Dexamethasone

What Are Steroids?

A steroid is a type of hormone. Steroidal hormones are produced by the body. The synthetic equivalents of some steroids can be manufactured in a laboratory.  

Dexamethasone

Dexamethasone is often referred to as “dex” for short. Some brand names for dexamethasone are 

• Decadron®
• Dexasone®
• Diodex®
• Hexadrol®
• Maxidex®*

*Note: This list is not inclusive of all available brands.

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 also known as glucocorticosteroids or corticosteroids.

How Is Dexamethosone Given? 

To treat myeloma, dexamethasone can be given as  

• an oral tablet,  
• an injection,  
• alone,  
• or in combination with other agents.  

Dexamethasone can irritate the stomach. Taking it with food can reduce this risk. Steroid therapy cannot be stopped abruptly. Abrupt discontinuation can lead to withdrawal symptoms. If steroid therapy must be discontinued, it must be done gradually and under the supervision of the doctor treating your myeloma. 

Dosages and Scheduling of Dexamethasone  

When your myeloma doctor determines your dose of dexamethasone and how it is administered, many factors are considered. Ask your doctor  

• about the optimal overall treatment strategy, 
• about finding a dosing regimen that is well tolerated, and 
• ensuring that the regimen is appropriate for the treatment of your individual disease.  

Dexamethasone has demonstrated activity in myeloma as a single agent. Yet, it is typically given in combination with one or more other agents, especially during induction therapy. Dexamethasone is a component of nearly all combination therapies. It appears to increase or “boost” the ability of other agents to destroy myeloma cells. As a result, it improves response to treatment. However, dexamethasone is associated with many short-term and long-term side effects.  

Dexamethasone in Clinical Trials  

A clinical trial is a medical research study with people who volunteer to test scientific approaches to a new treatment or a new combination therapy. Each clinical trial is designed to find better ways to prevent, detect, diagnose, or treat cancer. These trials seek to answer scientific questions.  

Dexamethasone has been part of most myeloma clinical trials over many years. Many clinical trials of different combination therapies with low-dose dexamethasone in patients with newly diagnosed multiple myeloma (NDMM), and relapsed and refractory disease have occurred. 

Low-dose dexamethasone in combination with other agents has been well established as the standard of care in myeloma. Depending upon the age and fitness of the patient, dexamethasone is usually prescribed at a dose of 20 mg to 40 mg once-weekly. For patients who cannot tolerate higher doses, dexamethasone has proven to be effective at doses as low as 4 mg once-weekly.  

ECOG E4A03 clinical trial  

In 2010, the results of the large ECOG E4A03 clinical trial were published in Lancet Oncology. Before this study, the standard of care in myeloma included 40 mg of dexamethasone. This dose was administered 4 days per week (“high-dose”). The E4A03 study is the legacy of Michael Katz, who was diagnosed with myeloma in 1990. Michael Katz later became a myeloma support group leader and a member of the IMF Board of Directors.  

Michael lost his battle with myeloma 25 years after diagnosis. Yet, it was his perseverance and insight that led to the evaluation of the “Rd” frontline therapy of the immunomodulatory agent Revlimid® (lenalidomide) with either high-dose or low-dose dexamethasone. The 1 day per week (“low-dose”) schedule of 40 mg dexamethasone demonstrated better survival at 1 year, with significantly fewer side effects than the 4 days per week schedule.  

Rd-R regimen vs. continuous Rd  

In 2021, the journal Blood published the results of a clinical trial designed specifically for treatment of older and less fit patients with myeloma. This is important since these individuals are often excluded from clinical trials.  

The trial was administered to newly diagnosed patients who were 65–80 years old and who were “intermediate-fit” on the International Myeloma Working Group (IMWG) frailty score. These patients were either 

•  randomized to receive 9 months of Rd followed by maintenance therapy of Revlimid (without dexamethasone) at 10 mg per day [Rd-R], 
•  or to a study arm that received continuous Rd.  

Side effects were mainly related to dexamethasone. These side effects were more frequent with continuous Rd. After 9 cycles of Rd, switching to reduced-dose Revlimid maintenance therapy without dexamethasone was feasible. Its outcomes were similar to standard continuous Rd.  

