As a multiple myeloma patient, you may be treated with steroids. It is important to know the benefits as well as side effects of these steroids, as well as possible withdrawal issues. Always follow your healthcare team's advice in adhering to steroid treatment. 

Steroids As a Treatment for Myeloma

For many years, steroids have been an important and effective treatment for MM, used alone and in combination with other drugs. Commonly prescribed steroids include dexamethasone, which is the most commonly used corticosteroid for myeloma, prednisone, prednisolone, and solumedrol.

Steroids cause a wide range of side effects, affecting nearly every system of the body. Identifying the side effects early and managing them quickly will contribute to successful treatment and ultimately improve overall quality of life. Do not stop or adjust your medications before consulting your physician. Abrupt discontinuation of steroids can lead to withdrawal symptoms.

Potential Side Effects of Dexamethasone and Other Steroids

Steroids can affect the immune, musculoskeletal, and endocrine systems, the skin, the heart and blood pressure, the gastrointestinal tract, and the eyes. In addition, they can cause psychological and neurological problems, affecting cognition, mood, and behavior. Common steroid-related side effects include:

  • “Let down” or withdrawal effect
  • Flushing and sweating
  • Difficulty sleeping (insomnia)
  • Sexual dysfunction
  • Personality changes or mood alterations
  • Hyperactivity and jitters
  • Dizziness and headaches
  • Difficulty concentrating
  • Increased number of white blood cells
  • Infection
  • Muscle weakness (myopathy)
  • Death of bone tissue (avascular necrosis)
  • Muscle cramps
  • Weight gain in body or face
  • Changes affecting hair
  • Blurred vision
  • Cataract formation
  • Ulcers and heartburn (dyspepsia)
  • Gas (flatulence)
  • Increased appetite
  • Changes in taste
  • Hiccoughs
  • Higher blood sugar levels
  • Temporary diabetes or thyroid issues
  • Temporary decrease in testicular size
  • Swelling of hands, legs, or feet
  • Acne or rashes
  • Thinning of skin

Strategies for Continuing Steroid Treatment

  • Take steroids with food.
  • Steroids can cause sleeplessness. If they affect you in a short period of time, take your dose early in the morning or, if it takes a while to affect you, take your dose before going to bed at night. If you're having difficulty sleeping, avoid alcohol, caffeine, and electronic screens before bedtime.
  • Discuss stopping or reducing the dose with your doctor if you are having cognitive or behavioral problems.
  • Take medication to prevent gastrointestinal issues.
  • Medications may be prescribed to prevent infection, especially shingles (herpes zoster), and thrush (white coating on tongue, bad taste, and painful swallowing).
  • Know the signs and symptoms of high and low blood sugar: aggressiveness, confusion, difficulty walking, increased thirst, and frequent urination. If you have known diabetes, consult with your endocrinologist prior to starting treatment with steroids.
  • Avoid taking clarithromycin (Biaxin®), which can increase circulating levels and side effects of steroids.
  • Always report symptoms to your healthcare provider.

Steroids and Interactions with Other Drugs

Drugs of many types can interact with steroids.

It is very important to tell your healthcare team about all prescription and over-the-counter medications you're taking, as well as vitamins, supplements, and herbal preparations.

Among the drugs that can interact with steroids are:

  • Diuretics that affect potassium levels
  • Antibiotics such as erythromycin, clarithromycin, rifampicin, and azithromycin
  • Anticoagulants such as warfarin and aspirin
  • Barbiturates
  • Diabetes medications
  • Ephedrine (found in weight-loss products)
  • Cyclosporine
  • Digitalis
  • Estrogen-containing medications (oral contraceptives and hormone replacement therapy)
  • NSAIDs such as aspirin, ibuprofen, and naproxen

 

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