceptors of bronchial tubes of small and average caliber to endogenous catecholamines and exogenous sympathomimetics, reduces viscosity of slime due to oppression or reduction of its products.

Antishock and anti-toxic action is connected with increase in arterial pressure (due to increase in concentration of the circulating catecholamines and recovery of sensitivity to them of adrenoceptors, and also vasoconstriction), decrease in permeability of a vascular wall, membranoprotektorny properties, activation of the enzymes of a liver participating in metabolism endo-and xenobiotics.

The immunodepressive effect is caused by braking of release of cytokines (interleykina-1, interleykina-2; gamma interferon) from lymphocytes and macrophages.

Suppresses synthesis and secretion of AKTG, and for the second time − synthesis of endogenous glucocorticosteroids. Slows down connective tissue reactions during inflammatory process and reduces a possibility of formation of cicatricial fabric.

Feature of action − considerable inhibition of function of a hypophysis and almost total absence of mineralokortikosteroidny activity. Doses of 1-1,5 mg/days oppress bark of adrenal glands; biological T1/2 − 32-72 hours (duration of oppression of system hypothalamus-hypophysis-bast layer of adrenal glands).

On force of glucocorticosteroid activity of 0,5 mg of dexamethasone there correspond about 3,5 mg of Prednisonum (or Prednisolonum), 15 mg of a hydrocortisone or 17,5 mg of a cortisone.

Pharmacokinetics. Dexamethasone phosphate belongs to is long to the operating glucocorticosteroids. After intramuscular introduction it is quickly absorbed from the place of an injection, and with a blood flow it is distributed in fabrics. About 80% of drug contact proteins of a blood plasma. Well gets through hematoencephalic and other barriers. The maximum concentration of dexamethasone in liquor is observed in 4 hours after intravenous administration and makes 15-20% of concentration in a blood plasma. After intravenous administration specific action is shown in 2 hours and lasts for 6-24 hours. Dexamethasone is metabolized in a liver much more slowly than a cortisone. The poluvyveniye period from a blood plasma about 3-4,5 hours.    About 80% of the entered dexamethasone eliminirutsya by kidneys in the form of a glucuronide for 24 hours. The maximum daily dose makes 80 mg.

At topical administration in ophthalmology drug is soaked up through an intact epithelium of a cornea in moisture of an anterior chamber of an eye. At an inflammation of tissues of eye or injury of a mucous membrane and a cornea the speed of absorption of dexamethasone increases.

Pharmaceutical characteristics:

main physical and chemical properties: transparent colourless liquid.

Incompatibility. Simultaneous use of a ritordin and dexamethasone contraindicated as it can lead to a fluid lungs. It was reported about the death of the woman in labor at the time of delivery in connection with development of such state.

Indications to use:

Dexamethasone is entered parenterally in urgent cases, and also in the absence of a possibility of use by the patient of a dosage form of drug in the form of tablets.

Endocrine narusheniya:zamestitelny therapy of primary or secondary (pituitary) insufficiency of bark of epinephral glands (except for acute insufficiency of epinephral glands for which treatment the cortisone or a hydrocortisone through their more expressed mineralokortikoidny action are suitable); inborn hyperplasia of epinephral glands; subacute inflammation of a thyroid gland and heavy radiation inflammation of a thyroid gland.

Rheumatic diseases: as auxiliary treatment - for support of the patient throughout the period when the main drugs are still inefficient, and also for treatment of patients for whom non-steroidal anti-inflammatory drugs have no satisfactory anesthetic and antiinflammatory effect, at a pseudorheumatism (including a juvenile pseudorheumatism), gouty and psoriasis arthritis, an osteoarthrosis (including posttraumatic), an ankylosing spondylitis, a bursitis, nonspecific tendosinovit, a synovitis, an epicondylitis at an osteoarthrosis.

General diseases of connecting fabric: treatment during an aggravation or as a maintenance therapy at system red wolf herpes, an acute rheumatic carditis.

Skin disease: pemphigus, heavy multiformny erythema (Stephens-Johnson's syndrome), violent herpetiform dermatitis, exfoliative dermatitis, heavy seborrheal dermatitis, psoriasis, fungoidny mycosis.

