Docetaxel with prednisone or prednisolone for the treatment of ...

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Background
possible benefit from such treatment warrants
the risk of further medullary suppression.
● No data are available in patients with renal
impairment.
● No data are available in patients treated with
mitoxantrone concomitantly with other
medications.
Adverse events
● No non-haematological adverse events of
grade 3 or 4 were seen in more than 5% of
patients.
● Severe neutropenia is very common, as are mild
to moderate nausea and vomiting.
● Congestive heart failure, tachycardia,
arrythmias, chest pain and asymptomatic
decreases in left ventricular ejection fraction
have been reported.
Estramustine
The following section of the report summarises
the product characteristics for estramustine
(Estracyt ® , Pfizer), available from the Electronic
Medicines Compendium 22 (www.medicines.org.uk/).
Estramustine is a compound consisting of
oestradiol and nitrogen mustard that has mild
anti-microtubule actions. It has a dual mode of
action; it acts as an anti-mitotic agent and exerts
an anti-gonadotrophic effect. Estramustine also
binds to a protein present at the tumour site,
resulting in an accumulation of the drug at the
target site.
Estramustine is available in 140-mg gelatine
capsules. Estramustine is licensed in the UK for
the treatment of carcinoma of the prostate,
especially in cases unresponsive to, or relapsing
after, treatment with hormones. The dosage of
estramustine can range from one to 10 capsules
per day, with standard starting doses of four to six
capsules per day. Each capsule should be taken
orally, not less than 1 hour before or 2 hours after
meals. The capsules should not be taken with milk
or milk products. Estramustine should not be
administered to children.
Contraindications
● Hypersensitivity to oestradiol or nitrogen
mustard
● children
● peptic ulceration, severe liver dysfunction or
myocardial insufficiency
Special warnings and precautions for use
● Caution should be exercised if using in patients
with moderate to severe bone marrow
depression, thrombophlebitis, thrombosis,
thromboembolic disorders, cardiovascular
disease, coronary artery disease and congestive
heart failure.
● Caution should also be exercised in patients
with diabetes, hypertension, epilepsy, hepatic
and renal impairment and diseases associated
with hypercalcaemia.
● Blood counts, liver function tests and serum
calcium in hypercalcaemia should be performed
at regular intervals and calcium levels closely
monitored.
● Milk, milk products or any drugs containing
calcium may impair the absorption of
estramustine and should not be taken
concomitantly.
Adverse events
● The most common adverse events are
gynaecomastia and impotence, anaemia,
granulocytopenia, nausea and vomiting
(particularly during the first 2 weeks of
treatment) and fluid retention and oedema.
● The most serious adverse events are
thromboembolism, ischaemic heart disease and
congestive heart failure.
● Therapy with estramustine should be
discontinued immediately should angioneurotic
oedema occur.