Dexamethasone prophylaxis for paclitaxel hypersensitivity

Objective. To evaluate single-dose intravenous (IV) dexamethasone as a viable alternative to the standard two-dose oral protocol and as a method for the administration of corticosteroid prophylaxis in the prevention of paclitaxel-induced hypersensitivity reactions (HSR).

Method. A retrospective analysis of pharmacy dispensing and medical records was undertaken to ascertain those patients who had received IV corticosteroid prophylaxis, details of therapy and incidence of HSR. A comprehensive literature review was also undertaken to determine the incidence of HSR to paclitaxel in patients receiving a similar IV dexamethasone premedication protocol.

Results. Thirty-five patients received prophylactic dexamethasone 20 mg IV, given 30 minutes before paclitaxel infusion. Patients also received promethazine 25 mg IV and ranitidine 50 mg IV. No HSR were reported. A number of studies were identified in which IV corticosteroid prophylaxis was used, including retrospective analyses, a prospective report, clinical studies involving paclitaxel employing IV corticosteroids as part of the premedication regimen, and comparative retrospective studies. Only one study described IV corticosteroid therapy adversely.

Conclusions. For the safe administration of paclitaxel, premedication with corticosteroids, and H₁ and H₂ receptor antagonists, is essential. The administration of IV dexamethasone 20 mg, given 30 minutes before paclitaxel infusion, is an appealing and practical alternative to the standard oral prophylactic regimen and offers benefits to patients in terms of compliance, convenience, ease of administration and flexibility.