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Taxanes

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VOL: 102, ISSUE: 30, PAGE NO: 37

GENERIC AND PROPRIETARY NAMES

 

GENERIC AND PROPRIETARY NAMES
- Docetaxel: Taxotere.

 

 

- Paclitaxel: Taxol.

 

 

ACTION
- Interferes with cell division and multiplication.

 

 

CLASSIFICATION
- Cytotoxic drugs.

 

 

INDICATIONS
- The indications for taxanes are subject to specific clinical conditions and therefore the BNF, NICE guidance and specialist texts should be consulted.

 

 

- Generally they are used in advanced or metastatic breast cancer, non-small cell lung cancer, hormone-resistant prostate cancer and inoperable ovarian cancer.

 

 

CONTRAINDICATIONS
- Pregnancy.

 

 

- Breastfeeding.

 

 

CAUTIONS
- Severe local tissue necrosis can occur with leakage into the extravascular compartment, so cytotoxic drugs are administered by appropriately trained staff.

 

 

COMMON SIDE-EFFECTS
- Myelosuppression.

 

 

- Peripheral neuropathy.

 

 

- Cardiac conduction defects with arrhythmias.

 

 

- Alopecia.

 

 

- Muscle pain.

 

 

- Nausea and vomiting.

 

 

- Hypersensitivity reactions.

 

 

- Paclitaxel can cause persistent fluid retention.

 

 

- Manufacturers’ product literature should be consulted for full details of side-effects associated with individual drugs.

 

 

ADMINISTRATION
- Intravenous infusion.

 

 

HANDLING CYTOTOXIC DRUGS
- Trained personnel should reconstitute cytotoxics.

 

 

- Reconstitution should be carried out in designated areas.

 

 

- Protective clothing to be worn including gloves and goggles.

 

 

- First-aid measures should be specified.

 

 

- Pregnant staff should never handle cytotoxics.

 

 

- Adequate care should be taken in the disposal of waste material.

 

 

NURSING CONSIDERATIONS
- Premedication with corticosteroid, antihistamine and histamine H2-receptor antagonist is recommended to prevent severe hypersensitivity reactions.l Dexamethasone by mouth is recommended for reducing fluid retention and hypersensitivity.

 

 

- Most cytotoxic drugs are teratogenic and all may cause life-threatening toxicity, so only experienced practitioners should administer them.

 

 

- Dosage regimens are complex and detailed specialist literature should be consulted.

 

 

- Scrips should not be repeated except on specialist instructions.

 

 

- It is important to ensure that any fever in a neutropenic patient receives immediate treatment with a broad-spectrum antibacterial therapy.

 

 

PATIENT TEACHING
- A balance has to be struck between the likely benefit from chemotherapy and toxicity.

 

 

- A sore mouth is a common complication so good mouth care is important.

 

 

- Nausea and vomiting may occur within 24 hours or have delayed onset.

 

 

- Reversible hair loss is common.

 

 

- Due to the teratogenic effects of cytotoxic drugs contraceptive advice should be offered where appropriate before therapy.

 

 

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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