Paclitaxel injection
Introduction
Paclitaxel Injection is a clear, colorless to slightly yellow viscous solution. It is supplied as a nonaqueous solution intended for dilution with a suitable parenteral fluid prior to intravenous infusion. Paclitaxel is available in 30 mg (5 mL), 100 mg (16.7 mL), and 300 mg (50 mL) multidose vials. Each mL of sterile nonpyrogenic solution contains 6 mg paclitaxel, 527 mg of purified Cremophor? EL (polyoxyethylated castor oil) and 49.7% (v/v) dehydrated alcohol, USP.
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Paclitaxel is a natural product with antitumor activity.?
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Indications
Paclitaxel is indicated as first-line and subsequent therapy for the treatment of advanced carcinoma of the ovary. As first-line therapy, Paclitaxel is indicated in combination with cisplatin.
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Paclitaxel is indicated for the adjuvant treatment of node-positive breast cancer administered sequentially to standard doxorubicin-containing combination chemotherapy. In the clinical trial, there was an overall favorable effect on disease-free and overall survival in the total population of patients with receptor-positive and receptor-negative tumors, but the benefit has been specifically demonstrated by available data (median follow-up 30 months) only in the patients with estrogen and progesterone receptor-negative tumors. (See Clinical Studies: Breast Carcinoma.)
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Paclitaxel is indicated for the treatment of breast cancer after failure of combination chemotherapy for metastatic disease or relapse within 6 months of adjuvant chemotherapy. Prior therapy should have included an anthracycline unless clinically contraindicated.
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Paclitaxel, in combination with cisplatin, is indicated for the first-line treatment of non-small cell lung cancer in patients who are not candidates for potentially curative surgery and/or radiation therapy.
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Paclitaxel is indicated for the second-line treatment of AIDS-related Kaposi's sarcoma..
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Effect
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
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Call your doctor at once if you have a serious side effect such as:
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fever, chills, body aches, flu symptoms, sores in your mouth and throat;
pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;
easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;
flushing (warmth, redness, or tingly feeling);
slow heart rate, feeling like you might pass out;
seizure (convulsions);
chest pain, dry cough, wheezing, feeling short of breath;
numbness, tingling, or burning pain in your hands or feet;
severe redness or swelling, severe irritation, a hard lump, or skin changes where the injection was given;
jaundice (yellowing of the skin or eyes); or
increased blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, uneven heartbeats).
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Precautions
Contact of the undiluted concentrate with plasticized polyvinyl chloride (PVC) equipment or devices used to prepare solutions for infusion is not recommended. In order to minimize patient exposure to the plasticizer DEHP [di-(2-ethylhexyl)phthalate], which may be leached from PVC infusion bags or sets, diluted Paclitaxel solutions should preferably be stored in bottles (glass, polypropylene) or plastic bags (polypropylene, polyolefin) and administered through polyethylene-lined administration sets.
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Paclitaxel should be administered through an in-line filter with a microporous membrane not greater than 0.22 microns. Use of filter devices such as IVEX-2? filters which incorporate short inlet and outlet PVC-coated tubing has not resulted in significant leaching of DEHP.
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Clinical Pharmacology
Paclitaxel is a novel antimicrotubule agent that promotes the assembly of microtubules from tubulin dimers and stabilizes microtubules by preventing depolymerization. This stability results in the inhibition of the normal dynamic reorganization of the microtubule network that is essential for vital interphase and mitotic cellular functions. In addition, paclitaxel induces abnormal arrays or "bundles" of microtubules throughout the cell cycle and multiple asters of microtubules during mitosis
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