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Brain Tumor and Neuro-Oncology News

From The Cleveland Clinic Foundation's Brain Tumor and Neuro-Oncology Center
Spring 1996


Decadron

Dr. Bruce Cohen answers many questions from patients about the medication called Decadron. Here Dr. Cohen explains the use of Decadron and how it should be managed.

What is Decadron?

Brain tumors cause the normal tissue surrounding them to swell. Decadron, the brand name for dexamethasone, is commonly prescribed to decrease the swelling in the normal brain tissue.

Decadron is used most frequently for brain tumors because it seems to offer the best balance of benefits versus side-effects and imitates the body's own production of cortisone. It helps minimize the swelling that can cause headaches, nausea, vomiting, or a weakness.

Decadron is a powerful medication that falls into the class of steroids known as glucocorticosteroids. These drugs differ from anabolic steroids (those sometimes abused by athletes) and sex steroids (such as estrogen and testosterone.) Glucocorticosteroids are used to treat many medical conditions, including brain tumors.

When is Decadron prescribed?

Decadron may be given at the time of diagnosis or before surgery to reduce swelling in the normal tissue around the brain tumor.

It also may be prescribed after surgery to reduce swelling associated with the operation. In this case, Decadron works by decreasing the flow of fluid across the damaged blood vessels in the normal tissue.

Decadron also can be used with radiation therapy. The normal brain tissue may respond to radiation by sweling. Decadron reduces these symptoms, without affecting the radiation's ability to kill the tumor cells.

Who makes it?

The pharmaceutical company Merck makes Decadron, but at least three other companies - Par, Roxane, and Organon - make generic versions. With respect to brain tumors, it does not matter which perparation you are taking as long as you continue to receive the medication from the same manufacturer each time you refill your prescription. This will ensure that if there is any variation, at least there will not be a problem as we decrease the dosage of the medication. The table below shows what the different manufacturers offer.

Manufacturer

Tablet Size Available (mg)

Liquid Available

Merck

0.25, 0.5, 0.75, 1.5, 4, 6

0.5mg/5 mL

Par

0.25, 0.5, 0.75, 1.5, 4, 6

not available

Organon

4

0.5mg/5 mL

Roxane

0.5, 0.75, 1, 1.5, 2, 4, 6

0.5 mg/mL, 2mg/20 mL

Please note that there is a 24-fold difference in the strength between the weakest and strongest tablet of Decadron. Therefore, it is very important that you know what dose you are taking (the number of tablets is not enough information) or bring your medication with you to your doctor's appointments. You also should tell your pharmacist that you do not want to change brands without warning.

Does it have side-effects?

Because Decadron can have some undesirable side effects, using it well is challenging. If you experience any of these side effects, report them to your doctor, but never stop taking Decadron without talking to your doctor! The benefits must be weighed against the side effects, which may include, but are not limited to:

Short and Long-term: Increased appetite, weight gain, fluid retention, personality changes that may be noted by the patient or family (feeling of well-being, sadness, meanness, psychosis), stomach pain, stomach and intestinal ulcers, and diabetes.

Long-term: Cataracts, osteoporosis (brittle bone disease), growth retardation (in children), stretch marks, and steroid dependence.

What is the best way to take Decadron?

Whenever a doctor places a patient with a brain tumor on Decadron, the goal is to get that patient off the medication as soon as possible. The decision to decrease the dosage gradually is based on the patient's progress. Some patients are taken off Decadron within a week of surgery, while others require the medication for years.

Most patients take about 4 mg four times a day after surgery. As you progress, you will be taking less medication per dose fewer times a day. The table below shows the best times to take your medication.

Number of Times Taken Per Day

Proposed Time for Taking Decadron

4

Breakfast, Lunch, Dinner, and at Bedtime

3

Breakfast, Lunch, and Dinner

2

Breakfast and Dinner

1

Breakfast

The dose of Decadron that is most often prescribed to patients with brain tumors has 25 times the biological effect as what the body produces naturally. Therefore, whenever a patient is on Decadron, the body's production of cortisol stops. Cortisol is a natural steroid that has hundreds of known effects on the body. Unfortunately, when the Decadron is stopped, the body cannot begin making cortisol right away, and symptoms may develop.

How will my dosage be decreased?

Your doctor will try to decrease your dosage to get you off steroids when possible. This may be complicated, but it is importnat because your doctor will not want you to become dependent on steroids. Remember that when you are placed on Decadron, your body senses the glucocorticosteroid and tells itself that it no longer needs to make its own cortisol. If the Decadron is stopped completely within two weeks, the body almost always begins to make its own cortisol. The longer you are on Decadron, though, the more time it will take to retrain your body to make its own cortisol. Your body will not begin to do this until your Decadron dose is less then 0.75 mg a day. If you have been taking more than that dose for a long time, it may take months to wean you off the drug.

There are no fixed rules for decreasing the dosage of Decadron. If you have been on the medication for a short while, the process may be quick and easy. If your dosage is decreased too rapidly, though, you may experience flu-like symptoms, including achiness, fatigue, fever, stiff neck, nausea, vomiting, or mood swings. When such symptoms occur, be sure to contact your doctor. When nausea and vomiting occur, the biggest danger is that you may not be able to take your Decadron pills. If you throw up (vomit) your Decadron, you should first try taking another dose. If you continue to throw up and cannot keep your Decadron pills down, you must call your doctor or go to an emergency room immediately where you will be given your Decadron intravenously (through a vein.) Stopping your Decadron suddenly can cause severe problems which can be life threatening, such as a dangerous drop in your blood pressure.

As a rule, once you are taking less than 4 mg per day, the dosage should not be cut faster than once every four days. That is because the medication stays in your body a long time, so adjusting to a new dose takes time. After your dosage is decreased, you may be told to take the medication every other day to help your body adjust to the world without Decadron.

Knowing more about Decadron and its side effects helps you understand why it is a useful and necessary medication. Remember that knowing what dosage and the type of the drug you are taking is important, so you can clearly communicate with your healthcare team. I encourage you to consult with your doctor if you have any questions or concerns about taking Decadron.

- Bruce Cohen, M.D.