Therapeutic Handbook - GGC Prescribing

Treatment / drug therapy• Treatment is initially to alleviate symptoms and when known directed at the underlying cause.• Ensure that the patient has no life-threatening symptoms (e.g. associated stridor) and is fitenough for active treatment.• If no contraindication to corticosteroids commence:Dexamethasone oral (unless swallowing problems then IV) 8 mg twice daily (morningand lunchtime) with gastroprotection if appropriate (e.g. Omeprazole oral 20 mg daily orlansoprazole oral 30 mg once daily if appropriate).This may be commenced while waiting for CT if clinical suspicion of SVCO is high. If CTconfirms SVCO continue dexamethasone and seek urgent advice. As symptoms improve,dose may be gradually reduced over several weeks. If symptoms do not improve after 7days consider stopping. If the CT scan shows no SVCO then stop dexamethasone.• Other treatments frequently used are radiotherapy, stent insertion and chemotherapyand will depend on clinical scenario. If thrombus is present consider anticoagulation if nocontraindications (see guideline on LMWH for VTE in cancer on the Clinical GuidelineElectronic Resource Directory on StaffNet).Respiratory SystemPage 156