Docetaxel - Instructions For Use, Price, Reviews, Analogues

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Docetaxel

Docetaxel: instructions for use and reviews

1. 1. Release form and composition
2. 2. Pharmacological properties
3. 3. Indications for use
4. 4. Contraindications
5. 5. Method of application and dosage
6. 6. Side effects
7. 7. Overdose
8. 8. Special instructions
9. 9. Application during pregnancy and lactation
10. 10. Use in childhood
11. 11. In case of impaired renal function
12. 12. For violations of liver function
13. 13. Use in the elderly
14. 14. Drug interactions
15. 15. Analogs
16. 16. Terms and conditions of storage
17. 17. Terms of dispensing from pharmacies
18. 18. Reviews
19. 19. Price in pharmacies

Latin name: Docetaxel

ATX code: L01CD02

Active ingredient: Docetaxel (docetaxel)

Manufacturer: VIVIMED LABS (India)

Description and photo update: 18.10.2018

Prices in pharmacies: from 2268 rubles.

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Docetaxel is an herbal anticancer drug.

Release form and composition

The dosage form of Docetaxel is a concentrate for the preparation of a solution for infusion 40 mg / ml: transparent, from brownish-yellow to yellow, viscous; solvent - colorless, transparent (in transparent glass vials of 0.5 or 2 ml, 1 bottle is placed in a cardboard box complete with solvent in vials of 1.5 or 6 ml, respectively).

Composition of 1 ml of concentrate:

• active ingredient: docetaxel - 40 mg (docetaxel trihydrate - 42.8 mg);
• auxiliary component: polysorbate 80 - up to 1 ml.

Composition of 1 ml of solvent:

• 95% ethanol - 127.4 mg;
• water for injection - up to 1 ml.

To compensate for losses in the syringe and needle, the vials of concentrate and solvent are filled with a slight excess.

Pharmacological properties

Pharmacodynamics

Docetaxel is a herbal anticancer drug (taxoid group). It accumulates tubulin in microtubules, preventing their breakdown, which leads to disturbances in the process of tumor cell division. The substance is stored for a long time in cells, where it reaches a high concentration. Also, docetaxel is active against certain cells that produce an excessive amount of P-glycoprotein (P-gP).

Pharmacokinetics

Docetaxel has a dose-dependent pharmacokinetics that is consistent with a three-phase pharmacokinetic model with half-lives for the α, β and γ phases (4 minutes / 36 minutes / 11.1 hours, respectively).

The mean values of the maximum plasma concentration of Docetaxel (C _max) after infusion of 100 mg / m ² Docetaxel for 60 minutes was 0.0037 mg / ml with the corresponding area under the concentration-time curve (AUC) 0.0046 mg / h / ml. The volume of distribution in the equilibrium state and the total clearance averaged 113 l and 21 l / h / m ^2, respectively. The total clearance of docetaxel varies between patients by about 50%.

The substance binds to blood plasma proteins by more than 95%.

Docetaxel is excreted within 7 days through the kidneys, gastrointestinal tract, urine and feces (6% and 75% of the administered dose, respectively). Approximately 80% of the administered dose of the substance is excreted in the form of metabolites in the feces (the main inactive metabolite and 3 less significant inactive metabolites) within 48 hours, unchanged - in a small amount.

Indications for use

• operable breast cancer (BC) (combination with doxorubicin and cyclophosphamide, adjuvant chemotherapy): with regional lymph node involvement; without damage to regional lymph nodes in women who, according to international selection criteria, are shown to undergo chemotherapy in the early stages of the disease (in cases of the presence of a factor / factors of high risk of recurrence: age up to 35 years, tumor size more than 20 mm, negative status of progesterone / estrogen receptors, II– III histological degree of tumor malignancy);
• non-small cell lung cancer: locally advanced / metastatic in cases of ineffectiveness of the previous course of chemotherapy - as monotherapy; unresectable locally advanced / metastatic - combination with cisplatin, first-line therapy;
• metastatic / locally advanced breast cancer: combination with doxorubicin, first-line therapy; with tumor overexpression of HER2 - combination with trastuzumab, first-line therapy; in cases of ineffectiveness of the previous course of chemotherapy, which included alkylating agents or anthracyclines - as monotherapy; if it included only anthracyclines, a combination with capecitabine;
• prostate cancer: metastatic hormone-resistant (androgen-independent) - combination with prednisolone or prednisone;
• ovarian cancer: metastatic ovarian cancer in cases of ineffectiveness of previous 1st-line therapy - as monotherapy, 2nd-line therapy;
• head and neck cancer: locally advanced squamous cell - combination with fluorouracil and cisplatin, induction therapy;
• gastric cancer: metastatic, including cancer of the esophageal-gastric junction - combination with fluorouracil and cisplatin, 1st line therapy.

Contraindications

Absolute:

• the initial number of neutrophils in the peripheral blood <1500 / μl;
• severe violations of hepatic function;
• the period of pregnancy and breastfeeding;
• age up to 18 years;
• the presence of severe hypersensitivity reactions to the components of the drug.

