Corticosteroids for raised intracranial pressure due to brain cancer in palliative care

Vecht, 1994

Corticosteroids can help relieve symptoms of raised intracranial pressure due to brain cancer (eg headache, impaired consciousness). For principles of management of raised intracranial pressure, see Management of raised intracranial pressure in palliative care.

Evidence to guide dosing of corticosteroids is limited; if possible, seek specialist advice. Initial dose depends on symptom severity and the risk of herniation. Subsequent dose adjustment depends on symptom response, adverse effects, and whether active treatments are used.

While seeking specialist advice, an initial regimen for patients with raised intracranial pressure due to brain cancer who have severe symptoms or are at risk of herniation is:

1dexamethasone 8 to 16 mg orally, daily dexamethasone

OR

1dexamethasone 8 to 16 mg subcutaneously or intravenously, daily. dexamethasone

For patients with raised intracranial pressure due to brain cancer who do not have severe symptoms or are not at risk of herniation, an initial regimen isPace, 2017Vecht, 1994:

1dexamethasone 4 to 8 mg orally, daily dexamethasone

OR

1dexamethasone 4 to 8 mg subcutaneously or intravenously, daily. dexamethasone

If dexamethasone is unavailable, an equivalent dose of another corticosteroid may be used initially—see Approximate relative potency and duration of effect of glucocorticoids in the Bone and Metabolism guidelines for approximate relative potencies of oral and intravenous corticosteroids.

Regularly review and decrease the dose in response to symptoms. Aim to reduce the dexamethasone dose by 1 week and stop dexamethasone by 4 weeks. For advice on stopping dexamethasone, see Rationalising corticosteroids used for symptom or complication management in palliative care.