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Patients on dexamethasone may experience fewer overall side effects due to its relative lack of mineralocorticosteroid effects and consequently lower sodium retention than seen with other steroidslike methotrexate. Thus, dexamethasone is an excellent treatment for patients with severe osteoporosis. It is commonly used along with calcium phosphate in patients with calcium phosphate deficiency and calcium phosphate-tolerant patients (see Calcium/magnesium). It is most commonly prescribed at 100 mg/day plus a daily dose of 1 mg/kg for the first 6 weeks (see Calcium/Magnesium). 2.3.2 Oral administration In a single, double-blind, placebo-controlled clinical trial (Trial No.: 12074), 590 patients were given dexamethasone at 3 or 6 g orally every day without a placebo-control period for 3 weeks. The drug was well tolerated and did not cause clinical changes. Dexamethasone is an excellent therapy in elderly patients; however, it is not a safe option if patients have a weak renal drive, have weak renal function, or have liver disease. It should be used with caution in patients with chronic kidney disease (see Kidney Disease). The oral form of dexamethasone is most commonly used in combination with other corticosteroids. It is generally recommended in patients over 65 years who have failed to respond to methotrexate after treatment with dexamethasone-metoclopramide. 2.3.3 Subcutaneous injection The intravenous subcutaneous injection of dexamethasone is an option for patients over 65 years of age and who have failed to respond to previous oral treatments. These patients are given a single dose of 100 mg every 12 hours for 6 weeks. 2.3.4 Administration of dexamethasone by IM The oral IM dexamethasone is available over the counter (OTC) and many doctors give it in multiples of 100 doses. (See Prescribing Information.) However, this method of administration has several disadvantages including the fact that it requires special equipment that does not exist at most hospitals. It is often the case that a doctor will refer a patient to the hospital for routine blood tests, a CT scan, or other routine medical care. A study by Kukulka et al2 using a large-scale survey of 909 orthopedic surgeons found that 70% used the subcutaneous subcutaneous injection only once a year, while 29% used it 4 times a year, and 19% used it 4 times a month. 2. Related Article: