Can dexamethasone be administered subcutaneously?

Subcutaneous Administration of Dexamethasone

Yes, dexamethasone can be administered subcutaneously and is well tolerated, with subcutaneous administration being the preferred route for certain patients, particularly those with pre-existing or high-risk peripheral neuropathy. 1

Evidence for Subcutaneous Administration

The National Comprehensive Cancer Network (NCCN) guidelines explicitly support subcutaneous administration of certain medications, including:

• Subcutaneous bortezomib is specifically recommended as the preferred method of administration for patients with pre-existing or high-risk peripheral neuropathy 1
• Subcutaneous formulations of other medications like daratumumab and hyaluronidase-fihj are recognized as alternatives to intravenous administration with similar efficacy and safety profiles 1

The European Society for Medical Oncology (ESMO) clinical practice guidelines also document subcutaneous administration of medications in multiple myeloma treatment regimens, confirming this as a standard practice 1.

Clinical Applications

Subcutaneous dexamethasone is particularly useful in:

• Palliative care settings when oral administration is not feasible 2
• Patients who cannot tolerate intravenous administration
• Outpatient settings where intravenous access may be challenging
• Patients with poor venous access

Administration Considerations

When administering dexamethasone subcutaneously:

• Both bolus injection and continuous infusion methods are used (with 88% of surveyed community services using continuous infusion for site preservation) 3
• Appropriate diluents include water for injection or normal saline 3
• Monitor injection sites for local reactions, though these appear to be uncommon 2

Alternative Corticosteroids

During dexamethasone shortages, betamethasone has been successfully used subcutaneously:

• Betamethasone was well-tolerated subcutaneously at doses ranging from 1-16 mg for periods of 6-27 days 2
• No significant injection-site reactions or severe adverse effects were reported 2
• Clinical improvement was observed across various indications including intracranial hypertension, liver capsule pain, superior vena cava obstruction, malignant spinal cord compression, and subacute bowel obstruction 2

Practical Recommendations

• Follow institutional or published guidelines for subcutaneous administration
• Consider the New Zealand Waitemata District Health Board's clinical guidelines, which are commonly used for subcutaneous dexamethasone administration 3
• For patients with difficulty swallowing or who cannot take oral medications, subcutaneous administration provides an effective alternative to maintain therapeutic efficacy

Cautions

• Some patients may not be appropriate candidates for subcutaneous administration, particularly those with significant thrombocytopenia 1
• As with any corticosteroid, monitor for systemic side effects regardless of administration route
• Ensure proper technique to minimize local injection site reactions

Subcutaneous dexamethasone administration represents an important option in the clinician's toolkit, particularly for patients who cannot tolerate oral or intravenous administration or in settings where these routes are not feasible.