Dexamethasone Dosing for Acute Situations

Critical Care & Immunotherapy Toxicities

• The National Comprehensive Cancer Network recommends dexamethasone 10 mg IV every 12-24 hours for persistent refractory hypotension after anti-IL-6 therapy in Grade 2 Cytokine Release Syndrome (CRS) 1
• The National Comprehensive Cancer Network recommends dexamethasone 10 mg IV every 6 hours as the standard dose for Grade 3 CRS 4, 5
• The National Comprehensive Cancer Network recommends dexamethasone 10 mg IV every 6 hours for Grade 4 CRS; if refractory, escalate to methylprednisolone 1000 mg/day IV 4, 5
• The National Comprehensive Cancer Network suggests considering dexamethasone 10 mg IV every 24 hours for prophylaxis in early-onset CRS (<72 hours after CAR T-cell infusion) 1
• The National Comprehensive Cancer Network recommends dexamethasone 10 mg IV every 12-24 hours for 2 doses for Grade 1 Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) if onset is <72 hours after lisocabtagene or idecabtagene infusion 2
• The National Comprehensive Cancer Network recommends dexamethasone 10 mg IV initially, then repeat every 6-12 hours if no improvement for Grade 2 ICANS 2
• The National Comprehensive Cancer Network recommends dexamethasone 10 mg IV every 6 hours (or methylprednisolone 1 mg/kg IV every 12 hours) for Grade 3 ICANS 2
• The National Comprehensive Cancer Network recommends high-dose methylprednisolone 1000 mg/day IV (may consider twice daily) for 3 days, followed by rapid taper for Grade 4 ICANS 2
• Antifungal prophylaxis should be strongly considered in all patients receiving steroids for CRS or neurotoxicity treatment, according to the National Comprehensive Cancer Network 6

Bacterial Meningitis

• The Clinical Microbiology and Infection guideline recommends dexamethasone 10 mg IV every 6 hours for 4 days as the standard regimen for adults with bacterial meningitis 3
• The Clinical Microbiology and Infection guideline recommends pediatric dosing of 0.15 mg/kg every 6 hours for 4 days 3
• The Clinical Microbiology and Infection guideline suggests stopping dexamethasone if the causative organism is not H. influenzae or S. pneumoniae, though some experts continue regardless of pathogen 3
• The Clinical Microbiology and Infection guideline reports that this regimen reduced hearing loss and neurologic sequelae in high-income countries with robust medical care, and decreased mortality specifically in pneumococcal meningitis 3

Chemotherapy-Induced Nausea and Vomiting (CINV)

• The Journal of Clinical Oncology recommends dexamethasone 12 mg oral or IV on day 1 (when combined with NK1 antagonist and 5-HT3 antagonist) for highly emetogenic chemotherapy 7, 8
• The Journal of Clinical Oncology recommends dexamethasone 8 mg oral or IV once daily on days 2-4 for highly emetogenic chemotherapy 7
• The Journal of Clinical Oncology recommends dexamethasone 8 mg oral or IV once on day 1 (with 5-HT3 antagonist) for moderately emetogenic chemotherapy 7