Dexamethasone is a corticosteroid medication, a type of steroid hormone similar to those naturally produced by the body. This drug is frequently administered immediately before a patient receives certain chemotherapy treatments. Its inclusion in the regimen is part of a strategy to support the body through the challenging side effects of cancer treatment. Its use in this context is highly targeted and specific to improving a patient’s experience during their cycle.
Preventing Chemotherapy-Induced Nausea and Vomiting
The primary reason dexamethasone is given before treatment is to prevent Chemotherapy-Induced Nausea and Vomiting (CINV). Chemotherapy agents can trigger the body’s emetic response pathways in the brain and in the gastrointestinal tract. Dexamethasone acts as a powerful antiemetic by influencing these pathways.
It is most often prescribed in combination with other anti-nausea medications, such as 5-HT3 receptor antagonists or NK1 receptor antagonists, because the drugs work together synergistically. This combination therapy is significantly more effective than a single antiemetic agent alone for preventing CINV. Dexamethasone’s ability to enhance the effects of these other drugs is important for patients receiving moderately or highly emetogenic chemotherapy.
CINV is categorized into acute and delayed phases, and dexamethasone plays a protective role in both. Acute CINV occurs within the first 24 hours after the chemotherapy infusion has started. Delayed CINV can begin 24 hours or more after the infusion and may last for several days. Dexamethasone is effective in preventing both the immediate and the later onset of these symptoms.
Secondary Benefits During Treatment
While the control of CINV is the main goal, dexamethasone also offers several other beneficial effects during the chemotherapy period. As a potent corticosteroid, it possesses strong anti-inflammatory properties. This reduction in inflammation can help manage swelling and discomfort that may be caused by the chemotherapy agents or by the cancer itself.
The drug also has anti-allergic properties, helping to stabilize mast cells and reduce the immune system’s response. This action helps to reduce the risk or severity of a hypersensitivity reaction to the chemotherapy agent being infused. The pre-treatment dose of dexamethasone helps to mitigate this danger.
How and When Dexamethasone is Administered
Dexamethasone is typically administered shortly before the start of the chemotherapy infusion. This ensures the drug is active in the patient’s system as the chemotherapy agent is introduced. This timing is intended to establish a preventive level of the drug to block the onset of acute CINV. It can be given either intravenously (IV) or as an oral tablet.
The dosage and the schedule for taking dexamethasone are determined by the oncologist. They base the decision on the specific chemotherapy drugs being used, which are categorized by their emetic risk level. For highly emetogenic regimens, the patient may receive a dose on day one, followed by a prescribed regimen to take at home for the next two to four days to prevent delayed CINV. The standard dose given before chemotherapy often ranges between 8 and 20 mg.
Potential Short-Term Effects
Patients may notice several temporary changes during the short period they are taking it. One of the most common acute side effects is difficulty sleeping (insomnia), which is why patients are advised to take their morning dose early in the day. This stimulation can also manifest as increased energy or a feeling of being jittery or restless.
Temporary mood changes are also frequently reported, which can include feelings of anxiety, agitation, or general irritability. The drug can cause an increase in appetite. For patients with diabetes, dexamethasone can cause a temporary elevation in blood glucose levels, requiring close monitoring by the healthcare team.
Other transient effects may include heartburn or general stomach upset. These effects are usually dose-dependent and resolve quickly once the short course of dexamethasone is completed. Patients should communicate any severe or persistent side effects to their care team, who may adjust the dosage or schedule in subsequent cycles.