Bumetanide
Severe
Textbook
Increased risk of ototoxicity (e.g., tinnitus, hearing impairment, deafness, vertigo).
Not explicitly stated, but implies careful monitoring or avoidance if possible.
Source: G&G 14e · p566
Drug reference
Paclitaxel
Taxane antineoplastic agent (mitotic inhibitor) · Chemotherapy; Anti-cancer drug
Also known as Taxol
START
Confirm ANC ≥1500, platelets ≥100,000. Verify LFTs (hold if bilirubin >5x ULN). Premedicate with steroids + antihistamine + H2 blocker. Assess baseline neuropathy.
TYPICAL MAX
Do not exceed 175-200mg/m² q3weeks without compelling evidence. Neuropathy is dose-limiting.
STOP IF
Severe hypersensitivity, ANC <500, platelets <25,000, grade ≥3 neuropathy, bilirubin >5x ULN.
WATCH
CBC before each cycle (nadir day 8-10). Cumulative neuropathy (dose-dependent). Cardiac monitoring during infusion (bradycardia common, usually transient).
CDSCO approvedSchedule HATC L01CD01
KDIGO 2024 + manufacturer label
- ONSET
- 30min · Onset ~30 min
- PEAK
- 3h · Cmax at end of infusion
- t½
- 20h · Terminal t½ 13-20 hours
- DURATION
- 3w · Cycle q3weeks (504 hours)
EXCRETION
Fecal as metabolites (~71%)
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Contraindicated in pregnancy—embryotoxic and fetotoxic in animals. Effective contraception required during and for 6 months after treatment.
FDA category + note
Top interactionssee all 12 →
- BumetanideSevereTextbookG&G 14e · p566
- FurosemideSevereTextbookG&G 14e · p566
- TorasemideSevereTextbookG&G 14e · p566
- TorsemideSevereTextbookG&G 14e · p566
Available in India
136 branded formulations and 1 fixed-dose combination. Look up specific brands in the Drugs workspace.
Mechanism
Promotes assembly of microtubules from tubulin dimers and stabilizes microtubules by preventing depolymerization, causing cell cycle arrest in G2/M phase and apoptotic cell death
Indications
Ovarian cancer (first-line and platinum-resistant)Breast cancer (adjuvant and metastatic)Non-small cell lung cancer (NSCLC)AIDS-related Kaposi's sarcomaGastric adenocarcinoma (combination)
Dosing
- Adult
- Ovarian: 135-175mg/m² IV over 3h q3weeks. Breast (adjuvant): 175mg/m² q3weeks x 4 cycles (AC-T regimen). Breast (metastatic): 175mg/m² q3weeks or 80-100mg/m² weekly. NSCLC: 135mg/m² q3weeks with cisplatin. Premedicate with dexamethasone 20mg PO 12h + 6h before, diphenhydramine 50mg IV, cimetidine 300mg IV.
- Pediatric
- Not routinely used in children; limited data in pediatric solid tumors.
- Renal adjustment
- No adjustment needed (minimal renal excretion).
- Hepatic adjustment
- Bilirubin 1.26-2.0x ULN: reduce to 135mg/m². Bilirubin 2.01-5.0x ULN: reduce to 75mg/m². Bilirubin >5x ULN: contraindicated. AST >10x ULN: reduce dose.
- Geriatric
- No specific adjustment; monitor closely for myelosuppression and neuropathy.
- Max dose
- 250mg/m² per cycle (investigational); standard max 175-200mg/m² q3weeks
Pharmacokinetics
Onset
Cell-cycle specific; cytotoxic effect during M phase
Peak effect
Cmax at end of 3-hour infusion; tissue distribution continues post-infusion
Duration
Myelosuppression nadir day 8-10; recovery by day 21
Half-life
Biphasic: α-phase ~0.5h; terminal β-phase 3-52h (mean ~13-20h)
Bioavailability
N/A (IV only)
Protein binding
89-98% (albumin, alpha-1-acid glycoprotein)
Metabolism
Extensive hepatic via CYP2C8 (major) and CYP3A4; 6α-hydroxypaclitaxel is major metabolite
Excretion
Fecal (~71% as metabolites); renal (~1.3-12.6% unchanged)
Contraindications
- Hypersensitivity to paclitaxel or polyoxyethylated castor oil (Cremophor EL)
- Severe neutropenia (ANC <1500 cells/mm³)
- Pregnancy
- Severe hepatic impairment (total bilirubin >5x ULN)
Side effects
Common
Myelosuppression (neutropenia, anemia, thrombocytopenia)Peripheral neuropathy (dose-limiting)AlopeciaMyalgia / arthralgiaNausea and vomiting (mild-moderate)Mucositis
Serious
- Severe hypersensitivity reactions (anaphylaxis)
- Severe neutropenia with fever
- Severe peripheral neuropathy
- Cardiac arrhythmias (bradycardia, AV block)
- Severe hepatic toxicity
- Pneumonitis / interstitial lung disease
Pregnancy & lactation
Pregnancy
Contraindicated in pregnancy—embryotoxic and fetotoxic in animals. Effective contraception required during and for 6 months after treatment.
Lactation
Excretion in breast milk unknown; not recommended during breastfeeding.
Drug interactions
Furosemide
Severe
Textbook
Increased risk of ototoxicity (e.g., tinnitus, hearing impairment, deafness, vertigo).
Not explicitly stated, but implies careful monitoring or avoidance if possible.
Source: G&G 14e · p566
Torasemide
Severe
Textbook
Increased risk of ototoxicity (e.g., tinnitus, hearing impairment, deafness, vertigo).
Not explicitly stated, but implies careful monitoring or avoidance if possible.
Source: G&G 14e · p566
Torsemide
Severe
Textbook
Increased risk of ototoxicity (e.g., tinnitus, hearing impairment, deafness, vertigo).
Not explicitly stated, but implies careful monitoring or avoidance if possible.
Source: G&G 14e · p566
Adalimumab
Severe
Database
Drug interaction classified as: synergy
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
Certolizumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Cladribine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Clozapine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Other Taxane antineoplastic agent (mitotic inhibitor) drugs
Ask House about Paclitaxel
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19