Paclitaxel Administration in Dextrose
Yes, paclitaxel can be safely administered in 5% dextrose solution. This is an established and widely accepted practice supported by multiple guidelines and stability studies.
Approved Diluents
Paclitaxel is compatible with two standard diluents 1, 2:
- 5% dextrose in water (D5W)
- 0.9% sodium chloride (normal saline)
Both diluents are equally acceptable for paclitaxel administration, with no clinical preference for one over the other 3.
Concentration Requirements
When preparing paclitaxel infusions, the following concentration parameters must be followed 2, 3:
- Final concentration range: 0.3-1.2 mg/mL
- The drug must be diluted 5-20 times from its original formulation before administration 4
- Concentrations outside this range risk precipitation or inadequate dilution
Stability in Dextrose
Paclitaxel demonstrates excellent stability when diluted in 5% dextrose 2, 3:
- At room temperature (25°C): Stable for at least 27 hours in clinical practice, with some studies showing 3-7 days depending on concentration and container type 1, 3
- Refrigerated (2-8°C): Stable for 13-20 days at 0.3 mg/mL concentration, depending on container type 3
- Lower concentrations (0.3 mg/mL) are more stable than higher concentrations (1.2 mg/mL) 3
Container and Administration Requirements
Critical equipment specifications must be followed when using dextrose as the diluent 5:
- Use only glass bottles, polyolefin bags, or polypropylene bags - never use PVC containers 2, 5
- Polypropylene-lined infusion tubing is required 5
- 0.22 micron in-line filter must be used during administration 5
These requirements exist because the Cremophor EL vehicle (polyoxyethylated castor oil) used to solubilize paclitaxel can leach plasticizers from PVC materials 6, 4.
Clinical Considerations
The choice between dextrose and saline does not impact hypersensitivity reaction risk 6:
- Hypersensitivity reactions occur in 4-10% of patients and are attributed to the Cremophor EL excipient, not the active drug or diluent 6
- Premedication with corticosteroids and H1-antihistamines is mandatory regardless of diluent choice, reducing reaction rates from 30% to 3% 6
- Reactions typically occur during the first or second administration 6
Common Pitfall to Avoid
Do not use PVC containers or tubing with paclitaxel in any diluent, including dextrose. The Cremophor EL vehicle will extract diethylhexylphthalate plasticizers from PVC materials, causing both equipment damage and potential patient toxicity 4. Always verify that polyolefin or polypropylene materials are being used 2, 3.