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Drug treatment for brain tumours:
If you have been diagnosed with a (suspected) brain tumour, you are likely to be started on some drug treatments including dexamethasone and often phenytoin.
Dexamethasone
Dexamethasone is a steroid drug that has proven benefit in reducing the swelling (oedema) caused by some brain tumours. Swelling associated with brain tumours may contribute to the symptoms produced by the tumour including headaches and neurological deficits (such as weakness and loss of speech). Steroids should, therefore, help to relieve some of these symptoms.
How long does it take to work?
Dexamethasone normally takes 8-24 hours for the first effects to be apparent.
How much do I take and for how long?
You will often be prescribed a high dose initially (4mg 4 times per day) and this will be reduced following your treatment, as directed by your treating doctors. Depending on your tumour type and your needs for other treatment (such as radiotherapy) you may be advised to remain on a small dose. If you have been taking dexamethasone for more than a few days it is very important not to stop it suddenly, rather the dose should be gradually reduced over a period of days.
What are the side effects?
Every drug has side effects. The more common side effects with dexamethasone are gastritis or stomach ulcers (to prevent this you will be given an anti-acid drug), increased appetite, weight gain, muscle weakness, diabetes, increased risk of infection, and psychological disturbances. Generally the side effects are worse with higher doses given for longer periods of time.
Phenytoin
Phenytoin is an anti-epileptic drug used to treat (or reduce the risk of you suffering) seizures (fits). It is sometimes known by the trade name ‘epanutin’. Although it is the most common drug used by neurosurgeons for seizures, some patients are given alternative drugs such as carbamazepine (‘tegretol’) or valproate (‘epilim’).
How long does it take to work?
This depends on how the first doses are given and how much you are given. For most rapid effect (e.g. if you have a fit) it will be given intravenously (into a vein) at high dose followed by a regular lower maintenance dose, commonly 300mg per day, which is often taken as 1 tablet at night. However, phenytoin needs to be given at a precise dose in order for it to work and too much can cause side effects – this will be checked by blood tests intermittently to check the levels in your bloodstream.
How much do I take and for how long?
Your blood levels will determine how much you need to take in the long term. If you have been suffering seizures, you may need to stay on medication in the long term (as directed by your doctors). If you have received phenytoin only as a measure to prevent seizures (for example, around the time of surgery), and you have never suffered a seizure, it is likely that your doctors will recommend a short course only. If you have been on phenytoin for a long time (weeks or longer) and it is decided to stop the drug, it should be withdrawn slowly over a few weeks.
What are the side effects?
Like all drugs, phenytoin has side effects. If taken at too high a dose, it may cause nausea, vomiting, tremor, insomnia, unsteadiness, slurred speech and blurred vision. Even if you are on the correct dose other side effects occasionally occur, including rashes, gum thickening, fevers, hepatitis, swollen lymph nodes and disorders of blood cells. Sometimes you will need to stop the drug or change to another drug if you develop severe side effects (as directed by your doctor). If you think you have developed a side effect then you should report this to your doctor (GP or surgeon) as very rarely some of the side effects can be life threatening.
Phenytoin:
What is phenytoin?
Phenytoin is an anti-epileptic drug, also called an anticonvulsant. Phenytoin works by slowing down impulses in the brain that cause seizures.
Phenytoin is used to control seizures. It does not treat all types of seizures, and your doctor will determine if it is the right medicine for you.
Important Information
You should not use phenytoin if you also take delavirdine (Rescriptor), or if you are allergic to ethotoin (Peganone), fosphenytoin (Cerebyx), or mephenytoin (Mesantoin). If you are pregnant, DO NOT START TAKING this medicine unless your doctor tells you to. Phenytoin may cause harm to an unborn baby, but having a seizure during pregnancy could harm both the mother and the baby. If you become pregnant while taking this medicine, DO NOT STOP TAKING the medicine without your doctor’s advice. Seizure control is very important during pregnancy and the benefits of preventing seizures may outweigh any risks posed by using phenytoin.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.
Before taking this medicine
You should not use phenytoin if you are allergic to it, or if you have ever had:
- liver problems caused by phenytoin;
- an allergy to similar medicines such as ethotoin, fosphenytoin, or mephenytoin; or
- if you currently take delavirdine (Rescriptor).
To make sure phenytoin is safe for you, tell your doctor if you have ever had:
- heart problems;
- liver disease;
- diabetes;
- depression;
- suicidal thoughts or actions;
- a vitamin D deficiency or any other condition that causes thinning of the bones;
- porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system); or
- if you are of Asian ancestry (you may need a special blood test to determine your risk for having a skin reaction to this medicine).
Some people have thoughts about suicide while taking this medicine. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.
Seizure control is very important during pregnancy. Do not start or stop taking phenytoin without your doctor’s advice if you are pregnant. Phenytoin may harm an unborn baby, but having a seizure during pregnancy could harm both mother and baby. Tell your doctor right away if you become pregnant while taking this medicine.
If you are pregnant, your name may be listed on a pregnancy registry to track the effects of phenytoin on the baby.
Dilantin:
What is Dilantin?
Dilantin (phenytoin) is an anti-epileptic drug, also called an anticonvulsant. It works by slowing down impulses in the brain that cause seizures.
Dilantin is used to control seizures. Phenytoin does not treat all types of seizures, and your doctor will determine if it is the right medicine for you.
Important Information
You should not use Dilantin if you also take delavirdine (Rescriptor), or if you are allergic to phenytoin, ethotoin (Peganone), fosphenytoin (Cerebyx), or mephenytoin (Mesantoin). If you are pregnant, DO NOT START TAKING this medicine unless your doctor tells you to. Phenytoin may cause harm to an unborn baby, but having a seizure during pregnancy could harm both the mother and the baby. If you become pregnant while taking Dilantin, DO NOT STOP TAKING the medicine without your doctor’s advice. Seizure control is very important during pregnancy and the benefits of preventing seizures may outweigh any risks posed by using phenytoin.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.
Before taking this medicine
You should not use Dilantin if you are allergic to phenytoin, or if you have ever had:
- liver problems caused by phenytoin;
- an allergy to similar medicines such as ethotoin, fosDilantin, or meDilantin; or
- if you currently take delavirdine (Rescriptor).
To make sure Dilantin is safe for you, tell your doctor if you have ever had:
- heart problems;
- liver disease;
- diabetes;
- depression;
- suicidal thoughts or actions;
- a vitamin D deficiency or any other condition that causes thinning of the bones;
- porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system); or
- if you are of Asian ancestry (you may need a special blood test to determine your risk for having a skin reaction to phenytoin).
Some people have thoughts about suicide while taking Dilantin. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.
Seizure control is very important during pregnancy. Do not start or stop taking Dilantin without your doctor’s advice if you are pregnant. Phenytoin may harm an unborn baby, but having a seizure during pregnancy could harm both mother and baby. Tell your doctor right away if you become pregnant while taking this medicine.
If you are pregnant, your name may be listed on a pregnancy registry to track the effects of phenytoin on the baby.