Allergic diseases (resistant to traditional treatment): bronchial asthma, the asthmatic status, contact dermatitis, atopic dermatitis, a serum disease, chronic or seasonal allergic rhinitis, an allergy to medicines and foodstuff, a small tortoiseshell after hemotransfusion, a Quincke's disease.

Diseases of eyes: inflammatory diseases of eyes (symptomatic ophthalmia, heavy slow lobbies and back uveites, optic neuritis, iritis and iridocyclitis, keratitis); allergic diseases of eyes (allergic helcomas, allergic forms of konyyuktivit).

Dexamethasone is appointed systemically or locally (by introduction under a conjunctiva or by means of retrobulbar or parabulbar introduction).

Gastrointestinal diseases: ulcer colitis (system therapy), disease Krone (system therapy).

Respiratory diseases: a sarcoidosis of the II-III Art., a pulmonary tuberculosis (together with specific therapy), aspiration pneumonia (together with specific therapy), a berylliosis, Leffler's syndrome.

Hematologic diseases: autoimmune hemolitic anemia, secondary thrombocytopenia at adults, an eritroblastopeniya (erythrocyte anemia), inborn (erythroidal) hypoplastic anemia, an idiopathic Werlhof's disease (only intravenous use; intramuscular introduction is contraindicated).

Disease of kidneys: stimulation of a diuresis or reduction of a proteinuria at an idiopathic nephrotic syndrome (without uraemia) and a renal failure at system red wolf herpes.

Malignant diseases: palliative treatment of leukemia and a lymphoma at adults, acute leukemia at children.

Wet brain: wet brain through primary or metastatic tumor of a brain, a craniotomy or an injury of the head.

Shock: the shock resistant to classical treatment, shock at patients with insufficiency of bark of epinephral glands, an acute anaphylaxis (intravenously after purpose of adrenaline), before operation for prevention of shock at suspicion or at the established insufficiency of bark of epinephral glands.

Other indications: tubercular meningitis with subarachnoidal blockade (together with appropriate antitubercular therapy), a trichinosis with neurologic symptoms or a myocardium trichinosis.

Indications for administration of dexamethasone vnutrisustavno or in soft tissues: the pseudorheumatism, sinoviit, an acute and subacute bursitis, acute gouty arthritis, an epicondylitis, an acute nonspecific tendovaginitis, a posttraumatic osteoarthritis.

Local appointment (introduction to the place of defeat): keloid defeats, hypertrophic, inflammatory and infiltration defeats at shingles, psoriasis, a ring-shaped granuloma, disk red wolf deprive, the localized alopecia.

Route of administration and doses:

Doses define individually, depending on a disease of the specific patient, the provided treatment period, portability of corticosteroids and reactions of an organism.

It is possible to appoint solution for injections intravenously (by means of an injection or infusion from 5% solution of glucose or 0,9% chloride sodium solution), intramusculary or locally (by means of an intra joint injection or an injection to the place of defeat on skin, or in infiltrate in soft tissues). It is necessary to remember that at intra joint introduction the drug cannot be administered in the labile and infected joints, unstable joints (owing to arthritis, a necrosis), the deformed joints (narrowing of a joint crack, an anchylosis). It is necessary to remember that at intra joint introduction, except local effects (antiinflammatory, antiallergic, anti-exudative action), accession of system effects (immunodepressive and anti-proliferative effect) is possible.

The recommended average initial daily dose for intravenous or intramuscular administration changes from 0,5 to 9 mg a day, if necessary the dose is increased. Initial doses of drug need to be applied before emergence of clinical reaction, and then the dose needs to be reduced gradually to an effective dose lowest clinically. If when using dexamethasone clinical reaction was not reached, then administration of drug needs to be stopped and passed to other glucocorticosteroids. At purpose of high doses for several days drug is sharply not cancelled, and gradually reduce a dose for several next days or longer period.

For intra joint introduction doses from 0,4 mg to 4 mg are recommended. The dose depends on the size of the affected joint. Usually 2-4 mg enter into big joints and 0,8-1 mg – in small. Use frequency usually makes from one introduction for 3-5 days to one vvedennya for 2-3 weeks. Frequent intra joint introduction can injure an articulate cartilage. The intra joint injection can be done at the same time no more than in 2 joints.

