Choosing the right dose

Patients with advanced malignancy may benefit from corticosteroids for a variety of symptoms. There should always be a clear indication to justify starting corticosteroids and benefits should always be balanced against the side effects.

Neurological

Symptoms secondary to cerebral tumour(s).

Dexamethasone: 16mg/day
(4mg-8mg often sufficient for headache. More than 16mg may be required for patients with high risk of coning, or those taking enzyme inducing medications e.g. phenytoin, carbamazepine, phenobarbitone)

Nerve compression pain

Dexamethasone: 8mg/day

Respiratory

Superior vena caval obstruction SVCO

Dexamethasone: 16mg/day

Pneumonitis after radiotherapy

Dexamethasone: 16mg/day

Lymphangitis carcinomatosa

Dexamethasone: 16mg/day

Large airways obstruction

Dexamethasone: 16mg/day

Gastrointestinal Tract

Dysphagia

Dexamethasone: 6mg-16mg/day

Intestinal obstruction

Dexamethasone: 6mg-16mg/day

Rectal discharge

Rectal corticosteroid preparations e.g. hydrocortisone or prednisolone foam enema, or prednisolone suppositories. Once at night.

Miscellaneous

Ureteric obstruction/pelvic disease.

Dexamethasone: 6mg–16mg/day

Pain from hepatic metastases

Dexamethasone: 4mg–8mg/day

Bone pain (occasionally helpful)

Dexamethasone: 4mg–8mg /day

Anti-emetic

Dexamethasone: 4mg–8mg /day

Anorexia/to improve wellbeing (short term)

Dexamethasone: 2mg–4mg / day Prednisolone 15mg–40mg/day

DISCLAIMER

This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.