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.

What Is Dexamethasone Used For?

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. Dexamethasone, used for its anti-inflammatory and anti-myeloma effects, and other steroids play an important role in treatment of multiple myeloma.

Is Dexamethasone a Steroid?

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 Does Dexamethasone Work?

A steroid is a type of hormone. Steroidal hormones are produced by the body, and the synthetic analogues (equivalents) of some steroids can be manufactured in a laboratory. Dexamethasone is a synthetic steroid that has multiple effects and is used for many conditions, including myeloma.

Dexamethasone is a synthetic adrenocortical steroid. In the body, adrenocortical steroids are produced naturally by the adrenal glands and are also known as glucocorticosteroids or corticosteroids. (From here forward, these compounds will be referred to as “steroids.")  Adrenal glands produce both hormones and steroids. These steroids influence many actions of the body’s systems. They are involved in the regulation of carbohydrates, proteins, and fats. They also inhibit inflammatory, allergic, and normal immune responses.

Synthetic versions of steroids can

• imitate the actions of the naturally occurring compounds, or
• replace them in conditions that are associated with insufficient production of much-needed steroids that are normally produced by the adrenal glands.

Dexamethasone is used to treat a wide variety of medical conditions in addition to myeloma and other hematologic malignancies. Steroids are generally additive or synergistic with other treatments. Steroids as a component of treatment for myeloma may also help improve other conditions, such as the following:

• Endocrine disorders,
• Rheumatic or collagen disorders,
• Dermatologic diseases,
• Allergic states,
• Ophthalmic (eye) diseases,
• Gastrointestinal (GI) diseases,
• Respiratory diseases, and
• Hematologic disorders.

Dexamethasone and other steroids suppress certain actions of the immune system and also inhibit cytokines, which control inflammation. Dexamethasone decreases inflammation by stopping white blood cells (WBCs), which normally fight infection, from traveling to areas of the body where there is swelling. Dexamethasone’s anti-inflammatory actions can stop the swelling around tumors and the pain caused by tumors pressing on nerve endings. Dexamethasone can also alter normal immune system responses and is therefore useful in the treatment of conditions that affect the immune system.

Dexamethasone has demonstrated activity in myeloma as a single agent, but it is typically given in combination with one or more other agents because it appears to increase the ability of other drugs to destroy myeloma cells were 65–80 years old and who were “intermediate-fit” on the International Myeloma Working Group (IMWG) frailty score (http://www.myelomafrailtyscorecalculator.net/) were 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 and were more frequent with continuous Rd. After 9 cycles of Rd, switching to reduced-dose Revlimid maintenance therapy without dexamethasone was feasible, with similar outcomes to standard continuous Rd.

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  

Your myeloma doctor will consider many factors when determining your overall treatment strategy. Ideally, the dose of your medication and how it is administered should be:

• appropriate for the treatment of your individual myeloma and
• well-tolerated by you.

Steroids are associated with many short-term and long-term side effects. To reduce the side effects experienced by patients, many clinical trials have investigated the use of low-dose dexamethasone, establishing this approach as the standard of care in myeloma.

Dexamethasone is usually prescribed at a dose of 20 mg to 40 mg once-weekly, contingent on the following:

• the age of the patient
• the fitness or frailty level of the patient

For patients who cannot tolerate these doses, dexamethasone has proven to be effective at doses as low as 4 mg once-weekly.

Dexamethasone in Clinical Trials  

A clinical trial (https://www.myeloma.org/clinical-trial-search)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.

The ECOG E4A03 Trial

Historically, dexamethasone doses used to be as high as 40 mg for 4 days per week. Then the ECOG E4A03 clinical trial demonstrated increased mortality at this dexamethasone dosing when compared with 40 mg once-weekly dexamethasone dosing. In addition, the recent increase in the number of effective anti-myeloma therapies and the growing use of effective quadruplet (4-drug) induction therapy regimens raised the question to what extent dexamethasone is necessary to treat myeloma.

Patients with myeloma are now living longer than ever, and it is important to minimize treatment toxicities. Possible steroid toxicities include the following:

• insomnia,
• heartburn,
• edema (swelling),
• psychiatric disturbances,
• muscle weakness,
• hyperglycemia,
• and diabetic complications.

There is a need to better identify which myeloma patients may benefit from dexamethasone dose reduction. National Comprehensive Cancer Network (NCCN) guidelines recommend limiting steroid use to the lowest possible effective dose in older adults, but these guidelines do not provide specific recommendations on how to determine that dose.

Secondary SWOG Analysis

In January 2025, the journal Blood published a secondary analysis by Dr. Banerjee et al. of pooled data from two completed clinical trials by the SWOG Cancer Research Network, known as SO777 and S1211 (https://www.myeloma.org/videos/impact-dexamethasone-dex-dose-strength-newly-diagnosed-multiple-myeloma). Data from both studies showed that dexamethasone dose reductions did not have a negative impact on outcomes in patients with newly diagnosed multiple myeloma (NDMM). There was no significant change to progression-free survival (PFS) and overall survival (OS) after induction therapy.

The same edition of Blood included a commentary on the secondary analysis, concluding that dexamethasone-sparing strategies can reduce steroid-induced toxicity and help patients to continue their long-term myeloma treatment with improved quality of life. Although the exact dosing and role of dexamethasone in the treatment of myeloma still needs to be clearly defined, the secondary analysis suggests that further reduction of dexamethasone toxicity is possible.

This secondary analysis adds to the growing evidence that limiting dexamethasone exposure may be possible without adversely affecting treatment outcomes. Less than a third of patients on stringently controlled clinical trials could tolerate full-dose dexamethasone, while also showing that dexamethasone dose reductions were not associated with decreased PFS or OS.

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) + Revlimid® [DR], in which patients received only 2 months of dexamethasone. The DR regimen had deeper responses, with an overall response rate (ORR) of 96% and a complete response (CR) rate of 37%. The Rd regimen had an ORR of 85% and a CR of 10%.

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, a group usually excluded from clinical trials. Newly diagnosed patients who were 65–80 years old and who were “intermediate-fit” on the International Myeloma Working Group (IMWG) frailty score were 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 and were more frequent with continuous Rd. After 9 cycles of Rd, switching to reduced-dose Revlimid maintenance therapy without dexamethasone was feasible, with similar outcomes to standard continuous Rd.

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 (https://www.myeloma.org/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 (https://www.myeloma.org/dexamethasone-side-effects#drug-interactions).