# Premedication against infusion reactions before taxanes, antibodies and other reaction-prone anticancer drugs

Source: https://onco.cc/protocols/premedication-before-reaction-prone-anticancer-drugs/  
OnCo record `premedication-before-reaction-prone-anticancer-drugs` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Before some cancer drugs you are given other medicines, usually a steroid such as dexamethasone and an antihistamine, to lower the chance of a reaction during the drip. For docetaxel the steroid tablets start the day before, so it matters that you take them as told. Many drugs need no premedication at all.

## Summary

ESMO (2017) recommends premedication with corticosteroids plus antihistamines before every taxane [IV, A]. For paclitaxel it gives intravenous dexamethasone with diphenhydramine 50 mg and an H2 antagonist 30 minutes before [II, A], noting a randomised trial in which short intravenous dexamethasone matched oral dexamethasone for reactions with fewer side effects [II, A]; the US label gives oral dexamethasone 20 mg 12 and 6 hours before, with diphenhydramine and an H2 antagonist 30 to 60 minutes before. For docetaxel the label and ESMO give oral dexamethasone 8 mg twice daily for 3 days starting the day before (8 mg at 12, 3 and 1 hours before in prostate cancer), against fluid retention as well as reactions.

For platinums ESMO does not routinely recommend premedication (consider in high-risk patients; it may not prevent a reaction) [IV, B]. For antibodies it varies by drug: rituximab always with an antipyretic and antihistamine [IV, A], with glucocorticoids considered in lymphoma and CLL; cetuximab with a corticosteroid plus antihistamine [IV, B], which can stop after the second infusion if no reaction; daratumumab with an intravenous corticosteroid, an antipyretic and an antihistamine before every infusion and oral corticosteroid on the two days after [IV, B]; none recommended for trastuzumab, bevacizumab, panitumumab or atezolizumab [IV, B]. Bleomycin in lymphoma starts with two doses of 2 units or less [IV, B]. ESMO asks nurses to check that oral premedication was taken [V, C]. Severe reactions still occur despite premedication (paclitaxel 2 to 4%).

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: chemotherapy premedication; taxane premedication; paclitaxel premeds; docetaxel dexamethasone; rituximab premedication; daratumumab premedication; pre-meds before chemotherapy

## Connected records

- protocols: [Anticancer treatment prescribing and pharmacy verification before each cycle](https://onco.cc/protocols/sact-prescribing-and-pharmacy-verification/), [Infusion and hypersensitivity reactions during anticancer treatment: recognition, emergency treatment and rechallenge](https://onco.cc/protocols/infusion-reaction-management/), [Rapid drug desensitisation after an allergic reaction to a platinum, taxane or antibody](https://onco.cc/protocols/drug-desensitisation-after-anticancer-hypersensitivity/)
- drugs: [Bleomycin](https://onco.cc/drugs/bleomycin/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [Daratumumab](https://onco.cc/drugs/daratumumab/), [Dexamethasone](https://onco.cc/drugs/dexamethasone/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Rituximab](https://onco.cc/drugs/rituximab/)
- terms: [Infusion reactions, hypersensitivity and extravasation](https://onco.cc/terms/extravasation-infusion-reaction/)

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