Dexamethasone Therapy in Patients With Brain Tumors - A Focus on Tapering

Ann E. Nahaczewski; Susan B. Fowler; S. Hariharan


J Neurosci Nurs. 2004;36(6):340-343. 

In This Article


The usual but empirical initial dose in brain tumor patients is an intravenous bolus of 10 mg of dexamethasone, followed by a maintenance dose of 4 mg given by the intravenous (IV) route every 6 hours (16 mg/day) (Szabo & Winkler, 1995). Because of both rapid and complete absorption from the gastrointestinal tract, dosing of oral and parenteral glucocorticoids is equivalent, and intravenous therapy should be converted to oral therapy at the earliest appropriate opportunity. Higher daily dexamethasone doses can be given to patients who do not respond to the usual initial dose. Response is usually measured in terms of improvement in neurological deficits within 48 hours. Corticosteroids can produce an improvement in neurologic symptoms and reduction in cerebral edema within the first 8 to 48 hours, with 12 to 24 hours being the usual time frame.

In recent years, doses as high as 100 mg per day of dexamethasone have been used occasionally in situations of imminent herniation or to achieve rapid stabilization prior to urgent surgery (DeAngelis, 1994). Preoperatively, doses may be increased to 40 mg but often a change in dosing is not warranted. Intra-operative dosing is not usually relevant to brain tumor patients, because intracranial pressure adjustment is managed by the anesthesiologist with various other drugs including IV fluids, pressors, and mechanical ventilation. Postoperatively, decisions regarding dosing are influenced by the type of brain tumor and extent of surgical resection, length of surgery, and other intraoperative complications, but often the standard dosing protocol of 4 mg IV every 6 hours is ordered.


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