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Category: Croup

May dexamethasone labelled for IM, IV or SC administration be administered orally

Question#: 665


The new ALS PCS 5.1 adds Dexamethasone to the paramedic scope of practice. The treatment routes listed are IM/IV; however, it is used as an oral medical as well. Can we use Dexamethasone orally as well?



With the addition of Dexamethasone to the upcoming Version 5.1 of the ALS PCS, there may be some questions regarding the approved routes of administration.

Remember, dexamethasone is only to be given PO under the Croup Medical Directive, and PO is the preferred route of administration under the Bronchoconstriction Medical Directive.

Having said that, certain manufacturers may label their vial of Dexamethasone to be administered IV/IM. You will notice this while performing the 5Rs of safe medication administration, as well as an independent medication double check. This understandably may lead to confusion.

We have consulted with our pharmacy partners, and explored the extant literature – all of which are supportive of PO administration.

The purpose of this memo is thus to state that despite the labelling of some manufacturers’ labels, paramedics in the RPPEO will adhere to the ALS PCS with respect to the dexamethasone routes of administration.

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