Paclitaxel
Antineoplastic Agent | Mitotic Inhibitor
Published on April 29, 2024Paclitaxel is a widely used chemotherapy agent, particularly effective in treating various types of cancer such as breast, ovarian, and non-small cell lung cancer.
- Premedication to Prevent Hypersensitivity: Paclitaxel can cause hypersensitivity reactions, which are often prevented by premedication with corticosteroids, antihistamines, and H2 blockers about 30 minutes to an hour before infusion.
- Infusion Time: The administration time can influence the risk of hypersensitivity reactions. Longer infusion times (e.g., over three hours) are generally associated with lower risks compared to shorter infusion durations.
- Use of Inline Filters: It’s essential to use a non-PVC (polyvinyl chloride) IV bag and tubing, as paclitaxel can leach plasticizers from PVC. Also, an inline filter (generally 0.22-micron) should be used during administration to prevent the infusion of particulate matter.
- Peripheral Neuropathy Management: Paclitaxel can cause peripheral neuropathy. Monitoring the patient for signs of nerve damage and adjusting the dose as necessary can help manage this side effect. Supplementing with pyridoxine (vitamin B6) may also be considered, although evidence on its effectiveness varies.
- Alopecia and Nail Changes: Most patients will experience some degree of hair loss, which typically begins after the first or second treatment. Nail changes, including discoloration and brittleness, may also occur.
- Bone Marrow Suppression: Monitoring blood counts is critical as paclitaxel can cause neutropenia, anemia, and thrombocytopenia. Support with growth factors or dose adjustments might be necessary based on the patient's blood counts.
- Alcohol Content: Some formulations of paclitaxel contain a significant amount of alcohol, which can cause dizziness or other symptoms related to alcohol intake, especially in sensitive patients.
- Hepatic Function Monitoring: Paclitaxel metabolism is heavily dependent on hepatic function. Dosage adjustments may be required for patients with liver impairment to avoid toxicity.
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