Side Effects From Steroids for Brain Tumours

Dexamethasone (steroids)

Your child may be given a type of medicine called a steroid. Steroids are given to manage some of the symptoms of the tumour. The steroid that is most commonly used with brain tumours is dexamethasone. It is sold as Decadron.

Dexamethasone falls into the class of steroids known as glucocorticosteroids. These are different from anabolic steroids, which some athletes use illegally. They are also different from sex steroids (or sex hormones) such as estrogen and testosterone. Glucocorticosteroids are used to manage many medical conditions.

Why does my child need dexamethasone?

Brain tumours cause swelling ( edema) in the normal tissues near the tumour, leading to symptoms. Dexamethasone is a strong anti-inflammatory medicine. It reduces swelling in normal tissues. It is prescribed as needed, and may be taken one or more times a day in a tablet or as a liquid.

Dexamethasone may be given:

  • at the time of diagnosis, to ease symptoms such as headache, nausea, and vomiting
  • with surgery, to reduce swelling after an operation
  • with radiation therapy, to reduce the swelling that may occur during treatment

Dexamethasone does not have an effect on the tumour. The benefit is only temporary.

Important information about dexamethasone

Your child needs to take dexamethasone exactly as the treatment team has told you. It can be dangerous for your child to stop taking it suddenly. This is because your child’s body stops making its own steroids when he is taking dexamethasone. Steroids are involved in many important functions in the body, such as helping the body respond to stress. If your child suddenly stops taking dexamethasone, he will have no steroids at all.

Your child’s treatment team will talk to you about how you can gradually reduce the dose of dexamethasone when it is appropriate, or “wean” him, so that it is safe.

What are the side effects of dexamethasone?

Even though they may make your child feel much better, dexamethasone may produce some unpleasant side effects. Most of these will end once treatment is over. However, in some cases dexamethasone may need to be used for months, and then certain effects will last longer.

Side effects

  • Stomach irritation: Dexamethasone can cause stomach irritation that feels like heartburn. Make sure your child takes dexamethasone with food. Your child may be given antacids, such as ranitidine​ (Zantac), that reduce acid production.
  • Stomach problems: If your child has problems with bowel movements, he may be given a stool softener. It makes bowel movements easier.
  • Personality changes, such as irritability: This is sometimes seen in children taking dexamethasone. It can be mild symptoms such as mood swings or crying easily, or more serious such as bizarre behaviour. This side effect will go away when the dexamethasone use is stopped or the dose is reduced.
  • Sleeping problems: Mild exercise before bed, such as a walk around the block, may help. If your child has several daily doses of dexamethasone, give the last dose no later than 6 pm.
  • Increased appetite: Your child may develop a huge appetite when he is given high doses of dexamethasone. As a result, he may gain weight. Most of the extra weight is from fluids that the body retains while on dexamethasone. Weight gain can lead to stretch marks on the skin, which are irreversible.
  • Make sure your child is eating healthy, well-balanced meals while his appetite is good. Avoid foods with high amounts of salt, as they can add to the water retention. Keep lots of low calorie snacks on hand, such as fruits and vegetables, or popcorn without salt or butter.
  • Your child’s appetite should return to normal and the weight will drop once he stops taking dexamethasone. If he continues to gain weight, talk to the treatment team.
  • Increase in thirst and more peeing: This may indicate an increase in blood sugar levels. Talk to your child’s treatment team. In some cases, the dietitian may recommend a low concentrated carbohydrate diet for your child.
  • Water retention: Your child may have swelling in his hands, feet, or around his face. Raise your child’s feet when he is sitting. Avoid tight fitting clothing. Avoid adding extra salt to foods, or serving foods with lots of salt ( sodium), such as processed foods.
  • Skin problems: Some of the problems that may develop are acne, hair on the shoulders or back. The acne usually goes away when the dose of the dexamethasone is reduced. Because steroids can lead to weight gain, some children develop stretch marks. These are irreversible. Talk to the treatment team about how to deal with skin problems.
  • Weakness: Your child may feel weak when walking up stairs or standing up from a sitting position. This side effect should go away when dexamethasone use stops.
  • Increased risk of infection : Dexamethasone can lower your child’s resistance to infections such as measles or chicken pox.

Side effects from long-term use

When steroids are used long-term, the dose must be continuously increased in order to maintain the same effect. This may result in some serious unwanted side effects.

  • Bone loss (osteoporosis): There are certain measures you can take to lessen the effects of steroids on the bone while your child is taking dexamethasone. Make sure your child stays physically active as much as possible. Each day, he needs to have a good intake of calcium, an important mineral found in bones, and vitamin D to help the bones absorb calcium. Talk to your child’s treatment team for further information.
  • High blood pressure: Avoid adding extra salt to food, or giving your child foods with lots of salt (sodium), such as processed foods.
  • Muscle wasting: The muscles involved in standing, walking, and moving the arms (proximal muscles) may become weak. Make sure your child stays physically active as much as possible. Muscle weakness may be improved by reducing the dose of dexamethasone. Rehabilitation, such as physical or occupational therapy, may also help.

Ute Bartels, MD