Dexamethasone Route

Question#: 670

Question:

With the definition of parenteral route being any route that bypasses the GI tract, does the contraindication for Dexamethasone (currently on PO or parenteral sterOIds) include the common daily puffers like: fluticasone (Flovent, Ellipta, Advair), budesonide (Pulmicort), ciclesonide (Alvesco), beclomethasone (Qvar) or mometasone (Asmanex)?

Answer:

When we refer to the parenteral route, we’re referring to administering the medication via injection (SQ, IV, IM). Thus you are correct in your interpretation that inhaled steroids are not parenteral, and thus not a contraindication to administer dexamethasone.

The contraindication only applies to systemic steroids, not inhaled or topical steroids. Further to that, inhaled steroids are very specific to lung tissue and do not contribute so systemic absorption.  Likewise for topical steroids, which largely remain in dermal tissues. In that same vein, intraarticular injection (it remains in the articular joint) would also not be a contraindication to steroids.

References:

ALS PCS - Bronchoconstriction Medical Directive

RPPEO Fall CME 2022 FAQ (https://www.rppeo.ca/frequently-asked-questions.html)