Is dexamethasone (po) (per oral) available as a liquid formulation for pediatric patients?

Availability of Oral Dexamethasone Liquid Formulation for Pediatric Patients

Yes, dexamethasone is available as a liquid formulation for pediatric patients, making it suitable for administration in children who have difficulty swallowing tablets.

Formulation Options for Pediatric Patients

• Dexamethasone is available as an oral liquid concentrate formulation specifically designed for pediatric use, with pharmacokinetic studies confirming its effectiveness 1
• The liquid formulation facilitates exact dosing and proper intake for children compared to other dosage forms 1
• Injectable dexamethasone sodium phosphate (DSPI) has also been administered orally in emergency departments as an alternative when the oral liquid formulation is unavailable, though it has slightly lower bioavailability (87.4-91.1%) compared to the oral concentrate 2

Pharmacokinetic Considerations

• Oral dexamethasone liquid formulation demonstrates similar pharmacokinetic profiles to tablet formulations, meeting bioequivalence criteria according to European Medicines Agency guidelines 1
• The liquid formulation shows comparable absorption rates with a Tmax of 0.89 hours compared to 0.97 hours for tablets 1
• Dexamethasone has excellent oral bioavailability (close to 100%), making the oral route highly effective for pediatric administration 3

Clinical Applications in Pediatrics

• Dexamethasone liquid is commonly used in pediatric patients for multiple conditions including:

  • Treatment of croup 4, 5
  • Management of asthma exacerbations 6, 7
  • As an antiemetic in pediatric oncology patients receiving chemotherapy 8
  • For allergic reactions and inflammatory conditions 5

• For pediatric patients receiving high-emetic-risk antineoplastic agents, dexamethasone is often part of a three-drug antiemetic regimen 8

Dosing Considerations

• Dexamethasone has equivalent dosing when converting from IV to PO administration (1:1 ratio), making dosing calculations straightforward 9
• Single-dose dexamethasone regimens are increasingly used in pediatric practice for conditions like mild-to-moderate asthma exacerbations, offering improved compliance and palatability compared to multi-day prednisone regimens 6, 7

Practical Advantages

• The liquid formulation improves compliance in pediatric patients who cannot swallow tablets 1
• Oral administration avoids the pain and potential complications associated with injections 3
• Dexamethasone oral liquid may have better palatability than other corticosteroid formulations, potentially improving adherence in pediatric patients 7

Common Pitfalls to Avoid

• Do not confuse dexamethasone with other corticosteroids that may have different oral-to-IV conversion ratios 9
• Be aware that injectable dexamethasone administered orally is not fully bioequivalent to the oral concentrate formulation, though it remains clinically effective 2