Another brain mets victim

• By ReneP
• Posted October 16, 2009 at 11:03 am
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are you in/near a large city/ cancer center?
some gals have had great response with the gamma knife. depending on how many and how large the mets are.

i am sorry for the news. we just can't prepare ourselves for such things.

• Reply

• By chloemom
• Posted October 16, 2009 at 11:34 am
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Dear Linda, I don't think it's as dismal as it sounds ... I know when I received the news in April and did a lot of research the stats were very scary ... but as we discovered the stats are old.

I had two in the cerebellum and like you, no symptoms until 5 months after diagnosis, then just one or two slight symptoms that only I noticed and the doctor saw when I pointed them out.

One tumor was gamma knifed, the other got bigger waiting for the gamma knife and I was told I'd need surgery. That was mid August. I had a few weeks of severe lost energy, weight loss, muscle wasting ect., turns out most of what I went through were reactions to steroids which are standard for brain mets and after any procedure to keep down swelling.

I'm happy to tell you that I met with the neurosurgeon again Friday after having a Brain scan last week .... he and I are both surprised and delighted to see that the remaining tumor has begun to shrink!!! The only thing I've taken all this time is Herceptin. We think that the blood-brain barrier was disrupted by both the tumors and the gamma knife procedure to the other tumor and that was enough for the herceptin to cross.

The Doctor thinks that if the remaining tumor stays as is or shrinks further, I won't need to do anything but watch it, or, if it continues to gets smaller, I can do gamma knife. As he said, this buys us time and gives you some choices back. The Medical Oncologist and I are now looking at Herceptin Chemo Combos to start that will cross the blood/brain barrier and shrink it further.

I'm so grateful to have found a Neurosurgeon who prefers to not do surgery, is very open to others opinions and research that I find, and most importantly for me, works with me rather than tells me that I have only limited choices. I hope you find such a doctor too.

A lot depends on where the tumors are, how big they are, how many you have and who you work with. The other thing that seems important is how controlled the cancer outside of your central Nervous system is. With all the activities you have been doing, I'd say yours is in control!!!


Lisa ( Chainsawz) has had great results with her brain mets and I'm sure she will be sharing that here with you ... there are several other members who have had good results as well.

My suggestions are to take several deep breaths, we'll send you some resources to start with. Find a Neurosurgeon you trust.....get 2nd and 3rd opinions .... or more if you need to. Don't rush into anything ... you have some time to make choices, not months or years but you don't have to choose in the next few days or even couple of weeks!

• Reply

• By chloemom
• Posted October 16, 2009 at 2:16 pm
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Here are three resources that I've found really helpful for brain mets from breast cancer.

1. brainmetsbc.com
a speciality site started by some women who are strong bc advocates

2. irsa.com
an international group who focus on all the types of radiation used for brain lesions, both mets and primary tumors. There is a lot of info on the differences between surgery, WBRT, Gamma Knife, Cyber Knife and other similar stereotactic procedures.

bc-brain.evidencewatch.com
go to the UPDATED link, from the pull down links there, go to the last link which is dated Arp. 13 and titled Brain Mets from Breast Cancer Review of State of the Art .... there not only is a wealth of medical info, both radiation and the latest medications used, but also some CAM info and all of the resources and references used for the issue so you can actually look at the research that is referred to in this issue and do further research on your own. I think this is one of the greatest resources I've found on brain mets and the most up to date.

• Reply

• By chainsawz
• Posted October 16, 2009 at 2:39 pm
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Chloemom is right - this is scary at first but there is always hope. There are women who have lived many, many years after brain mets. There is someone on this board who posted on the thread "how long since stage IV diagnosis" (under the recommend tab) - she is the founder of the HER2support.org and she had brain mets treated 10 years ago!

Research so you can make informed decisions - and as Chloemom said find a Neuro that you trust and who will listen to you. Many of us (myself included) have had wonderful success with gamma knife or SRS (stereotactic radiosurgery) and have refused the standard WBR (whole brain radiation) only saving that for a last resort. My neuro respects my decision and supported my choice and was willing to review all the research literature I presented to him :>

I work full time and haven't missed one single day since my brain mets were discovered.

Are you HER2 positive? If so, tykerb is one of the drugs believed to possibly cross the BBB (blood brain barrier).

Please do not feel alone - we are here with you! lisa

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• By linskate
• Posted October 17, 2009 at 8:28 am
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Thanks so much for your responses. In answer to your question Rene, I am in Boston at a large teaching hospital so I feel I am getting the best of care. I am her2 positive which I think is a more aggresive type of bc. I spoke at length with my oncol. & he set up an appt on Wed with the radiologist oncol. He did mention WBR will probably be the protocol. Of course, I have spent hours researching this and am completely freaked out by what I have read on the internet. I am so happy I have this site as no one really understands what we go through with all of this. My husband has been great but he feels this is just routine radiation and "poof" I will be all better as soon as the sessions are done! Hope he's right!!!

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• By Beachbabe
• Posted October 17, 2009 at 9:11 am
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It warms my heart to see how many 'experts' and people who have walked in our flip flops before us on this site! I know the brain mets finding must scare the crap out of you, but I'm praying you find some solace in the fact so many of your sisters are wrestling that particular alligator with phenomonal results!

You are in my prayers~

• Reply

• By chainsawz
• Posted October 17, 2009 at 1:09 pm
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Take some time to read the link from Chloemom: bc-brain.evidencewatch.com. There is lots of information about WBR. The standard protocol which requires WBR seems to have her2+ women clumped in with all cancer patients. Sometimes it is the only choice based on size, number, swelling, etc. But for smaller mets, having SRS or Gamma without or with WBR did not change survival in one study. They are beginning to realize her2+ patients have a longer survival with brain mets. I told my radiology oncologist I needed all my brain cells and that I planned to live a very long time....I want to save WBR for later since it is a one shot deal. He and the neurosurgeon finally agreed.

