Pacliwel Injection
Paclitaxel
30mg/ml
Getwell Pharmaceuticals
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Available as:
Indications
Pacliwel Injection is used for:
Ovarian carcinoma, Breast cancer, Lung cancer, Kaposi's sarcoma
Adult Dose
Intravenous
Ovarian carcinoma
Adult: Primary treatment (in combination with cisplatin or carboplatin): 135 mg/m2 infused over 24 hr followed by cisplatin and repeated at 3 wk intervals.
Secondary treatment (as single agent): 135 or 175 mg/m2 infused over 3 hr once every 3 wk.
Breast cancer
Adult: Adjuvant therapy; 2nd line monotherapy or 1st line treatment with trastuzumab: 175 mg/m2 infused over 3 hr once every 3 wk for 4 courses; when used with trastuzumab, dose should be given the day after the 1st dose of trastuzumab or immediately after subsequent doses if well-tolerated.
1st line with doxorubicin: 220 mg/m2 over 3 hr every 3 wk, dose to be administered 24 hr after doxorubicin.
Advanced non-small cell lung cancer
Adult: 135 mg/m2 over 24 hr or 175 mg/m2 over 3 hr, followed by cisplatin and repeated at 3 wk intervals.
AIDS-related Kaposi's sarcoma
Adult: 135 mg/m2 over 3 hr every 3 wk. Alternatively, 100 mg/m2 over 3 hr every 2 wk especially in patients with poor performance status.
Hepatic Impairment
With solid carcinomas and not Kaposi sarcoma
24-hr infusion
AST/ALT <2 x ULN and bilirubin ?1.5 mg/dL: 135 mg/m² over 24 hr
AST/ALT 2-<10 x ULN and bilirubin ?1.5 mg/dL: 100 mg/m² over 24 hr
AST/ALT <10 x ULN and bilirubin 1.6-7.5 mg/dL: 50 mg/m² over 24 hr
AST/ALT ?10 x ULN OR bilirubin >7.5 mg/dL: Do not administer
3-hr infusion
AST/ALT <10 x ULN and bilirubin <1.25 x ULN: 175 mg/m² over 3 hr
AST/ALT <10 x ULN and bilirubin 1.26-2 x ULN: 135 mg/m² over 3 hr
AST/ALT <10 x ULN and bilirubin 2.01-5 x ULN: 90 mg/m² over 3 hr
AST/ALT ?10 x ULN OR bilirubin >5 x ULN: Do not administer
Child Dose
Safety and efficacy not established
Renal Dose
Administration
Reconstitution: Paclitaxel must be diluted before infusion. It can be diluted in 0.9% sodium chloride inj, 5% dextrose inj, 5% dextrose and 0.9% sodium chloride inj or 5% dextrose in lactated Ringer's inj to a concentration of 0.3-1.2 mg/ml.
Contra Indications
History of hypersensitivity (especially macrogol glycerol ricinolate). Patients with baseline neutropenia of <1500 cells/mm3 (<1000 cells/mm3 for kaposi's sarcoma). Pregnancy and lactation. In kaposi's sarcoma, contraindicated in patients with concurrent, serious, uncontrolled infections.
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 platinum derivatives (cisplatin, carboplatin) if used in combination. Hazardous agent; use appropriate precautions for handling and disposal.
Lactation: not known if excreted in breast milk, do not nurse
Pregnancy-Lactation
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.
Adverse Effects
Side effects of Paclitaxel :
>10%
Neutropenia (78-100%),Alopecia (55-96%),Anemia (47-96%),Arthralgia/myalgia (93%),Diarrhea (90%),Leukopenia (90%),Nausea/vomiting (9-88%),Opportunistic infections (76%),Peripheral neuropathy (42-79%),Thrombocytopenia (4-68%),Mucositis (5-45%),Hypersensitivity (2-45%),Renal impairment (34%),Hypotension (17%)
1-10%
Bradycardia (3%)
<1%
Grand mal seizures,Cardiac conduction abnormalities
Frequency Not Defined
Pyrexia,Dehydration,Pancytopenia,Congestive heart failure,Left ventricular dysfunction,Stevens-Johnson syndrome, toxic epidermal necrolysis, and extravasation
Potentially Fatal: Infections and infestations leading to death e.g. pneumonia and peritonitis.
Mechanism of Action
Paclitaxel promotes microtubule formation by enhancing the action of tubulin dimers, stabilising existing microtubules and preventing their disassembly, thereby disrupting normal cell division in the late G2 mitotic phase of the cell cycle. This results in the inhibition of cell replication.
Note
Pacliwel 30mg/ml Injection manufactured by Getwell Pharmaceuticals. Its generic name is Paclitaxel. Pacliwel is availble in Nepal.
Farmaco Nepal drug index information on Pacliwel Injection is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.