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Dexamethasone is a corticosteroid used to treat multiple myeloma, asthma, chronic obstructive pulmonary disease, inflammatory processes, and rheumatoid arthritis. It is also the most commonly prescribed corticosteroid for myeloma. Like all medicines, dexamethasone can cause side effects, although not everyone experiences them. Dexamethasone can cause muscle weakness, which is known as corticosteroid-induced myopathy. This is a toxic noninflammatory myopathy that occurs as an adverse effect of prolonged oral or intravenous glucocorticoid use. It is believed to be caused by an excess of exogenous corticosteroids. Corticosteroid-induced myopathy is often overlooked as a diagnosis because symptoms are sometimes attributed to the primary illness that the corticosteroid is treating.
| Characteristics | Values |
|---|---|
| Muscle weakness | Dexamethasone can cause muscle weakness, especially with prolonged use. |
| Myopathy | Dexamethasone can cause myopathy, a toxic non-inflammatory muscle disease. |
| Muscle atrophy | Dexamethasone can lead to a reduction in muscle mass and grip strength. |
| Biomechanical changes | Dexamethasone can alter muscle tone, stiffness, and elasticity. |
| Risk factors | Higher doses (6mg or more per day) and long-term use increase the risk of muscle weakness. |
| Treatment | Treatment includes reducing/discontinuing dexamethasone, switching to non-fluorinated glucocorticoids, and physical therapy. |
| Prevention | Regular exercise and a healthy diet may help prevent or reduce the severity of muscle weakness. |
| Diagnosis | Diagnosis requires a high index of suspicion, as symptoms may be attributed to the primary illness. |
| Recovery | Recovery from dexamethasone-induced myopathy typically occurs within 3-4 weeks of tapering the medication. |
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What You'll Learn
Dexamethasone is a corticosteroid
Dexamethasone is a long-acting corticosteroid used to treat inflammatory conditions such as allergies, skin conditions, ulcerative colitis, arthritis, and breathing disorders. It is also used to treat eczema, asthma, multiple sclerosis, and cancer. Dexamethasone is available in tablet, liquid, and oral solution forms, and is typically taken with food to reduce the chances of stomach problems.
As a corticosteroid, dexamethasone can cause muscle weakness, particularly in the pelvic girdle, in some individuals. This condition, known as corticosteroid-induced myopathy, is a toxic non-inflammatory myopathy that occurs as an adverse effect of prolonged oral or intravenous glucocorticoid use. It is often overlooked as a diagnosis because symptoms may be attributed to the primary illness being treated. Corticosteroid-induced myopathy is typically confirmed when muscle weakness improves after 3 to 4 weeks of tapering or discontinuing the steroid, although recovery may take several months to a year.
The risk of developing corticosteroid-induced myopathy may be higher with fluorinated steroids such as dexamethasone compared to non-fluorinated steroids. A sedentary lifestyle may also increase the risk of muscle weakness in patients taking corticosteroids. In addition, long-term use of dexamethasone can lead to osteoporosis and an increased risk of bone fractures. This is particularly true for pediatric and elderly patients, who are more likely to experience slower growth and bone problems with prolonged dexamethasone use.
Other side effects of dexamethasone include stomach problems, weight gain, high blood sugar, muscle pain, cramps, and blurred vision. Serious side effects are more likely with higher doses (6 mg or more per day) or prolonged use. It is important for patients to work closely with their doctors to monitor for any unwanted effects and adjust the treatment plan as needed.
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Dexamethasone causes muscle weakness
Dexamethasone is a type of corticosteroid medication that can cause muscle weakness in some patients. This is known as corticosteroid-induced myopathy, a toxic non-inflammatory myopathy that occurs as an adverse effect of prolonged oral or intravenous glucocorticoid use. The condition was first described in 1932 by Harvey Cushing, who also described the associated condition known as Cushing's syndrome, which can cause a "moon face" appearance.
Corticosteroid-induced myopathy is a frequently overlooked diagnosis, as symptoms are sometimes attributed to the primary illness being treated by the corticosteroid. This can delay treatment and increase morbidity. Therefore, a high index of suspicion is required when patients present with muscle weakness, particularly in the pelvic girdle, after taking any dose, route, or duration of steroids.
Dexamethasone-induced myopathy can cause a decrease in skeletal muscle androgen receptor mRNA levels and an increase in plasma insulin-like growth factor-1 (IGF-1) levels. Studies in rats have shown that dexamethasone treatment can alter muscle tone, stiffness, and elasticity, leading to muscle weakness. In humans, dexamethasone has been shown to reduce the cross-sectional area of type 1 and type 2A muscle fibers.
The treatment for dexamethasone-induced myopathy involves reducing or discontinuing the use of dexamethasone. Close monitoring for adrenal insufficiency and exacerbation of the primary illness is necessary during this process. For patients unable to taper off dexamethasone, switching to non-fluorinated glucocorticoids, such as prednisone or hydrocortisone, may be considered. Physical therapy, including resistance and aerobic exercise, has been shown to prevent and treat steroid-induced myopathy.
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Dexamethasone side effects
Dexamethasone is a corticosteroid medication that can cause a wide range of side effects, affecting nearly every system of the body. Side effects are less likely if you're on a lower dose (less than 6mg a day).