This is definitely a personal choice and should be made between you and your docs, but it is important to read the research so you are armed with the tools to make your best decisions. I also read stories of women who had WBR many years ago and are still around fighting the fight, so it is not scary to me. I am mainly interested in having more tools for the long haul :> Best of luck to you!!! lisa

• Reply

• By lamorna
• Posted October 17, 2009 at 2:03 pm
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my sister MartyJoe74 finished WBRT three weeks ago. No choice for her as she has HER2+ which tends to 'seed' rather than 'clump' - so seeded all over the brain.

She too has liver mets ++ which have responded well to Herceptin and Taxatere - so hopeful same good response to WBRT.

Of course we were all petrified by the thought of her brain being blasted - but I have to say she has tolerated it really well. She has had some sickness, dizziness and problems with her balance - and of course she has had the relentless fatigue that accompanies all cancer treatments.

She is on reducing doses of steroids now and is having lots of small 'symptoms' that are panicking her that something sinister (rather than positive) is happening up there.

We are in the unenviable position of living in England. Lapatinib is practically impossible to get prescribed - and would you believe it - brain MRI/CT scans are NOT repeated as a matter of course. They say 'we wont be able to discriminate between active/inactive tumours'. They wait for the tumours to grow sufficiently to cause more symptoms - and then they will scan you to see. We have already decided to 'feign' symptoms in a few weeks time to get a scan for her - how can she relax and learn to live with her cancer if she doesn't even know what's going on??!

To Linskate - wishing you well on the next leg of your journey. Our worst fears have not been confirmed - and hope this is the same for you too.

• Reply

• By chloemom
• Posted October 17, 2009 at 7:52 pm
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hi LaMorna,
I just read your post and wanted MartyJoe74 to know that some of the things she is experiencing may be related to steroids rather than the WBR or tumors. I was put on steroids following my Gamma Knife procedure to prevent swelling of a remaining tumor. I experienced all kinds of symptoms that I feared were permanent and tumor related. When I did some research I discovered that for me, every symptom I had was from the steroids and as I have been weaning off them, the symptoms are quickly subsiding. It was very scary but it was a relief to know that it was medication and not tumor related!! I'll try to attach a link and an article here that I found very helpful.

1) www.cushings-help.com
On left is a list of links, go to Interactive
there will be a list of links that pop out on right, go to
Interactive in the 3rd column, look for a link to Checklist of Symptoms

This site also has a checklist specific to Steroid Use symptoms

2) From University of Maryland Medical Center: www.umm.edu

Pronunciation:
(deks a METH a sone)

U.S. Brand Names:
Decadron®; Decadron® Phosphate [DSC]; Dexamethasone Intensol®; DexPak® TaperPak®; Maxidex®

Synonyms:
Dexamethasone Sodium Phosphate

Generic Available:
Yes

Canadian Brand Names:
Decadron®; Dexasone®; Diodex®; Maxidex®; PMS-Dexamethasone

Use:
Systemically and locally for chronic swelling; allergic, hematologic, neoplastic, and autoimmune diseases; may be used in management of cerebral edema, septic shock, as a diagnostic agent, antiemetic

Use - Dental:
Treatment of a variety of oral diseases of allergic, inflammatory or autoimmune origin

Use - Unlabeled/Investigational:
General indicator consistent with depression; diagnosis of Cushing's syndrome

Pregnancy Risk Factor:
C
Pregnancy Implications:
Dexamethasone has been used in patients with premature labor (26-34 weeks gestation) to stimulate fetal lung maturation. Crosses the placenta; transient leukocytosis reported. Available evidence suggests safe use during pregnancy.

Lactation:
Excretion in breast milk unknown

Contraindications:
Hypersensitivity to dexamethasone or any component of the formulation; active untreated infections; ophthalmic use in viral, fungal, or tuberculosis diseases of the eye

Warnings/Precautions:
Use with caution in patients with hypothyroidism, cirrhosis, hypertension, CHF, ulcerative colitis, or thromboembolic disorders. Corticosteroids should be used with caution in patients with diabetes, osteoporosis, peptic ulcer, glaucoma, cataracts, or tuberculosis. Use caution following acute MI (corticosteroids have been associated with myocardial rupture). Use caution in hepatic impairment. Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in the elderly in the smallest possible effective dose for the shortest duration.
May cause suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. Symptoms of adrenocortical insufficiency in suppressed patients may result from rapid discontinuation/withdrawal; deficits in HPA response may persist for months following discontinuation and require supplementation during metabolic stress. Patients receiving 20 mg/day of prednisone (or equivalent) may be most susceptible. Particular care is required when patients are transferred from systemic corticosteroids to inhaled products due to possible adrenal insufficiency or exacerbation of underlying disease, including an increase in allergic symptoms. Fatalities have occurred due to adrenal insufficiency in asthmatic patients during and after transfer from systemic corticosteroids to aerosol steroids; aerosol steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or infections. Dexamethasone does not provide adequate mineralocorticoid activity in adrenal insufficiency (may be employed as a single dose while cortisol assays are performed). Dexamethasone does not cross-react with cortisol assays.

Controlled clinical studies have shown that orally-inhaled and intranasal corticosteroids may cause a reduction in growth velocity in pediatric patients. (In studies of orally-inhaled corticosteroids, the mean reduction in growth velocity was ~1 cm per year [range 0.3-1.8 cm per year] and appears to be related to dose and duration of exposure). The growth of pediatric patients receiving inhaled corticosteroids, should be monitored routinely (eg, via stadiometry). To minimize the systemic effects of orally-inhaled and intranasal corticosteroids, each patient should be titrated to the lowest effective dose.

