Dexamethasone (Steroid) Side Effects

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

Potential Side Effects of the Steroid Dexamethasone

Dexamethasone (also known as dex) can cause side effects. Few patients experience all of the possible side effects. Some patients do not experience any side effects at all. Alert your doctor if you experience any side effects or if you notice changes in your health. Do not skip or stop taking your medication.Do not reduce your doses on your own. 

The longer you take dexamethasone and the higher your dose, the greater your chances of having side effects. Most side effects will go away when treatment is completed. Ask your doctor how you can avoid or reduce side effects from dex, or manage the side effects if they occur. The most important side effects are described below.

Infections

Any drug that suppresses your immune system increases your risk of infections. Steroids can make you vulnerable to bacterial, viral, and fungal infections. They may also cause existing infections to get worse. Generally, steroids should not be given to a patient who has an infection, but steroids may be necessary to treat serious infections that cause major inflammation or tissue destruction, such as septic shock (an infection that involves the whole body).

Steroids can hide the signs of infection, but a blood test can detect that your immune system is fighting an infection if it shows abnormal white blood cell counts, elevated inflammatory markers, or microscopic germs in your bloodstream.

Alert your doctor as soon as possible if you have been exposed to an infectious illness. Your doctor must know your entire vaccination history. Also, make sure to wash your hands frequently, especially after being in public places.

Steroids can hide the signs of infection. A blood test can detect that your immune system is fighting an infection. In this case, your blood test will show abnormal white blood cell counts, elevated inflammatory markers, or microscopic germs in your bloodstream.

Heart Conditions and High Blood Pressure

Steroids can raise blood pressure, make the body hold more salt and water, and cause it to lose potassium and calcium. This can cause swelling (edema), especially in the feet and ankles. Your doctor may direct you to modify your diet, restrict salt intake, or add foods higher in potassium and calcium.

Extra fluid and low potassium can be serious for people who have high blood pressure or congestive heart failure. The steroid methylprednisolone tends to cause less fluid retention. Ask your doctor if it may be an appropriate option for you.

Skin-Related Side Effects

Steroids can cause increased sweating, acne, rashes, and bruising. It may take longer than usual for wounds to heal. Proper hygiene is especially important when taking steroids. If your skin is injured, administer first aid and contact your doctor.

Endocrine Side Effects

Steroids can interfere with how you metabolize carbohydrates and can cause blood glucose levels to rise. Patients with diabetes can take steroids, but may need to monitor their blood glucose levels more frequently. Your doctor will decide if additional medication to control blood sugar levels is needed. Do not adjust your medication on your own.

Steroids can also cause menstrual irregularities. Women of reproductive potential should take added precautions not to become pregnant while taking dex. If you are pregnant, ask your doctor about the potential effects of your medications on the developing child.

Gastrointestinal (GI) Effects

Steroids can irritate the stomach and increase the risk of GI holes (perforations). Dex should be taken with food or after meals to avoid or minimize bloating, nausea, vomiting, hiccups, and heartburn. Patients with peptic ulcers, diverticulitis, and ulcerative colitis may be prescribed antacid therapy to take between meals.

To decrease nausea, eat small and frequent meals. Medication may be prescribed to treat constant hiccups. Avoid alcoholic beverages and limit caffeine.

Steroids can decrease or increase appetite, and increased caloric intake can cause weight gain. Alert the doctor if you gain of 5 pounds or more over only a day or two. Reducing carbohydrate intake is especially helpful during steroid therapy.

Musculoskeletal Side Effects

Steroids affect bones because they decrease calcium absorption and increase calcium excretion, sometimes leading to pain and osteoporosis. Patients with myeloma who already have bone loss and bone pain must be monitored carefully by their doctors. The best dietary sources of calcium are dairy products, dark-green leafy vegetables, peas and beans, canned fish such as sardines and salmon, and calcium-fortified juices and cereals.

Steroids can cause muscle weakness and muscle pains due to the loss of potassium. Potassium is available in many fruits and vegetables, leafy greens, beans, nuts, dairy foods, and starchy vegetables. Do not take any supplements or change your diet without consulting your doctor.

Many patients with myeloma receive bisphosphonate therapy as treatment for myeloma-related bone disease. Bisphosphonate therapy also reduces the negative effects of steroids on bone strength and density. For more information, read the IMF’s publication Understanding Treatment of Myeloma Bone Disease. (https://www.myeloma.org/resource-library/understanding-treatment-myeloma-bone-disease)

Eye (Ophthalmologic) Side Effects

Prolonged steroid treatment may raise intraocular pressure that could lead to glaucoma, optic nerve damage, cataracts, and eye infections.

