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Neurology (Expert Forum)
Weaning off Decadron (Dexamethasone)
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Weaning off Decadron (Dexamethasone)
by hal56, Jan 13, 2006 12:00AM
Dear Doctor;
My situation is I have been diagnosed with Glioblastoma Multi Forme (12/29/2004) I have had two(2) surgeries for resection and one(1) for placement of a shunt. currently on a clinical trail (Cilengitide).
I have been on Dexamethasone from the onset of my condition (up and down on doses) most recently 11/25/2005 I was at a dose of 1 1/2 mg at which point I had a minor focal siezure, in the emergency room they took that up to 16 mg, they also raised my Keppra from 1500 mg to 1750 mg. currently I am at 2 mg.
My concern is at the next reduction, is another siezure. Is there a standard protocol for reducing Dexamethasone? Can i assume that i can completely elimanate this drug or have to stay on a certian dose indefinitely? What signs should I be looking for as my dosage is being reduced?
Thank you
Hal
My situation is I have been diagnosed with Glioblastoma Multi Forme (12/29/2004) I have had two(2) surgeries for resection and one(1) for placement of a shunt. currently on a clinical trail (Cilengitide).
I have been on Dexamethasone from the onset of my condition (up and down on doses) most recently 11/25/2005 I was at a dose of 1 1/2 mg at which point I had a minor focal siezure, in the emergency room they took that up to 16 mg, they also raised my Keppra from 1500 mg to 1750 mg. currently I am at 2 mg.
My concern is at the next reduction, is another siezure. Is there a standard protocol for reducing Dexamethasone? Can i assume that i can completely elimanate this drug or have to stay on a certian dose indefinitely? What signs should I be looking for as my dosage is being reduced?
Thank you
Hal
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jan 19, 2006 12:00AM
The dose is usually reduced gradually over a few weeks, there is no standard-wide protocol. You probably dont need such as high dose on a chronic basis, although you may need a few mgs indefinetely.
The seizure may not necessarily be caused by the reduction in dose. Not much change in the tumor or edema woul dbe expected by a minor dose change, but the tumor does irritate the surrounding brain cells, sometimes enough for them to discharge and cause a seizure. This can be made more likely, for example, when you are sleep deprived, take alcohol, fevers, miss your Keppra etc.
Try to avoid these precipitating events, try to get enough sleep etc. 2 grams of Keppra a day is a standard dose, and should hopefully protect against a furhter seizure. If not, then there is room to increase it further, unless you have intoelrable side effects.
The steroid are best titrated according to your symptoms ie worsenign headache etc, clinical exam (ie worsening weakness) or more swelling on the brain scan.
As always keep in close contact with your doctors and inform them of any change in your condition
Good luck
The seizure may not necessarily be caused by the reduction in dose. Not much change in the tumor or edema woul dbe expected by a minor dose change, but the tumor does irritate the surrounding brain cells, sometimes enough for them to discharge and cause a seizure. This can be made more likely, for example, when you are sleep deprived, take alcohol, fevers, miss your Keppra etc.
Try to avoid these precipitating events, try to get enough sleep etc. 2 grams of Keppra a day is a standard dose, and should hopefully protect against a furhter seizure. If not, then there is room to increase it further, unless you have intoelrable side effects.
The steroid are best titrated according to your symptoms ie worsenign headache etc, clinical exam (ie worsening weakness) or more swelling on the brain scan.
As always keep in close contact with your doctors and inform them of any change in your condition
Good luck
I think you should consider adding another antiepileptic medication to control you better (such as dilantin, if you can tolerate it) which would allow you to tolerate lower dose of dexamethasone. Ultimately, however, you may require titrate it up again as need arises.
Hope you do well.