An Evidence-Based Summary of Recommendations for the use of Dexamethasone in the Management of Brain Metastases

Intracranial edema associated with brain metastases commonly contributes to symptoms of headache, nausea or emesis. Corticosteroids are the pharmacologic agent of choice for many patients, to temporize symptoms until definitive antineoplastic therapy can be initiated. However, careful management is required to minimize related side effects which may compromise a patient's quality of life. The literature on dosing, appropriate duration of therapy and tapering will be reviewed, along with practical guidelines on the initiation of dexamethasone, appropriate prophylaxis, and secondary screening for adverse events.