When carrying out combined treatment, contraindications to other drugs in the treatment regimen should also be taken into account.

Combined use with drugs that induce / inhibit isoenzymes of cytochrome P450-3A, or are metabolized using isoenzymes of cytochrome P450-3A (terfenadine, cyclosporine, drugs with antifungal action from the group of imidazoles - itraconazole, ketoconazole, troleitoryandomycin - inhibitors)) requires caution.

Instructions for the use of Docetaxel: method and dosage

Docetaxel should be used under the supervision of an experienced physician in a specialized hospital.

All patients (except for prostate cancer), in cases where there are no contraindications, should be premedicated with a glucocorticosteroid, for example, 8 mg 2 times a day, oral dexamethasone for 3 days, starting 1 day before the start of drug administration (this is a preventive measure the development of hypersensitivity reactions and a decrease in fluid retention). For prostate cancer patients receiving prednisone / prednisolone, dexamethasone is prescribed in the same single dose 12, 3 and 1 hour before the start of drug administration.

To reduce the likelihood of hematological complications, prophylactic administration of granulocyte colony-stimulating factor (G-CSF) is recommended.

Docetaxel is assigned 1 every 3 weeks intravenously for 1 hours on the 75 or 100 mg / m ² as a single agent or in combination with other drugs (therapeutic and indications determined scheme).

Docetaxel is administered when the number of neutrophils in the peripheral blood is ≥ 1500 / μl. In cases when developing febrile neutropenia expressed / cumulative skin reactions or severe peripheral neuropathy observed for more than 7 days a decrease of neutrophil count <500 / ul, the following dose administration should be reduced to 75/100 mg / m ² to 60 / 75 mg / m ². If symptoms persist when using the minimum dose (60 mg / m ²), docetaxel is canceled. Also, correction of the dosage regimen can be carried out with the development of other disorders.

Docetaxel concentrate must first be diluted in the supplied solvent. If the drug and solvent were stored in the refrigerator, the vials should be kept at room temperature for 5 minutes before diluting them. All the solvent contained in the vial must be drawn with a needle into a syringe and introduced into the vial with the concentrate (in compliance with the rules of asepsis). The solution should be stirred by turning the bottle up and down for 45 seconds (shaking is unacceptable), after which it must be left for 5 minutes at room temperature. The resulting concentration is 10 mg / ml.

To prepare an infusion solution, a single dose should be introduced into an infusion bottle / bag containing 250 ml of 5% dextrose solution or 0.9% sodium chloride solution. If the required dose of Docetaxel is more than 200 mg, a larger volume of infusion solution must be used (the concentration of docetaxel is not more than 0.74 mg / ml). The contents of the bottle / infusion bag must be mixed with a rotary motion.

Infusion should be carried out within 4 hours after receiving the solution (taking into account 1 hour of its administration) when stored at temperatures up to 25 ° C.

Side effects

Estimation of the incidence of side effects:> 10% - very often; > 1% and 0.1% and 0.01% and <0.1% - rarely; <0.01% - very rare.

Monotherapy at doses of 75 or 100 mg / m ²

• digestive system: very often - anorexia, vomiting, nausea, diarrhea, stomatitis; often - stomatitis, nausea, diarrhea and vomiting in severe course, gastrointestinal bleeding, constipation, epigastric pain, esophagitis; infrequently - esophagitis, constipation and gastrointestinal bleeding in severe course;
• lymphatic system: very often - noncumulative / reversible neutropenia (observed in 96.6% of cases in the absence of G-CSF; the number of neutrophils decreases to a minimum value usually after 7 days, this period may be shorter in patients with intensive previous chemotherapy; the average duration is pronounced neutropenia - 7 days), infections, febrile neutropenia; often - severe infections occurring with a decrease in the number of neutrophils in the peripheral blood <500 / μL, severe infections (including pneumonia, sepsis, including fatal), bleeding in combination with thrombocytopenia <50,000 / μL and anemia (hemoglobin <11 g / dl, sometimes in severe course - hemoglobin <8 g / dl), thrombocytopenia <100,000 / μl; infrequently - severe thrombocytopenia;
• subcutaneous tissue / skin: very often - reversible skin reactions (mild / moderate; in the form of localized rashes, often accompanied by itching; most often develop within 7 days after intravenous infusion of Docetaxel), nail disorders (hyper- and hypopigmentation, pain and onycholysis), alopecia; often - severe skin reactions (rash followed by desquamation, including severe hand-plantar syndrome, may be the reason for interrupting / discontinuing the use of the drug); infrequently - severe alopecia;
• immune system: very often - allergic reactions (they can develop soon after the start of the solution, they are usually mild / moderately pronounced, manifest as hyperemia of the skin, rash with / without itching, chest tightness, back pain, shortness of breath, chills, drug fever); often - severe allergic reactions (manifested as a generalized rash / erythema, bronchospasm, a decrease in blood pressure; after stopping the administration of the solution and taking appropriate measures, they pass);
• liver and biliary tract: often - a significant increase in the activity of AST (alanine aminotransferase), ALT (aspartate aminotransferase), alkaline phosphatase and the concentration of bilirubin in the blood;
• cardiovascular system: often - bleeding, decrease / increase in blood pressure, heart rhythm disturbances; infrequently - heart failure;
• musculoskeletal / connective tissue: very common - myalgia; often - arthralgia;
• respiratory system: very often - shortness of breath; often severe shortness of breath;
• nervous system: very often - neurosensory reactions in mild / moderate severity (dysesthesia, paresthesia, pain), impaired taste, neuromotor reactions (muscle weakness); often - neuromotor / neurosensory reactions in severe course (III-IV degree); infrequently - violations of taste sensations in severe course;
• general disorders, local reactions: very often - asthenia (including severe), localized / generalized pain syndrome, fluid retention (peripheral edema, weight gain, pericardial / pleural effusion, ascites; decreased blood pressure or acute episodes of oliguria not accompanied); often - reactions at the injection site of Docetaxel (hyperpigmentation, inflammation, redness / dryness of the skin, phlebitis, hemorrhages from the punctured vein, vein edema; usually mild), pronounced localized / generalized pain syndrome.