The dexamethasone dose which is entered into a synovial bag usually makes 2-3 mg, the dose which is entered into a sinew cover makes 0,4-1 mg, and a dose which is entered in a ganglion, – from 1 to 2 mg.

The dexamethasone dose which is entered into the place of defeat equals to an intra joint dose. It is possible to enter dexamethasone in parallel no more than into two places of defeat.

Doses from 2 to 6 mg of dexamethasone are recommended for introduction to soft tissues (around a joint).

For treatment of wet brain - 10 mg intravenously at the first introduction, further on 4 mg intramusculary once at 6 hours before disappearance of symptoms. The dose can be reduced in 2-4 days with gradual cancellation for 5-7 days after elimination of wet brain. At achievement of therapeutic effect it is recommended to pass from parenteral administration to oral administration of drug.

For treatment of shock - intravenously 20 mg at the first introduction, then 3 mg/kg in 24 hours in the form of continuous intravenous infusion or 2-6 mg/kg in the form of one intravenous injection, or 40 mg once, then repeatedly intravenously to an injection are each 4-6 hours at observation of symptoms of shock. Also perhaps intravenous single administration   of 1 mg/kg once. Therapy of shock needs to be cancelled as soon as the condition of the patient is stabilized, the usual duration of treatment no more than 2-3 days.

At allergic diseases – intramusculary 4-8 mg at the first introduction. Further treatment is carried out by peroral dosage forms.

Doses for children. The recommended dose at replacement therapy makes 0,02 mg/kg of body weight or 0,67 mg/sq.m of surface area of a body within a day in three injections. At all other indications the range of initial doses makes 0,02-0,3 mg/kg/days in            3-4 injections (0,6-9,0 mg/sq.m of surface area bodies/days).

The dose of 0,75 mg of dexamethasone is equivalent to a dose of 4 mg of Methylprednisolonum and Triamcinolonum, either 5 mg of Prednisonum, or 20 mg of a hydrocortisone, or 25 mg of a cortisone, or 0,75 mg of betamethasone.

Features of use:

During parenteral treatment by corticosteroids hypersensitivity reactions therefore it is necessary to take appropriate measures before an initiation of treatment dexamethasone in rare instances can be observed, considering an opportunity (especially at patients with allergic reactions to any other medicine in the anamnesis) allergic reactions.

At patients who long time are treated by dexamethasone at the termination of treatment the withdrawal (without visible signs of insufficiency of adrenal glands) with symptoms can be observed: the increased temperature, cold, reddening of a conjunctiva, a headache, dizziness, drowsiness or irritability, muscle and joints pain, vomiting, a body degrowth, the general weakness, convulsions. Therefore the dose of dexamethasone needs to be reduced gradually. The sudden termination of reception can have deadly effects.

If the patient is in a condition of an unusual stress (in connection with an injury, operation or a serious illness) during therapy or during the therapy termination by dexamethasone, a dose it is necessary to increase or use a hydrocortisone or a cortisone.

To patients who accepted dexamethasone long time and will have a heavy stress after the therapy termination, it is necessary to recover dexamethasone reception as the caused insufficiency of adrenal glands can last several months after the treatment termination.

Treatment by dexamethasone or natural glucocorticosteroids can hide symptoms of the existing or new infection, and also symptoms of intestinal perforation.

Dexamethasone can cause an exacerbation of a system fungal infection, a latent amebiasis and a pulmonary tuberculosis.

Patients with a pulmonary tuberculosis in an active form have to receive dexamethasone (together with drugs against tuberculosis) only at a rapid or disseminated pulmonary tuberculosis. Patients with an inactive form of a pulmonary tuberculosis who are treated by dexamethasone or patients who react to tuberculine have to receive chemical prophylactics.

Care and medical observation are recommended to patients with osteoporosis, an arterial hypertension, heart failure, tuberculosis, glaucoma, a liver or renal failure, a diabetes mellitus, an active round ulcer, a recent intestinal anastomosis, colitis and epilepsy. Patients for the first weeks after a myocardial infarction, patients with a thromboembolism, a heavy myasthenia, a hypothyroidism, psychosis or a psychoneurosis, and also patients of old age need special attention.

During treatment by dexamethasone the aggravation of a diabetes mellitus or transition from a latent phase to clinical displays of diabetes can be observed.

