Dexamethasone Dosing by Body Weight
The recommended dose of dexamethasone varies by indication, but generally ranges from 0.15 mg/kg to 0.6 mg/kg per day, with 0.3 mg/kg being a common effective dose for many pediatric conditions. 1, 2, 3
Standard Dosing Guidelines
General Dosing Parameters:
- Minimum effective dose: 0.15 mg/kg for most conditions 1, 3
- Standard dose range: 0.3-0.6 mg/kg 1, 2
- Maximum daily dose: Often capped at 4-8 mg for children 1
Condition-Specific Dosing:
| Condition | Recommended Dose | Duration |
|---|---|---|
| Acute asthma exacerbation | 0.3-0.6 mg/kg daily | 1-5 days [2] |
| Bacterial meningitis (≥6 weeks age) | 0.15 mg/kg every 6 hours | 2-4 days [1] |
| Non-life-threatening mucosal bleeding | 0.6 mg/kg/day (max 40 mg) | 4 days [1] |
| Post-tonsillectomy | 0.15 mg/kg (min 2-4 mg) | Single dose [1] |
| Croup | 0.15 mg/kg | Single dose [3] |
Dosing Considerations
Potency and Equivalence:
- Dexamethasone is approximately 5-6 times more potent than prednisone 1
- 4 mg dexamethasone ≈ 20-25 mg prednisone 1
Administration Routes:
- For IV/IM administration: 0.5-9 mg/day depending on disease severity 4
- For oral administration: Similar dosing to IV can be used 4
Special Populations:
Children with Obesity:
- Weight-based dosing at 0.5-1 mg/kg has been shown to provide appropriate exposure in children with obesity 5
Preterm Infants:
- For prevention of chronic lung disease in preterm infants: 0.25 mg/kg/dose every 12 hours for first week, with tapering doses over subsequent weeks 6
- However, routine use in preterm infants is not recommended due to potential side effects 6
Monitoring and Side Effects
When administering dexamethasone, monitor for:
- Hyperglycemia
- Hypertension
- Increased infection risk
- Gastrointestinal issues
- Growth parameters in children 1
Practical Application
For most common pediatric indications requiring short-term use (such as croup, asthma exacerbation):
- Start with 0.15-0.3 mg/kg as a single dose
- For conditions requiring multiple doses, continue with 0.3-0.6 mg/kg/day divided as appropriate
- Limit treatment duration to shortest effective period (typically 1-5 days) to minimize side effects
For chronic conditions requiring longer-term therapy, dosing should be adjusted based on response and side effects, with the goal of using the minimum effective dose.