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Palliative cancer care - pain - Management
What issues should I consider before prescribing dexamethasone?
- Insomnia can occur with dexamethasone use; therefore, the dose is often taken each morning [BNF 56, 2008]. Experts suggest that if the volume of tablets or injection is difficult to manage in a single dose, it is acceptable to split the dose, in which case it should be given at 8 a.m. and 12 p.m. (noon).
- Psychiatric adverse effects include depression and psychosis [BNF 56, 2008]. Other adverse effects include hypertension, hypokalaemia, osteoporosis, worsening of diabetic control, and proximal myopathy [ABPI Medicines Compendium, 2008a].
- Regular mouth care is essential in people taking oral corticosteroids because oral candidiasis is common.
- Consider gastroprotection with a proton pump inhibitor for people at high risk of gastrointestinal adverse effects.
- For people who are immunosuppressed by long-term corticosteroid use, there is a risk of severe chickenpox infection in those who are not immune [DH, 2006]. Advise all such people using corticosteroids to seek urgent medical attention if they come into contact with anyone with chickenpox or shingles [CSM, 1998].
- Dexamethasone may help to improve appetite and a general feeling of well-being.
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