Spinal Cord Compression
Pharmaceutical Issues
Rebecca Mills
Senior Clinical Pharmacist
Points to Cover
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Steroids
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Dose
Adverse effects
Counselling
Thromboprophylaxis
 Laxatives
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Steroids
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Reduce inflammation around the tunour &
cord oedema
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Reduce pain
Preserve neurological function
Increase number of patients who remain
ambulatory
High dose initially
 Reduce rapidly
 Where good results possible to stop
steroid treatment completely
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Choice and dose of steroid
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Use dexamethasone
Dose is 16mg per day divided into 2 doses (N.B.=
approx 100mg prednisolone)
Trials compared 16mg per day with 96mg per day
showed more side-effects with higher dose
Give after Breakfast and Lunch.
Reduce dose over 2 weeks
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can cause problems if stopped suddenly.
If symptoms worsen increase dose/reduce more slowly.
Some patients may be on maintenance steroids.
WPH Reducing regimen
Day
Dexamethasone daily
dose
Administration
1-3
16mg
16mg OM or
8mg BD
(8am & 12noon)
4-6
8mg
8mg OM
7-9
4mg
4md OM
10-12
2mg
2mg OM
13
Discontinue
Adverse Effects
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Gastric irritation
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Take after food.
PPI cover
 Lansoprazole 15mg OD
 Only for the duration of the steroids.
Increased Appetite
 Impaired glucose tolerance
 Mood disturbances
 Fluid retention
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Long-term adverse effects
Osteoporosis
 Muscle weakness
 Reduced healing/ability to fight infection
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Care around people with chicken pox/
measles/influenza
Glaucoma
 Impaired healing
 “Cushing’s Syndrome”……
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Points to remember
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Take steroids with or after food
Avoid take steroids later than 4pm
Dexamethasone can be dispersed in water &
given via PEG/NG (off license)
Dexamethasone liquid is available
If the patient has had other courses of steroids in
the last year they may need to reduce the dose
more slowly
Avoid contact with anyone with suspected chicken
pox or shingles.
Check the patient understands how to reduce
their dose.
Thromboprophylaxis
Active Cancer
 Reduced Mobility
 Inpatient hospital stay
= VTE Risk
 Prescribe thromboprophylaxis unless
contra-indicated.
 Consider if thromboprophylaxis is
indicated on discharge – immobility?
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Laxatives
Constipation often associated with mSCC
 Can be one of the presenting symptoms
 Maintaining regular bowel action is
important for patient comfort
 Psychological issues also need to be
overcome e.g. patients embarrassment at
needing to be assisted with toileting
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Laxatives
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Oral laxatives may be ineffective or inappropriate
Reflex bowel
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Patient has little/no awareness of bowel fulness
Reflex function of the rectum remains
Fast acting rectal measures most appropriate
Bisacodyl suppositories or sodium citrate enemas (1530mins to effect)
If hard stools, glycerol suppository
Flaccid bowel
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May need digital removal
No laxatives recommended
Pain Control
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Analgesia
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WHO Pain ladder
NICE neuropathic pain guidance
Bone Pain
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Zoledronic Acid (IV)
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Check Renal function
Denosumab (SC)
Licensed for prevention of skeletal events
Any Questions?