Care During Chemotherapy and Beyond
(deks a METH a sone ASS a tate)
Brand names: Decadron, Dexasone, Diodex, Hexadrol, Maxidex
Other names: dexamethasone sodium phosphate, dexamethasone acetate
Drug type: Dexamethasone has many uses in the treatment of cancer. It is classified as a glucocorticosteroid. (For more detail, see "How this drug works" section below).
What This Drug Is Used For:
- As an anti-inflammatory medication. Dexamethasone relieves inflammation in various parts of the body. It is used specifically to decrease swelling (edema), associated with tumors of the spine and brain, and to treat eye inflammation.
- To treat or prevent allergic reactions.
- As treatment of certain kinds of autoimmune diseases, skin conditions, asthma and other lung conditions.
- As treatment for a variety of cancers, such as leukemia, lymphoma, and multiple myeloma.
- To treat nausea and vomiting associated with some chemotherapy drugs.
- Used to stimulate appetite in cancer patients with severe appetite problems.
- Also used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids produced by the adrenal glands).
Note: If a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful.
How This Drug Is Given:
- This medication may be given to you in many forms. In a pill form, it is available in a variety of tablet sizes. If you are on a daily dose of dexamethasone (usually less than 10 mg), and you miss a dose, take the dose as soon as you remember. If you are on high doses of dexamethasone (20 mg or 40 mg per day for 4 days out of the month), and you miss your dose, contact your healthcare provider. You may be instructed to repeat the missed dose, and continue the medication.
- Take pills with food or after meals
- This medication may also be given by infusion into a vein (intravenously or IV)
- Dexamethasone eye drops are given to treat or prevent many eye conditions. The eye drops are most commonly given to patients with leukemia or lymphoma, to prevent inflammation of the eyes (conjunctivitis), if you are receiving high dose chemotherapy (usually Cytarabine [Ara-C]). The eye drops are given every six hours, in both eyes, and for at least 48 hours after the chemotherapy has completed. Do not stop taking these eye drops unless directed by your healthcare provider.
- You may be given dexamethasone as a lotion (topical) to treat skin disorders.
- The amount of dexamethasone you will receive depends 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.
Important things to remember about the side effects of dexamethasone:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset and duration.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
The following side effects are common (occurring in greater than 30%) for patients taking dexamethasone:
- Increased appetite
- Difficulty sleeping (insomnia)
- Swelling in your ankles and feet (fluid retention)
- Muscle weakness
- Impaired wound healing
- Increased blood sugar levels. (Persons with Diabetes may need to have blood sugar levels monitored more closely and possible adjustments to diabetes medications).
The following are less common side effects (occurring in >10%) for patients receiving dexamethasone:
- Mood swings
- Cataracts and bone thinning (with long-term use)
This list includes common and less common side effects for individuals taking dexamethasone. Side effects that are very rare, occurring in less than 10% of patients, are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:
Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:
- Fever of 100.4° F (38° C), chills (possible signs of infection)
- If you feel an irregular or fast heart beat, shortness of breath, or chest or jaw pain, seek emergency help and notify your healthcare provider
- If you become suddenly confused
The following symptoms require medical attention, but are not emergency situations. Contact your health care provider within 24 hours of noticing any of the following:
- Extreme fatigue (unable to carry on self-care activities)
- Any unusual bleeding or bruising
- Black or tarry stools, or blood in your stools or urine
- Nausea (interferes with ability to eat and unrelieved with prescribed medications)
- Vomiting (vomiting more than 4-5 times in a 24-hour period)
- Dizziness or lightheadedness, feeling faint.
- Persistent headache
- Severe hot flashes or mood swings
- Inability to sleep (insomnia)
- Severe skeletal (bone) pain
- Difficult or painful urination; increased urination, or severe thirst
- Changes in vision, blurred vision, eye pain, enlarged pupils, discharge
- Any new rashes or changes in your skin
- Swelling of the feet or ankles. Sudden weight gain (greater than 3 pounds a week)
- Swelling, redness and/or pain in one leg or arm and not the other
Always inform your health care provider if you experience any unusual symptoms.
