Dexamethasone and other Steroids

Dexamethasone, as well as other drugs within the same class as dexamethasone: namely, the adrenal corticosteroids (prednisone, prednisolone, and methylprednisolone) are used to treat multiple myeloma. Steroids play an important role in treatment of multiple myeloma and have both anti-inflammatory and anti-myeloma effects.

Dexamethasone (which is sometimes called  “dex”  for  short)  is  also  known  by the  brand  names  Decadron®,  Dexasone®, Diodex®,  Hexadrol®,  and  Maxidex®.  It  is one  of  the  most  frequently  used medications in the treatment of myeloma.  It is a synthetic adrenocortical steroid.  Adrenocortical steroids are produced naturally by the adrenal glands in the  body, and are also known as glucocorticosteroids or corticosteroids. 

 

Possible Side Effects

As is the case with any medication, use of dexamethasone can cause some unwanted side effects. Few, if any, patients experience all of these side effects. In fact, some patients do not experience any side effects at all while taking dexamethasone. There are certain precautionary measures that patients and their healthcare providers should take in order to reduce or avoid adverse effects. The most important side effects and precautions are described here. Members of your healthcare team can provide more information in greater detail about these and other possible side effects. They also can make recommendations about managing these side effects if they occur.

The longer you take a steroid, and the higher the dose you are taking, the greater are your chances of experiencing side effects. Most of the side effects can be reversed and will go away when treatment is completed. Do not stop taking any of your medications or reduce your doses on your own. Speak to your healthcare team if you are experiencing any side effects or if you have any questions. 

Infections

Because steroids block white blood cells from reaching sites of infection, these agents may cause existing infections to get worse or allow new infections to occur. A paradoxical effect is that the white blood cell level in the blood increases because the cells are not exiting the bloodstream to enter infected tissues. Any drugs that suppress normal immune responses can make a person susceptible to infections. Steroids may actually mask signs that an infection is present. They may also decrease a person’s ability to fight the start of a new infection. Therefore, patients who are taking steroids have an increased risk of all types of infections (bacterial, viral, or fungal).

Cardiac conditions and fluid retention

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 hypertension. 

Dermatologic effects

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

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 can take steroids, but additional treatment, including insulin therapy, may be needed to control blood sugar levels. Steroids can also cause menstrual irregularities. 

Gastrointestinal effects

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, nausea, vomiting, hiccups, and heartburn. 

Muscoloskeletal effects

Because steroids decrease calcium absorption and increase its excretion, they affect bones. These effects can lead to pain and osteoporosis in adults. Patients with myeloma who are already subject to severe bone loss and bone pain must be watched carefully and given appropriate supportive care to prevent further bone damage. Patients taking steroids may also experience muscle pains because they may be losing potassium. 

Opthalmogic effects

Prolonged steroid treatment may produce 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. This involves removal of the cataract and implantation of a new lens in the eye, which usually allows for enhanced vision.

Psychiatric and neurologic effects

Steroids can also cause irritability, mood swings, personality changes, and severe depression. They also can cause insomnia. Emotional instability or psychotic tendencies are aggravated and may become worse during steroid therapy.  Patients also have reported experiencing headaches and dizziness.

Allergic reactions

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

Some patients may experience coughing or hoarseness. Resting the voice can help with this condition.  Use of steroids, including dexamethasone, can cause weight gain.