May suppress the immune system; patients may be more susceptible to infection. Use with caution in patients with systemic infections or ocular herpes simplex. Avoid exposure to chickenpox and measles.

Adverse Reactions:
Frequency not defined.
Cardiovascular: Edema, hypertension, arrhythmia, cardiomyopathy, myocardial rupture (post-MI), syncope, thromboembolism, thrombophlebitis, vasculitis

Central nervous system: Insomnia, nervousness, vertigo, seizure, psychosis, pseudotumor cerebri (usually following discontinuation), headache, mood swings, delirium, hallucinations, euphoria

Dermatologic: Hirsutism, acne, skin atrophy, bruising, hyperpigmentation, pruritus (generalized), perianal pruritus (following I.V. injection), urticaria

Endocrine & metabolic: Diabetes mellitus, adrenal suppression, hyperlipidemia, Cushing's syndrome, pituitary-adrenal axis suppression, growth suppression, glucose intolerance, gynecomastia, hypokalemia, alkalosis, amenorrhea, sodium and water retention, hyperglycemia, hypercalciuria, weight gain

Gastrointestinal: Appetite increased, indigestion, peptic ulcer, nausea, vomiting, abdominal distention, ulcerative esophagitis, pancreatitis, intestinal perforation

Genitourinary: Altered (increased or decreased) spermatogenesis

Hematologic: Transient leukocytosis

Hepatic: Transaminases increased, hepatomegaly

Neuromuscular & skeletal: Arthralgia, muscle weakness, osteoporosis, fractures, myopathy (particularly in conjunction with neuromuscular disease or neuromuscular blocking agents), tendon rupture, vertebral compression fractures, neuropathy, neuritis, parasthesia

Ocular: Cataracts, glaucoma, exophthalmos, intraocular pressure increased

Miscellaneous: Infections, anaphylactoid reaction, anaphylaxis, angioedema, avascular necrosis, secondary malignancy, Kaposi's sarcoma, intractable hiccups, impaired wound healing, abnormal fat deposition, moon face

Topical:<1%: Itching, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, skin maceration, skin atrophy, striae, miliaria, local burning, irritation. secondary infection

Overdosage/Toxicology:

When consumed in high doses over prolonged periods, systemic hypercorticism and adrenal suppression may occur. In these cases, discontinuation of the corticosteroid should be done judiciously.

Drug Interactions:
Substrate of CYP3A4 (minor); Induces CYP2A6 (weak), 2B6 (weak), 2C8/9 (weak), 3A4 (weak)
Aminoglutethimide: May reduce the serum levels/effects of dexamethasone; likely via induction of microsomal isoenzymes.

Antacids: May increase the absorption of corticosteroids; separate administration by 2 hours.

Anticholinesterases: Concurrent use may lead to severe weakness in patients with myasthenia gravis.

Azole antifungals: May increase the serum levels of corticosteroids; monitor.

Bile acid sequestrants: May reduce the absorption of corticosteroids; separate administration by 2 hours.

Calcium channel blockers (nondihydropyridine): May increase the serum levels of corticosteroids; monitor.

Cyclosporine: Corticosteroids may increase the serum levels of cyclosporine. In addition, cyclosporine may increase levels of corticosteroids

Estrogens: May increase the serum levels of corticosteroids; monitor.

Fluoroquinolones: Concurrent use may increase the risk of tendon rupture, particularly in elderly patients (overall incidence rare).

Isoniazid: Serum concentrations may be decreased by corticosteroids.

Neuromuscular-blocking agents: Concurrent use with corticosteroids may increase the risk of myopathy.

Nonsteroidal anti-inflammatory drugs (NSAIDs): Concurrent use with corticosteroids may lead to an increased incidence of gastrointestinal adverse effects; use caution.

Phenytoin: Dexamethasone may decrease serum levels/effects of phenytoin; monitor.

Salicylates: Salicylates may increase the gastrointestinal adverse effects of corticosteroids.

Thalidomide: Concurrent use with corticosteroids may increase the risk of selected adverse effects (toxic epidermal necrolysis and DVT); use caution

Vaccines, toxoids: Corticosteroids may suppress the response to vaccinations. The use of live vaccines is contraindicated in immunosuppressed patients. In patients receiving high doses of systemic corticosteroids for 14 days, wait at least 1 month between discontinuing steroid therapy and administering immunization.

Warfarin: Corticosteroids may lead to a reduction in warfarin effect; monitor.

Ethanol/Nutrition/Herb Interactions:

Ethanol: Avoid ethanol (may enhance gastric mucosal irritation).

Food: Dexamethasone interferes with calcium absorption. Limit caffeine.

Herb/Nutraceutical: Avoid cat's claw, echinacea (have immunostimulant properties).

Stability:

Injection solution: Store at room temperature; protect from light and freezing.
Stability of injection of parenteral admixture at room temperature (25°C): 24 hours

Stability of injection of parenteral admixture at refrigeration temperature (4°C): 2 days; protect from light and freezing

Injection should be diluted in 50-100 mL NS or D5W.

