Adverse drug reactions myelosuppression

Although not a taxane, ixabepilone is a novel microtubule inhibitor that was recently approved for metastatic breast cancer in combination with the oral fluoropyrimidine capecitabine or as monotherapy. It is a semisynthetic analog of epothilone B, and is active in the M phase of the cell cycle. This agent binds directly to 6-tubulin subunits on microtubules, leading to inhibition of normal microtubule dynamics. Of note, this agent continues to have activity in drug-resistant tumors that overexpress P-glycoprotein or tubulin mutations. The main adverse effects include myelosuppression, hypersensitivity reactions, and neurotoxicity in the form of peripheral sensory neuropathy. 

Drugs that inhibit folate metabolism increase the likelihood of serious adverse reactions to methotrexate, particularly hematological toxicity. The additional risk of myelosuppression and subsequent severe pancytopenia has been particularly exemplified by the combination of methotrexate and co-trimoxazole (trimethoprim plus sulfamethoxazole) (133). This should also be taken into account in patients taking trimethoprim alone (SEDA-22, 418). 

Adverse reactions to gemcitabine are typically mild, including myelosuppression, nausea and vomiting, raised hepatic aminotransferases, and flu-like symptoms. About 10% of patients experience more severe toxicity, most commonly hematological. Patients with cytidine deaminase deficiency are more likely to have early and significant drug-related adverse reactions [40. ... 

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