At long treatment by dexamethasone it is necessary to control potassium level in blood serum.

Vaccination by a live vaccine is contraindicated during treatment by dexamethasone. Vaccination by a lifeless virus or bacterial vaccine does not lead to the expected development of antibodies and does not give the expected protective effect. Dexamethasone is not appointed in 8 weeks prior to vaccination and does not begin to be appointed earlier, than in 2 weeks after vaccination.

Patients who long time are treated by high doses of dexamethasone and never had measles, have to avoid contact with the infected persons; at accidental contact preventive treatment by immunoglobulin is recommended.

It is recommended to be careful to patients who recover after operation or a fracture of bones as dexamethasone can slow down healing of wounds and an osteogenesis.

Action of glucocorticosteroids amplifies at patients with cirrhosis or a hypothyroidism.

Intra joint use of dexamethasone can result in local or system effects. Frequent use can cause damage of a cartilage or a necrosis of a bone.

Before intra joint introduction it is necessary to remove synovial fluid from a joint and to investigate it (to check for existence of an infection). It is necessary to avoid introduction of corticosteroids to the infected joints. If the infection of a joint develops after an injection, it is necessary to begin appropriate therapy with antibiotics.

Patients need to avoid an exercise stress on the affected joints before when the inflammation is cured.

It is necessary to avoid administration of dexamethasone in unstable joints.

Kortikoida can break results of allergic cutaneous tests.

Children and teenagers can be treated dexamethasone only in case of explicit need. During treatment by dexamethasone careful control of growth and development of children and teenagers is necessary.

Patients have to be careful with disturbance of water and electrolytic balance at dexamethasone reception since average and high doses of glucocorticosteroids can cause a delay of salt and water in an organism, and also the raised potassium excretion. In these cases additional reception of potassium and restriction of the use of salt is shown. All corticosteroids increase calcium removal process owing to what secretion of mineralokortikoid can be broken. Therefore additional purpose of salt and/or mineralokortikoid is shown. At cancellation of long therapy by corticosteroids development of a withdrawal which is followed by fervescence, muscle and joints pain, a febricula is possible. These symptoms can appear also at patients without signs of insufficiency of bark of adrenal glands.

Immunization by live vaccines is contraindicated to persons who apply immunosuppressive doses of corticosteroids. In cases of immunization of such patients with the inactivated virus or bacterial vaccines reaction of antibodies of blood serum can be reduced.

At active forms of tuberculosis use of dexamethasone should be limited to cases of the fulminant or disseminated disease forms at which corticosteroids are used in parallel with specific therapy. Patients with latent forms of tuberculosis or positive tuberkulinovy reactions to which corticosteroids are shown have to be under constant observation of the doctor for avoidance of emergence of a recurrence.

It is necessary to appoint corticosteroids with care the patient with bubbly we deprive of eyes (herpes sіmplex) as their use can lead to perforation of a cornea. Long reception of corticosteroids can lead to development of a back subkapsulyarny cataract, glaucoma, with possible injury of an optic nerve, and also to increase risk of consecutive viral or fungal eye infections.

Drug is contraindicated to patients at whom at intra joint introduction of corticosteroids pain which is followed by a swelling and further restriction of mobility of a joint, fever and a febricula considerably amplified (these symptoms demonstrate developing of septic arthritis). In case of development of septic arthritis and at confirmation of the diagnosis of sepsis it is necessary to appoint the corresponding antibacterial therapy. It is necessary to avoid introduction of corticosteroids directly in the infection center. It is necessary to investigate carefully intra joint liquid for an exception of septic process. Corticosteroids cannot be entered into labile joints. Frequent intra joint injections can injure joint tissues. Excessive loads of the injured joints before total disappearance of inflammatory process, even are contraindicated to patients at approach of symptomatic improvement.

Drug with care is appointed by the infectious patient, especially with chicken pox and measles as these diseases at use of dexamethasone proceed in more severe form. Therefore persons who had no these diseases earlier should be careful as much as possible to exclude infection. In case of contact with patients it is necessary to see a doctor at once.

Ability to influence speed of response at control of motor transport or in operating time with other mechanisms. During treatment it is necessary to be other potentially dangerous types of activity, careful at control of motor transport and occupations, which need the increased concentration of attention and speed of psychomotor reactions.

