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The full explanation.
Managing Steroid Side Effects During Treatment
Steroids appear in cancer care more often than almost any other supportive medicine. The two you are most likely to be handed are dexamethasone and prednisone. MedlinePlus describes dexamethasone as "similar to a natural hormone produced by your adrenal glands," and says prednisone works "by changing the way the immune system works." This page covers what steroids do to the body; the sleep and mood effects have their own page.
Why a steroid is in your regimen
Sometimes the steroid is the cancer treatment. NCI lists dexamethasone as used with other drugs for leukemia, lymphoma, multiple myeloma, and mycosis fungoides, and for cerebral edema (fluid build-up in the brain) with brain tumors, hypercalcemia, and thrombocytopenia.
More often it is there to make chemotherapy tolerable. NCI's antiemesis guidance builds dexamethasone into the standard anti-nausea combinations at every risk level, from a four-drug combination before highly emetogenic chemotherapy down to a single 8 mg dose for low-risk drugs. Infusion-day dosing is covered under premedications.
Blood sugar, fluid, and salt
Hyperglycemia is a listed adverse reaction on the FDA label for dexamethasone tablets. MedlinePlus is direct: "If you have diabetes, dexamethasone may increase your blood sugar level. If you monitor your blood sugar (glucose) at home, test your blood or urine more frequently than usual."
The label also lists fluid retention, sodium retention, potassium loss, and hypertension — that is where puffiness in the face, hands, and ankles comes from. Your doctor may instruct you to follow "a low-sodium, low-salt, potassium-rich, or high-protein diet."
Appetite and the stomach
Increased appetite and weight gain are both listed adverse reactions. Steroid hunger is a drug effect, not a failure of willpower; see weight gain during treatment. Steroids also irritate the stomach lining. The label lists "peptic ulcer with possible perforation and hemorrhage," and MedlinePlus says to take dexamethasone "with food or milk." Black or tarry stool means bleeding, not indigestion.
Infection, and the fever that may not appear
This is the part that matters most. The FDA label states: "Patients who are on corticosteroids are more susceptible to infections than are healthy individuals," and "corticosteroids may also mask some signs of current infection." MedlinePlus says prednisone "may decrease your ability to fight infection and may prevent you from developing symptoms if you get an infection." A steroid can raise your risk and flatten the fever that would normally warn you.
MedlinePlus instructs you to "report any injuries or signs of infection (fever, sore throat, pain during urination, and muscle aches) that occur during treatment." For prednisone, "sore throat, fever, chills, cough, or other signs of infection" sit on the list where the instruction is to "call your doctor immediately." It also says to stay away from people who are sick, wash your hands often, and "call your doctor immediately if you think you may have been around someone who had chicken pox or measles" — those infections "can have a more serious or even fatal course" in adults on corticosteroids. Do not have a vaccination or skin test while taking dexamethasone unless your doctor tells you that you may. See also fever and infection concerns.
What longer courses add
Over months, the label lists muscle weakness, osteoporosis, pathologic fracture, aseptic necrosis, impaired wound healing, thin fragile skin, cataracts, and glaucoma. MedlinePlus states that "prednisone may increase the risk that you will develop osteoporosis." The American Cancer Society says bone density is measured with a DEXA scan, which "you may have before, during, and after cancer treatment," and names calcium, vitamin D, weight-bearing exercise, and bone-protecting drugs as the defenses. A short burst each chemotherapy cycle is not the same exposure as months of daily prednisone.
Why the dose is tapered instead of stopped
Corticosteroids "can produce reversible hypothalamic-pituitary adrenal (HPA) axis suppression" — your own adrenal glands go quiet while the drug does their job. The label says that after long-term therapy the drug should "be withdrawn gradually rather than abruptly," and that "patients should be warned not to discontinue the use of corticosteroids abruptly or without medical supervision."
Stopping prednisone suddenly can cause "extreme tiredness, weakness, slowed movements, upset stomach, weight loss, changes in skin color, sores in the mouth, and craving for salt." The logic runs the other way too: "increased dosage of rapidly acting corticosteroids is indicated in patients on corticosteroid therapy subjected to any unusual stress." Before surgery or during a serious illness, tell whoever is treating you that you are on steroids.
What to report, and how fast
Call your doctor immediately for skin rash; swollen face, lower legs, or ankles; vision problems; a cold or infection that lasts a long time; muscle weakness; or black or tarry stool. Call if your blood sugar is high or if sugar is present in your urine. If your team has given you a different rule for when to call, follow theirs.
Related pages
Steroid Insomnia, Anxiety, and Mood Changes, Side Effects From Steroids and Premedications, Fever and Infection Concerns During Cancer Treatment, and Bone Health and Fractures After Cancer Treatment.
Sources
- DailyMed, U.S. National Library of Medicine: Dexamethasone Tablets, USP (FDA label). https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=93bb34a7-c8ca-4dab-b2a0-cbe011e1090c&type=display
- MedlinePlus, U.S. National Library of Medicine: Dexamethasone. https://medlineplus.gov/druginfo/meds/a682792.html
- MedlinePlus, U.S. National Library of Medicine: Prednisone. https://medlineplus.gov/druginfo/meds/a601102.html
- National Cancer Institute: Dexamethasone. https://www.cancer.gov/about-cancer/treatment/drugs/dexamethasone
- National Cancer Institute: Nausea and Vomiting Related to Cancer Treatment (PDQ) — Health Professional Version. https://www.cancer.gov/about-cancer/treatment/side-effects/nausea/nausea-hp-pdq
- American Cancer Society: Osteoporosis. https://www.cancer.org/cancer/side-effects/osteoporosis.html
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