• Dexamethasone (Decadron)

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

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
• Agitation (less common)

Steroids also increase your risk for developing ulcers. Often, your doctor will place you on an additional medicine to decrease this risk. Steroids are also associated with joint aching (arthralgias) 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 the 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. Tumors located outside the cortex or immediate subcortical area are less likely to cause seizures.

A 2008 review of five studies found that medicine does not appear to prevent seizures in patients with brain tumors who have no history of seizures. The medicines included in the study were phenytoin, phenobarbital, and divalproex sodium, which is closely related to valproic acid.

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 (red and white blood cells are made in the marrow)
• 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 (this can occur with all anti-epileptic medicine but may be more likely with valproic acid)
• Pancreatitis
• Thrombocytopenia (persistent decrease in the number of blood platelets)
• Weakness, sleepiness
• Dizziness
• 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
• Psychosis
• Rashes

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

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

There are currently twenty NSAIDs on the market, either as prescription, over-the-counter, or both, each having a slightly different chemistry and side effect profile. NSAIDS are used primarily to control pain. They do not control intracranial edema or swelling as well as the steroid drugs, and they have side effects of their own. The newer and more expensive selective NSAIDs, such as celecoxib, are expected to produce fewer gastrointestinal problems. There is evidence that some of these selective NSAIDs increased risk of stroke. The evidence has lead to the removal of some of them from the market.

These drugs reduce inflammation by other pathways than the cortisone class of drugs. Since they do not interfere with the body’s defenses against infection, they are safer to use in the presence of infection.

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)

The first three are usually effective for mild to moderate pain. Those listed from morphine to oxycodone are used to relieve intense pain. These drugs are addicting, and the potential for abuse is high. However, there is no substitute for narcotics in the treatment of severe pain. They are tightly controlled by the Federal Drug Enforcement Agency (DEA).

Most important side effects include:

• Dizziness
• Sleepiness / Somnolence
• Nausea and vomiting
• Itchiness (pruritus)
• 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