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Treatment Name: Dexamethasone (Decadron®)

Dexamethasone (Decadron®) is a Supportive Care Therapy for Nausea and Vomiting

How does dexamethasone (Decadron®) work?

Dexamethasone is designed to help prevent both early and delayed nausea and vomiting caused by chemotherapy.

Goals of dexamethasone (Decadron®) therapy:

Dexamethasone is commonly given on a scheduled basis to prevent nausea and vomiting. When a medicine is given to prevent nausea and vomiting, it is known as prophylaxis, or prophylactic therapy.

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How is dexamethasone (Decadron®) given to prevent nausea and vomiting?

Dexamethasone is usually given by mouth or intravenously (I.V.) in an outpatient infusion center before chemotherapy to prevent nausea and vomiting. Dexamethasone may also need to be taken at home after chemotherapy for two or three days to help prevent delayed nausea and vomiting.

  • Usual dexamethasone starting dose just before chemotherapy:
    • 8 to 20 mg (two to five 4 mg tablets) by mouth approximately 30 minutes before chemotherapy
      OR
    • 8 to 20 mg I.V. infusion over 20-30 minutes approximately 30 minutes before chemotherapy
      • Smaller doses (such as 10 mg or less) are reserved for I.V. push 
  • Usual dexamethasone starting dose at home:
    • 8 mg (two 4 mg tablets) by mouth once daily with food on Days 2, 3 and 4
      OR
    • 8 mg (two 4 mg tablets) by mouth once daily with food on Days 2 and 3

Dexamethasone is typically given with each planned chemotherapy treatment. Dose and Duration of therapy depends upon response, tolerability, type of and number of cycles of chemotherapy prescribed.

Side Effects

What are the most common side effects from dexamethasone (Decadron®) when used to prevent nausea and vomiting?

In the prescribing label information (dexamethasone package insert), the most commonly reported side effects from dexamethasone (Decadron®) are shown here. The exact percentages of patients that will experience dexamethasone side effects is unknown because it has been used under widely varying patient populations in a variety of clinical trials:

  • Increased blood pressure
  • Increased blood glucose (sugar)
  • Trouble sleeping
  • Increased appetite
  • Fluid retention
  • Swelling of feet and hands
  • Upset stomach
  • Stomach ulcers
  • Jitteriness
  • Mood swings
  • Increased white blood cell count
  • Muscle weakness
  • Impaired wound healing
  • Weight gain

Dexamethasone should be used in pregnant women only if the potential benefits to the mother outweigh the potential risks to the unborn baby.

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Monitoring

How often is monitoring needed with dexamethasone (Decadron®)?

Labs (blood tests) may be checked to monitor for side effects of dexamethasone. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood glucose (sugar), plus any others your doctor may order.

How often is imaging needed?

Imaging is not usually necessary to start or continue dexamethasone therapy.

How might blood test results/imaging affect treatment with dexamethasone (Decadron®)?

Depending upon the results, your doctor may advise to continue dexamethasone as planned or switch to an alternative therapy. Dexamethasone may increase blood sugars. If you are diabetic, you may need to adjust medications used to lower blood sugar while taking dexamethasone.

ChemoExperts Tips

What are the most important things to know about dexamethasone while receiving therapy?

  • It is best to take dexamethasone early in the day if possible to avoid trouble sleeping at night
  • Dexamethasone may cause stomach upset. Medications such as omeprazole (Prilosec®), lansoprazole (Prevacid®), esomeprazole (Nexium®), famotidine (Pepcid®), or ranitidine (Zantac®) may be taken to help prevent upset stomach. Check with your Doctor or Pharmacist to make sure that antacid therapy will not interfere with other medications you are already taking
  • When dexamethasone is given by I.V. push, it may cause a burning, itching, or tingling sensation in the genital area. If this happens, your dose of dexamethasone will need to be given by I.V. infusion instead
  • High blood pressure and high blood sugar are common side effects of dexamethasone. You may need additional medications or adjustment in your current medications to treat these side effects, but these changes in medications are not commonly needed as these side effects typically will go away shortly after your last dose of dexamethasone
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Dexamethasone (Decadron®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Dexamethasone (Decadron®). Depending upon your income, they may be able to help cover the cost of:

  • Dexamethasone (Decadron®)

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Dexamethasone (Decadron®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

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Created: April 2, 2020 Updated: April 17, 2020

What is Nausea and Vomiting?

Nausea is the sensation that there is a need to vomit. Nausea can be acute and short-lived, or it can be prolonged. When prolonged, it is a debilitating symptom. Nausea (and vomiting) can be psychological or physical in origin.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium