METADEXAN 4mg Tablet — Dexamethasone by Beximco Pharmaceuticals

METADEXAN 4mg Tablet — Dexamethasone | Beximco Pharmaceuticals

Overview

METADEXAN 4mg provides Dexamethasone 4mg — the standard intermediate-to-high dose for severe inflammatory, autoimmune, and haematological conditions. At 4mg, each tablet is equivalent to approximately 25mg prednisolone in anti-inflammatory potency. Dexamethasone 4mg is used for conditions requiring significant immunosuppression, for anti-emesis in chemotherapy regimens (typically 8–20mg IV/orally), for cerebral oedema, and for haematological malignancies. The 4mg strength is also the standard dose used in the RECOVERY trial for severe COVID-19 (6mg once daily — 1.5 tablets). Dexamethasone 4mg has profound hyperglycaemic effects in diabetic patients and requires intensive BGL monitoring.

Mechanism of Action

Dexamethasone binds cytoplasmic glucocorticoid receptors, forming receptor-drug complexes that translocate to the nucleus and alter transcription of inflammatory genes. It suppresses virtually all phases of inflammation: inhibits prostaglandin and leukotriene synthesis, reduces vascular permeability, inhibits cytokine production (IL-1, IL-6, TNF-α), and suppresses T-lymphocyte activation. Metabolic effects driving hyperglycaemia: increased hepatic glucose output (gluconeogenesis), peripheral insulin resistance, and impaired glucose uptake in muscle and fat.

Indications

• Severe allergic reactions — acute anaphylaxis adjunct, drug hypersensitivity
• Severe asthma exacerbations
• Cerebral oedema — peritumoral or post-neurosurgical
• Haematological — ITP, AIHA, multiple myeloma (VAD/REDD regimens)
• Chemotherapy antiemesis — 4–8mg pre-chemotherapy
• Severe COVID-19 — 6mg/day × 10 days (approximately 1.5 tablets)
• Autoimmune conditions — SLE, dermatomyositis, vasculitis
• Spinal cord compression — acute neurological deterioration
• Meningitis — reduce cerebral inflammation (4mg 6-hourly for 4 days)

Dosage (Adult)

Take with food to minimise GI upset. Never stop abruptly after more than 1–2 weeks — taper gradually to allow adrenal recovery.

Critical Diabetic Patient Warnings

• Severe hyperglycaemia: Dexamethasone 4mg causes profound hyperglycaemia — post-dose BGL can rise to 15–25 mmol/L in diabetic patients. This is not optional to manage — hyperglycaemia during illness is an independent risk factor for worse outcomes (including in COVID-19 and post-operative recovery).
• Insulin requirement: Most Type 2 diabetic patients will need temporary insulin during dexamethasone treatment. Basal insulin should be increased by 20–50%, and prandial doses may need to double. Steroid-induced hyperglycaemia typically peaks in the afternoon (when morning-dose steroid effect is maximal).
• Once-daily dosing timing: Give morning (with breakfast) to align peak hyperglycaemia with daytime monitoring. Avoid evening doses in diabetics if possible — overnight hyperglycaemia is harder to detect and correct.
• Withhold metformin: During severe illness (COVID-19, hospitalisation), withhold metformin and use insulin for glycaemic control. Resume metformin when recovered and eating normally.
• HbA1c unreliable during steroid treatment: Short courses of steroids cause transient hyperglycaemia that may not significantly affect HbA1c — use time-in-range BGL data for monitoring during treatment.

Side Effects

Hyperglycaemia (common in diabetics even at short courses), mood changes/euphoria/insomnia, GI upset. With prolonged use: Cushing's syndrome, osteoporosis, adrenal suppression, muscle wasting, easy bruising, cataracts. Immune suppression → increased infection risk. Fluid retention (less than other steroids due to low mineralocorticoid activity).

Storage

Store below 25°C. Protect from light and moisture. Keep out of reach of children.

Medical Disclaimer: Dexamethasone 4mg causes severe hyperglycaemia in diabetic patients — blood glucose monitoring every 2–4 hours during treatment and insulin dose adjustment are essential. Never self-prescribe. Taper dose under medical supervision. Prescription required.