Why Are Steroids Given — With Chemotherapy?
If you have had trouble sleeping or noticed your blood sugar rising since starting chemotherapy, the likely cause is the steroid in your regimen, not the chemotherapy drug itself. Steroids are added for specific reasons — understanding what they do helps you separate your side effects and know which one to report.
Medically reviewed by Dr. N. Kiranmayee, Medical Oncologist · Last reviewed September 2026
- Not just a support medicine — In blood cancers, steroids are part of the treatment itself — they work directly against cancer cells.
- Blame the right medicine — Poor sleep, high blood sugar, and mood changes on chemo days are usually the steroid, not the chemotherapy drug.
- Usually a short course — For most solid tumour regimens, steroids are taken on and around infusion days only, not continuously.
- Never stop them without asking — If your team has prescribed steroids for more than a few days, stopping early without guidance is not safe.
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Steroids are added to chemotherapy to prevent allergic reactions, reduce nausea, and — in blood cancers — to kill cancer cells directly. Several symptoms people blame on chemotherapy, like poor sleep and high blood sugar, are actually steroid effects. Your oncologist decides the steroid and how long you take it.
Which side effects come from the steroids, not the chemotherapy?
| Symptom | Likely cause: the steroid | Likely cause: the chemotherapy drug |
|---|---|---|
| Poor sleep or feeling wired at night | Yes — especially with evening doses; one of the strongest steroid clues | Less likely |
| High blood sugar | Yes — steroids raise glucose, even in people without diabetes | Rarely |
| Mood changes, irritability, or unusual energy | Yes — a recognised steroid effect | Occasionally, but the steroid is the more common cause |
| Increased appetite | Yes — common on steroid days | No — chemotherapy more often reduces appetite |
| Heartburn or acidity | Yes — steroids irritate the stomach lining, especially on an empty stomach | Occasionally |
| Fluid retention or a puffy face | Yes — short-term, usually resolves when steroids stop | Less common |
| Hair loss | No — steroids do not cause hair loss | Yes — certain chemotherapy drugs cause this |
| Mouth sores or ulcers | No | Yes — some chemotherapy drugs cause this |
| Low blood counts or anaemia | No — steroids may briefly lift energy, but do not affect bone marrow | Yes — this is a main effect of several chemotherapy drugs |
What is the steroid actually doing?
Steroids are added to chemotherapy regimens for one or more of four reasons.
First, they prevent allergic and hypersensitivity reactions. Some chemotherapy drugs — including paclitaxel, docetaxel, and oxaliplatin — can trigger reactions during the infusion. Dexamethasone (sold in India as Dexona or Decdan) or prednisolone is given beforehand to lower that risk.
Second, steroids enhance anti-nausea medicines. On their own, anti-sickness drugs are less effective. Adding a steroid around the infusion day improves control of vomiting, according to ASCO and ESMO anti-emesis guidelines.
Third, in blood cancers such as lymphoma and myeloma, the steroid is an active treatment agent, not a support drug. The 'P' in R-CHOP stands for prednisolone. In VMP for myeloma, prednisolone is counted as one of the treatment drugs.
Fourth, in tumours affecting the brain or spine, steroids reduce swelling around the tumour and help control symptoms while other treatments take effect.
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What should you do on the days you take a steroid?
- Take steroids with food — an empty stomach makes heartburn and acidity significantly worse.
- If your team agrees, take your dose in the morning — evening doses are more likely to disturb sleep.
- If you have diabetes, check your blood sugar more often on steroid days and for a day or two after. Tell your team what your readings show.
- Tell your team if you feel unusually irritable, anxious, or energetic — these mood effects are common and manageable.
- Do not add extra steroid days because you feel better, and do not cut days short without asking your team.
- If you are on a course of more than a few days, never stop suddenly — ask your team how the dose should taper down.
How long will you need to take them?
For most solid tumour chemotherapy, steroids are a short pre-medication taken on and around the infusion day, then stopped until the next cycle.
In blood cancer regimens such as R-CHOP or VMP, the steroid is prescribed across a longer scheduled block within each cycle. Your written prescription states exactly which days.
If your course runs for more than a few days, do not stop it suddenly. The dose is usually tapered down. Follow what your team has prescribed and call before changing anything.
Did you know?
In several blood cancer regimens, the steroid is named as one of the active treatment agents — not a pre-medication. Prednisolone is the 'P' in R-CHOP for lymphoma, and a partner drug in VMP for myeloma.
That makes steroid days treatment days, counted as part of the chemotherapy course itself.
Source: NCCN Clinical Practice Guidelines in Oncology — B-Cell Lymphomas and Multiple Myeloma
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Frequently asked questions
My blood sugar has gone up since starting chemotherapy. Is that the chemo?
In most cases it is the steroid, not the chemotherapy drug. Steroids raise blood glucose reliably, and this happens even in people who have never had diabetes before. If you have diabetes, your levels may rise significantly on steroid days and for a day or two afterwards. Tell your team what readings you are seeing — your diabetes medicines may need temporary adjustment on steroid days, and your oncologist or a specialist can advise. Do not adjust doses yourself.
Why can I not sleep on the days I take my steroid?
Steroids stimulate the nervous system, which is why poor sleep — and sometimes a wired or restless feeling — is one of the most common side effects. The timing of your dose matters. Taking the steroid earlier in the day, with food, reduces how much it affects your sleep that night. Ask your team whether your prescription allows a morning dose instead of an evening one. If sleep disruption is severe, tell your oncologist.
Is the steroid itself a chemotherapy drug?
In blood cancers such as lymphoma and myeloma, yes — the steroid is one of the active agents in the regimen, counted as treatment. In solid tumour regimens, steroids are given as a pre-medication to prevent reactions and improve nausea control — in that setting they support the chemotherapy rather than treat the cancer directly. Which applies to you depends on your diagnosis and regimen. Your oncologist can tell you directly, and it is a straightforward question to ask at your next visit.
What should I do if I forget to take my steroid dose?
Call your oncology team and ask. Do not double up on the next dose without guidance, and do not simply skip without checking. The right answer depends on which steroid you are taking, which day of your cycle it is, and whether it was a pre-medication or part of a treatment regimen. Most centres have a helpline number for exactly this kind of question — use it rather than guessing.
Will the steroid make me gain weight?
Short steroid courses taken around infusion days tend to cause temporary fluid retention — a puffy feeling or a slightly swollen face — rather than actual fat gain. This usually settles once the steroid stops. Longer courses used in some blood cancer regimens can cause more noticeable changes to appetite and weight over time. If you are concerned about your weight or eating pattern during treatment, tell your team — dietary support is available at most centres.
Can I take something for the heartburn the steroid causes?
Many teams prescribe a stomach-protecting medicine alongside steroids as standard, because the combination is well known to cause acidity. If you are experiencing heartburn and were not given one, tell your team — it is a straightforward addition. Taking your steroid with food rather than on an empty stomach also helps. Do not take over-the-counter antacids alongside your treatment without checking first, as some can interact with other medicines you are receiving.
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