Esophageal retention

Docetaxel, another taxane, binds to tubulin to promote microtubule assembly. The pharmacokinetics of docetaxel are best described by a three-compartment model, with an a half-life of 0.08 hours, a 3 half-life of 1.6 to 1.8 hours, and a terminal half-life of 65 to 73 hours.14 Docetaxel has activity in the treatment of breast, non-small cell lung, prostate, bladder, esophageal, stomach, ovary, and head and neck cancers. Dexamethasone, 8 mg twice daily for 3 days starting the day before treatment, is used to prevent the fluid retention syndrome associated with docetaxel and possible hypersensitivity reactions. The fluid... 

Sodium and fluid retention, congestive heart failure in susceptible patients, potassium loss, hypokalemic alkalosis, hypertension Muscle weakness, steroid myopathy, loss of muscle mass, vertebral compression fractures, aseptic necrosis of humeral and femoral heads, pathologic fracture of long bones, osteoporosis Peptic ulcer with possible perforation and hemorrhage, pancreatitis, abdominal distension, ulcerative esophagitis... 

Smart, J.D., et al. 2003. The retention of 14C-labelled poly(acrylic acids) on gastric and esophageal mucosa an in vitro study. Eur J Pharm Sci 20 83. 

Carbachol is a quaternary ammonium compound that shares both the muscarinic and nicotinic actions of acetylcholine but is much more slowly deactivated. Carbachol has been used topically in ophthalmology and systemically (subcutaneously, for example in doses of 2 mg/day) for urinary retention. Severe cholinergic effects can result. In one instance they primarily involved the gastrointestinal tract and the patient died of esophageal rupture (1). In other cases patients have experienced extreme bradycardia with hypotension, requiring treatment with intravenous atropine. As carbachol is not destroyed by cholinesterase, a cumulative effect is possible in patients who receive regular doses at short intervals in one case, hypotension only developed on the third treatment day (2). 

Fig. 13.5. An 80 year old lady, 3 years after fundoplication presented with severe solid food dysphagia, weight loss and heartburn. Endoscopy revealed severe esophagitis. Upper G1 series showed a constant level of mucus and sedimented contrast material as a sign of delayed oesophageal clearance (white arrow). Small parts of the stomach are above the diaphragmatic hiatus (black arrow), indicating a partial migration of the fundoplication without disruption of the wrap itself. pH monitoring did not reveal reflux and the oesophagitis was suspected to be due to retention. Dilatation of the wrap was successful...

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