osterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to fungi or viruses. children who are on immunosuppressant drugs are more susceptible to infections than healthy children. chickenpox and measles, for example, can have a more serious or even fatal course in children on immunosuppressant corticosteroids. in such children or in adults who have not had these diseases, particular care should be taken to avoid exposure. if exposed, therapy with varicella zoster immune globulin (vzig) or pooled intravenous immunoglobulin (ivig), as appropriate, may be indicated. if chickenpox develops, treatment with antiviral agents may be considered. similarly, corticosteroids should be used with great care in patients with known or suspected strongyloides (threadworm) infestation. in such patients, corticosteroid-induced immunosuppression may lead to strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia. usage in pregnancy since adequate human reproduction studies have not been done with corticosteroids, use of these drugs in pregnancy, nursing mothers or women of childbearing potential requires that the possible benefits of the drug be weighed against the potential hazards to the mother and embryo or fetus. infants born of mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism. average and large doses of cortisone or hydrocortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. these effects are less likely to occur with the synthetic derivatives except when used in large doses. patients with a stressed myocardium should be observed carefully and the drug administered slowly since premature ventricular contractions may occur with rapid administration. dietary salt restriction and potassium supplementation may be necessary. all corticosteroids increase calcium excretion. while on corticosteroid therapy patients should not be vaccinated against smallpox. other immunization procedures should not be undertaken in patients who are on corticosteroids, especially in high doses, because of possible hazards of neurological complications and lack of antibody response. the use of dexamethasone sodium phosphate injection in active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate anti-tuberculosis regimen. if corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary as reactivation of the disease may occur. during prolonged corticosteroid therapy, these patients should receive chemoprophylaxis. because rare instances of anaphylactoid reactions have occurred in patients receiving parenteral corticosteroid therapy, appropriate precautionary measures should be taken prior to administration, especially when the patient has a history of allergy to any drug.

nitial intravenous dose of 10 mg is recommended followed by 4 mg intramuscularly every six hours until maximum response has been noted. this regimen may be continued for several days postoperatively in patients requiring brain surgery. oral dexamethasone, 1 to 3 mg t.i.d., should be given as soon as possible and dosage tapered off over a period of five to seven days. nonoperative cases may require continuous therapy to remain free of symptoms of increased intracranial pressure. the smallest effective dose should be used in children, preferably orally. this may approximate 0.2 mg/kg/24 hours in divided doses. in treatment of acute exacerbations of multiple sclerosis daily doses of 200 mg of prednisolone for a week followed by 80 mg every other day or 4–8 mg dexamethasone every other day for 1 month have been shown to be effective. the initial dosage should be maintained or adjusted until a satisfactory response is noted. if after a reasonable period of time there is a lack of satisfactory clinical response, dexamethasone sodium phosphate injection should be discontinued and the patient transferred to other appropriate therapy. it should be emphasized that dosage requirements are variable and must be individualized on the basis of the disease under treatment and the response of the patient. after a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. it should be kept in mind that constant monitoring is needed in regard to drug dosage. included in the situations which may make dosage adjustments necessary are changes in clinical status secondary to remissions or exacerbations in the disease process, the patient's individual drug responsiveness and the effect of patient exposure to stressful situations not directly related to the disease entity under treatment. in this later situation it may be necessary to increase the dosage of dexamethasone sodium phosphate injection for a period of time consistent with the patient's condition. if after a long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly. b. intra-articular, soft tissue or intralesional administration. the dose for intrasynovial administration is usually 2 to 4 mg for large joints and 0.8 to 1 mg for small joints. for soft tissue and bursal injections a dose of 2 to 4 mg is recommended. ganglia require a dose of 1 to 2 mg. a dose of 0.4 to 1 mg is used for injection into tendon sheaths. injection into intervertebral joints should not be attempted at any time and hip joint injection cannot be recommended as an office procedure. intrasynovial and soft tissue injections should be employed only when affected areas are limited to 1 or 2 sites. it should be remembered that corticoids provide palliation only and that other conventional or curative methods of therapy should be employed when indicated. parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. frequency of injection usually ranges from once every 3 to 5 days to once every 2 to 3 weeks. frequent intra-articular injection may cause damage to joint tissue.

eased intraocular pressure glaucoma endocrine: menstrual irregularities development of cushingoid state suppression of growth in children secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery, or illness decreased carbohydrate tolerance manifestations of latent diabetes mellitus increased requirements for insulin or oral hypoglycemic agents in diabetics metabolic: negative nitrogen balance due to protein catabolism miscellaneous: hyperpigmentation or hypopigmentation subcutaneous and cutaneous atrophy sterile abscess post-injection flare, following intra-articular use charcot-like arthropathy itching, burning, tingling in the ano-genital region

se calcium excretion. while on corticosteroid therapy patients should not be vaccinated against smallpox. other immunization procedures should not be undertaken in patients who are on corticosteroids, especially in high doses, because of possible hazards of neurological complications and lack of antibody response. the use of dexamethasone sodium phosphate injection in active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate anti-tuberculosis regimen. if corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary as reactivation of the disease may occur. during prolonged corticosteroid therapy, these patients should receive chemoprophylaxis. because rare instances of anaphylactoid reactions have occurred in patients receiving parenteral corticosteroid therapy, appropriate precautionary measures should be taken prior to administration, especially when the patient has a history of allergy to any drug.