8 applications of dexamethasone in oncology

According to studies by MD Anderson Cancer Center Bruera, dexamethasone (4 mg/time, twice daily) is superior to placebo in reducing the incidence of fatigue in patients with advanced cancer.

First, dexamethasone and cachexia, fatigue, fatigue

1 Dexamethasone can promote appetite, increase body weight, and improve the cachexia state of patients with advanced disease;

2 Studies have shown that oral administration of 0.75~1.5mg dexamethasone once a day can significantly improve the appetite of cancer patients;

3 Dexamethasone can improve the quality of life, physical state and physical discomfort of patients with advanced cancer;

4 For patients with advanced cancer with significant cancer-related fatigue, 1-2 weeks of dexamethasone may be used for treatment, or depending on the patient's condition;

5 According to studies by MD Anderson Cancer Center Bruera et al.: Dexamethasone (4 mg/time, twice daily) is superior to placebo in reducing the incidence of fatigue in patients with advanced cancer;

6 patients with advanced disease suffer from fatigue, fatigue, lack of appetite, and patients with advanced stage have limited survival. They should pay more attention to the benefits of dexamethasone and fully improve the quality of life of patients.

7 also pay attention to the impact of dexamethasone on sleep, advanced patients may also suffer from insomnia, but also should pay attention to improve sleep.

Second, dexamethasone and cerebral edema

Dexamethasone can be used in the treatment of brain edema caused by primary tumors and brain metastases in the brain.

Mechanism:

1 stable cell membrane;

2 to stabilize the permeability of capillaries by anti-serotonin action, reduce and prevent brain edema;

3 to restore the blood flow of the brain tissue to automatically adjust, reduce capillary leakage;

4 reduce the production of cerebrospinal fluid and promote the dissipation of brain edema;

5 It is helpful to reconstruct the normal distribution of sodium and potassium ions in the fluid inside and outside the cell, improve the cerebral blood flow in the cerebral edema area, and help the recovery of the function of the god;

6 can increase renal blood flow, increase glomerular source rate, and help dehydration and diuresis;

7 inhibit the secretion of antidiuretic hormone in the posterior pituitary;

8 can improve the body's ability to stress.

Instructions:

1 combined with diuretics, radiotherapy, chemotherapy, molecular targeted therapy;

2 The first dose of intravenous bolus injection of 10mg, followed by intramuscular injection of 4mg every 6 hours, generally 12-24 hours of patients can be improved, gradually reduced after 2-4 days, 5-7 days to discontinue. For brain tumors that are not suitable for surgery, the first dose can be intravenously injected 50mg, and then 8mg will be given every 2 hours, and then reduced to 2mg per day after several days, divided into 2-3 intravenous doses. Clinically, often use 10-20mg each time, intravenous drip, 1-2 times a day, depending on the condition;

3 for patients with milder conditions, not routinely applied;

4 After giving mannitol for three hours, give dexamethasone to prolong the dehydration time;

5 Note: Mannitol and dexamethasone are incompatible.

Third, dexamethasone and spinal cord compression syndrome

Dexamethasone can be used in the treatment of spinal cord compression syndrome caused by bone metastases, cervical vertebrae and primary spinal cord tumors. The mechanism of action is consistent with its role in cerebral edema.

Instructions:

1 combined with diuretics and anti-tumor treatment (chemotherapy, etc.) and other measures;

2 can choose one of the methods of use: dexamethasone injection 10-20mg, 1-2 times a day to stabilize the anti-tumor treatment of patients, gradually reduce the drug; anti-tumor treatment measures are invalid, the use of time should Depending on the patient's condition.

Fourth, dexamethasone and tumor treatment

1 alone or in combination with other chemotherapeutic drugs for the treatment of lymphoproliferative tumors such as multiple myeloma, Hodgkin's lymphoma, non-Hodgkin's lymphoma and acute lymphocytic leukemia.

2 The mechanism of action may be to dissolve lymphocytes; it can also inhibit mitosis of cells when administered in large doses, and can act as a non-specific drug of cell cycle in S phase and G2 phase and delay the G1/S phase boundary.

3 different lymphoma chemotherapy regimens use glucocorticoids differently, NHL commonly used regimens to choose prednisone, the dose is 40 ~ 100mg / m2 / d, continuous oral for 5 days.

4 glucocorticoids can be used alone in the treatment of multiple myeloma. When used alone, dexamethasone 40 mg/d was selected for oral or intravenous infusion on days 1 to 4, 9 to 12, and 17 to 20 days, and 35 days was a course of treatment. In most patients, glucocorticoids should be combined with other chemotherapy drugs. Older age, not prepared for hematopoietic stem cell transplantation, prednisone 60mg/m2/d, combined with melphalan, continuous oral administration for 4 days, is a simple and easy solution for multiple myeloma. Other combined chemotherapy regimens (DT, VAD, DVD, and DT-PACE) were all dexamethasone 40 mg/d, administered orally or intravenously on days 1-4. Patients who are older or have a combined infection should be appropriately reduced in dose.

5 large doses of dexamethasone, 40mg / d combined with 4d alone or in combination with other drugs for the treatment of multiple myeloma, Hodgkin's lymphoma, non-Hodgkin's lymphoma and acute lymphocytic leukemia.

6 According to reports in the literature, dexamethasone combined with gemcitabine, cisplatin, mitoxantrone and other chemotherapy drugs are effective in some lymphoma patients.

7 According to the literature, large doses of dexamethasone have successfully treated lymphoma cases.

5. Treatment of dexamethasone and cancerous ascites

Mechanism:

1 reduce the side effects of chemotherapy drugs in the thoracic and abdominal cavity;

2 promote the absorption of chest and ascites;

3 promote the absorption of chest and ascites;

4 Stabilize the cell membrane, stabilize capillary permeability and reduce capillary extravasation;

5 reduce intestinal adhesions, intestinal obstruction.

Method of use: In combination with chemotherapy drugs or other drugs that inhibit pleural and ascites, a dose of 10 mg/time can be used.

Six, dexamethasone and chemotherapy antiemetic

1 dexamethasone has a strong anti-inflammatory effect, mainly to prevent delayed vomiting, so the guidelines are recommended for CINV in multi-day chemotherapy to 2-3 days after the end of chemotherapy;

2 high emetic drug control program: NK-1 receptor inhibitor + 5-HT3 receptor inhibitor + dexamethasone. This scheme is especially suitable for the prevention and treatment of CINV caused by cisplatin;

3 moderate vomiting drug prevention and treatment program: acute phase application of 5-HT3 receptor inhibitor + dexamethasone, dexamethasone can be applied in the delay period.