What is the recommended dosage of dexamethasone (corticosteroid) for an 11-year-old patient weighing 110 pounds?

Dexamethasone Dosing for an 11-Year-Old Patient Weighing 110 Pounds

For most pediatric indications, dexamethasone should be dosed at 0.2 mg/kg/24 hours divided into appropriate intervals, which translates to approximately 10 mg/day for this 50 kg (110 lb) patient, though the specific indication will determine the exact dosing regimen. 1

Weight-Based Dosing Framework

The FDA label establishes that the smallest effective dose should be used in children, preferably orally, approximating 0.2 mg/kg/24 hours in divided doses 1. For this 110-pound (50 kg) patient:

• Standard pediatric dose: 0.2 mg/kg/24 hours = 10 mg/day total 1
• This can be divided into 2-4 doses depending on the indication 1
• Recent pharmacokinetic data confirms weight-based dosing of 0.5-1 mg/kg is appropriate for children with various body compositions 2

Indication-Specific Adjustments

For Acute Asthma Exacerbations

• Single oral dose of 0.3 mg/kg (15 mg for this patient) has been shown equivalent to multi-day prednisolone courses 3, 4
• This single-dose approach reduces vomiting (RR 0.29-0.32) compared to multi-day regimens 4
• No difference in relapse rates at 5,10-14, or 30 days compared to 5-day prednisone courses 4

For Cerebral Edema

• Initial IV dose of 10 mg, followed by 4 mg intramuscularly every 6 hours 1
• This is the adult dosing; pediatric dosing should follow the 0.2 mg/kg/24 hours guideline unless life-threatening 1

For Life-Threatening Conditions

• In overwhelming, acute, life-threatening situations, doses exceeding usual dosages may be justified and may be in multiples of the oral doses 1
• For unresponsive shock, regimens range from 1-6 mg/kg as a single IV injection 1

Route of Administration

• Oral and IV dexamethasone are bioequivalent with 1:1 conversion 5, 1
• The same dose can be used whether administering orally or intravenously 5
• Parenteral dosage ranges are typically one-third to one-half the oral dose given every 12 hours for maintenance therapy 1

Critical Dosing Considerations

Frequency and Duration

• Initial dosage should be maintained or adjusted until satisfactory response is noted 1
• For short courses (3-5 days), no taper is typically needed 6
• If therapy exceeds 5 days at doses ≥8 mg/day, gradual tapering is required to prevent adrenal suppression 5

Common Pitfalls to Avoid

• Do not use adult dosing (8-40 mg) in pediatric patients without weight-based calculation 1
• Avoid abrupt discontinuation after long-term therapy; withdraw gradually 1
• Monitor for hyperglycemia, which occurred in 70-76% of ICU patients receiving dexamethasone 7
• Parenteral administration should use dexamethasone sodium phosphate with appropriate salt factor correction 2

Practical Dosing Algorithm

1. Calculate weight-based dose: 0.2 mg/kg/24 hours = 10 mg/day for this 50 kg patient 1
2. For acute conditions (asthma, croup): Consider single dose of 0.3 mg/kg = 15 mg 3, 4
3. For ongoing therapy: Divide daily dose into 2-4 administrations 1
4. Choose route: Oral preferred; IV equivalent at same dose if oral not feasible 5, 1
5. Duration: Use shortest effective course; taper if >5 days 5, 1