Can intravenous (IV) Decadron (dexamethasone) be taken orally (PO)?

From the Guidelines

Iv decadron can be taken po with a 1:1 conversion ratio, meaning the oral dose is equivalent to the IV dose, as dexamethasone has excellent oral absorption (nearly 100%) 1. When considering the conversion of IV decadron to oral administration, several factors come into play, including the patient's ability to tolerate oral medications, their gastrointestinal tract function, and the stability of their condition.

• The switch from IV to oral administration is appropriate when a patient can tolerate oral medications and has a functioning gastrointestinal tract.
• The oral dose of dexamethasone is equivalent to the IV dose, allowing for a straightforward conversion.
• This conversion reduces infection risks associated with IV lines, decreases hospital costs, and often allows for earlier discharge from healthcare facilities.
• However, this change should always be directed by a healthcare provider who can evaluate the patient's specific clinical situation and determine the appropriate timing and dosing for the conversion 1. In terms of specific dosing, the guidelines suggest that dexamethasone can be administered orally in doses ranging from 8 mg to 20 mg, depending on the clinical context and the presence of other medications 1.
• For example, in the context of chemotherapy-induced nausea and vomiting, dexamethasone may be administered orally at a dose of 8 mg to 12 mg, depending on the emetic risk category and the use of other antiemetic agents 1. Overall, the conversion of IV decadron to oral administration is a common and effective practice, as long as it is done under the guidance of a healthcare provider and with careful consideration of the patient's individual needs and clinical context.

From the FDA Drug Label

When the intravenous route of administration is used, dosage usually should be the same as the oral dosage The FDA drug label does not answer the question.

From the Research

Administration of Dexamethasone

• Dexamethasone can be administered orally, as studied in patients with community-acquired pneumonia, where the bioavailability of oral dexamethasone was found to be sufficient 2.
• The practice of administering injectable dexamethasone orally has been evaluated in a pharmacokinetic analysis, which found that the relative bioavailability of injectable dexamethasone administered orally was 87.4% when using AUC(0-t) and 91.1% when using AUC(0-∞) 3.
• Oral dexamethasone has been compared to intravenous dexamethasone in the prevention of docetaxel-induced allergic reactions, with no hypersensitivity reactions found in either group 4.

Bioavailability and Efficacy

• The bioavailability of oral dexamethasone in patients hospitalized with pneumonia was found to be 81% after correction for differences in dexamethasone dose 2.
• The use of dexamethasone in hospitalized patients with Covid-19 has been studied, with results showing lower 28-day mortality among those receiving dexamethasone, particularly among those receiving invasive mechanical ventilation or oxygen alone at randomization 5.
• The efficacy of dexamethasone in patients with moderate or severe acute respiratory distress syndrome and Covid-19 has also been evaluated, with results showing a statistically significant increase in the number of ventilator-free days over 28 days 6.