Compatibility:

Stable in D5W, NS
Y-site administration: Compatible: Acyclovir, allopurinol, amifostine, amikacin, amphotericin B cholesteryl sulfate complex, amsacrine, aztreonam, cefepime, cefpirome, cisatracurium, cisplatin, cladribine, cyclophosphamide, cytarabine, docetaxel, doxorubicin, doxorubicin liposome, etoposide phosphate, famotidine, filgrastim, fluconazole, fludarabine, foscarnet, gatifloxacin, gemcitabine, granisetron, heparin, heparin with hydrocortisone sodium succinate, levofloxacin, linezolid, lorazepam, melphalan, meperidine, meropenem, morphine, ondansetron, paclitaxel, piperacillin/tazobactam, potassium chloride, propofol, remifentanil, sargramostim, sodium bicarbonate, sufentanil, tacrolimus, teniposide, theophylline, thiotepa, vinorelbine, vitamin B complex with C, zidovudine. Incompatible: Ciprofloxacin, idarubicin, midazolam, topotecan. Variable (consult detailed reference): Methotrexate

Compatibility in syringe: Compatible: Granisetron, metoclopramide, ranitidine, sufentanil. Incompatible: Doxapram, glycopyrrolate. Variable (consult detailed reference): Diphenhydramine, hydromorphone, ondansetron

Compatibility when admixed: Compatible: Aminophylline, bleomycin, cimetidine, floxacillin, furosemide, granisetron, lidocaine, meropenem, mitomycin, nafcillin, netilmicin, ondansetron, prochlorperazine edisylate, ranitidine, verapamil. Incompatible: Daunorubicin, diphenhydramine with lorazepam and metoclopramide, metaraminol, vancomycin. Variable (consult detailed reference): Amikacin

Mechanism of Action:

Decreases inflammation by suppression of neutrophil migration, decreased production of inflammatory mediators, and reversal of increased capillary permeability; suppresses normal immune response. Dexamethasone's mechanism of antiemetic activity is unknown.

Pharmacodynamics/Kinetics:

Onset of action: Acetate: Prompt

Duration of metabolic effect: 72 hours; acetate is a long-acting repository preparation

Metabolism: Hepatic

Half-life elimination: Normal renal function: 1.8-3.5 hours; Biological half-life: 36-54 hours

Time to peak, serum: Oral: 1-2 hours; I.M.: ~8 hours

Excretion: Urine and feces

Dosage:

Children:

Antiemetic (prior to chemotherapy): I.V. (should be given as sodium phosphate): 5-20 mg given 15-30 minutes before treatment

Anti-inflammatory immunosuppressant: Oral, I.M., I.V. (injections should be given as sodium phosphate): 0.08-0.3 mg/kg/day or 2.5-10 mg/m2/day in divided doses every 6-12 hours

Extubation or airway edema: Oral, I.M., I.V. (injections should be given as sodium phosphate): 0.5-2 mg/kg/day in divided doses every 6 hours beginning 24 hours prior to extubation and continuing for 4-6 doses afterwards

Cerebral edema: I.V. (should be given as sodium phosphate): Loading dose: 1-2 mg/kg/dose as a single dose; maintenance: 1-1.5 mg/kg/day (maximum: 16 mg/day) in divided doses every 4-6 hours for 5 days then taper for 5 days, then discontinue

Bacterial meningitis in infants and children >2 months: I.V. (should be given as sodium phosphate): 0.6 mg/kg/day in 4 divided doses every 6 hours for the first 4 days of antibiotic treatment; start dexamethasone at the time of the first dose of antibiotic

Physiologic replacement: Oral, I.M., I.V.: 0.03-0.15 mg/kg/day or 0.6-0.75 mg/m2/day in divided doses every 6-12 hours

Adults:

Antiemetic:

Prophylaxis: Oral, I.V.: 10-20 mg 15-30 minutes before treatment on each treatment day

Continuous infusion regimen: Oral or I.V.: 10 mg every 12 hours on each treatment day

Mildly emetogenic therapy: Oral, I.M., I.V.: 4 mg every 4-6 hours

Delayed nausea/vomiting: Oral: 4-10 mg 1-2 times/day for 2-4 days or

8 mg every 12 hours for 2 days; then

4 mg every 12 hours for 2 days or

20 mg 1 hour before chemotherapy; then

10 mg 12 hours after chemotherapy; then

8 mg every 12 hours for 4 doses; then

4 mg every 12 hours for 4 doses

Anti-inflammatory:

Oral, I.M., I.V. (injections should be given as sodium phosphate): 0.75-9 mg/day in divided doses every 6-12 hours

Intra-articular, intralesional, or soft tissue (as sodium phosphate): 0.4-6 mg/day

Ophthalmic:

Ointment: Apply thin coating into conjunctival sac 3-4 times/day; gradually taper dose to discontinue

Suspension: Instill 2 drops into conjunctival sac every hour during the day and every other hour during the night; gradually reduce dose to every 3-4 hours, then to 3-4 times/day

Topical: Apply 1-4 times/day. Therapy should be discontinued when control is achieved; if no improvement is seen, reassessment of diagnosis may be necessary.

Chemotherapy: Oral, I.V.: 40 mg every day for 4 days, repeated every 4 weeks (VAD regimen)

Cerebral edema: I.V. 10 mg stat, 4 mg I.M./I.V. (should be given as sodium phosphate) every 6 hours until response is maximized, then switch to oral regimen, then taper off if appropriate; dosage may be reduced after 24 days and gradually discontinued over 5-7 days

Dexamethasone suppression test (depression indicator) (unlabeled use): Oral: 1 mg at 11 PM, draw blood at 8 AM the following day for plasma cortisol determination

Cushing's syndrome, diagnostic: Oral: 1 mg at 11 PM, draw blood at 8 AM; greater accuracy for Cushing's syndrome may be achieved by the following:

Dexamethasone 0.5 mg by mouth every 6 hours for 48 hours (with 24-hour urine collection for 17-hydroxycorticosteroid excretion)

Differentiation of Cushing's syndrome due to ACTH excess from Cushing's due to other causes: Oral: Dexamethasone 2 mg every 6 hours for 48 hours (with 24-hour urine collection for 17-hydroxycorticosteroid excretion)

