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Docetaxel

(doe-suh-tax-uhl)

Trade/other name(s): Taxotere, Docefrez

Why would this drug be used?

This drug is used to treat breast, lung, stomach, prostate, and head and neck cancers. Your doctor might use it to treat other types of cancer as well.

How does this drug work?

Docetaxel is a type of chemotherapy drug known as a taxane. It interferes with microtubules, which are part of the internal structure cells need when they are dividing. This leads to cell death. Because cancer cells divide faster than normal cells, they are more likely than normal cells to be affected by this drug.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods. Tell your doctor if you have ever reacted to docetaxel or other drugs made with polysorbate 80.
  • If you have any type of liver disease (including hepatitis). This drug is cleared from the body mainly by the liver. Reduced liver function might result in more drug than expected staying in the body, which could lead to serious side effects. Your doctor may need to adjust your dose accordingly.
  • If you have ever been treated with cisplatin or carboplatin (platinum drugs) for lung cancer. You might have a higher risk of certain serious side effects from docetaxel.
  • If you have problems with alcohol or drinking, or have any medical conditions that might be affected by alcohol intake. This drug contains small amounts of alcohol.
  • If you have any other medical conditions such as kidney disease, heart disease, diabetes, gout, high blood pressure, or infections. Your doctor may need to monitor you more closely during treatment.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause problems with the fetus if taken at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine. In pregnant women, treatment with this drug should be used only if the potential benefit to the mother outweighs the risk to the fetus.
  • If you are breastfeeding. While no studies have been done, this drug may pass into breast milk and affect the baby. Breastfeeding is not recommended during treatment with this drug.
  • If you think you might want to have children in the future. Talk with your doctor about the possible fertility risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Docetaxel may interact with a number of drugs and supplements, which may either raise or lower the level of docetaxel in your blood. This can worsen side effects or make the drug less effective. Tell your doctor if you are taking any of the following:

  • Antidepressant drugs such as nefazodone (Serzone), trazodone (Desyrel), fluvoxamine (Luvox), or buspirone (Buspar)
  • Antibiotics such as erythromycin, clarithromycin, or telithromycin
  • Anti-fungal antibiotics such as ketoconazole, itraconazole, and voriconazole
  • The anti-nausea drug aprepitant
  • Blood pressure medicines such as diltiazem and verapamil
  • HIV drugs such as indinavir, ritonavir, saquinavir, amprenavir, fosamprenavir, and nelfinavir
  • Anti-seizure drugs such as carbamazepine, phenobarbital, and phenytoin
  • TB drugs such as rifampin and rifabutin
  • Anti-anxiety medicines such as alprazolam (Xanax), diazepam (Valium), triazolam (Halcion), and midazolam (Versed)
  • St. John’s wort (an herbal supplement)
  • Methadone
  • Sildenafil (Viagra)

If you are on any of these medicines when you start taking docetaxel, talk to your doctor before you stop them. Many other medicines may also affect docetaxel, and changing any of your medicines may change the actual amount of the drug that stays in your body.

This drug contains small amounts of alcohol. Some medicines, such as strong pain relievers and sleep aids, might interact with the alcohol and worsen effects such as feeling dizzy, drunk, confused, or sleepy. A few drugs such as metronidazole (Flagyl), tinidazole (Tindamax or Fasigyn), and disulfiram (Antabuse) cause severe nausea, vomiting, flushing, raised blood pressure or severe headache if alcohol is taken.

Research on interactions with other drugs is incomplete at this time. Check with your doctor, nurse, or pharmacist about whether your other medicines, herbs, and supplements can cause problems with this medicine.

Interactions with foods

Grapefruit or grapefruit juice may change the level of docetaxel in your blood. Check with your doctor, nurse, or pharmacist about whether these or other foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Docetaxel is given by an infusion into a vein over 1 hour, usually either every week or every 3 weeks. You will probably get steroid pills, such as dexamethasone, to take the day before you start treatment and for the next 2 days to lessen the chance you will have an allergic reaction or get swelling in your body. You may also get an anti-nausea medicine before the docetaxel, especially if the medicine is given every 3 weeks.

The dose will depend on your size, how well your liver works, and how often you will be given the medicine. Your blood will be checked before treatment; if your blood counts are too low or other test results are not normal, the dose may be lowered or the treatment delayed.

Precautions

This drug can cause allergic reactions in some people when the drug is given, especially with the first few treatments. Although you will be given medicine ahead of time to lower this risk, reactions are still possible. Mild reactions may consist of fever, chills, skin itching, or feeling flushed. More serious reactions happen rarely, but can be dangerous. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), chest tightness, shortness of breath, back pain, or swelling of the face, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms during or after being given the drug.

