3.3mg/1mL Injection dexamethasone base

Dexamethasone used to be prescribed as dexamethasone phosphate in 4mg doses equivalent to dexamethasone base 3.3mg. There is little clinical difference between these so the DTC has agreed to substitution of whole ampoules of 3.3mg base to be given where a BNF 4mg dose has been prescribed. e.g if 8mg is prescribed administer 2 x 3.3mg ampoules.

Recommendation: better to prescribe in whole 3.3mg units as per manufacturer's SPC (see SPC link)rather than confusing BNF doses.

Reserved for young children who cannot tolerate soluble tablets.

NB: Availibility in Primary Care may be limited as many pharmacies do not hold stock of the oral solution.

Entry reviewed: November 2025

2mg, 10mg soluble tablets

1st choice on Formulary for management of croup

See Medicines for Children Guide on using Dexamethasone for Croup

To access the BLMK ICB Childrens croup pathway click here

Entry reviewed: December 2025

• Hydrocortisone sodium succinate 100mg powder and solvent for solution for injection vials (preferred cost-effective option) NB: Also available without solvent

• Hydrocortisone sodium phosphate 100mg/1ml solution for injection ampoules (2nd choice)

 Shortage of hydrocortisone sodium phosphate injection: Info here

• For patients with known adrenal insufficiency, hydrocortisone injection is amber SpA to allow primary care to replace supplies of hydrocortisone that have been used or expired following clear communication to the GP via a clinic letter.
• Endocrinology will remain responsible for patient education, training in recognition of an Addisonian crisis and injection technique and the initial supply of an emergency injection kit with a steroid card.
• Suitable contents of an emergency injection kit include:
  - 2-3 vials of hydrocortisone 100mg injection
  - 2-3 vials of 2mL water for injection (not required if hydrocortisone sodium phosphate is prescribed as this presentation is already in solution)
  - Intramuscular needles and 2mL syringes∗
  
• Further information for patients and prescribers can be found via links below.
• See the Addisons disease website for training videos on how to give an emergency injection of hydrocortisone sodium succinate in an adrenal crisis.
  
  ∗Note: IM needles and 2mL syringes are NOT in the Drug Tariff and therefore NOT prescribable on FP10. These should preferably be supplied by the Specialist at routine review. Where that is not practical, surgeries could supply from practice stock or direct patients to purchase their own consumables through reputable supplier, see link to Addison's  Society Self Help Group below.

Entry reviewed: June 2023

2.5mg, 10mg & 20mg Tablets

5mg tablets are restricted to use where cutting 10mg tablets is not an option - e.g. to allow dosing in schools or to facilitate dosing where patients have dexterity issues that make cutting tablets difficult.

Entry reviewed: September 2023

Restricted to use where cutting 10mg tablets is not an option - e.g. to allow dosing in schools or to facilitate dosing where patients have dexterity issues that make cutting tablets difficult

Entry reviewed: September 2023

0.5mg,1mg and 2mg

Restricted to use in children who require doses of less than 2.5mg

5mg is Non-Formulary - use tablets

Not suitable for enteral tubes

Entry reviewed: September 2023

100mg Tablet

Restricted to recommendation by consultant Neurologist

Methylprednisolone sodium succinate
40mg, 125mg, 500mg, 1g & 2g Injection

for intravenous or intramuscular use only

Restricted for paediatric inpatient use only- used for palatability, not for discharge

40mg in 1mL

Kenalog vials 40mg/mL suspension for injection will be discontinued 6.6.2025.

https://www.sps.nhs.uk/shortages/discontinuation-of-triamcinolone-acetonide-10mg-ml-adcortyl-ampoules-and-40mg-ml-kenalog-vials-suspension-for-injection/

Entry update May 2025