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 see the monograph: 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 once they occur. Since you can develop these symptoms from the treatment and/or from the cancer itself, it is essential that you discuss them with your doctor when you notice and ask him or her if any of these medications are appropriate for you.

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

Swelling in the Brain

Many brain tumors cause swelling (also called edema) of the tissues surrounding them. This leads to brain irritation and diminished brain function. Corticosteroids, which are cortisone-like drugs, can decrease the volume of edema 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 quite 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; or convulsions, muscle spasms, and loss of consciousness.

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

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 (regular or chewable) 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)
  • Dizziness
  • 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, 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
  • Dizziness
  • Drowsiness
  • Headache
  • Muscle pain
  • Rash
  • Change in urine color

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

Gabapentin

Common brand name: Neurontin

The mechanism by which gabapentin prevents convulsive seizures is unknown, 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
  • Dizziness
  • Fatigue
  • Lack of coordination (ataxia)
  • Weight gain
  • Rapid back-and-forth eyeball movements (nystagmus)

Lamotrigine

Common brand name: Lamictal

The mechanism by which lamotrigine prevents convulsive seizures is uncertain but it may be by stabilizing nerve membranes. The medication is taken in tablet (regular or chewable) form. Maintenance dosage varies among patients. It is best taken with liquid to prevent stomach upset.

When you are taking lamotrigine, contact your doctor immediately 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
  • Dizziness
  • 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 thereby 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
  • Dizziness
  • Nausea or vomiting
  • Sleepiness
  • Headache
  • Fatigue

Phenytoin

Common brand name: Dilantin

Phenytoin prevents seizures by promoting sodium loss in nerve fibers. This inhibits nerve excitability and the spread of nerve impulses. This medication is taken in tablet (regular or chewable) 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
  • Dizziness
  • Drowsiness
  • Nausea, vomiting
  • Diarrhea or constipation
  • Liver and bone marrow damage
  • Nerve and brain dysfunctions
  • Respiratory inflammations
  • Rapid eyeball movement (nystagmus)

Primidone

Common brand name: Mysoline

Primidone is believed to prevent seizures by inhibiting the repetitious 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
  • Dizziness
  • Drowsiness

Valproic Acid

Common brand name: Depakene, Depakote

Valproic acid may prevent seizures by increasing concentrations of gamma-aminobutyric acid (GABA). This inhibits nerve transmissions in parts of the brain. This medication is taken in capsule or syrup form. It is best taken once a day, at the same time each day, and 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
  • Dizziness
  • Weakness, sleepiness
  • Headache
  • Visual disturbances
  • Hair loss
  • Liver damage
  • Pancreatitis
  • Respiratory infection
  • Thrombocytopenia (decrease in the number of blood platelets)
  • Menstrual changes in young women
  • Fetal damage if pregnant

Benzodiazepines

  • Diazepam (Valium)
  • Clonazepam (Klonopin)

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

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 discontinue or reduce your medications without first consulting your doctor.