by Polsdorfer R

Medicines for Brain Tumors

The information provided here is meant to give you a general idea of what to expect from each of these medications. Only the most common side effects are included, so ask your doctor if there are any precautions specific to your case. Use each of these medications as recommended by your doctor or according to the instructions provided with the medications. If you have further questions about usage or side effects, contact your doctor.
The use of some of the most commonly prescribed medications is designed to assist with some of the symptoms that the tumor or the treatment can cause.

Prescription Medicines

  • Dexamethasone (Decadron)
  • Levetiracetam (Keppra)
  • Carbamazepine (Tegretol)
  • Valproic acid (Depakene, Depakote)
  • Phenytoin (Dilantin)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) in higher doses:
    • Indomethacin (Indocin)
    • Naproxen (Naprosyn, Anaprox)
    • Celecoxib (Celebrex)
    • Acetaminophen (Tylenol)
  • Aspirin
  • NSAIDs in lower doses
  • Acetaminophen (Tylenol)

Prescription Medicines

Glucocorticoids (Cortisone-like Drugs, Steroids)
  • 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 osteoporosis .
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.
Anticonvulsants
  • 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
Pain Killers
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
Narcotics and Their Derivatives
  • 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

Over-the-Counter Medicines: Pain Killers

  • Aspirin
  • NSAIDs in higher doses
    • Indomethacin (Indocin)
    • Naproxen (Naprosyn, Anaprox)
    • Celecoxib (Celebrex)
  • Acetaminophen/Paracetamol (Tylenol, Panadol)
Possible side effects include:
  • Stomach irritation
  • Ulceration
  • Bleeding
  • Allergic reactions
  • Kidney damage
  • Liver damage
Acetaminophen (Tylenol) is the common pain killer used for mild-to-moderate pain. Possible side effects include allergic reactions that damage blood cells or cause rashes. Overdoses can damage the liver. Because brain tumors grow, a medication that works at first may not do so as the tumor enlarges. Doses may have to be increased or stronger medications used.
When to Contact Your Doctor
  • The desired effect is not achieved
  • An undesired effect appears
  • If you are taking aspirin or other NSAIDs and experience new stomach symptoms

Special Considerations

Whenever you are taking a prescription medicine, take the following precautions:
  • Take your medicines as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Ask what results and side effects to expect. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medicines and herb or dietary supplements.
  • Plan ahead for refills so you don’t run out.

References

About brain tumors: a primer for patients and caregivers. American Brain Tumor Association website. Available at: http://www.abta.org/secure/about-brain-tumors-a-primer.pdf. Published 2012. Accessed June 4, 2013.

Brain tumor. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated May 28, 2013. Accessed June 4, 2013.

Brain tumor. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/brain. Accessed June 4, 2013.

5/28/2008 DynaMed's Systematic Literature Surveillance: http://www.ebscohost.com/dynamed/what.php. Tremont-Lukats IW, Ratilal BO, et al. Antiepileptic drugs for preventing seizures in people with brain tumors. The Cochrane Library. 2008;(2):DOI: 10.1002/14651858.CD004424.pub2.

11/30/2010 DynaMed's Systematic Literature Surveillance: http://www.ebscohost.com/dynamed/what.php. US Food and Drug Administration. Propoxyphene: withdrawal—risk of cardiac toxicity. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm234389.htm. Published November 19, 2010. Accessed November 30, 2010.

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