Most common corticosteroids utilized for tumor edema and associated dosing, pros, and cons

NameDosingProsCons
Dexamethasone

  • - Loading: 10–20 mg intravenous (IV) up to 100 mg/day [23]

  • - Maintenance: 4–8 mg/day (mild symptoms) to 16 mg/day (moderate to severely symptomatic); up to 24 mg/day [23, 44]

  • - Long half-life (3–4 h with biologic half-life 34–54 h) [45]

  • - Low/absent mineralocorticoid activity, less psychosis, improvement in clinical condition pre-operatively, lower infection risk [23]

  • - Increased risk of myopathy [23]

  • - May alter the appearance of post-contrast imaging [45]

  • - Decreased survival among GBM patients undergoing radiation [45]

  • - Decreased half-life in the setting of co-administration of phenytoin [47]

Prednisone

  • - 5–60 mg/day [49]

  • - Lower risk of myopathy [23]

  • - Allows smaller dose taper for those with adrenal insufficiency history

  • - Less mineralocorticoid potency that hydrocortisone [49]

  • - Less efficacious for brain edema [23]

Hydrocortisone

  • - 20–30 mg/day [49]

  • - Lower risk of myopathy [23, 49]

  • - Increased mineralocorticoid potency compared to dexamethasone [49]

  • - Shorter biological half-life (8–12 h)