From the Guidelines
Dexamethasone for nausea is typically administered at a dose of 4-8 mg intravenously or orally, given once or twice daily, with a single dose of 4-8 mg before surgery often being sufficient for postoperative nausea and vomiting. The use of dexamethasone for nausea has been extensively studied, and its efficacy has been demonstrated in various clinical settings, including chemotherapy-induced nausea and vomiting, postoperative nausea and vomiting, and palliative care settings 1.
Key Considerations
- The dose of dexamethasone may vary depending on the specific clinical context, with higher doses (8-12 mg) often used for chemotherapy-induced nausea and vomiting, and lower doses (4-8 mg) used for postoperative nausea and vomiting and palliative care settings 1.
- Dexamethasone works by inhibiting prostaglandin synthesis and reducing inflammation, which helps decrease stimulation of the chemoreceptor trigger zone in the brain that causes nausea, and also has central antiemetic effects and may reduce serotonin release.
- Side effects to monitor include increased blood glucose, insomnia, and gastric irritation, so the medication should be taken with food when possible, and for prolonged use beyond a few days, the dose should typically be tapered to avoid adrenal suppression.
Clinical Evidence
- A recent meta-analysis with 6696 patients showed that a 4–5 mg dose of dexamethasone had clinical effects similar to the 8–10 mg dose, suggesting that lower doses may be effective in certain clinical contexts 1.
- The DREAMS Trial, which studied 1350 patients, found that a single 8 mg dose of dexamethasone reduced postoperative nausea and vomiting at 24 hours and reduced the need for rescue antiemetics for up to 72 hours, without an increase in adverse events 1.
Recommendations
- For postoperative nausea and vomiting, a single dose of 4-8 mg of dexamethasone before surgery is often sufficient, and this dose has been shown to be effective in reducing nausea and vomiting in the postoperative period 1.
- For chemotherapy-induced nausea and vomiting, a common regimen is 8-12 mg given 30 minutes before chemotherapy, followed by 4-8 mg once or twice daily for 1-4 days depending on the emetogenic potential of the chemotherapy 1.
- For palliative care settings, 4-8 mg once or twice daily may be used, and the dose should be adjusted based on the individual patient's response and side effect profile.
From the Research
Dexamethasone Dose for Nausea
- The dexamethasone dose for nausea can vary depending on the specific context and combination with other antiemetic drugs 2, 3, 4.
- In the context of chemotherapy-induced nausea and vomiting, a dose of 20 mg dexamethasone or its equivalent in combination with 5-HT3 antagonists has been considered a gold-standard dose for antiemetic prophylaxis 2.
- However, studies have suggested that lower doses of dexamethasone, such as 8 mg, may be more beneficial and have fewer adverse effects 2, 3.
- In one study, patients receiving cisplatin-based chemotherapy were assigned to a control regimen with 20 mg dexamethasone or an aprepitant regimen with 12 mg dexamethasone on Day 1, and 8 mg dexamethasone on subsequent days 3.
- Another study found that combination therapy with dexamethasone and a 5-HT3-receptor antagonist achieved complete response (no nausea and vomiting) in 58% to 92% of patients receiving cisplatin-treated patients 4.
- The use of dexamethasone with 5-HT3-receptor antagonists is rational given the different mechanisms of action, low incidence of adverse effects, and potential synergistic effect 4.