Cataracts are common in older age and usually take years to develop, but steroids can speed up this process. Cataract surgery involves replacing a cataract with a new lens to improve vision. Be sure to have your eyes checked regularly, and report any change in vision immediately to your doctor.

Allergic Reactions

Allergic hypersensitivity reactions to steroids are rare but possible, and more likely in patients who have been allergic to other drugs. Alert your doctor if you have a history of allergic responses to any medication.

• Symptoms of allergic reactions include the following:
• Difficulty breathing
• Closing of the throat
• Swelling of the lips and tongue
• Skin hives

Psychiatric and Neurologic Effects

Steroids can also cause:

• Irritability
• Mood swings
• Personality changes
• Insomnia
• Depression

Patients taking dex may have cognitive and behavioral changes, which can affect the patient and/or those around them.

Psychotic tendencies may worsen during steroid therapy. Patients have also reported headaches and dizziness. Your doctor may need to reduce or stop your steroid therapy temporarily or permanently. Do not make any changes on your own.

If you have insomnia, ask your doctor if taking dex earlier in the day can lower the chances of dex interfering with your sleep. However, taking dex before going to bed can be very effective in helping you sleep through the night, with sleep medication prescribed if needed.

Message to Care Partners About Caring for a Loved One on Dexamethasone

If your loved one is receiving steroid therapy, they may become more short-tempered. The stresses and pressures of a myeloma diagnosis, added to life’s other challenges, may feel overwhelming for the patient. Counseling may be helpful to both the patient and the care partners. Visit carepartners.myeloma.org (https://www.myeloma.org/caregivers-or-care-partners-myeloma-patients)for available resources.

Dexamethasone and Its Possible Drug Interactions

Steroids can interact with and interfere with other medications. Most myeloma therapies are made up of several medications. Some myeloma patients have other medical conditions that also require treatment. The more medications you take, the greater the chances of drug interactions. Below is a partial list of prescription and over-the-counter medications that may interact with steroids:

• Amphotericin B
• Antibiotics
• Anticoagulants
• Barbiturates
• Cyclosporine
• Diabetes medications
• Digitalis
• Diuretics
• Ephedrine
• Phenytoin
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Estrogen-containing medications (including oral contraceptives)
• Hormone-replacement therapy (HRT) products

The Expected Duration of Dexamethasone Side Effects

While some side effects are expected for steroids like dexamethasone, the good news is that most people will likely only experience a few at a time. Others don't experience any side effects at all. Furthermore, side effects are tied to the continued use of the drug, meaning that you should start to feel relief within weeks of finishing the course of treatment. Exactly how long your dexamethasone side effects last will depend on how long you've been taking the drug and your dosage.

That does not mean you should stop taking your medication when you begin to experience side effects, as this can cause serious complications with treatment and lead to other serious conditions. If you find the side effects you experience to be unacceptable, you should talk to your provider immediately and come up with a plan together regarding how to best mitigate the challenges. Most providers agree that removing a medication entirely is a last-ditch effort, and there may in fact be other changes and additions you can make to address side effects without stopping the treatment entirely.

Experiencing Dexamethasone Withdrawal Symptoms

Like most medications, steroids are not something you should stop taking cold turkey unless directed by your doctor. When it's time for you to stop dexamethasone, your provider may decrease the amount of medication you take over time until you are at a low enough dose to come off it completely. Despite this and other safeguards your team may have for you, many people still experience standard withdrawal symptoms like fever, chills, body aches, and fatigue.

These symptoms typically appear within a few days of stopping treatment, and you will experience them most intensely in the week or two after you finish taking the medication. Most people start to feel normal within a month, though it may take a few months for your body to completely recover.

Find Support at the International Myeloma Foundation

As you consider these options for you or a loved one with multiple myeloma, it's important to remember that dexamethasone is just one of the dozens of treatment options that may be available to you. At the International Myeloma Foundation, our resource center (https://www.myeloma.org/publications-videos) is home to a comprehensive and ever-expanding library of information regarding the newest and most effective treatments. We also help you connect with others in your situation and stay up to date as our understanding of MM continues to develop.

You can learn more about dexamethasone from our pamphlet. (https://www.myeloma.org/resource-library/understanding-dexamethasone) Let us help you find your path to recovery today.