Dexamethasone and Hyperactivity in Pediatric Patients
Yes, dexamethasone commonly causes hyperactivity and other behavioral changes in children, particularly in preschool-aged children under 6 years old, though these effects are typically transient and resolve after treatment ends. 1, 2, 3
Age-Dependent Behavioral Effects
Preschool children (under 6 years) are at significantly higher risk for neurobehavioral side effects compared to school-age children and adolescents. 3
In a structured study of 62 children with acute lymphoblastic leukemia, preschool children showed significant increases (P < 0.001) in emotional dyscontrol, mood disturbances, behavior regulation problems, and executive function difficulties during active steroid treatment, while school-age children (≥6 years) did not demonstrate these increases. 3
These behavioral changes peaked during the active steroid week and returned to baseline during "off-steroid" weeks, demonstrating the transient nature of these effects. 3
Common Behavioral Manifestations
The spectrum of behavioral changes includes hyperactivity, aggression, mood swings, agitation, and emotional lability. 1, 2, 4
These effects occur across different routes of administration, including systemic and even inhaled corticosteroids, though inhaled formulations generally cause less severe neuropsychiatric effects. 2, 4
Children are particularly vulnerable to these adverse drug reactions compared to adults. 4
Clinical Recognition and Management
Timely recognition is critical to prevent unnecessary diagnostic investigations and problems at home or school, as these side effects are completely reversible upon discontinuation. 4
Parents and caregivers should be warned proactively about the potential for behavioral adverse effects when children receive corticosteroids. 2
Counseling about side effects should be adapted according to the child's age, with more intensive anticipatory guidance for families of preschool-aged children. 3
Mechanism and Long-term Considerations
The behavioral effects during active treatment are distinct from the potential long-term neurodevelopmental concerns associated with high-dose dexamethasone in neonates. 5, 6
Dexamethasone binds only to glucocorticoid receptors and has been shown in animal models to cause hippocampal neuronal degeneration, which may explain some of its neuropsychiatric effects. 5, 6
However, the acute behavioral changes (hyperactivity, mood swings) observed during short-term treatment courses are transient and do not appear to cause lasting neurobehavioral toxicity in older children. 3
Important Caveats
The type of corticosteroid (dexamethasone versus prednisone) was not a significant predictor of acute neurobehavioral side effects in children with ALL, suggesting this is a class effect. 3
Attempts to mitigate dexamethasone-induced neurobehavioral problems with physiological hydrocortisone supplementation have proven ineffective in randomized controlled trials. 7
The American Society of Hematology notes that the higher corticosteroid dose of dexamethasone was deemed potentially intolerable by some pediatric patients with regard to short-term side effects. 5