Medulloblastoma Medication

Updated: Jan 10, 2018
  • Author: George I Jallo, MD; Chief Editor: Amy Kao, MD  more...
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Medication

Medication Summary

Medulloblastoma is treated primarily with surgical excision followed by radiation therapy and chemotherapy. Few drugs are of benefit in this disease. Exceptions are glucocorticoids, which can aid in decreasing vasogenic edema. Mannitol or hypertonic saline is utilized in the acute setting when the physician is faced with a herniating patient. Chemotherapy is used as adjuvant therapy in some patients. Administration of toxic compounds that affect multiple organ systems is in the realm of the experienced oncologist.

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Glucocorticoids

Class Summary

Reduction of vasogenic edema is the role of glucocorticoids in malignant brain tumors. They can be very effective in medulloblastoma and can even alleviate hydrocephalus by reopening CSF pathways in the posterior fossa. Although any of several glucocorticoids can be used, dexamethasone is used most often. Equivalent doses of various glucocorticoids are 0.75 mg for dexamethasone, 4 mg for methylprednisolone and triamcinolone, 5 mg for prednisolone and prednisone, 20 mg for hydrocortisone, and 25 mg for cortisone.

Dexamethasone (DoubleDex, DexPak, Zodex)

Most commonly used drug to treat vasogenic edema secondary to medulloblastoma. Promotes reduction of edema after craniotomy.

Methylprednisolone (Solu-Medrol, Depo-Medrol, Medrol)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Prednisolone (Millipred, Veripred 20, Orapred ODT)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Prednisone (Rayos, Deltasone)

May decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear cell activity.

Hydrocortisone (Solu-Cortef, Cortef)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Cortisone

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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Osmotic diuretics

Class Summary

These agents are used in the acute setting to prevent further increases of intracranial pressure. In addition to mannitol, hypertonic saline (3% or 5%) also creates an osmotic gradient that shifts fluid from the intracellular to the interstitial and intravascular space. Improves mean arterial pressure and increases total intravascular volume avoiding hypotension as seen commonly with the administration of mannitol.

Mannitol (Osmitrol)

A diuretic agent used to create an osmotic gradient between CSF in arachnoid space and plasma. Used in the acute setting to prevent further increases of intracranial pressure, however can precipitate hypotension given mechanism.

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