Drug reference

Docetaxel

Taxane antineoplastic agent (mitotic inhibitor) · Antineoplastic

START

Confirm ANC ≥1500, platelets ≥100,000. Verify LFTs (hold if bilirubin >ULN or severe hepatic impairment). Premedicate with dexamethasone 8mg BID x 3 days starting day before. Assess baseline neuropathy.

TYPICAL MAX

100mg/m² q3weeks. Dose-limiting toxicity is neutropenia. Fluid retention is cumulative—reduces after 4-5 cycles with premedication.

STOP IF

Grade 4 neutropenia >7 days, febrile neutropenia, severe hypersensitivity, bilirubin >ULN, severe neuropathy (grade ≥3), severe fluid retention.

WATCH

CBC before each cycle (nadir day 7-10). Fluid retention signs (weight gain, edema, dyspnea). Hypersensitivity despite premedication (have epinephrine ready). Dexamethasone premedication essential for fluid retention and hypersensitivity prevention.

CDSCO approvedSchedule HATC L01CD02

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 30min · Onset ~30 min
PEAK: 1h · Cmax at end of infusion
t½: 14h · Terminal t½ 11-18 hours
DURATION: 3w · q3weeks cycle (504 hours)

EXCRETION

Fecal as metabolites (~80%)

route + CYP

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Contraindicated in pregnancy—embryotoxic and fetotoxic. Effective contraception required during and for 6 months after treatment (both sexes).

FDA category + note

Top interactionssee all 12 →

AzolesSevereTextbookHarrison 22e · p1742
AdalimumabSevereDatabaseDDInter
AmiodaroneSevereDatabaseDDInter
AmprenavirSevereDatabaseDDInter

Available in India

117 branded formulations. Look up specific brands in the Drugs workspace.

Mechanism

Promotes tubulin assembly into stable microtubules and inhibits microtubule depolymerization, causing cell cycle arrest in G2/M phase and apoptotic cell death. More potent than paclitaxel in some tumor types.

Indications

Breast cancer (adjuvant and metastatic)Non-small cell lung cancer (NSCLC)Prostate cancer (castration-resistant, with prednisone)Gastric adenocarcinoma (with cisplatin and 5-FU)Head and neck cancer (with cisplatin and 5-FU)Ovarian cancer

Dosing

Adult: Breast (metastatic): 60-100mg/m² IV q3weeks. NSCLC: 75mg/m² q3weeks (with cisplatin). Prostate: 75mg/m² q3weeks + prednisone 5mg BID. Gastric/head-neck: 75mg/m² q3weeks + cisplatin + 5-FU. Premedicate with dexamethasone 8mg PO BID x 3 days (starting day before).
Pediatric: Not routinely used in children.
Renal adjustment: No adjustment needed (minimal renal excretion).
Hepatic adjustment: Bilirubin >ULN or AST/ALT >1.5x with ALP >2.5x: contraindicated. Elevated LFTs: reduce dose to 60mg/m². Monitor closely.
Geriatric: No specific adjustment; increased risk of myelosuppression, diarrhea, and fatigue.
Max dose: 100mg/m² per cycle (standard); higher doses investigated in trials

Pharmacokinetics

Onset

Cell-cycle specific; cytotoxic effect during M phase

Peak effect

Cmax at end of 1-hour infusion

Duration

Myelosuppression nadir day 7-10; recovery by day 21

Half-life

Triphasic: α 4 min, β 0.5h, terminal γ 11-18 hours

Bioavailability

N/A (IV only)

Protein binding

~94-97% (albumin, lipoproteins, AAG)

Metabolism

Extensive hepatic via CYP3A4 and CYP3A5; major metabolites M1, M2, M3 (all active)

Excretion

~80% fecal (majority as metabolites); ~5-10% renal

Contraindications

Hypersensitivity to docetaxel or polysorbate 80
Severe hypersensitivity to paclitaxel (possible cross-reactivity)
ANC <1500 cells/mm³
Severe hepatic impairment (bilirubin >ULN or AST/ALT >1.5x ULN with alkaline phosphatase >2.5x ULN)

Side effects

Common

Neutropenia (dose-limiting)AnemiaAlopeciaNausea and vomiting (mild-moderate)DiarrheaFatigue / astheniaFluid retention (cumulative with dexamethasone premedication)Nail changes (onycholysis, discoloration)Peripheral neuropathy

Serious

Febrile neutropenia
Severe hypersensitivity reactions (despite premedication)
Severe cutaneous reactions (SJS/TEN, erythema multiforme)
Acute myelosuppression
Severe fluid retention / pleural effusion / ascites
Severe hepatotoxicity
Interstitial pneumonitis

Pregnancy & lactation

Pregnancy

Contraindicated in pregnancy—embryotoxic and fetotoxic. Effective contraception required during and for 6 months after treatment (both sexes).

Lactation

Excretion in breast milk unknown; discontinue breastfeeding during treatment.

Drug interactions

Azoles

Severe

Textbook

Increased plasma levels of docetaxel.

Source: Harrison 22e · p1742

Adalimumab

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Amiodarone

Severe

Database

Increased docetaxel plasma concentrations, potentially leading to increased toxicity.

Monitor closely for docetaxel toxicity if co-administered. Consider a docetaxel dose reduction if toxicity occurs or if amiodarone is initiated during docetaxel treatment.

Source: DDInter

Amprenavir

Severe

Database

Drug interaction classified as: metabolism

Source: DDInter

Atazanavir

Severe

Database

Drug interaction classified as: metabolism

Source: DDInter

Baricitinib

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Boceprevir

Severe

Database

Drug interaction classified as: metabolism

Source: DDInter

Ceritinib

Severe

Database

Drug interaction classified as: metabolism

Source: DDInter

Certolizumab

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Cladribine

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Clarithromycin

Severe

Database

Increased docetaxel plasma concentrations, potentially leading to increased toxicity.

Avoid concomitant use if possible. If co-administration is necessary, consider a docetaxel dose reduction and monitor closely for signs of toxicity. Azithromycin or other macrolides with less CYP3A4 inhibition may be safer alternatives.

Source: DDInter

Clozapine

Severe

Database

Drug interaction classified as: synergy

Source: DDInter