From the Guidelines
Dexamethasone (Dexa) for refractory nausea and vomiting is typically administered at a dose of 4-8 mg intravenously or orally every 6-8 hours, with a maximum daily dose of 16-24 mg, as supported by a recent meta-analysis with 6696 patients showing that a 4–5 mg dose had clinical effects similar to the 8–10 mg dose 1.
Key Considerations
- The dose of dexamethasone may vary depending on the specific context, such as chemotherapy-induced nausea and vomiting, postoperative nausea and vomiting, or palliative care settings.
- A single dose of 8 mg of dexamethasone has been shown to reduce PONV at 24 h and reduce the need for rescue antiemetics for up to 72 h, without an increase in adverse events, as demonstrated in the DREAMS Trial 1.
- The use of dexamethasone should be balanced with its potential side effects, including hyperglycemia, insomnia, mood changes, and increased risk of infection with prolonged use.
Administration and Monitoring
- Dexamethasone can be administered intravenously or orally, with a frequency of every 6-8 hours.
- Patients should be monitored for side effects, particularly with prolonged use, and the dose should be tapered if used for more than a few days to prevent adrenal suppression.
Evidence-Based Recommendation
- The most recent and highest quality study supports the use of a 4-8 mg dose of dexamethasone for refractory nausea and vomiting, with a maximum daily dose of 16-24 mg 1.
From the Research
Dexa Dose for Refractory Nausea and Vomiting
- The studies provided do not directly address the specific dosage of Dexa (dexamethasone) for refractory nausea and vomiting.
- However, some studies mention the use of dexamethasone in combination with other medications for nausea and vomiting:
- A study from 2008 2 used a scheduled IV cocktail of 4 mg dexamethasone, 10 mg metoclopramide, and 25 mg diphenhydramine for the palliation of nausea and vomiting in a hospice population.
- Another study from 2011 3 compared the administration of 4 mg or 8 mg of dexamethasone combined with a subhypnotic dose of propofol for the prevention of postoperative nausea and vomiting.
- The mechanisms of action of dexamethasone as an antiemetic are discussed in a study from 2014 4, which suggests that glucocorticoids like dexamethasone may act through various mechanisms, including anti-inflammatory effects, direct central action, and interaction with neurotransmitters.
- A comprehensive review of treatments for nausea and vomiting from 2021 5 highlights the importance of finding effective therapies for these symptoms, but does not provide specific guidance on the use of dexamethasone for refractory nausea and vomiting.
- A case report from 2015 6 discusses the use of dronabinol for refractory nausea and vomiting, but does not mention dexamethasone.