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.

Who Can Be Treated with Dexamethasone?

Dex is a part of many combination therapies used in myeloma throughout the disease course. Steroids are generally used in combination with other drugs to produce a combined benefit.

In addition to dex, other steroids used to treat patients with myeloma include prednisone, prednisolone, and methylprednisolone. Because these steroids all belong to the same drug class, they behave similarly in the body and can be used to treat many of the same medical conditions.

Different steroids have many of the same side effects on the body, and they are used to treat many medical conditions. This includes myeloma, other types of blood disorders, and conditions such as

• Endocrine disorders, 
• Rheumatic or collagen disorders, 
• Dermatologic (skin) diseases, 
• Ophthalmic (eye) diseases, 
• Gastrointestinal (GI) diseases, 
• Respiratory diseases, and 
• Allergies.

How Does Dexamethasone Work?

Dex is a type of hormone. In the human body, adrenal glands produce both steroids and hormones. Steroids can suppress certain actions of the immune system. Steroids influence the regulation of carbohydrates, proteins, and fats. Steroids also inhibit cytokines that control inflammation. Steroids can prevent or decrease allergic and other immune responses.

Synthetic steroids like dex imitate the functions of naturally occurring steroids. Dex can replace or supplement the steroids produced naturally by the adrenal glands. Dex can decrease inflammation by stopping white blood cells (WBC) from traveling to areas of the body where there is swelling. Dex can stop the swelling around tumors and the pain caused by tumors pressing on nerve endings.

Benefits of Dexamethasone

Dex is useful in the treatment of conditions that affect the immune system, such as myeloma. Dex has been proven to be effective in myeloma even when used alone as a single agent (monotherapy).

But dex is typically given in combination with other drugs as it improves their ability to destroy myeloma cells. In brief, dex is helpful in several myeloma-related settings:

• Dex kills myeloma cells directly.
• Dex enhances the benefits of other anti-myeloma drugs.
• Dex is helpful during treatment with bispecific antibodies or CAR T-cell therapies.
• Dex is used to help patients reduce their nausea.
• Dex is an effective defensive measure against allergic reactions, nausea, and infusion-related reaction (IRR).
• Dex can quickly reduce pain and swelling, including bone pain, pressure on nerves, and compression of the spinal cord.

How Is Dexamethosone Given? 

Dexamethasone is available in many forms. To treat myeloma, dexamethasone can be given alone or in combination with other agents as either

• an oral tablet or
• as an intravenous (IV) infusion,

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

Dosages and Scheduling of Dexamethasone  

In April 2026, the Journal of Clinical Oncology (JCO), the official journal of the American Society of Clinical Oncology (ASCO), published the review article  “Past, Present, and Future of Dexamethasone in Multiple Myeloma and AL Amyloidosis,” which covers the use of dex in myeloma since the 1950s.

Dexamethasone at 40 mg vs. 160 mg

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 and to answer scientific questions.

Originally, dexamethasone doses used to be as high as 40 milligrams (mg) for 4 days per week – a total of 160 mg weekly, a very high dose with numerous side effects! Then the ECOG E4A03 clinical trial compared combining Revlimid® (lenalidomide) plus high-dose dex vs. Revlimid plus lower-dose dex in patients with newly diagnosed multiple myeloma (NDMM).and answer scientific questions. 

The ECOG E4A03 study’s conclusion was published in the journal Lancet Oncology in 2010. The lower-dose dex regimen of 40 mg given once-weekly was proven to be superior, with higher response rates and far fewer side effects. Importantly, the ECOG E4A03 study showed increased mortality with high-dose dex. The overall survival (OS) was 96% in the low-dose dex group compared to 87% in the high-dose group. The improvement in survival and toxicity was so decisive that the Data Monitoring Committee stopped the trial early to switch all the patients in the high-dose dex study group to low-dose dex.

In a clinical trial, overall survival (OS) represents the amount of time from diagnosis or start of treatment until death from any cause. OS used to be the standard for assessing if a treatment extends a patient’s life. As myeloma therapies become more e fective and OS duration is increased, clinical trials are using faster endpoints to validate outcomes.

At that time, the two-drug Rd combination therapy was considered a standard of care for NDMM. Since then, dex doses of 40 mg once weekly have been given to myeloma patients – and often continued for months or years. However, evidence continued to show dose-dependent side effects, such as cataracts and infections and more. These side effects can have a significant negative effect on a patient’s quality of life.

Dexamethasone at 20 mg to 40 mg once-weekly

Authors of the JCO article state that dex at a dose of 20 mg to 40 mg once-weekly is still associated with dose-related side effects. In patients with relasped/refractory multiple myeloma (RRMM), clinical trials have shown that indefinite once-weekly doses of dex cause more side effects.

Published in 2021, a study comparing Sarclisa® (isatuximab) and dexamethasone [Isa-d] vs. Sarclisa alone showed that patients in the dex group experienced 25% insomnia vs. 2% in the Sarclisa alone group.

The GEM-CLARIDEX clinical trial of Rd with or without the antibiotic clarithromycin in NDMM saw an increase in infectious deaths in the clarithromycin arm. This was attributed to clarithromycin-related CYP3A4 inhibition that led to increased dex exposure above the dose of 20 mg once-weekly given to most patients.