- Before starting dexamethasone treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.) Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
- Do not receive any kind of immunization or vaccination without your doctor's approval while taking dexamethasone.
- If you have been on dexamethasone pills daily, for a long period of time, serious side effects may occur if you discontinue the medication abruptly. Do not stop taking this medication unless directed by your healthcare provider. Do not change the dose of dexamethasone on your own.
- Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus).
- For both men and women: Do not conceive a child (get pregnant) while taking dexamethasone. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.
- If you are on this medication for a long period of time, you may be more susceptible to infection. Wash your hands well, and report any symptoms of infection to your healthcare provider if noted.
- If you are given eye drops or eye ointment: You may be more sensitive to the light. Wearing sunglasses may help. It is normal to notice a little blurriness for a short time after the drops or ointment are placed in your eyes. Notify your healthcare provider with any changes in vision, blurriness, or eye pain.
- If you are given eye drops or eye ointment: Ask your healthcare provider if you may wear contact lenses. Contact lenses may absorb the medication for at least 15 minutes. Wash your hands well before putting eye drops, to decrease the chance of a bacterial infection in your eyes.
- If you are dexamethasone as a lotion (topical) to treat skin disorders: Do not apply to open areas of skin, or if you have open or weeping sores. Topical dexamethasone should not be used for a long time. Discuss this with your healthcare provider.
- Take this medication with food to lessen an upset stomach. Also take this medication early on in the day (before 12:00 noon, if possible), so you will be able to sleep better at night.
- If you have diabetes, this medication may increase your blood sugar levels. You may need more frequent monitoring.
- Drink 2 to 3 quarts of fluid every 24 hours, unless you were told to restrict your fluid intake, and maintain good nutrition.
- Avoid sun exposure. Wear SPF 15 (or higher) sun block and protective clothing.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
- In general, drinking alcoholic beverages should be avoided. You should also limit caffeine intake (colas, tea, coffee and chocolate, especially). These beverages may irritate your stomach.
- If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
Monitoring and Testing:
You will be checked regularly by your health care professional while you are taking dexamethasone, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.
How This Drug Works:
Corticosteroids are naturally produced by the adrenal gland in the body. Corticosteroids influence the functioning of most of the body's systems (heart, immune, muscles and bones, endocrine and nervous system). They exert a wide array of effects including effects on the metabolism of carbohydrates, protein and fats. They help to maintain balance of fluids and electrolytes.
Dexamethasone is classified as a corticosteroid (more precisely a glucocorticosteroid), and has many uses in the treatment of cancer.
One way that it works is to decrease inflammation (swelling). It does this by preventing infection- fighting white blood cells (polymorphonuclear leukocytes) from traveling to the area of swelling in your body. (This is why you are more prone to infection while taking steroids). Taking advantage of the anti-inflammatory properties of the medication, corticosteroids are used to decrease the swelling around tumors. For example, by decreasing swelling around tumors in the spine, brain, or bone, it can decrease the pressure of the tumor on nerve endings and relieve pain or other symptoms caused by the pressing tumor.
Another way this drug works is by altering the body's normal immune system responses. Corticosteroids are used to treat certain conditions that effect the immune system such as aplastic anemia (AA), Immune Thrombocytopenia Purpura (ITP), Thrombotic Thrombocytopenia Purpura (TTP), or hemolytic anemia.
In addition, it is thought that corticosteroids may help in the treatment of patients with blood disorders, such as multiple myeloma. Corticosteroids may work by causing programmed cell death (apoptosis) of certain cells, which may help to fight your disease.
Dexamethasone is also used in the short-term treatment of nausea caused by chemotherapy. How it does this is not fully understood. It also has been used to stimulate appetite for patients with severe appetite problems.
Corticosteroids are used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids produced by the adrenal glands).
Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.
Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org