Multiple sclerosis (acute exacerbation): 30 mg/day for 1 week, followed by 4-12 mg/day for 1 month

Physiological replacement: Oral, I.M., I.V. (should be given as sodium phosphate): 0.03-0.15 mg/kg/day or 0.6-0.75 mg/m2/day in divided doses every 6-12 hours

Treatment of shock:

Addisonian crisis/shock (ie, adrenal insufficiency/responsive to steroid therapy): I.V. (given as sodium phosphate): 4-10 mg as a single dose, which may be repeated if necessary

Unresponsive shock (ie, unresponsive to steroid therapy): I.V. (given as sodium phosphate): 1-6 mg/kg as a single I.V. dose or up to 40 mg initially followed by repeat doses every 2-6 hours while shock persists

Hemodialysis: Supplemental dose is not necessary

Peritoneal dialysis: Supplemental dose is not necessary

Administration:

Oral: Administer with meals to decrease GI upset.

I.M.: Acetate injection is not for I.V. use.

I.V.: Administer as a 5-10 minute bolus; rapid injection is associated with a high incidence of perianal discomfort.

Topical: For external use. Do not use on open wounds. Apply sparingly to occlusive dressings. Should not be used in the presence of open or weeping lesions.

Monitoring Parameters:

Hemoglobin, occult blood loss, serum potassium, and glucose

Reference Range:

Dexamethasone suppression test, overnight: 8 AM cortisol <6 mcg/100 mL (dexamethasone 1 mg); plasma cortisol determination should be made on the day after giving dose

Dietary Considerations:

May be taken with meals to decrease GI upset. May need diet with increased potassium, pyridoxine, vitamin C, vitamin D, folate, calcium, and phosphorus.

Patient Education:

Inform prescriber of all prescriptions, OTC medications, or herbal products you are taking, and any allergies you have. Do not take any new medication during therapy unless approved by prescriber. Take exactly as directed, do not increase dose or discontinue abruptly without consulting prescriber.
Oral: Take with or after meals. Avoid alcohol and limit intake of caffeine or stimulants. Prescriber may recommend increased dietary vitamins, minerals, or iron. If you have diabetes, monitor glucose levels closely (antidiabetic medication may need to be adjusted). Inform prescriber if you are experiencing greater-than-normal levels of stress (medication may need adjustment). You may be more susceptible to infection (avoid crowds and persons with contagious or infective conditions and do not have any vaccinations unless approved by prescriber). Some forms of this medication may cause GI upset (small, frequent meals and frequent mouth care may help). Report promptly excessive nervousness or sleep disturbances; signs of infection (eg, sore throat, unhealed injuries); excessive growth of body hair or loss of skin color; vision changes; excessive or sudden weight gain (>3 lb/week); swelling of face or extremities; respiratory difficulty; muscle weakness; tarry stool, persistent abdominal pain; worsening of condition or failure to improve. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Ophthalmic: For use in eyes only. Wash hands before using. Lie down or tilt your head back and look upward. Put drops of suspension or apply thin ribbon of ointment inside lower eyelid. Close eye and roll eyeball in all directions. Do not blink for 1/2 minute. Apply gentle pressure to inner corner of eye for 30 seconds. Do not use any other eye preparation for at least 10 minutes. Do not let tip of applicator touch eye; do not contaminate tip of applicator (may cause eye infection, eye damage, or vision loss). Do not share medication with anyone else. Wear sunglasses when in sunlight; you may be more sensitive to bright light. Inform prescriber if condition worsens, fails to improve, or if you experience eye pain, disturbances of vision, or other adverse eye response.

Topical: For external use only. Do not use for eyes, mucous membranes, or open wounds. Use exactly as directed and for no longer than the period prescribed. Before using, wash and dry area gently. Apply in thin layer (may rub in lightly). Apply light dressing (if necessary) to area being treated. Do not use occlusive dressing unless so advised by prescriber. Avoid exposing treated area to sunlight (severe sunburn may occur). Inform prescriber if condition worsens (swelling, redness, irritation, pain, open sores) or fails to improve.

Additional Information:

Effects of inhaled/intranasal steroids on growth have been observed in the absence of laboratory evidence of HPA axis suppression, suggesting that growth velocity is a more sensitive indicator of systemic corticosteroid exposure in pediatric patients than some commonly used tests of HPA axis function. The long-term effects of this reduction in growth velocity associated with orally-inhaled and intranasal corticosteroids, including the impact on final adult height, are unknown. The potential for "catch up" growth following discontinuation of treatment with inhaled corticosteroids has not been adequately studied.
Withdrawal/tapering of therapy: Corticosteroid tapering following short-term use is limited primarily by the need to control the underlying disease state; tapering may be accomplished over a period of days. Following longer-term use, tapering over weeks to months may be necessary to avoid signs and symptoms of adrenal insufficiency and to allow recovery of the HPA axis. Testing of HPA axis responsiveness may be of value in selected patients. Subtle deficits in HPA response may persist for months after discontinuation of therapy, and may require supplemental dosing during periods of acute illness or surgical stress.

Anesthesia and Critical Care Concerns/Other Considerations:

Dexamethasone is a long-acting corticosteroid with minimal sodium-retaining potential. Corticosteroids and muscle relaxants appear to trigger some types of ICU myopathy; avoid or administer at the lowest dose possible.
Patients will often have steroid-induced adverse effects on glucose tolerance and lipid profiles. In discontinuing steroid therapy in patients on long-term steroid supplementation, it is important that the steroid therapy be discontinued gradually. Abrupt withdrawal may result in adrenal insufficiency with hypotension and hyperkalemia. Patients on long-term steroid supplementation will require higher corticosteroid doses when subject to stress (ie, trauma, surgery, severe infection).

