การให้ยาป้องกันการเกิดภาวะภูมิไวเกิน(Hypersensitivity reactions )จากยา Paclitaxel
นายแพทย์ ชำนาญ เกียรติพีรกุล
สาขาวิชามะเร็งวิทยานรีเวช ภาควิชาสูติศาสตร์และนรีเวชวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยเชียงใหม่ จังหวัดเชียงใหม่ 50200
Hypersensitivity Reactions Induced by Paclitaxel : Focus on Premedication
Department of Obstetrics and Gynecology Faculty of Medicine, Chiang Mai University
Chiang Mai 50200, Thailand
Purpose of review
Paclitaxel is widely employed in standard oncologic treatment including cancer of ovary, breast and lung. Although it is generally well tolerate, some potential serious adverse affects had been reported especially hypersensitivity reaction which became the most characteristics toxicity and could be prevented by various prophylactic treatments. This review summarized the results from published studies which conducted to investigate the efficacy of prophylactic management, of particular interest in premedication regimen.
The overall incidence of hypersensitivity reaction of paclitaxel had been reported in up to 40% in phase I study. The polyoxyethylated castor oil or cremophor EL which dissolved paclitaxel was thought to be causative based on animal study and experience in other drugs formulated in this solvent. After the introduction of the standard premedication regimen consisted of 20 mg dexamethasone orally or intravenously 12 and 6 hours before treatment, 50 mg diphenhydramine (H1 antagonist), 20 mg famotidine (H2 antagonist) intravenously 30 minutes before infusion of paclitaxel, the incidence of major hypersensitivity reaction had decreased to be approximately 1- 2%. However, this regimen is quite inconvenient. So the modified regimen consisted of 20 mg dexamethasone intravenously at the same time as histamine-antagonist drugs administration was proposed and demonstrated its effectiveness as the standard regimen. Although current data from several retrospective analyses comparing the effectiveness of both prophylactic regimens are still inconclusive, it is clear that both premedication regimens have not completely eliminate major drug reaction. Thus, the patient who treated with paclitaxel should be actively monitored and recognized for this adverse affect regardless of premedication type. . . .