Rd regimen vs. DR regimen  

In December 2022, at the annual meeting of the American Society of Hematology (ASH), the efficacy and safety analysis of the IFM2017-03 phase III clinical trial became a point of interest for its limited use of dexamethasone in frail or elderly patients with newly diagnosed myeloma. The Rd regimen was compared to a combination of Darzalex® (daratumumab) and Revlimid [DR]. With this regimen, patients received only 2 months of dexamethasone. The DR regimen had deeper responses. Its overall response rate (ORR) was 96%, and its complete response (CR) rate of 37%. The Rd regimen had ORR of 85% and CR of 10%. 

Secondary Analysis of SWOG S0777 and S1211  

A study presented at the ASH meeting in December 2023 investigated outcomes from two large clinical trials, SWOG S0777 and SWOG S1211. This study showed that reducing the dose of dexamethasone did not negatively impact patients with newly diagnosed multiple myeloma. 

Dexamethasone was reduced in 76% of the 541 evaluable patients during induction therapy. Progression-free survival (PFS) and overall survival (OS) were comparable between full-dose patients. Review the Understanding Dexamethasone in the Treatment of Multiple Myeloma booklet for more details about this study. 

Medrol (methylprednisolone) 

Medrol® (methylprednisolone) is an adrenal corticosteroid, or glucocorticoid, similar to those produced in your own body that can be used in the treatment of multiple myeloma. Other similar steroids include dexamethasone and prednisone. Like other steroids, Medrol reduces the activity of the immune system and mimics the glucocorticoids our bodies make naturally in our adrenal glands. Steroids are beneficial for myeloma as they have both anti-inflammatory and anti-myeloma effects. Medrol can also be used to manage side effects related to other medications used to treat myeloma. 

Medrol is available in multiple formulations, including intravenous (IV) form. It is less potent than dexamethasone and therefore you may be given a larger dose: 1mg of dexamethasone is equal to approximately 5.3mg of Medrol. 

Deltasone (Prednisone) 

Deltasone® (prednisone) is a corticosteroid, or glucocorticoid, that is used frequently in the treatment of multiple myeloma and management of side effects. Deltasone is similar to steroid hormones (glucocorticoids) produced naturally by the adrenal glands in the body. Glucocorticoids decrease the activity of the immune system and are used to treat a variety of inflammatory diseases. Therefore, steroids, such as Deltasone play an important role in treatment of multiple myeloma as they have both anti-inflammatory and anti-myeloma effects. 

Deltasone is apart of the same class of drugs as dexamethasone, another steroid frequently used in the treatment of myeloma. Compared to dexamethasone, Deltasone is shorter-acting and less potent (1 milligram of dexamethasone is equivalent to roughly 7mg of Deltasone) and in some cases can be used as an alternative to dexamethasone.  

Possible Steroid 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/or 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 dexamethasone side effects on the dexamethasone side effects page.

Infections That Can Occur While Taking Steroids

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 Due to Steroid Use

Use of dexamethasone and other steroids can cause

• increases in blood pressure,
• salt and water retention, and 
• 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.

Dermatologic Effects of Steroid Use

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.

Endocrine Effects of Steroid Use

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.

Gastrointestinal Effects of Steroid Use

Steroids can have various effects on your gastrointestinal (GI) tract. They increase the risk of GI perforations. Therefore, patients who have peptic (stomach) ulcers, diverticulitis (inflammation of the large intestine), and ulcerative colitis (inflammation of the colon) should use corticosteroids cautiously to minimize the risk of perforation. For these reasons, many physicians automatically recommend antacid therapy (e.g., Pepcid®) of some type for patients taking steroids. 

Other possible GI side effects seen with dexamethasone therapy are 

• increased or decreased appetite, 
• stomach bloating, 
• nausea,
• vomiting,
• hiccups,
• and heartburn.

Musculoskeletal Effects of Steroid Use

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.

Ophthalmologic Effects of Steroid Use

Prolonged steroid treatment may cause:

• elevated intraocular pressure  (pressure within the eye) 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 necessary. 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 of Steroid Use

Steroids can also cause

• insomnia,
• irritability,
• 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 Reactions Due to Steroid Use

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.

General Effects of Steroid Use

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.

Drug Interactions

Find more information about drug interactions with dexamethasone in the drug interactions section on the dexamethasone side effects page.