Drug Action
Dexamethasone has very high glucocorticoid activity and insignificant mineralocorticoid activity.
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Drug reference
Dexamethasone has very high glucocorticoid activity and insignificant mineralocorticoid activity.
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Local treatment of inflammation (short-term) ▶TO THE EYE USING EYE DROP ▶Child: Apply 4–6 times a day ▶Adult: Apply every 30–60 minutes until controlled, then reduced to 4–6 times a day Short term local treatment of inflammation (severe conditions) ▶TO THE EYE USING EYE DROP ▶Child: Apply every 30–60 minutes until controlled, Eye reduce frequency when control achieved Macular oedema following either branch retinal vein occlusion or central retinal vein occlusion (specialist use only) | Visual impairment due to diabetic macular oedema in adults who are pseudophakic, or who are insufficiently responsive to, or unsuitable for non- corticosteroid therapy (specialist use only) | For the treatment of inflammation of the posterior segment of the eye presenting as non-infectious uveitis (specialist use only) ▶BY INTRAVITREAL INJECTION ▶Adult: 700 micrograms, to be administered into the affected eye, concurrent administration to both eyes not recommended. For further information on pre- treatment, administration and repeat dosing, consult product literature l UNLICENSED USE Maxidex ® not licensed for use in children under 2 years. Dropodex ® not licensed for use in children.
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▶With intravitreal use Active ocular herpes simplex. active or suspected ocular infection. active or suspected periocular infection. rupture of the posterior lens capsule in patients with aphakia, iris or transscleral fixated intra-ocular lens or anterior chamber intra-ocular lens. uncontrolled advanced glaucoma
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▶With intravitreal use History of ocular viral infection (including herpes simplex). posterior capsule tear or iris defect (risk of implant migration into the anterior chamber which may cause corneal oedema and, in persistent severe cases, the need for corneal transplantation). retinal vein occlusion with significant retinal ischaemia
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▶When used by eye Although multi-dose dexamethasone eye drops commonly contain preservatives, preservative-free unit dose vials may be available.
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NICE decisions ▶Dexamethasone intravitreal implant for the treatment of macular oedema secondary to retinal vein occlusion (July 2011) NICE TA229 ▶With intravitreal use Dexamethasone intravitreal implant is recommended as an option for the treatment of macular oedema following central retinal vein occlusion. Dexamethasone intravitreal implant is also recommended as an option for the treatment of macular oedema Eye following branch retinal vein occlusion when: . treatment with laser photocoagulation has not been beneficial, or . treatment with laser photocoagulation is not considered suitable because of the extent of macular haemorrhage. www.nice.org.uk/TA229 ▶Dexamethasone intravitreal implant for treating diabetic macular oedema (July 2015) NICE TA349 ▶With intravitreal use Dexamethasone intravitreal implant is recommended as an option for treating diabetic macular oedema only if: . the implant is to be used in an eye with an intraocular (pseudophakic) lens and . the diabetic macular oedema does not respond to non- corticosteroid treatment, or such treatment is unsuitable. www.nice.org.uk/TA349 ▶Adalimumab and dexamethasone for treating non-infectious uveitis (July 2017) NICE TA460 ▶With intravitreal use Dexamethasone intravitreal implant is recommended as an option for treating non-infectious uveitis in the posterior segment of the eye in patients, only if there is: . active disease (that is, current inflammation in the eye), and . worsening vision with a risk of blindness. Patients currently receiving dexamethasone whose disease does not meet the above criteria should be able to continue treatment until they and their clinician consider it appropriate to stop. www.nice.org.uk/TA460 Scottish Medicines Consortium (SMC) decisions ▶With intravitreal use The Scottish Medicines Consortium has advised (June 2012) that dexamethasone intravitreal implant (Ozurdex ®) is accepted for restricted use within NHS Scotland for the treatment of patients with macular oedema following central retinal vein occlusion, and in patients with branch retinal vein occlusion who are not clinically suitable for laser treatment, including patients with dense macular haemorrhage, or patients who have received and failed on previous laser treatment.
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→Appendix 1: corticosteroids
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▶Common or very common ▶When used by eye (topical) Eye discomfort ▶With intravitreal use Eye discomfort ▶Uncommon ▶When used by eye (topical) Photophobia. taste altered ▶With intravitreal use Retinitis necrotising
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Dexamethasone readily crosses the placenta. ▶With intravitreal use Manufacturer advises avoid unless potential benefit outweighs risk—no information available.
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▶With intravitreal use Manufacturer advises avoid unless potential benefit outweighs risk—no information available.
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▶With intravitreal use Monitor intra-ocular pressure and for signs of ocular infection. In patients with posterior capsule tear or iris defect monitor for implant migration to allow for early diagnosis and management.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: eye drops Eye drops EXCIPIENTS: May contain Benzalkonium chloride, disodium edetate, polysorbates ▶Dexafree (Thea Pharmaceuticals Ltd) Dexamethasone sodium phosphate 1 mg per 1 ml Dexafree 1mg/1ml eye drops 0.4ml unit dose | 30 unit dose P £9.70 ▶Dropodex (Rayner Pharmaceuticals Ltd) Dexamethasone sodium phosphate 1 mg per 1 ml Dropodex 0.1% eye drops 0.4ml unit dose | 20 unit dose P £10.48 DT = £10.48 ▶Eythalm (Aspire Pharma Ltd) Dexamethasone 1 mg per 1 ml Eythalm 1mg/ml eye drops | 6 ml P £9.75 DT = £9.75 ▶Maxidex (Novartis Pharmaceuticals UK Ltd) Dexamethasone 1 mg per 1 ml Maxidex 0.1% eye drops | 5 ml P £1.42 DT = £1.42 | 10 ml P £2.80 DT = £2.80 Implant ▶Ozurdex (Allergan Ltd) Dexamethasone 700 microgram Ozurdex 700microgram intravitreal implant in applicator | 1 device P £870.00 (Hospital only) Combinations available: Dexamethasone with framycetin sulfate and gramicidin, p. 1227. Dexamethasone with hypromellose, neomycin and polymyxin B sulfate, p. 1227. Dexamethasone with tobramycin, p. 1228
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Apply 4–6 times a day
First-line fragment. Read the complete Indications and Dose section above.
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Apply every 30–60 minutes until controlled,
First-line fragment. Read the complete Indications and Dose section above.
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Apply every 30–60 minutes until controlled,
First-line fragment. Read the complete Indications and Dose section above.
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700 micrograms, to be administered into the
First-line fragment. Read the complete Indications and Dose section above.
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