Dexamethasone is often known as “dex” for short. Other brand names for dexamethasone are
Dexamethasone is one of the most frequently used medications in the treatment of multiple myeloma. It is within the same class as the adrenal corticosteroids, such as prednisone, prednisolone, and methylprednisolone. These steroids play an important role in treatment of multiple myeloma. They have both anti-inflammatory and anti-myeloma effects.
Dexamethasone is a synthetic adrenocortical steroid. Adrenocortical steroids are also produced naturally by the adrenal glands in the body. They are known as glucocorticosteroids or corticosteroids.
Possible Side Effects
Like most medications, dexamethasone and other steroids can cause some unwanted side effects. Few, if any, patients experience all of these side effects. In fact, some patients taking dexamethasone do not experience any side effects. Healthcare providers should take precautionary measures to reduce or avoid adverse effects.
The most important side effects and precautions are described here. Members of your healthcare team can make recommendations about managing these side effects. Call your doctor if these side effects occur.
Your chances of experiencing side effects from a steroid may result from high doses and taking the steroid for a long time. Most of the side effects can be reversed. They will go away when treatment is completed. Do not stop taking any of your medications or reduce your doses on your own. Talking to your doctor about side effects is important. You can also find more information about side effects on the dexamethasone side effects page.
Steroids block white blood cells from reaching sites of infection. As a result, they may cause existing infections to get worse or allow new infections to occur. Any drugs that suppress normal immune system responses can make a person susceptible to infections. Because the cells are not exiting the bloodstream to enter infected tissues, the white blood cell level in the blood increases. Thus, steroids may actually mask signs that an infection is present.
Patients who are taking steroids have an increased risk of
- bacterial infections,
- viral infections, and
- fungal infections.
Cardiac Conditions and Fluid Retention
Use of dexamethasone and other steroids can cause
- increases in blood pressure
- salt and water retention
- potassium and calcium excretion.
These changes are more likely to occur when steroids are taken in large doses. Salt retention may lead to edema or swelling. You may notice that your ankles and feet are swollen. Fluid retention and loss of potassium can be a problem for patients who have cardiac conditions, especially congestive heart failure and high blood pressure.
Patients taking dexamethasone or other steroids may notice that it takes longer than usual for wounds to heal. Patients may develop acne and rashes while taking dexamethasone. Increased sweating is seen in some patients during steroid therapy.
Steroids, including dexamethasone, may interfere with the way patients metabolize carbohydrates and can cause blood glucose levels to rise. This is especially important in patients who have diabetes. Patients with diabetes are able to take steroids. Yet, additional treatment, including insulin therapy, may be needed to control blood sugar levels. Steroids may also cause menstrual irregularities.
Steroids can have various effects on your GI tract. They increase the risk of GI perforations. Therefore, patients who have peptic ulcers, diverticulitis, and ulcerative colitis should use corticosteroids cautiously to minimize the risk of perforation. For these reasons, many physicians automatically recommend antacid therapy of some type for patients taking steroids (e.g., Pepcid®).
Other possible GI side effects seen with dexamethasone therapy are
- increased or decreased appetite,
- stomach bloating,
- and heartburn.
Steroids decrease calcium absorption and increase its excretion. Therefore, they affect bones. These effects can lead to pain and osteoporosis in adults. Patients with multiple myeloma who are already subject to severe bone loss and bone pain must be watched carefully. They must be given appropriate supportive care to prevent further bone damage. Because they may be losing potassium, patients taking steroids may also experience muscle pains.
Prolonged steroid treatment may cause:
- elevated intraocular pressure that could lead to glaucoma
- optic nerve damage,
- eye infections,
- and cataracts.
Cataracts occur commonly in older age and usually take years to develop to the point where surgery is indicated. Steroids can speed up this process. With ongoing steroid treatment, it is not uncommon for myeloma patients to develop mature cataracts requiring surgery. Surgery removes cataracts and places a new lens in the eye to improve vision.
Psychiatric and Neurologic Effects
Steroids can also cause
- mood swings,
- personality changes,
- and severe depression.
Emotional instability or psychotic tendencies are aggravated and may become worse during steroid therapy. Patients also have reported experiencing headaches and dizziness.
Allergic and hypersensitivity reactions to steroids are possible in patients who are susceptible or have had allergic responses to other drugs. Allergic reactions can include
- difficulty breathing,
- closing of the throat,
- swelling of lips and tongue,
- and hives.
Such allergic reactions to steroids are exceedingly rare.
Some patients may experience coughing, sore throat, or hoarseness. Resting the voice can help with this condition. Use of steroids, including dexamethasone, can cause weight gain.
Find more information about drug interactions with dexamethasone in the drug interactions section on the dexamethasone side effects page.