Oral premedication for the prevention of hypersensitivity reactions to paclitaxel

Premedication with dexamethasone, H1 and H2 receptor antagonists given intravenously prior to paclitaxel are highly successful in preventing life-threatening hypersensitivity reactions. We conducted a prospective study to assess the availability and safety of the administration of promethazine and dexamethasone per os in the premedication of paclitaxel hypersensitivity reactions. Of 180 eligible cancer patients, 100 patients received paclitaxel weekly and 80 patients, every 3 weeks. Patients received premedication with promethazine 25 mg per os, dexamethasone 2-20 mg per os and cimetidine 300 mg intravenously. One hundred patients in the weekly group received 940 cycles of paclitaxel. Hypersensitivity reactions occurred in one (1%) patient. There were no hypersensitivity reactions in 99% of patients. Eighty patients in the 3 weekly group received 464 cycles of paclitaxel. Hypersensitivity reactions occurred in (3) 4% of patients while 96% of patients had no hypersensitivity reactions. Two of these three patients had no further hypersensitivity reactions after receiving premedication intravenously. In the two groups 40 min/cycle reduction in treatment duration was observed. In conclusion, this study shows that drugs used for premedication prior to paclitaxel can be given orally. This strategy is feasible, gives excellent results in reducing hypersensitivity reactions and shortens the time of treatment for patients and treating staff.