Oral and intravenous steroid therapy in patients with heart failure should be administered cautiously with special attention given to signs and symptoms of fluid retention.

Cardiovascular Considerations:

Oral and intravenous steroid therapy in patients with heart failure should be administered cautiously with special attention given to signs and symptoms of fluid retention.

Dental Health: Effects on Dental Treatment:

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

Insomnia and nervousness are common; may cause euphoria, confusion, or hallucinations

Mental Health: Effects on Psychiatric Treatment:

Barbiturates and carbamazepine may decrease dexamethasone effects

Oncology: Emetic Potential:

Very low (<10%); may cause nausea/indigestion if taken orally on an empty stomach

Oncology: Vesicant:
No
Dosage Forms:
[DSC] = Discontinued product
Elixir, as base: 0.5 mg/5 mL (240 mL) [contains alcohol 5%; raspberry flavor]
Injection, solution, as sodium phosphate: 4 mg/mL (1 mL, 5 mL, 10 mL, 25 mL, 30 mL); 10 mg/mL (1 mL, 10 mL)

Decadron® Phosphate: 4 mg/mL (5 mL, 25 mL); 24 mg/mL (5 mL) [contains sodium bisulfite] [DSC]

Ointment, ophthalmic, as sodium phosphate: 0.05% (3.5 g)

Solution, ophthalmic, as sodium phosphate: 0.1% (5 mL)

Solution, oral: 0.5 mg/5 mL (500 mL) [cherry flavor]

Solution, oral concentrate (Dexamethasone Intensol®): 1 mg/mL (30 mL) [contains alcohol 30%]

Suspension, ophthalmic (Maxidex®): 0.1% (5 mL, 15 mL)

Tablet: 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg [some 0.5 mg tablets may contain tartrazine]

Decadron®: 0.5 mg, 0.75 mg, 4 mg

DexPak® TaperPak®: 1.5 mg [51 tablets on taper dose card]

International Brand Names:

Aacidexam® (BE, LU); Adexone® (IL); Adrecort® (MX); afpred-DEXA® (DE); Alfalyl® (CO); Alin® (CR, DO, GT, MX, PA, SV); Alin Depot® (CR, DO, MX, PA, SV); Aphtasolon® (JP); Auxiloson® (CZ, DE); Azulcort® (AR); Calonat® (AR); Cébédex® (TR); Cetadexon® (ID); Chronocort® (CH); Colircusi Dexametasona® (ES); Corsona® (ID); Cortidexason® (DE); Cortidex® (ID); Cortisumman® (DE); Dalamon Inyectable® (ES); Danasone® (ID); Decadran® (ES); Decadronal® (BR, MX); Decadron® (AR, BR, CA, EG, GB, HK, IE, IT, LU, MX, NO, SE, TH, ZA); Decadron Fosfato® (IT); Decadron® [inj.] (AR, AU, BE, DK, EG, GB, IE, MX, NL, NO, SE, ZA); Decadron-L.A.® (BE, HK); Decadron Phosphate® (HK, NZ); Decasone® (ZA); Decilone® (ID); Dectancyl® (FR); Dekort® [inj.] (TR); Dekort® (TR); Deksamet® (TR); Dellamethasone® (ID); Dermadex® (IT); Desametasone Fosfato® (IT); Désocort® (FR); Dexa-Allvoran® (DE); Dexa ANB® (TH); Dexabene® (AT, DE, LU); Dexabeta® (DE); Dexa-Citroneurin® (BR); dexa-clinit® (DE); Dexacom® (TR); Dexacortal® (SE); Dexacort® (IL); Dexacortin® (CH); Dexacortin® [inj.] (CH); Dexacortin-K® (CH); DexaEDO® (DE); Dexa-Effekton® (DE); Dexafarm® (AR); Dexafar® (YU); Dexaflam® (DE); Dexagalen® (DE); Dexagel® (DE); Dexagliko® (BR); Dexagrane® (RO); Dexagrin® (MX); Dexahexal® (DE); Dexa IM® (BD); Dexa Jenapharm® (DE); Dexalergin® (AR); Dexalocal® (CH, CY, DO, GT, HK, JO, KW, LB, SV); Dexa Loscon® (DE); Dexaltin® (CZ, RO, SG, TH); Dexa-Mamallet® (JP); Dexamed® [compr.] (RU, SG); Dexamed® [inj.] (CZ, RO); Dexameral® (AR); Dexametasona Belmac® (ES); Dexametasona Biocrom® (AR); Dexametasona® (BR, CL, CO); Dexametasona Drawer® (AR); Dexametasona Duncan® (AR); Dexametasona Fabra® (AR); Dexametasona Fada® (AR); Dexametasona Fecofar® (AR); Dexametasona Larjan® (AR); Dexametasona Richet® (AR); Dexametasona Richmond® (AR); Dexametason® (AT, RU); Dexamethason Azupharma® (DE); Dexamethason-Cophar® (CH); Dexamethasone Beacons® (SG); Dexamethasone DBL® (SG); Dexamethasone® (GB, IL, NZ); Dexamethasone-Organon® (LU); Dexamethasone Sodium Phosphate® (AU, GB, RO); Dexamethason® (FI, HR, PL, RU, SI); Dexamethason FNA® (NL); Dexamethason GALEN® (DE); Dexamethason Helvepharm® (CH); Dexamethason Jenapharm® (DE); Dexamethason LAW® (DE); Dexamethason Monofree® (NL); Dexamethason-mp® (DE); Dexamethason Nycomed® (AT, RU); Dexamethason-Rotexmedica® (DE); Dexamethason Sandoz® (DE); Dexamethazon® (CZ); Dexa-M® (ID); Dexamin® (BD); Dexaminor® (BR); Dexamonozon® (DE); Dexan® (BD); Dexanil® (BR); Dexano® (TH); Dexa-Phlogont® (DE); Dexapolcort® (PL); Dexapos® (DE); Dexa-Pos® (NL); Dexapos® (RU); Dexa-P® (TH); Dexa-ratiopharm® (DE, HU); Dexa-Rhinospray® (DE); Dexa-Shiwa® (TH); Dexa-Sine® (DE, TR); Dexa Siozwo® (DE); Dexasone® (CA, HK, SG, TH); Dexasone® [inj.-im,-iv] (TH); Dexason® (YU); Dexatab® (BD); Dexaval® (PT); Dexaven® (PL); dexa von ct® (DE); Dexmethsone® (AU); Dexolan® (CH); Dexona® (CZ, IN, RO); Dexon® (TH); Dexsol® (GB); Dextasona® (BR); Dexthasol® (TH); Dexton® (TH); Diazetard® (BR); Dibasona® (MX); Diodex® (CA); Duo-Decadron® (AR, BR); Erladexone® (SG); Etason® (ID); Fexadron® (ID); Fortecortin® [compr.] (AT, CH, CZ, DE, ES, LU, RU); Fortecortin® [inj.] (AT, CH, CZ, DE, ES, ID); Fortecortin Mono® (CZ, PL, RU); Fortecortin Oral® (ES); Fosfato de Dexametasona Apolo® (AR); Fosfato Dissodico de Dexametasona® (BR); G-Dexamethasone® (BD); Indarzona® (MX); Indexon® (ID); Inthesa-5® (ID); Isopto-Dex® (DE, ID); Isopto Maxidex® (AR); Isopto-Maxidex® (NO, SE); Kalmethason® (ID); Kemotason® (ID); Lanadexon® (ID); Limethason® (SG, TH); Lipotalon® (DE); Lormine® (AR); Luxazone® (IT); Maxidex® (AU, BE, BR, CA, CH, CL, DK, ES, FR, GB, HK, HR, HU, IL, LU, NL, NZ, RO, RU, SG, SI, TR, YU, ZA); Mefamesona® (CR, GT, PA); Megacort® (IT); Mephameson® (CH); Mephamesone® (HU); Methaderm® (JP); Millicortenol® (IN); Minims Dexamethasone® (GB, SG); Nexadron® (AR); Nufadex® (ID); Oftan Dexa® (FI); Oftan Dexamethason® (RU); Oft Cusi Dexametasona® (ES); Onadron® (TR); Ophthasona® (CO); Opnol® (SE); Oradexon® (BE, CO, CY, CZ, EG, FI, HK, ID, JO, KW, LB, LU, PH, SY, ZA); Oradexon® [inj.] (BD, FI, HK, HU, ID, NL, TH, ZA); Oradexon Organon® (CL); Orgadrone® (JP); Perazone® (CY); PMS-Dexamethasone (CA); Predni-F-Tablinen® (DE); Prednisolon F® (BG); Prodexon® (ID); Pyderma® (ID); Pyradexon® (ID); Santeson® [compr.] (JP); Santeson® [inj.] (JP); Scandexon® (ID); Sedesterol® (AR); Selftison® (JP); Soldesam® (IT); Solupen® (DE); Solutio cordes Dexa N® (DE); Spersadex® (BG, CH, DE, HK, LU, NO); Steron® (BD); Superprednol® (RO); Topidexa® (BR); Totocortin® (DE); Trofinan® (AR); Uniao Dexametasona® (BR); Visumetazone® (IT); Voalla® (JP); Wymesone® (IN); Zalucs® (JP)

