Corticosteroids, like dexamethasone and prednisone, are staple drugs that almost every myeloma patient will take. They are the drugs that patients love to hate.

They can make us hyper-crazy with energy, neurotic, and quick to anger. These steroids can mess with blood sugar levels; once the dose is complete, it can make us "crash." So why can't we stop taking dex and move on to something else? It's simple. It works well alone and in combination with other myeloma drugs. So how do they work, and why are they used in myeloma? Here's a little more about this important class of drugs:

What Type of Drug is Dexamethasone? 

Dexamethasone is a corticosteroid that prevents the release of substances in the body that cause inflammation. Dexamethasone is used to treat many different inflammatory conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders. And, yes, multiple myeloma. Source: Drugs.com

More on Corticosteroids

Corticosteroids, such as dexamethasone and prednisone, are an important part of the treatment of multiple myeloma. They can be used alone or combined with other drugs as a part of treatment. Corticosteroids are also used to help decrease the nausea and vomiting that chemo may cause. Common side effects of these drugs include:

• High blood sugar
• Increased appetite and weight gain
• Problems sleeping
• Changes in mood (some people become irritable or “hyper”)

When used for a long time, corticosteroids also suppress the immune system. This leads to an increased risk of serious infections. They can also weaken bones. 

How Does Dexamethasone Work? 

From Every Day Health:

Although the body makes steroids in the adrenal glands, which are small glands located on top of your kidneys, dexamethasone is a synthetic (man-made) product created in the laboratory. Dexamethasone may be used alone or in combination with other drugs at any point in the course of myeloma treatment, including during chemotherapy, before a stem cell transplant, and after myeloma has come back, or in a myeloma that has not responded to other therapies.

Myeloma Treatment and Dex

Dexamethasone and other steroids are helpful in myeloma treatment because they can stop white blood cells from traveling to areas where cancerous myeloma cells are causing damage. This decreases the amount of swelling or inflammation in those areas and relieves associated pain and pressure. More importantly, in high doses, dexamethasone can actually kill myeloma cells.

When combined with other myeloma drugs, it can also increase the synergy between the drugs. Other agents used with dexamethasone include chemotherapeutic drugs, immunomodulatory, such as lenalidomide (REVLIMID), and immunotherapies, such as daratumumab (Darzalex). 

Dexamethasone and other steroids are sometimes used by themselves to treat the disease. The risk of side effects is much higher at these doses, however.

What are the Side Effects of Dexamethasone? 

• Upset stomach/stomach irritation/vomiting
  • Avoid taking medications on an empty stomach 
• Headaches
• Dizziness
• Insomnia:
  • Try a sleep aid, like Ambien
• Restlessness
  • Yoga, meditation, exercise, and hot baths can help
• Depression/anxiety
  • Seek help, let your doctor know right away 
• Acne
• Increased hair growth
• Easy bruising
• Irregular or absent menstrual periods
• Skin rash
  • Tell your doctor immediately if you develop any kind of rash
• Swollen face, lower legs, or ankles
  • Tell your doctor if you experience this
• Vision problems
• Colds or infections that last a long time
• Muscle weakness
  •  Keep moving. Lift weights.
• Black or tarry stool

Bottom line: You must keep your doctor informed of your health, concerns, and potential side effects of any drug you're taking. Do not be lax on this one. Yes, it matters! 

While dexamethasone might bring about a cleaner house or a shopping spree, it can also bring about severe mood swings and unwanted rapid weight gain. If you are experiencing side effects from the dexamethasone that significantly lower your quality of life (or the quality of life of those around you), please talk to your doctor about a dose reduction. No physician or treating medical team wants you or your family to be so negatively affected by treatment. 

If you want to learn more about dexamethasone, consider one of the following resources. 

• HealthTree Medication Information Pages: Dexamethasone 
• HealthTree University (Free Myeloma Education): All About Dexamethasone and other Corticosteroids 
• Recently Published Dexamethasone Research: Seniors Enjoy Life with Less Dex (ASH 2022) Article 
• Steroids 101: Darn that Dex Webinar with Myeloma Specialist Dr. Banerjee
• Myeloma 101: Dexamethasone and Blood Sugar Levels