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Managing the Side Effects of a Brain Tumor and Its Treatment

This page discusses the management of side effects specific to brain cancer and its treatment. For a review of methods to manage side effects common to all cancers and their treatments, please visit: Managing the Side Effects of Cancer and Cancer Treatment.

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your health care provider if you need to take any special precautions. Use each of these medications as recommended by your health care provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your health care provider.

Medications may help to either prevent or reduce side effects of treatment, or to manage certain side effects when they occur. Since you can develop these symptoms from the treatment and/or from the cancer itself, it is important that you discuss them with your doctor when you notice and ask if any of these medications are appropriate for you.

Some of the complications of brain cancer that may require supportive care include:

  • Swelling in the brain
  • Seizures

Swelling in the Brain

Many brain tumors cause swelling of the tissues surrounding them. This leads to brain irritation and diminished brain function. Corticosteroids, which are cortisone-like drugs, can decrease swelling surrounding brain tumors and improve brain function.

Among the many corticosteroid drugs available, dexamethasone (Decadron) is the only one in common use for brain swelling, because it has the fewest side effects. It is given in divided doses of 12 to 20 milligrams a day or more, orally or through an IV. These doses are effective in reducing brain swelling and usually do not produce the major side effects associated with corticosteroids.

Side effects of corticosteroids include:

  • Increased risk of infection and difficulty getting over an infection
  • Increased appetite
  • Indigestion
  • Nervousness or restlessness

Seizures

Brain tumors may cause seizures or convulsions. Seizures result when clusters of nerve cells in the brain, called neurons, communicate with each other abnormally. During a seizure, the neurons' normal pattern of activity is disturbed. This can cause strange sensations, emotions, and behavior. It can also cause convulsions, muscle spasms, and loss of consciousness.

Anticonvulsants are medications that can help prevent and/or manage seizures:

  • Carbamazepine (Tegretol, Carbatrol)
  • Ethosuximide (Zarontin)
  • Gabapentin (Neurontin)
  • Lamotrigine (Lamictal)
  • Oxcarbazepine (Trileptal)
  • Phenytoin (Dilantin)
  • Primidone (Mysoline)
  • Valproic acid (Depakene)
  • Diazepam rectal gel (Diastat)
  • Clonazepam (Klonopin)

Carbamazepine

Common brand names include:

  • Tegretol
  • Carbatrol

Carbamazepine prevents seizures by reducing the excitability of nerve fibers in the brain. This medication is taken as a tablet or liquid. It is best taken at the same time or times each day. Taking it with food or liquid can help prevent stomach upset.

Possible side effects include:

  • Blurred vision
  • Nystagmus—rhythmic back and forth eye movements
  • Lightheadedness
  • Drowsiness
  • Possibly severe skin reactions
  • Bone marrow damage

More serious, but less common side effects include bone marrow suppression, rashes, and heart failure.

Ethosuximide

Common brand name: Zarontin

Ethosuximide controls seizures by depressing nerve transmissions in the motor cortex, which is the part of the brain that controls muscles. The medication is taken in liquid or capsule form. It is best taken at the same time or times each day. Taking it with food or liquid can help prevent stomach upset.

Possible side effects include:

  • Nausea
  • Appetite loss
  • Vomiting
  • Fatigue
  • Lightheadedness
  • Drowsiness
  • Headache
  • Muscle pain
  • Rash
  • Change in urine color

Persistent fever or sore throat should be reported to your doctor. These symptoms may indicate a low white blood cell count due to bone marrow suppression.

Gabapentin

Common brand name: Neurontin

It is not known how gabapentin prevents convulsive seizures, but is thought to increase the brain concentration of a protein called gamma-aminobutyric acid (GABA), which calms the brain. This medication is taken in capsule form. Maintenance dosage varies among patients. It is best taken with food or liquid to prevent stomach upset.

