Parenteral Manual

DOCEtaxel (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
TAXOTERE
Classification: 
Antineoplastic agent, mitotic inhibitor - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
  • Treatment of refractory solid tumors

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Available as 40 and 80 mg vials as a concentrate.  Store in refrigerator.
  • Allow vial to stand at room temperature for 5 minutes.  Withdraw entire contents of supplied diluent and transfer to vial of docetaxel to further dilute
  • Gently roll for 15 seconds to mix, then allow to stand for 5 minutes (appears viscous).  If foam forms, let vial stand until most of the foam has dissipated.
  • Final concentration is 10 mg/mL
  • Stable 1 week (vial and infusion of 0.3-0.9 mg/mL) at room temperature or refrigerated
  • Protect from light
  • Solutions for infusion must be dispensed in non-PVC bags. Use glass bottles
  • Non PVC tubing must be used to administer the drug
  • DO NOT FILTER

Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: no information

- Incompatible: PVC

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO

IV Intermittent Infusion

Yes, patient must be pre-medicated prior to infusion (see pre-printed orders)

Usual dilution: 0.3-0.9 mg/mL

Infusion time: 1 hour

IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • 125 mg/m2 every 21 days (CCG Study 0962)

** Dosage may differ according to protocol

Dosage adjustment in hepatic impairement

  • Modify dose in patients with AST/ALT > 2.5 times upper limit of normal, concurrently with an alkaline phosphatase > 2.5 times the upper limit of normal
  • Contraindicated in patients with severe liver impairment
Potential hazards of parenteral administration: 

Minor Hypersensitivity Reactions (~30%):

  • Rash, pruritis, chest tightness, back pain, dyspnea, drug fever, chills

Major Hypersensitivity Reactions (~0.4%):

  • Hypotension, bronchospasm, generalized rash/erythema.  Can present within minutes of starting infusion
  • Fluid retention (~80% without premedication), may become severe (9%)
  • Nausea (40%), vomiting, diarrhea
  • Myelosuppression (neutropenia may be severe--nadir 8 days)
  • Paresthesia, burning sensation, pain (50%)
  • Localized erythema of extremities with edema followed by desquamation (5%).  Nail changes.
  • Alopecia
  • Not a vesicant, but is an irritant.  Consult policy for prevention of infiltration (Section H, Infusion Therapy Manual). If extravasation occurs, click HERE for treatment guidelines.   

- Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

Notes: 

PREMEDICATION PROTOCOL (follow pre-printed orders):

Guidelines: in order to reduce hypersensitivity reactions and fluid retention, give:
- Dexamethasone (6 mg/m2) IV at HR -12, -6
- Diphenhydramine (Benadryl) (1 mg/kg) IV at -30 minutes and Q6H PRN
- Ranitidine (4 mg/kg) po at -30 minutes and bid x 7 days WEIGH TWICE DAILY x 3 days Have anaphylaxis kit available at bedside.  RN to remain with patient for first 15 minutes monitoring vitals.  Recheck vitals every 15 minutes for duration of infusion and one hour post.  At any sign of hypotension or bronchospasm, stop infusion and call doctor Use G-CSF (filgrastim) to attempt to shorten recovery of neutrophil count Caution with other drugs that are inhibitors of CYP 450 3A, i.e. cyclosporine, ketoconazole, erythromycin

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