This drug can cause your body to retain fluid. This can lead to swelling in your hands or feet. Fluid may also collect in your belly, which could make you feel or look bloated. In more serious cases, fluid may collect in your chest, which can lead to trouble breathing. Let your doctor or nurse know right away if you suddenly gain weight, notice swelling in any part of your body, or develop shortness of breath.

You might have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

This drug can cause sores in the mouth or on the lips, which often occur within the first few weeks after starting treatment. This can cause mouth pain, bleeding, or even trouble eating. The sores and pain can extend down the swallowing tube (esophagus) and into the intestines. Your doctor or nurse can suggest ways to reduce this, such as changing the way you eat or how you brush your teeth. If needed, your doctor can prescribe medicine to help with the pain.

This drug can cause diarrhea, which in some cases can be severe. If left unchecked, this could lead to dehydration and chemical imbalances in the body. Your doctor may prescribe medicine to help prevent or control this side effect. It is very important that you take this medicine as prescribed. Make sure you get the medicine right away, so that you will have it at home when you need it.

This drug may cause damage to certain nerves in the body, which can lead to a condition called peripheral neuropathy. This can cause numbness, weakness, pain, or sensations of burning or tingling, usually in the hands or feet. These are sometimes related to being exposed to hot or cold temperatures. These symptoms can sometimes worsen to include trouble walking or holding something in your hands. You will be watched closely for these symptoms. Let your doctor know right away if you notice any of them. If your symptoms are severe enough, this drug may need to be stopped or the dose reduced until they get better.

This drug can increase liver enzyme levels in your blood. Your doctor will likely check your liver function with blood tests on a regular basis. The drug might need to be stopped if the changes are severe. If you have liver metastasis or other liver problems before starting treatment, the doctor may need to monitor you more carefully.

This drug can cause a condition known as hand-foot syndrome, in which a person may experience pain, numbness, tingling, reddening, or swelling in the hands or feet. Peeling, blistering, or sores on the skin in these areas are also possible. Let your doctor know right away if you notice any of these symptoms.

Your doctor will probably test your blood frequently throughout your treatment, looking for possible effects of the drug on blood counts or on blood chemistry levels. Based on the test results, you might be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Be sure to keep all appointments for lab work and doctor visits.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting a serious, or even life-threatening, infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your red blood cell count. If this occurs, it is usually a few months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor can give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

In rare cases, this drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body’s ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor’s OK. This drug may affect your immune system, which could make vaccinations ineffective, or could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

A few patients have an eye problem called cystoid macular edema while taking this drug. Let your doctor know right away if you notice changes in vision.

Rarely, people who get this drug along with doxorubicin and cyclophosphamide can later develop myelodysplastic syndrome (a bone marrow disease), or even a type of cancer known as acute myeloid leukemia (AML).

This drug contains small amounts of alcohol. This might cause some people to feel drunk, dizzy, confused, or sleepy during and after the infusion. Avoid driving, operating machinery, or other activities that might be dangerous for 1 to 2 hours after the infusion. Some medicines, such as strong pain relievers and sleep aids, might interact with the alcohol and worsen these effects.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • Low white blood cell count with increased risk of serious infection*
  • Fever without infection
  • Retaining fluid (may include swelling in hands or feet, shortness of breath)*
  • Nausea*
  • Diarrhea*
  • Hair loss, including face and body hair
  • Feeling very tired or weak
  • Low red blood cell count (anemia)*
  • Stopping of menstrual cycles (periods) in women
  • Skin rash

Less common

  • Allergic reaction (fever, flushing, itching, rapid heart rate, shortness of breath, throat swelling, dizziness)*
  • Numbness, tingling, or pain in the hands, feet, or elsewhere*
  • Weakness in the hands and feet
  • Sores and/or pain on the lips or in the mouth, throat, esophagus, or intestines*
  • Vomiting
  • Change in how things taste
  • Loss of appetite
  • Nails changing color or becoming brittle
  • Severe skin rash
  • Muscle or joint aches
  • Abnormal blood test results which suggest that the drug is affecting the liver (Your doctor will discuss the importance of this finding, if any.)*

Rare

  • Low blood platelet count with increased risk of bleeding*
  • Redness, pain, swelling, or blisters on hands or feet (hand-foot syndrome)*
  • Shortness of breath due to lung scarring or disease, inflamed lungs, pneumonia, fluid in the lungs, or lung failure
  • Excess tears or redness of the eyes
  • Darkening of skin where prior radiation was given (radiation recall)
  • Harm to the fetus if taken by a woman during pregnancy
  • Death from infection, bleeding, allergic reaction, lung inflammation or damage, or other complication

*See “Precautions” section for more detailed information.

Other side effects not listed above can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1996.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 06/18/2014
Last Revised: 06/18/2014