Decadron® (Dexamethasone)

Decadron® (dexamethasone) is probably the most frequently used drug for brain tumor patients. Most patients at some point in their treatment will have it prescribed. It makes sense to be knowledgeable about its benefits and side effects.

Brain tumors cause abnormalities in the normal tissue surrounding them. This is called "tumor associated edema" or "brain swelling". Decadron works by decreasing the flow of fluid across the abnormal blood vessels of the tumor, and this in turn reduces swelling (edema) in the normal tissue.

When may Decadron be prescribed?

Decadron may be given at the time of diagnosis or preoperatively to reduce swelling in the normal brain around the tumor. A child who has previously been feeling very unwell with headache, nausea, vomiting or weakness may feel much better as the swelling is reduced. Remember that the skull acts like a closed box and can only hold a fixed volume. Reducing the swelling lowers the pressure inside the head and thus, reduces some of the more discomforting symptoms.
Decadron may also be prescribed postoperatively to reduce swelling associated with an operative procedure. During the removal of a tumor, normal tissue can be damaged and in this situation, decadron works by decreasing the flow of fluid across the damaged normal blood vessels.
Decadron is also used in conjunction with radiation therapy. The normal brain may respond to radiation by swelling. Many children take Decadron during radiation to reduce this. The medication does not alter the ability of radiation to kill the tumor cells.

Taking Decadron

Decadron is in a class of drugs called "corticosteroids" (or "steroids"). The body normally produces steroids, but if a patient takes the medication, it depresses the body's production of its own steroids from the adrenal gland.

When your doctor wishes to reduce or stop your dose, he or she will gradually reduce your dose over a period of days. This is called "tapering". Sometimes other steroid medications (such as prednisone) are used instead of Decadron. All corticosteroid medications work in similar ways and have similar side effects.

NEVER DISCONTINUE THIS MEDICATION ABRUPTLY.

It is important to follow this regime in order to stimulate your body to take over its normal production of steroids. Pay careful attention to the "tapering" as prescribed by your physician. A patient will rarely be required to stay on Decadron indefinitely because the body can no longer produce adequate amounts of its own steroids. This is referred to as "steroid dependent". In certain situations, especially with tumors of the pituitary area, the body can no longer produce steroids and the patient must take the medication indefinitely.

Decadron can alter the gastric lining of your stomach and cause stomach upset or irritation. Steroids should be taken with milk or preferably food. Your physician will generally prescribe Zantac (Ranitidine), Tagamet (Cimetidine) or other medication to prevent this irritation. Ask if such a medication is not prescribed. If your child is taking Decadron, you may be told to not use other medications, such as A.S.A. (aspirin), that can also irritate the stomach.

Side Effects

Decadron may affect your child's immune system which allows him/her to fight off infection. Fever and chills should be reported. Mouth or throat infections called candida or thrush are common while on Decadron. It may also cause swelling in his/her hands, feet or facial area (water retention).

Decadron may cause weakness of the lower extremities. This may be noticed when walking up stairs or getting up from a sitting position. This weakness should be reported to your physician but usually will return to normal when the medication is discontinued.

In adolescence, there may be an increase in acne if on steroids. This usually disappears with the decrease in steroid dosage.

Personality changes or mild depression and irritability are sometimes noted. Decadron can increase blood sugar levels and this may be important if your child is a diabetic. While on Decadron, the appetite may be hearty and there may be a weight gain associated with this. Weight gain may be more pronounced in children and they may have an altered facial appearance (Cushingoid appearance or "moon face"). This will disappear when the medication is discontinued. Rarely, a child will become "Decadron dependent" and must be maintained on a low dose of Decadron.

If your child is having any surgery, it is important to mention that he/she has been or is on Decadron.

Summary

Decadron can be a necessary and very useful drug in the treatment of brain tumor patients. It is always wise to be knowledgeable about the uses and side effects of any medications your child is taking. If you have unanswered questions, keep in mind that your neighborhood pharmacist is a valuable member of the health care team.