Possible side effects include:

  • Sleepiness
  • Lightheadedness
  • Fatigue
  • Lack of coordination
  • Weight gain
  • Rapid back-and-forth eyeball movements known as nystagmus
Lamotrigine

Common brand name: Lamictal

It is not known how lamotrigine prevents convulsive seizures, but it is thought to stabilize nerve membranes. The medication is taken in tablet form. Maintenance dosage varies among patients. It is best taken with liquid to prevent stomach upset.

When you are taking lamotrigine, contact your doctor right away if you have the following symptoms:

  • Rash
  • Fever
  • Flu-like symptoms
  • Swollen glands
  • An increase in your seizures

Other possible side effects include:

  • Double or blurred vision
  • Clumsiness
  • Lightheadedness
  • Headache
  • Nausea or vomiting
  • Drowsiness
Oxcarbazepine

Common brand name: Trileptal

Oxcarbazepine is believed to prevent convulsive seizures by altering the transmission of nerve impulses in the brain and stabilizing the nerve membranes. This medication is taken in tablet or liquid form. Maintenance dosage varies among patients. It is best taken with liquid.

Possible side effects include:

  • Vision changes
  • Lightheadedness
  • Nausea or vomiting
  • Sleepiness
  • Headache
  • Fatigue
Phenytoin

Common brand name: Dilantin

Phenytoin prevents seizures by promoting sodium loss in nerve fibers. This reduces nerve excitability and the spread of nerve impulses. This medication is taken in tablet or liquid form. It is best taken with liquid and at the same time each day.

Possible side effects include:

  • Bleeding
  • Swollen gums
  • Fever
  • Rashes
  • Lightheadedness
  • Drowsiness
  • Nausea, vomiting
  • Diarrhea or constipation
  • Liver and bone marrow damage
  • Nerve and brain dysfunctions
  • Respiratory inflammations
  • Rapid eyeball movement known as nystagmus
Primidone

Common brand name: Mysoline

Primidone is believed to prevent seizures by inhibiting the repeated spread of nerve impulses. This medication is taken in tablet or liquid form. It is best taken at the same time each day, and it is best taken with liquid or food.

Possible side effects include:

  • Rash
  • Confusion
  • Rapid eye movements
  • Clumsiness
  • Lightheadedness
  • Drowsiness
Valproic Acid

Common brand name: Depakene, Depakote

Valproic acid may prevent seizures by increasing concentrations of gamma-aminobutyric acid (GABA). This holds back nerve transmissions in parts of the brain. This medication is taken in capsule or liquid form. It is best taken once a day at the same time each day. Taking it with liquid or food can help prevent stomach upset.

Possible side effects include:

  • Nausea or vomiting
  • Indigestion, abdominal pain, loss of appetite
  • Diarrhea
  • Tremors
  • Lightheadedness
  • Weakness, sleepiness
  • Headache
  • Visual disturbances
  • Hair loss
  • Liver damage
  • Pancreatitis
  • Respiratory infection
  • Thrombocytopenia—a decrease in the number of blood platelets
  • Menstrual changes in young women
  • Fetal damage if pregnant
Benzodiazepines
  • Diazepam (Valium)
  • Clonazepam (Klonopin)

These two drugs are approved for use in various kinds of seizure disorder. Diazepam is more frequently used than clonazepam. It can be given orally, by injection, or by rectal gel. They are central nervous system depressants.

Possible side effects of benzodiazepines include:

  • Drowsiness
  • Difficulty breathing
  • Headaches
  • Chemical dependence

When to Contact Your Health Care Provider

Contact your health care provider if:

  • You experience any unusual, rare, or severe symptoms or side effects
  • You suffer any recurrence of epileptic seizures

Never stop or reduce your medications without first consulting your doctor.

Revision Information

  • Brain tumor. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 28, 2013. Accessed June 4, 2013.

  • Brain tumor. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/brain. Accessed June 4, 2013.

  • Dreifuss FE, Rosman NP, Cloyd JC, et al. A comparison of rectal diazepam gel and placebo for acute repetitive seizures. N Engl J Med. 1998;338:1869-1875.