What is the dose of Dexamethasone (Dexa) for refractory nausea and vomiting?

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 this dose has been shown to have clinical effects similar to higher doses 1. When considering the treatment of refractory nausea and vomiting, it is essential to prioritize the most effective and safest option.

Key Considerations

• The dose of dexamethasone may vary, but a recent meta-analysis with 6696 patients showed that a 4–5 mg dose had clinical effects similar to the 8–10 mg dose 1.
• A single 8 mg dose of dexamethasone reduced PONV at 24 h and reduced the need for rescue antiemetics for up to 72 h, without an increase in adverse events 1.
• The use of dexamethasone for open or laparoscopic bowel surgery was further confirmed in the recently published Dexamethasone Reduces Emesis After Major Gastrointestinal Surgery (DREAMS) Trial 1.

Administration and Monitoring

• Dexamethasone can be administered intravenously or orally, and the dose may need to be adjusted based on the individual patient's response.
• It is crucial to monitor patients for potential side effects, including hyperglycemia, insomnia, and increased infection risk, especially with prolonged use.
• In diabetic patients, blood glucose monitoring is recommended to prevent hyperglycemia.

Combination Therapy

• Dexamethasone is often used in combination with other antiemetics, such as ondansetron or metoclopramide, to enhance its effectiveness.
• The use of multimodal administration of antiemetic drugs can reduce PONV even further 1.

From the FDA Drug Label

DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE AND THE RESPONSE OF THE PATIENT. The initial dosage of dexamethasone sodium phosphate injection varies from 0.5 to 9 mg a day depending on the disease being treated.

The FDA drug label does not provide a specific dose for refractory nausea and vomiting.

• Dexamethasone dose is variable and must be individualized based on the disease and patient response.
• The initial dosage ranges from 0.5 to 9 mg per day, depending on the disease being treated. 2

From the Research

Dexamethasone Dose for Refractory Nausea and Vomiting

• The optimal dose of dexamethasone for refractory nausea and vomiting is not explicitly stated in the provided studies, but we can look at the doses used in various contexts:
  • A study on postoperative nausea and vomiting used dexamethasone 4 mg or 8 mg in combination with propofol 3
  • Another study on the treatment of established postoperative nausea and vomiting used dexamethasone 3,6, or 12 mg 4
• It's worth noting that the study on refractory nausea and vomiting related to peritoneal carcinomatosis did not mention the use of dexamethasone, but rather dronabinol 5
• A retrospective analysis of a scheduled IV cocktail of antiemetics, including dexamethasone 4 mg, for the palliation of nausea and vomiting in a hospice population showed that 90% of patients had an objective response to the treatment 6
• A comprehensive review of treatments for nausea and vomiting mentions the use of dexamethasone as part of pharmacotherapy, but does not specify a dose for refractory cases 7

Efficacy of Dexamethasone

• The study on the treatment of established postoperative nausea and vomiting found that dexamethasone was ineffective in treating PONV, regardless of the dose used 4
• In contrast, the study on postoperative nausea and vomiting prevention found that dexamethasone 4 mg or 8 mg in combination with propofol was effective in reducing the incidence of PONV 3
• The retrospective analysis of a scheduled IV cocktail of antiemetics, including dexamethasone 4 mg, found that 90% of patients had an objective response to the treatment 6