From the Guidelines
IV dexamethasone can be administered orally in pediatric patients, with a 1:1 dose conversion, as the oral bioavailability of dexamethasone is high (about 80-90%). When switching from IV to oral administration, for example, if a child was receiving 4 mg IV dexamethasone, they can be switched to 4 mg oral dexamethasone 1. Oral dexamethasone is available as tablets or liquid formulation, with the liquid form often preferred for younger children or those who have difficulty swallowing tablets. However, in certain situations, such as severe vomiting, unconsciousness, or inability to tolerate oral medications, IV administration should be continued. Also, for conditions requiring rapid onset of action, such as severe asthma exacerbations or anaphylaxis, the IV route may be initially preferred. The ability to switch to oral administration can improve patient comfort, reduce the risk of line-associated complications, and potentially allow for earlier hospital discharge. The high bioavailability of oral dexamethasone ensures that therapeutic levels are maintained when switching from IV to oral route, making it an effective and convenient option for many pediatric patients requiring corticosteroid therapy. Some key points to consider when administering dexamethasone orally include:
- Dexamethasone has excellent bioavailability orally and is rapidly absorbed 1
- Dexamethasone consistently reduced the incidence of nausea and vomiting after tonsillectomy, being effective in low doses, that is, 2–4 mg i.v. 1
- There was no consistent evidence concerning the appropriate dose, or a dose-dependent effect for analgesia, but studies showing an analgesic effect in children use a dose of at least 0.15 mg.kg–1 1
- The plasma elimination half time of exogenously administered hydrocortisone is approximately 90 min, but may be shorter in patients taking inducers of liver enzyme CYP3A4 or suffering from hyperthyroidism, and longer in critically ill patients 1
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Dexamethasone sodium phosphate injection, USP 4 mg/mL is for intravenous, intramuscular, intra-articular, intralesional and soft tissue injection. When the intravenous route of administration is used, dosage usually should be the same as the oral dosage
The answer is no, intravenous (IV) dexamethasone cannot be administered orally in pediatric patients, as the label specifies that the IV formulation is for intravenous use, and oral administration is not mentioned as an option for this formulation. 2
From the Research
Administration of IV Dexamethasone Orally in Pediatric Patients
- The study 3 assessed the efficacy of injectable dexamethasone administered orally in pediatric patients with asthma exacerbation, suggesting it may be an efficacious treatment.
- However, the study 4 found that injectable dexamethasone sodium phosphate administered orally is not bioequivalent to dexamethasone oral concentrate, with a relative bioavailability of 87.4% and 91.1% when using AUC(0-t) and AUC(0-∞), respectively.
- The study 5 described factors associated with prescribed dexamethasone in a pediatric emergency department, but did not specifically address the administration of IV dexamethasone orally.
- The study 6 prepared and evaluated the physicochemical stability of liquid oral dosage forms of dexamethasone free of potentially harmful excipients, but did not address the administration of IV dexamethasone orally.
- The study 7 compared the efficacy of a single dose of dexamethasone to 2 doses of dexamethasone in treating mild to moderate asthma exacerbations in pediatric patients, but did not address the administration of IV dexamethasone orally.
Key Findings
- Injectable dexamethasone administered orally may be an efficacious treatment for asthma exacerbation in pediatric patients 3.
- Injectable dexamethasone sodium phosphate administered orally is not bioequivalent to dexamethasone oral concentrate 4.
- Dosing adjustments may be considered when administering injectable dexamethasone orally 4.