References

American Academy of Pediatrics Committee on Infectious Diseases, "Dexamethasone Therapy for Bacterial Meningitis in Infants and Children,"Pediatrics, 1990, 86(1):130-3.

Bahal N and Nahata MC, "The Role of Corticosteroids in Infants and Children With Bacterial Meningitis,"DICP, 1991, 25(5):542-5.

Brophy TR, McCafferty J, Tyrer JH, et al, "Bioavailability of Oral Dexamethasone During High Dose Steroid Therapy in Neurological Patients,"Eur J Clin Pharmacol, 1983, 24(1):103-8.

Couser RJ, Ferrara TB, Falde B, et al, "Effectiveness of Dexamethasone in Preventing Extubation Failure in Preterm Infants at Increased Risk for Airway Edema,"J Pediatr, 1992, 121(4):591-6.

de los Reyes RA, Ausman JI, and Diaz FG, "Agents for Cerebral Edema,"Clin Neurosurg, 1981, 28:98-107.

"Dexamethasone, Granisetron, or Both for the Prevention of Nausea and Vomiting During Chemotherapy for Cancer. The Italian Group for Antiemetic Research,"N Engl J Med, 1995, 332(1):1-5.

Duggan DE, Matalia N, Ditzler, CA, et al, "Bioavailability of Oral Dexamethasone,"Clin Pharmacol Ther, 1975, 18(2):205-9.

Durand M, Sardesai S, and McEvoy C, "Effects of Early Dexamethasone Therapy on Pulmonary Mechanics and Chronic Lung Disease in Very Low Birth Weight Infants: A Randomized, Controlled Trial,"Pediatrics, 1995, 95(4):584-90.

Kris MG, Baltzer L, Pisters KM, et al, "Enhancing the Effectiveness of the Specific Serotonin Antagonists. Combination Antiemetic Therapy With Dexamethasone,"Cancer, 1993, 72(11 Suppl):3436-42.

Latreille J, Stewart D, Laberge F, et al, "Dexamethasone Improves the Efficacy of Granisetron in the First 24 h Following High-Dose Cisplatin Chemotherapy,"Support Care Cancer, 1995, 3(5):307-12.