The negative impacts of chronic steroid use on bone health, glycemic control, and peptic ulcers have not been studied in myeloma. However, several reviews – in healthy adults and people with autoimmune conditions – have identified negative associations even with low-dose steroids.

Split dosing of dexamethasone

There is no consensus among myeloma specialists about once-weekly dosing vs. split dosing. Which is better, taking split doses of 20 mg of dex for 2 consecutive days or taking 40 mg at once? If you are at higher risk of side effects such as dizziness or hyperglycemia, ask your doctor if split dosing should be considered in your particular case of myeloma.

In one study, patients receiving twice-per-week Velcade® (bortezomib) received split-dosing of dex with each of their Velcade doses. Patients receiving their dex twice per week had less numbness, tingling, burning, and/or pain caused by nerve damage. This is called neuropathy, and 46% of patients on split-dosing developed it. Of the patients receiving once-weekly dosing, 64% developed neuropathy. However, this split-dosing schedule may not apply to patients receiving Velcade once-weekly,

Dexamethasone with/without transplant 

All modern phase 3 clinical trials with NDMM patients who are eligible for an autologous stem cell transplant (ASCT) have used weekly dex doses of 40 mg and higher. Clinical trials with NDMM patients who are not eligible for ASCT have used average total dex doses below 60 mg weekly. Half of these studies used individualized dosing strategies, such as 20 mg once-weekly for patients age 75 or older.

A pooled analysis of two studies assessed more than 500 patients who received dex at 40 mg to 60 mg once-weekly with Rd, Velcade and Rd [VRd], or Empliciti® (elotuzumab) and VRd [Elo-VRd]. Only 31% of patients stayed on their dex doses for the 24 week period of frontline therapy, the initial treatment given to a patient with NDMM. There were no significant differences between the two groups in OS or progression-free survival (PFS), PFS is the length of time during and after the treatment of myeloma that a patient lives with the disease but the myeloma does not get worse.

Published in 2021, the MAIA phase 3 clinical trial studied a group of patients who received Darzalex® (daratumumab) and Rd [DRd], with dex dosing at 20 mg to 40 mg once-weekly until progression. Published in 2024, the phase 3 IFM2017-03 clinical trial of older and more frail patients compared Rd vs. a modified version of the DRd regimen, with the DRd patients receiving only 8 weeks of dex at 20 mg once-weekly. 

The total exposure to dex in the IFM2017-03 study was less than 5% of the total exposure to dex in the MAIA study. The median PFS was 53.4 months in IFM 2017-03 vs. 22.5 months in MAIA. The IFM2017-03 dosing of 8 weeks of dex at 20 mg once-weekly is an evidence-based standard-of-care for autologous stem cell transplant (ASCT)-ineligible patients.

Published in 2025, the REST phase 2 single-arm clinical trial of Sarclisa and VRd [Isa-VRd] studied frontline therapy in ASCT-ineligible patients. Several studies of Isa-VRd have been conducted in ASCT-ineligible patients but the REST study patients i included 31% of patients who were 80 years and older, and 45% were considered frail. Dex at 20 mg once-weekly was stopped after 8 weeks. Quality of life was preserved with this approach. The overall response rate (ORR) was 100% and MRD negativity
was 41%. This shows that more exposure to dex is largely unnecessary in NDMM patients.

Dexamethasone after frontline therapy

Post-induction therapy is given after ASCT as maintenance therapy for transplant-eligible patients. It is also given to transplant-ineligible patients as their treatment is reduced. Post-induction therapy can continue for many years, in which case the side effects from the total amount of dex received by the patient most likely outweigh the benefits of dex.

In 2021, a study published in the journal Blood compared continuous Rd with 20 mg dex once-weekly in elderly, intermediate-fit patients with NDMM vs. dose/schedule-adjusted Rd with dex that was stopped after 9 months and maintenance with Revlimid alone at 10 mg per day [Rd-R]. PFS was comparable between the two groups of patients, but the Rd-R group met the study’s primary endpoint for superior event-free survival. At 3 years, OS was 74% in the Rd-R group vs. 63% in the Rd group, demonstrating that dex should not be routinely used in maintenance therapy.

Dexamethasone in the Modern Era

Given the many significant advances in the treatment of myeloma, many myeloma specialists would agree that doses of dex are generally still too high for most patients. The National Comprehensive Cancer Network (NCCN) guidelines recommend using the lowest possible effective dose of steroid for older adults. But the NCCN has made no recommendations on how to determine the dose.

Data from several clinical trials support stopping dex after 1 or 2 cycles in patients who are older and frailer. In addition, data suggest that patients who are given dex indefinitely may experience reduced efficacy of therapies if their myeloma progresses. Dex in supportive care is often sufficient at lower doses of 4 mg to 8 mg given as needed.

All steroids can have short-term and long-term side effects. More studies are needed to better understand the use of dex in myeloma. The dose of dex depends on the age and fitness or frailty of the myeloma patient. Ideally, you tolerate your dose of dex well. But don’t wait to ask your doctor if your dex dosing and schedule should be personalized.

Your myeloma doctor takes many factors into account when advising you about your overall treatment strategy, including your dose and schedule of dex. Shared decision-making takes into account your current and future preferences. For more information, read the IMF’s publication Myeloma Treatment Discussion Tool

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.