Dexamethasone Dosing for Facial Swelling
For acute facial swelling, administer dexamethasone 8 mg IV or oral as an initial dose, which can be repeated daily for 3-5 days depending on severity and etiology of the swelling. 1
Initial Dosing Strategy
- Start with 8 mg dexamethasone administered either IV or orally (doses are equivalent 1:1) for moderate to severe facial swelling 2
- For severe airway-threatening edema, higher initial doses of 1.0-1.5 mg/kg dexamethasone may be warranted, with effects beginning within 15-30 minutes of intramuscular injection 3
- The steroid effect is local and directly proportional to tissue concentration, so early administration is critical 3
Duration and Tapering
- Continue 8 mg daily for 3-5 days for most inflammatory causes of facial swelling 1
- For chemotherapy-related facial swelling, use 8 mg twice daily for 5 days, followed by 4 mg twice daily for 1 day, then 4 mg once daily for 1 day 1
- Short courses of 24 hours or less carry negligible risk of harm 3
Route of Administration
- IV and oral dexamethasone are bioequivalent - use the same dose regardless of route 2
- IV administration provides faster onset when immediate effect is needed 3
- Oral administration is appropriate for stable patients who can tolerate PO intake 2
Evidence Supporting This Approach
- Studies in oral surgery demonstrate that dexamethasone 8 mg prophylactically plus 4 mg postoperatively significantly reduces facial swelling compared to NSAIDs alone 4
- Research shows dexamethasone is superior to diclofenac for controlling postoperative facial swelling, with effects lasting up to 48 hours 5
- Higher doses (15 mg) do not provide additional benefit over 5 mg for facial swelling reduction, suggesting a ceiling effect around 8 mg 6
Common Pitfalls to Avoid
- Do not use lower doses than 8 mg for significant facial swelling - studies show this is the minimum effective dose 1, 4
- Do not extend treatment beyond 5-7 days without reassessing the underlying cause, as prolonged courses increase side effect risk 7
- Do not rely on topical steroids alone for significant facial swelling - systemic administration is required for adequate tissue penetration 3
- Do not confuse dexamethasone with other corticosteroids that have different potency ratios (dexamethasone is approximately 25 times more potent than hydrocortisone) 2
Expected Timeline
- Onset of anti-inflammatory effect occurs within 15-30 minutes of IV/IM administration 3
- Peak reduction in facial swelling typically occurs at 48 hours after treatment initiation 6
- Swelling should subside by approximately 86% at 1 month in surgical cases 6