Medicines for Brain Tumors

• Dexamethasone (Decadron)

Cortisone-like drugs are used to reduce brain swelling. Swelling is common with brain tumors. Dexamethasone is most often used. It is given by mouth or by IV. Decreasing swelling associated with brain tumors is the most effective way to decrease head pain.

Typical side effects include:

• Feeling of hunger and associated weight gain
• Acne
• Muscle weakness called steroid myopathy—most noticeable when rising from a seated position or going up stairs
• Insomnia
• Increased blood sugar
• Increased blood pressure
• Restlessness—less common

Steroids also increase your risk of developing ulcers . Often, your doctor will place you on an additional medicine to decrease this risk. Steroids are also associated with joint aching and an increased risk for osteoperosis .

Dexamethasone for brain swelling is usually used short-term, avoiding the majority of side effects. Your doctor will often taper you off the steroids slowly.

• Levetiracetam (Keppra) (not approved as a single agent by the FDA)
• Carbamazepine (Tegretol)
• Valproic acid (Depakene, Depakote)
• Phenytoin (Dilantin)

Your doctor will choose an anti-epileptic medicine based on the potential benefits and the risks of side effects. The potential interactions with your other medicine will also be considered. In any given case, one may work better than another.

Many of the anti-epileptic medicine have the potential to interact with your other medicine, including chemotherapies.

Possible side effects for carbamazepine (Tegretol) include:

• Bone marrow damage
• Mental status changes
• Rashes/possibly severe skin reactions
• Hyponatremia—low sodium level in the blood

Possible side effects for valproic acid (Depakene, Depakote) include:

• Liver damage
• Fetal damage if pregnant
• Pancreatitis
• Thrombocytopenia—persistent decrease in the number of blood platelets
• Weakness, sleepiness
• Lightheadedness
• Nausea, vomiting
• Diarrhea
• Indigestion, abdominal pain, loss of appetite
• Visual disturbances
• Hair loss
• Respiratory infection
• Weight gain
• Rashes

Possible side effects for phenytoin (Dilantin) include:

• Mental status changes
• Rashes
• Nausea, vomiting
• Diarrhea or constipation
• Liver and bone marrow damage
• Gum swelling
• Respiratory inflammations

Possible side effects for Levetiracetam (Keppra) include:

• Mental status changes
• Irritability
• Loss of contact with reality known as psychosis
• Rashes

Nonsteroidal anti-inflammatory drugs (NSAIDs) in higher doses, including:

• Indomethacin (Indocin)
• Naproxen (Naprosyn, Anaprox)
• Celecoxib (Celebrex)

Each NSAID has a slightly different chemistry and side effect profile. NSAIDS are used primarily to control pain. They do not control swelling as well as the steroid drugs, and they have side effects of their own.

Possible side effects include

• Stomach irritation, ulceration, and bleeding
• Allergic reactions
• Kidney damage
• Liver damage

• Codeine
• Pentazocine (Talwin)
• Morphine
• Meperidine (Demerol)
• Fentanyl (Duragesic)
• Hydromorphone (Dilaudid)
• Methadone
• Oxycodone (Oxycontin)

These drugs are addicting, and the potential for abuse is high. However, there is no substitute for narcotics in the treatment of severe pain.

Most important side effects include:

• Lightheadedness
• Sleepiness / Somnolence
• Nausea and vomiting
• Itchiness
• Constipation
• Allergic reactions
• Decreased respiratory drive
• Overdose—can lead to death

• The desired effect is not achieved
• An undesired effect appears
• If you are taking aspirin or other NSAIDs and experience new stomach symptoms