McDonnell M and Evans N, "Upper and Lower Gastrointestinal Complications With Dexamethasone Despite H2 Antagonists,"J Paediatr Child Health, 1995, 31(2):152-4.

Ng PC, "The Effectiveness and Side Effects of Dexamethasone in Preterm Infants With Bronchopulmonary Dysplasia,"Arch Dis Child, 1993, 68(3 Spec No):330-6.

Peterson C, Hursti TJ, Borjeson S, et al, "Single High-Dose Dexamethasone Improves the Effect of Ondansetron on Acute Chemotherapy-Induced Nausea and Vomiting But Impairs the Control of Delayed Symptoms,"Support Care Cancer, 1996, 4(6):440-6.

Randin D, Vollenweider P, Tappy L, et al, "Suppression of Alcohol-Induced Hypertension by Dexamethasone,"N Engl J Med, 1995, 332(26):1733-7.

Ruvinsky ED, Douvas SG, Roberts WE, et al, "Maternal Administration of Dexamethasone in Severe Pregnancy-Induced Hypertension,"Am J Obstet Gynecol , 1984, 149(7):722-6.

Wald ER, Kaplan SL, and Mason, EO Jr, "Dexamethasone Therapy for Children With Bacterial Meningitis,"Pediatrics, 1995, 95(1):21-8.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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• Reply

• By chloemom
• Posted October 17, 2009 at 8:07 pm
• Report post

Hi, here is one more list from the
www.cushings-help.com

Side Effects of Steroid Therapy

Side Effects of Steroid Therapy considered acceptable and expected by the prescriber /(though not by the patient!)

Nature of Effect followed by action to help correct or minimize the side effect

Facial mooning (Cushing's syndrome) May be minimized by restricted calorie intake.
Weight gain: Restrict calorie intake; may require a change in steroid medication: may require a diuretic.
Edema: May require diuretics and potassium.
Potassium loss: Use potassium supplement.
Acne: Treat with topical medications.
Urinary frequency and nocturia: Check for evidence of genitourinary infection or diabetes mellitus; urinalysis
Insomnia, headache, fatigue, euphoria. Treat symptomatically.
Side Effects of Steroid Therapy - considered undesirable and dangerous by the prescriber

Nature of Effect followed by action to help correct or minimize the side effect

Allergic reaction to ACTH or steroid: Withdraw drug promptly. Substitute steroid or synthetic ACTH.
Cardiovascular system effects
Hypertension: Suggest reduction in dosage of steroids.
Thromboembolic complications
Arthritis
Infection: Suggest anti-microbial medications as indicated.
Eye complications:
Glaucoma - refer to ophthalmologist.
Corneal lesions
Subcapsular cataract
Musculoskeletal effects:
Osteoporosis
Pathologic fractures
Growth suppression
Myopathies
Central nervous system
Seizures: refer to neurologist.
Neuritis
Psychotic reactions
Adrenal insufficiency (after steroid withdrawal)
LIST OF SOME STEROID SIDE EFFECTS

(and, yes that includes anabolics) compiled on the Exogenous or Iatrogenic (Steroid Induced) Cushing's Syndrome Message Board

Hypertension
Skin Atrophy (Wasting Away)
Myopathy (Muscle Disease/Weakness)
Impaired Wound Healing
Post Traumatic (After-Shock) Stress (Anxiety, Fear)
Suppression (Lowering) of Immune Response (Defense Of Body Against Virus, Bacteria)
Subcutaneous (Under Skin) Tissue Atrophy (Decrease)
Skin Infections
Depression
Hair Loss
Excessive Facial Hair Growth
Ingrown Hairs
Arthritis
Coronary Artery Disease
Osteoporosis
Contact Dermatitis
Acne, Eczema
Cysts, Rashes
Lesions, Blisters
Open-Angled Glaucoma
Cataracts
Menstrual Irregularities
Premature Menopause
Secondary Diabetes Mellitus
Sleep Disorders
Water Retention
Growth Retardation In Children
Cushing's Syndrome (Affects Almost Every System In The Body; Moonface, Humpback, Central Obesity And Other Symptoms)
Steroid Induced Asthma
Headaches
Shakiness And Tremors
Easy Bruising
Necrosis (A Localized Death Of Tissue)
Increase Susceptibility To Infection
Redistribution Of Body Fat
Increase In Circulating Blood Fats (Triglycerides)
Muscle Cramping, Joint Pain
HOME | C

• Reply

• By lamorna
• Posted October 18, 2009 at 5:51 am
• Report post

chloemum. Thanks so much.

We were convinced it was the steroids causing the symptoms - but it is hard for MArt to believe us when we have never experienced it.

Now i can give her some reassurance from someone who REALLY knows what they are talking about and am sure that will make a difference.

Thanks for taking the time to reply and share your knowledge.

• Reply

• By chainsawz
• Posted October 30, 2009 at 4:27 pm
• Report post

I just read this interesting article about brain mets - very encouraging!!

http://latimesblogs.latimes.com/booster_shots/2009/10/brain-metastases-canc er.html

• Reply

• By PinkMelba
• Posted October 30, 2009 at 6:14 pm
• Report post

I am so sorry to hear about your diagnosis. Lots of prayer and positive energy coming your way. We need a cure and I hope that in some way we will all be part of that cure, so that there will be no more metsters, and pink can just be a color again.

Melba

• Reply

• By gasketman
• Posted October 30, 2009 at 7:10 pm
• Report post

Linda,
My prayers and thoughts are with you. Stay strong and positive there are many new breaking treatments for mets to the brain. As you already know we will all be here to lend our support.

GOD BLESS

Scott

• Reply

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