Side effects:

From endocrine system: increase in appetite, increase in body weight, steroid diabetes, decrease in tolerance to carbohydrates, a hyperglycemia, oppression гипоталамо - pituitary and adrenal system, disturbance of secretion of sex hormones (disturbance of a menstrual cycle, an amenorrhea, a hirsutism, impotence), premature epiphyseal closing, a growth inhibition at newborns, children and teenagers, cortical paralysis at premature children, an Icenco-Cushing syndrome;

from immune system: increase in risk of emergence or an exacerbation of fungal, viral or bacterial infections, reduction of an immune response, development of opportunistic infections, reduction of reactivity to inoculations and skin tests, the slowed-down healing of wounds, regress of an adenoid tissue, a leukocytosis;

from the central nervous system: dizziness, a headache, affective disturbances (irritability, euphoria, a depression, lability of mood, suicide thoughts), psychotic reactions (including a mania, hallucinations, psychoses and an exacerbation of schizophrenia), alarm, a sleep disorder, perception dysfunction, including confusion of consciousness and amnesia, and also neuritis, neuropathy, paresthesia, a hyperkinesia, spasms. Drug can cause paralysis of bark in children head мозгаПрепарат can cause physical dependence;

from the alimentary system: dyspepsia, nausea, vomiting, abdominal distention, a round ulcer with numerous perforation and hemorrhages, perforation of small and big intestines, an ulcer esophagitis, hemorrhagic pancreatitis, an atony of a digestive tract, candidiasis;

from a liver and bilious ways: increase in level of enzymes of a liver, hepatomegalia;

from a metabolism: a delay of sodium and water, the increased release of potassium, a gipokaliyemichesky alkalosis, negative nitrogenous balance;

from organs of sight: increase in intraocular pressure, glaucoma, papilloedema, back subcapsular cataract, thinning of a cornea or sclera, aggravation of ophthalmologic viral or fungus diseases, retrolental fibroplasia;

from cardiovascular system: to a syncope, bradycardia, tachycardia, a stenocardia attack, increase in heart sizes, a rupture of a myocardium as a myocardial infarction complication, polytropic ventricular premature ventricular contraction, hypostases, arterial hypertension, increase in intracranial and intraocular pressure, congestive heart failure;

from system of blood: purpura, eosinophilia, thrombocytopenia, not Werlhof's disease, increase in risk of a thrombogenesis, thrombophlebitis;

from system of a respiratory organs: fluid lungs, thromboembolism, bronchospasm;

dermatological reactions: the raised potovydeleniye, eels, oppression of regenerative and reparative functions of skin, thinning of skin, an erythema, petechias, striya, a skin atrophy, an ecchymoma, a teleangiectasia, hyper - and a hypoxanthopathy, sterile abscess, disturbance of distribution of hypodermic cellulose;

reactions in an injection site: reddening and a pricking of skin, the painless destruction of a joint which is symptomatic reminding a neurogenic arthropathy (Sharko's joint).

from a musculoskeletal system: osteoporosis, fractures of tubular bones or vertebrae, avaskulyarny osteonecrosis, ruptures of sinews, muscular weakness, atrophy of muscles, proximal myopathy;

allergic reactions: hypersensitivity reactions, Quincke's disease, small tortoiseshell, allergic dermatitis, acute anaphylaxis.

Signs of a withdrawal of glucocorticoids.

At patients who long time were treated by dexamethasone at too bystry dose decline the withdrawal and thereof cases of insufficiency of adrenal glands, arterial hypotension or a lethal outcome take place can be observed.

In certain cases signs of a withdrawal can be similar to signs of deterioration or a recurrence of a disease for which the patient was treated.

If there are heavy undesirable reactions, treatment needs to be stopped.

Interaction with other medicines:

Parallel use of dexamethasone and non-steroidal anti-inflammatory drugs increases risk of gastrointestinal bleeding and formation of ulcers.

Efficiency of dexamethasone decreases if in parallel to accept rifampicin, carbamazepine, Phenobarbitonum, Phenytoinum (diphenylhydantoin), Primidonum, ephedrine or аминоглутетимид therefore the dexamethasone dose in such combinations needs to be increased.

