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Indication & Dosage
 
 
Intravenous
OVARIAN CARCINOMA
Adult: Primary treatment (in combination with cisplatin or carboplatin): 135 mg/m2 infused over 24 hr or 175 mg/m2 infused over 3 hr, followed by cisplatin and repeated at 3 wk intervals. Secondary treatment (as single agent): 135-175 mg/m2 infused over 3 hr once every 3 wk.
 
Intravenous
BREAST CANCER
Adult: Adjuvant therapy: 175 mg/m2 infused over 3 hr once every 3 wk; give 4 courses of treatment following sequentially to an anthracycline-based regimen. 1st line chemotherapy of breast carcinoma: in combination with doxorubicin 50 mg/m2 (administered 24 hr after doxorubicin): 220 mg/m2 over 3 hr every 3 wk. In combination with trastuzumab (started day after trastuzumab dose or immediately after successive doses of trastuzumab if the previous dose was tolerated): 175 mg/m2 over 3 hr every 3 wk. 2nd line chemotherapy of breast carcinoma: 175 mg/m2 over 3 hr every 3 wk.
 
Intravenous
ADVANCED NON-SMALL CELL LUNG CANCER
Adult: Primary treatment (in combination with cisplatin or carboplatin): 135 mg/m2 infused over 24 hr or 175 mg/m2 infused over 3 hr, followed by cisplatin and repeated at 3 wk intervals. Secondary treatment (as single agent): 135-175 mg/m2 infused over 3 hr once every 3 wk.
 
Intravenous
AIDS-RELATED KAPOSI'S SARCOMA
Adult: Primary treatment (in combination with cisplatin or carboplatin): 135 mg/m2 infused over 24 hr or 175 mg/m2 infused over 3 hr, followed by cisplatin and repeated at 3 wk intervals. Secondary treatment (as single agent): 135-175 mg/m2 infused over 3 hr once every 3 wk.
   
Precautions Bone marrow suppression during therapy. Monitor cardiac function if conduction abnormalities result. Premedicaton (with corticosteroid, antihistamine and histamine H2-receptor antagonist) may be required to reduce risk of hypersensitivity reaction. Discontinue, if severe reactions e.g. hypotension, dyspnoea, angioedema or urticaria occur. Caution in patients with moderate hepatic impairment. Monitor for reactions of admin. Safety and efficacy in paediatric patients have not been established. Administer before cisplatin if used in combination. Hazardous agent; use appropriate precautions for handling and disposal.
   
Potentially Life-threatening 
Adverse Drug Reactions
Neutropenia, leukopenia, thrombocytopenia, anaemia, bleeding; hypersensitivity reactions (dyspnoea, flushing, chest pain, tachycardia, rash, hypotension, hypertension); bradycardia, abnormal ECG; neurotoxicity (mainly peripheral neuropathy), myalgia, arthralgia; nausea, vomiting, diarrhoea; severe mucositis, alopecia; rarely hepatic necrosis and encephalopathy, inj site reactions e.g. erythema, tenderness, skin discolouration, swelling; interstitial pneumonitis; infections (mainly UTIs and upper respiratory tract); mucosal inflammation, severe elevation in LFTs (aspartate aminotransferase and alkaline phosphatase).
   
Adverse Drug Reactions Infections and infestations leading to death e.g. pneumonia and peritonitis.
   
Interactions Myelosuppression was more profound when given after cisplatin than with the alternate sequence (e.g., paclitaxel before cisplatin). CYP2C8 inducers e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, rifapentine, and secobarbital may reduce levels or effects. CYP2C8 inhibitors e.g. gemfibrozil, ketoconazole, montelukast, and ritonavir may increase levels or effects. CYP3A4 inducers e.g. aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins may decrease the levels or effects. CYP3A4 inhibitors e.g. azole antifungals, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid, nefazodone, nicardipine, propofol, protease inhibitors, quinidine, telithromycin, and verapamil may increase levels or effects. May increase anthracycline (eg doxorubicin, epirubicin) levels or toxicity; admin of anthracycline at least 24 hr prior to paclitaxel may reduce interaction. May decrease the absorption of cardiac glycosides (may only affect digoxin tablets); levels should be monitored.
   
   
 

 

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