From the Guidelines
Dexamethasone Intensol for pediatric patients should be dosed at 0.6 mg/kg per day, with a maximum of 40 mg per day for 4 days, as recommended for children with newly diagnosed ITP who have non–life-threatening mucosal bleeding and/or diminished HRQoL. This dosing regimen is based on the most recent guidelines from the American Society of Hematology 2019 guidelines for immune thrombocytopenia 1.
Key Considerations
- The dosing regimen of 0.6 mg/kg per day, with a maximum of 40 mg per day for 4 days, is specifically recommended for pediatric patients with newly diagnosed ITP who have non–life-threatening mucosal bleeding and/or diminished HRQoL.
- It is essential to note that this dosing regimen may not be applicable to all pediatric conditions, and the treatment duration should be kept as short as possible to minimize side effects.
- Common side effects of dexamethasone include increased appetite, mood changes, and sleep disturbances, and long-term use can affect growth, immune function, and bone density.
Administration and Monitoring
- The concentrated oral solution (Intensol) contains 1 mg/mL and should be diluted in liquid or food before administration.
- Tapering is necessary for courses longer than 5-7 days to prevent adrenal suppression.
- Patients should be closely monitored for signs of adverse effects, and the dosing regimen should be adjusted accordingly.
Evidence-Based Recommendation
The recommendation for dosing dexamethasone Intensol at 0.6 mg/kg per day, with a maximum of 40 mg per day for 4 days, is based on the American Society of Hematology 2019 guidelines for immune thrombocytopenia 1, which prioritizes HRQoL in RCTs and emphasizes the need for properly designed studies applying modern short-course dosing regimens.
From the Research
Dosing of Dexamethasone for Pediatric Patients
- The dosing of Dexamethasone (Decadron) Intensol for pediatric patients can vary depending on the condition being treated and the patient's weight.
- According to a study published in the Journal of clinical pharmacology 2, a single dose of 0.5 and 1 mg/kg every 8 hours resulted in 68% or more of virtual children with obesity attaining simulated exposures that were within exposure ranges previously reported in adult studies.
- A study published in Pediatric emergency care 3 found that a single dose of oral dexamethasone (0.6 mg/kg to a maximum of 18 mg) was effective in the management of mild to moderate asthma exacerbations in children.
- Another study published in The Journal of asthma 4 compared the effectiveness of dexamethasone, prednisone, and combination therapy for inpatient asthma management, but did not provide specific dosing recommendations for pediatric patients.
- A retrospective review published in the British journal of neurosurgery 5 found that the average initial dose of dexamethasone for pediatric patients with posterior fossa tumors was 9.15 mg; 0.31 mg/kg, with a range of 1-16.7 mg; 0.05-1.77 mg/kg.
- The study recommended a weight-based regimen, with a suggested dose of 0.02-0.3mg/kg/day in 3-4 divided doses, as provided by the Food and Drug Administration.
- A study published in The journal of pediatric pharmacology and therapeutics 6 compared the effectiveness of standardized and weight-based dosing strategies for dexamethasone in pediatric asthma exacerbations, and found that there was no difference in return visits to the ED within 30 days and 31 to 90 days between the two groups.
Weight-Based Dosing
- The studies suggest that a weight-based dosing approach may be effective for pediatric patients, with doses ranging from 0.02-0.3mg/kg/day in 3-4 divided doses 5, and 0.5 and 1 mg/kg every 8 hours 2.
- However, the optimal dosing strategy for pediatric patients may depend on the specific condition being treated and the patient's individual needs.