Combined use of dexamethasone and drugs which inhibit CYP 3A4 fermental activity, such as кетоконазол, antibiotics macroleads, increase in concentration of dexamethasone in serum and a blood plasma can entail.

Dexamethasone is the moderate inductor CYP 3A4. Combined use with drugs which are metabolized by CYP 3A4, such as индинавир, erythromycin, can increase their clearance.

Ketokonazol can oppress epinephral synthesis of glucocorticoids. Thus, owing to decrease in concentration of dexamethasone epinephral insufficiency can be observed.

Dexamethasone reduces therapeutic effect of medicines against a diabetes mellitus, an arterial hypertension, coumarinic anticoagulants, a prazikvantel and natriuretik (therefore the dose of these medicines needs to be increased). Dexamethasone increases activity of heparin, albendazole and kaliuretik (the dose of these medicines should be reduced in case of need).

Dexamethasone can change effect of coumarinic anticoagulants therefore at the use of such combination of medicines the thicket needs to control a prothrombin time.

Parallel use of dexamethasone and high doses of glucocorticosteroids or agonists of b2-receptors increases risk of a hypopotassemia. At patients with a hypopotassemia cardiac glycosides promote disturbance of a rhythm to a large extent and have big toxicity.

Glucocorticosteroids strengthen renal clearance of salicylates therefore it is sometimes heavy to receive therapeutic concentration of salicylates in blood serum. It is necessary to be careful to patients who gradually reduce a dose of corticosteroids as at the same time increase in concentration of salicylates in serum and intoxication can be observed.

If oral contraceptives are in parallel applied, time of semi-removal of glucocorticoids can increase that will strengthen their biological effect and can increase risk of side effects.

Simultaneous use of a ritordin and dexamethasone contraindicated as it can lead to a fluid lungs. It was reported about the death of the woman in labor at the time of delivery in connection with development of such state.

Simultaneous use of dexamethasone and thalidomide can cause a toxic epidermalny necrolysis.

At simultaneous use of dexamethasone with Amphotericinum In and drugs which bring potassium out of an organism (diuretics), the hypopotassemia is noted that can lead to heart failure.

Simultaneous use of dexamethasone with antikholinesterazny drugs can result in the expressed weakness at patients with gravis myasthenia.

Holestiramin can increase clearance of creatinine.

Simultaneous use of cyclosporine and corticosteroids leads to increase in their activity, at their simultaneous use emergence судорг is possible.

Types of interaction which have therapeutic advantages: parallel purpose of dexamethasone and Metoclopramidum, difengidramid, prochlorperazine or antagonists of receptors 5-HT3 (receptors of serotonin or 5-hydroxy-triptamina, type 3, such as ондансетрон or гранисетрон) it is effective for the prevention of nausea and vomiting caused by chemotherapy Cisplatinum, cyclophosphamide, a methotrexate, ftoruratsily.

Contraindications:

Hypersensitivity to dexamethasone or to any other component of drug.

Acute viral, bacterial or system fungal infections (if the corresponding therapy is not applied), vaccination by a live vaccine.

It is possible to apply during pregnancy only according to vital indications.

Drug is contraindicated during feeding by a breast.

Use during pregnancy or feeding by a breast. Pilot studies on pregnant females of laboratory animals show danger and toxicity of drug DEKSAMETAZON-DARNITSA to a germ. Strictly controlled researches on safety and efficiency of use of drug for pregnant women were not conducted. Use is possible according to vital indications if the advantage for mother exceeds potential risk for a fruit.

During feeding by a breast it is necessary to refrain from drug use.

Children. To children in a growth period glucocorticosteroids apply only according to absolute indications and under observation of the attending physician.

Overdose:

There are rare messages on acute overdose or on a lethal outcome in view of acute overdose.

The overdose arises usually only after several weeks of the use of overdoses. The overdose can cause the majority of the undesirable effects specified in the section "Side reactions", first of all Cushing's syndrome.

There is no specific antidote. Treatment of overdose has to be supporting and symptomatic. The hemodialysis is not an effective method of the accelerated dexamethasone conclusion from an organism.

Storage conditions:

Period of validity. 2 years. To store in the place, unavailable to children, in original packaging at a temperature not above 15 °C.

Issue conditions:

According to the recipe

Packaging:

On 1 ml in ampoules, on 5 or 10 ampoules in packaging.