Dexamethasone may decrease levels of drugs that are broken down by liver enzymes. Examples include abiraterone, apixaban (Elquis), aripiprazole ( Abilify ), boceprevir ( Victrelis ), dronedarone (Multaq), and quetiapine ( Seroquel , Seroquel XR ) . Consider increasing the dose of the drug or avoiding this combination altogether. Adverse effects, such as bone marrow suppression, are enhanced when dexamethasone is used with other immunosuppressants such as leflunomide ( Arava ) and tacrolimus ( Prograf ). Dosing schedules should be evaluated and alternative therapies should be considered. Live vaccines should also be avoided because dexamethasone reduces immune function.
Intramuscular Injection: Provides an extended duration of therapeutic effect and fewer side effects of the kind associated with oral corticosteroid therapy, particularly gastro-intestinal reactions such as peptic ulceration. Studies indicate that, following a single intramuscular dose of 80 mg triamcinolone acetonide, adrenal suppression occurs within 24 - 48 hours and then gradually returns to normal, usually in approximately three weeks. This finding correlates closely with the extended duration of therapeutic action of triamcinolone acetonide.