How it Works

Dexamethasone is a corticosteroid that prevents the release of substances in the body that cause inflammation. Dexamethasone works by mimicking the effect of cortisol, a hormone released by the adrenal glands (which are located on top of the kidneys) that controls metabolism and stress.

In multiple myeloma and acute myeloid leukemia, dexamethasone and other steroids are helpful 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 kill malignant cells. When combined with other myeloma drugs, it can increase the response to the treatment.

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How it’s Administered

Dexamethasone can be administered in different forms. 

• Pills: take pills with food or after meals
• IV: it can be given by infusion into a vein (which can reduce emotional side effects)
• Eye drops to treat or prevent many eye conditions (non-myeloma related)
• Lotion to treat skin disorders (non-myeloma related)

The amount of dexamethasone provided will depend on many factors, including your general health or other health problems and the reason you are receiving this drug. Your doctor will determine your dosage and schedule.

Dexamethasone should not suddenly be stopped if it has been used long-term. Reduce dosage gradually over several weeks or months to allow the adrenal glands to return to their normal secretion patterns. Too rapid a withdrawal of dexamethasone may cause symptoms such as bone and muscle pain, fatigue, weight loss, nausea, and vomiting.

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Who Should Take Dexamethasone

Dexamethasone is currently approved for:

• Autoimmune diseases
• Some types of cancer, such as leukemias, lymphomas, and multiple myeloma
• Allergic diseases
• Other inflammatory diseases 

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Who Shouldn’t Take Dexamethasone

• Patients with active fungal infection
• Patients with alcohol problems 
• Patients with severe mental conditions (discuss with your doctor)

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The Most Common Side Effects of Taking Dexamethasone Include:

• Fluid retention (swelling in your hands or ankles)

• Muscle weakness
• Increased appetite and weight gain
• Mood changes 
• Trouble sleeping (insomnia)
• Skin rash, bruising, or discoloration
• Acne, increased sweating 
• Headache 
• Dizziness
• Nausea, vomiting, heartburn
• Changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).
• Increased blood sugar levels (persons with Diabetes may need to monitor blood sugar levels and make possible adjustments to diabetes medications)

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Commonly Used for Multiple Myeloma With 

• Chemotherapeutic drugs such as vincristine and doxorubicin 
• Immunomodulators agents such as thalidomide and lenalidomide 
• Proteasome inhibitors such as bortezomib and carfilzomib.
• Monoclonal antibodies such as daratumumab and elotuzumab

Commonly Used for AML With 

• Chemotherapeutic drugs such as Cytarabine, Azacitidine, and Decitabine

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Currently Being Tested With Dexamethasone in Multiple Myeloma

• Chemotherapeutic drugs: cyclophosphamide, Melphalan Flufenamide, Bendamustine
• Immunomodulators agents: Lenalidomide, Pomalidomide, Thalidomide 
• Proteasome inhibitors: Carfilzomib, Ixazomib, Bortezomib, Oprozomib  
• Monoclonal antibodies: Daratumumab, Felzartamab (TJ202), Elotuzumab, Belantamab Mafodotin, Nivolumab, Durvalumab, Isatuximab, Pembrolizumab, Mezagitamab (TAK-079)
• Bispecific engagers: Elranatamab
• Histone deacetylase inhibitor: Ricolinostat (ACY-1215), Vorinostat, Citarinostat (ACY-241)
• Selective inhibitor of nuclear export (SINE): Selinexor
• BCL-2 inhibitors: Venetoclax
• Antibiotics with antineoplastic activity: Clarithromycin, Doxorubicin
• Others: Nelfinavir, Sotatercept (ACE-011), CLR-13, hydroxychloroquine, Idasanutlin, Osalmid

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Currently Being Tested With Dexamethasone in AML

• Chemotherapeutic drugs: Cytarabine, Azacitidine, Decitabine, Fludarabine, Mitoxantrone, Vincristine, Cyclophosphamide and Etoposide
• Protein kinase inhibitors: Dasatinib, Palbociclib
• Monoclonal antibodies: Tocilizumab, Isatuximab, Rituximab
• Bispecific antibodies: Vibecotamab, Blinatumomab
• Selective inhibitor of nuclear export (SINE): Eltanexor
• BCL-2 inhibitors: Venetoclax
• Antibiotics with antineoplastic activity: Daunorubicin, Idarubicin, Doxorubicin

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