Common side effects include muscle weakness, muscle pain, and muscle cramps. This is due to dexamethasone-induced myopathy, which is a toxic noninflammatory myopathy caused by an excess of exogenous corticosteroids. Corticosteroid-induced myopathy is almost always reversible, with improvement in myopathy within 3 to 4 weeks of tapering corticosteroids.
Dexamethasone can also cause:
- Mood changes
- Loss of appetite and weight loss
- High blood sugar (hyperglycaemia)
- Increased risk of infections
- Adrenal gland problems
- Osteoporosis (weak bones)
- Eyesight problems
- Slower growth in children and teenagers
- Sleep problems
- Psychological and neurological problems, affecting cognition, mood, and behaviour
- Stomach problems
If you are experiencing any of these side effects, it is important to consult your doctor. They may adjust your dosage or prescribe additional medications to help manage the side effects.
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Dexamethasone treatment for multiple myeloma
Dexamethasone is a synthetic adrenocortical steroid, also known as a glucocorticosteroid or corticosteroid. It is one of the most frequently used medications in the treatment of multiple myeloma. It is often used in combination with other drugs, such as lenalidomide (Revlimid) and daratumumab (Darzalex), but can also be used alone. Dexamethasone can be used at any point in the course of myeloma treatment, including during chemotherapy, before a stem cell transplant, and after myeloma has come back or has not responded to other therapies.
Dexamethasone is helpful in the treatment of multiple myeloma because it can stop white blood cells from travelling 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. In high doses, dexamethasone can even kill myeloma cells.
Dexamethasone has also been shown to improve overall survival rates in patients with relapsed or refractory multiple myeloma when used in combination with lenalidomide, as compared to lenalidomide alone. A phase 2 study of bortezomib in relapsed, refractory myeloma, and a phase 2 study to evaluate the efficacy and safety of CDC-5013 dose regimens used alone or in combination with dexamethasone for the treatment of relapsed or refractory multiple myeloma have also shown promising results.
However, dexamethasone can cause various side effects, including muscle weakness, weight gain, mood swings, upset stomach, vomiting, dizziness, high blood sugar (hyperglycaemia), muscle pain, weakness or cramps, and more. These side effects are less likely to occur at lower doses (less than 6mg per day) and may be mitigated by taking dexamethasone with a meal or snack and taking the last dose before 6 pm. Serious side effects are more likely with higher doses (6mg or more per day) or if dexamethasone is taken for more than a month.
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Dexamethasone and Cushing's syndrome
Dexamethasone is a man-made version of cortisol, a steroid hormone. It is used to treat a variety of conditions, including asthma, chronic obstructive pulmonary disease, and inflammatory processes such as polymyositis, connective tissue disorders, and rheumatoid arthritis. While dexamethasone can be an effective treatment, it is important to be aware of its potential side effects, which can become more likely and severe with higher doses (6mg or more per day) or prolonged use.
One of the potential side effects of dexamethasone is muscle weakness, which can be a symptom of a condition called corticosteroid-induced myopathy. This condition was first described by Harvey Cushing in 1932 as part of a group of symptoms now known as Cushing's syndrome. Cushing's syndrome is characterised by high levels of cortisol over an extended period, which can be caused by tumours on the pituitary gland or other organs that produce excess adrenococorticotrophic hormone (ACTH). The excess ACTH stimulates the adrenal glands to produce large amounts of cortisol, leading to the symptoms of Cushing's syndrome.
The symptoms of Cushing's syndrome can be challenging to distinguish from other diseases, so doctors typically perform multiple tests to confirm the diagnosis. One such test is the dexamethasone suppression test, which helps determine whether an individual has Cushing's syndrome and identifies its cause. This test involves administering dexamethasone, either in low or high doses, to see if it reduces cortisol levels in the body. If the dexamethasone does not lead to decreased cortisol levels, it suggests that the individual may have Cushing's syndrome.
In addition to muscle weakness, other signs and symptoms of Cushing's syndrome include weight gain, a puffy, rounded face ("moon face"), thinning skin, easy bruising, and an increased risk of bone fractures and eye problems. It is important to consult a doctor if you experience any of these symptoms, especially if you are taking dexamethasone or other corticosteroids.
To manage corticosteroid-induced myopathy, the first step is typically to reduce or discontinue the use of dexamethasone or other corticosteroids. This should be done under medical supervision to monitor for adrenal insufficiency and exacerbation of the underlying condition. For those who cannot taper off corticosteroids, switching from fluorinated glucocorticoids to non-fluorinated alternatives, such as replacing dexamethasone with prednisone or hydrocortisone, may be considered. Additionally, physical therapy, including resistance and aerobic exercises, has been shown to help prevent and treat steroid-induced myopathy.
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Frequently asked questions
Yes, dexamethasone is a steroid that can cause muscle weakness. It is a commonly prescribed corticosteroid and can induce myopathy, a toxic non-inflammatory myopathy.
Dexamethasone causes muscle weakness by altering muscle tone, stiffness and elasticity. It also decreases skeletal muscle androgen receptor mRNA levels.
The signs of dexamethasone-induced muscle weakness include unexplained muscle pain, tenderness, and weakness. It can also cause proximal muscle weakness, which affects the upper and lower limbs and the neck flexors.
To prevent dexamethasone-induced muscle weakness, one can consider reducing the dosage or discontinuing the use of dexamethasone. Regular exercise, including resistance and aerobic training, can also help prevent and treat steroid-induced myopathy. Additionally, it is important to consult a doctor before making any changes to your medication.
