Effect of Ethanol in Paclitaxel Injections on the Ethanol Concentration in Exhaled Breath

Abstract

Background: Ethanol is included in certain injectable preparations of anticancer drugs to increase their solubility. Since the volume of ethanol in these preparations is approximately half of the total injection volume, the potential inhibitory effects of ethanol on the central nervous system cannot be disregarded, especially considering that patients may drive immediately after administration of the medication. Therefore, the concentration of ethanol was examined in exhaled breath after administration of paclitaxel, an anticancer medication containing ethanol. Methods: The ethanol concentration in exhaled breath immediately after an intravenous infusion of paclitaxel was measured in 30 patients, using a balloon-type gas detector tube. Correlations between the concentration of ethanol in exhaled breath and the total amount of ethanol administered or the intravenous infusion speed were calculated. Results: The mean ethanol concentration in exhaled breath was 0.028 -0.015 mg/L. The correlation between the ethanol concentration in exhaled breath and the total dose of ethanol was weak (R 2 = 0.25; p = 0.055), while the intravenous infusion speed showed a stronger positive correlation with the concentration of ethanol in the breath (R 2 = 0.49; p = 0.11). The maximum concentration of ethanol measured in exhaled breath (0.06 mg/L) was equivalent to 40% of the threshold for drunk driving, as specified in the Road Traffic Act in Japan. Conclusion: In this study, no patient had a breath ethanol concentration exceeding the legal threshold for drunk driving. However, it is still advisable for patients to avoid driving after receiving paclitaxel injections. When driving cannot be avoided, patients should wait for a sufficient time after receiving the injection before driving.

Ethanol Exposure During the Intravenous Administration of Chemotherapeutic Drugs: An Analysis of Clinical Practice and a Literature Review

“…18 Of the three studies that evaluated the presence of ethanol in expired air, only one detected the substance. 22 No ethanol was detected in saliva—even at the end of docetaxel infusion. Finally, low plasma ethanol concentrations were measured after 3 hours of paclitaxel infusions.…”

“…Seven articles analyzed the occurrence of ethanol-related symptoms and/or the detectability of ethanol in expired air, saliva, or blood plasma. 8,12,13,17,18,21,22 A retrospective comparison of five docetaxel formulations showed that the safety profile was worse when the dose of both excipients (ethanol and polysorbate) was high—notably with regard to injection site reactions ( P = .0012), hand-foot syndrome ( P = .0003), and oral mucositis ( P = .008). 13 Another study evaluated paclitaxel infusions in 25 patients with a polymorphism in the gene coding for type 2 aldehyde dehydrogenase ( ALDH2 ): five patients developed grade 1 ethanol-related adverse events.…”

“…Consequently, pharmacists and physicians in every institution should be aware of this patients should be monitored before discharge from hospital-especially if they plan to drive home. 22 Finally, patients should be told to reduce their consumption of alcohol during treatment periods and to alert their physician if potential ethanol-related adverse events occur.…”

“…Some publications were excluded because they were outside the scope of the study. The selected articles variously reported on gemcitabine, 8 docetaxel, 10,13,16 carmustine, 17 and paclitaxel 16,[18][19][20][21][22] ; they were all case reports (n 5 4) or studies of small numbers of patients (n 5 7) that sought to identify effects potentially related to the presence of ethanol (Appendix Table A1, online only).…”

“…Moreover, the removal of ethanol from the paclitaxel solution in a patient with known ethanol intolerance abrogated the ethanol-related symptoms. 20 Ethanol levels in patients receiving gemcitabine, 8 docetaxel, 12 and paclitaxel 18,21,22 have been evaluated using a variety of methods, with detection in expired air, 8,21,22 saliva, 12 or blood plasma. 18 Of the three studies that evaluated the presence of ethanol in expired air, only one detected the substance.…”