Docetaxel (Taxotere)
Antineoplastic Agent | Mitotic Inhibitor
Black Box Warning: Docetaxel includes a black box warning for neutropenia and hypersensitivity. It carries a significant risk of severe neutropenia leading to infection and potentially fatal outcomes. Hypersensitivity reactions, including severe reactions such as anaphylaxis, can also occur.
Docetaxel is classified as a taxane chemotherapeutic agent. It is primarily used in the treatment of various cancers, including breast, non-small cell lung, prostate, gastric, and head and neck cancers.
Dosing Strategies:
- Docetaxel dosing typically needs to be tailored according to patient body surface area, type of cancer, the severity of the disease, and patient tolerance. Periodic dose adjustments may be required based on toxicity and the patient's response to therapy.
- Premedication with corticosteroids is required to prevent severe hypersensitivity and fluid retention.
Administration Guidelines:
- Administered intravenously, docetaxel must be given under the supervision of a qualified healthcare professional in an environment where full resuscitation facilities are available.
- Infusion duration should typically be one hour, as per standard protocols, to minimize the risk of reactions.
Side Effect Management:
- Common side effects include neutropenia, alopecia, nausea, vomiting, and mucositis. Patients should be monitored closely for the development of these effects.
- Docetaxel can cause significant fluid retention; patients should be monitored for weight gain and peripheral edema. Corticosteroid premedication can help mitigate this risk.
Hypersensitivity Reactions:
- Despite premedication, some patients may still experience hypersensitivity reactions characterized by rash, pruritus, flushing, and, in severe cases, bronchospasm, fever, and hypotension.
- Immediate treatment discontinuation and appropriate medical management are required for significant hypersensitivity reactions.
Impact on Blood Counts:
- Regular monitoring of complete blood counts is essential, particularly for neutrophils. Severe neutropenia (<500 cells/mm³) is a significant concern that can lead to serious infections.
- Growth factor support may be necessary to manage or prevent severe neutropenia.
Patient Education and Safety:
- Instruct patients to report any symptoms of infection, including fever, chills, or sore throat, given their increased susceptibility due to potential neutropenia.
- Patients should be informed about the risk of alopecia and other potential long-term side effects.
- Advise patients to avoid missing scheduled appointments for blood work or follow-up infusions to ensure safety and effectiveness of treatment.
Handling and Disposal:
- Docetaxel is a cytotoxic agent, and proper precautions should be taken in handling and disposal. Only trained personnel should handle and administer the drug.
Use in Special Populations:
- Caution is advised in patients with liver impairment as docetaxel metabolism is significantly affected by liver function. Dose adjustments may be necessary.
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