Docetaxel in combination with doxorubicin

In comparison with monotherapy, there is a change in the frequency of occurrence of the following disorders:

• increase: neutropenia (including severe), febrile neutropenia, infections (including severe), heart failure, alopecia, thrombocytopenia (including severe), anemia, nausea, vomiting, diarrhea (including including severe), constipation, stomatitis (including severe);
• decrease: asthenia, myalgia, allergic / skin reactions (including severe), rhythm disturbances, nail damage (including severe), fluid retention (including severe), anorexia, neuromotor / sensorineural reactions (including severe), hypotension, increased activity of alkaline phosphatase, hepatic transaminases, the concentration of bilirubin in the blood.

Docetaxel in combination with doxorubicin and cyclophosphamide (TAS regimen)

In comparison with monotherapy, there is a change in the frequency of occurrence of the following disorders:

• increase: arthralgia, alopecia, mild anemia, thrombocytopenia, asthenia, nausea, constipation, vomiting, stomatitis, taste disturbances;
• decrease: febrile neutropenia, allergic reactions, arrhythmia, nail lesions, diarrhea, neutropenia, severe anemia, infections, peripheral edema, neuromotor / sensorineural reactions.

Additional adverse reactions: enterocolitis, colitis, nonfatal colon perforation, myelodysplastic syndrome / acute myeloid leukemia.

In cases of prophylactic use of G-CSF, a significant decrease in the incidence of neutropenia and neutropenic infections of III – IV severity is observed.

Docetaxel in combination with capecitabine

In comparison with monotherapy, there is a change in the frequency of occurrence of the following disorders:

• increase: disturbances from the digestive system (disturbances in taste perception, vomiting, stomatitis, abdominal pain, diarrhea, constipation), arthralgia, thrombocytopenia and anemia in severe course, hyperbilirubinemia, palmar-plantar syndrome;
• decrease: severe neutropenia, anorexia, alopecia, disorders of the nails (including onycholysis), myalgia, asthenia, loss of appetite.

Additional adverse reactions: weight loss, lacrimation, pain, nosebleeds, back pain, lethargy, shortness of breath, dehydration, cough, dizziness, peripheral neuropathy, headache, paresthesia, dry mouth, pyrexia, dyspepsia, sore throat, cavity candidiasis mouth, erythematous rash, dermatitis, discoloration of nails, pain in the extremities.

In patients over 60 years of age, the development of grade III – IV toxicity is observed more often than in younger patients.

Docetaxel in combination with trastuzumab

In comparison with monotherapy, there is a change in the frequency of occurrence of the following disorders:

• increase: anorexia, nausea, taste disturbances, diarrhea, abdominal pain, constipation, arthralgia, febrile neutropenia, toxic effects of IV degree of severity, cases of heart failure;
• decrease: stomatitis, vomiting, myalgia, alopecia, neutropenia III – IV degree of severity, weakness, asthenia, skin rashes, nail damage.

Additional side reactions: pain in the pharynx and larynx, paresthesia, hypesthesia, headache, rhinorrhea, conjunctivitis, lacrimation, inflammation of the mucous membranes, nasopharyngitis, nosebleeds, pain in the bones, back and limbs, lethargy, shortness of breath, dyspepsia, insomnia, erythema, flu-like illnesses, cough, pyrexia, chills, pain, chest pain.

In comparison with monotherapy, there is an increase in the incidence of adverse reactions in severe cases against the background of combined treatment.

Docetaxel in the AC-TH scheme

In comparison with monotherapy, there is a change in the frequency of occurrence of the following disorders:

• increase: heart failure, alopecia, anemia (including III-IV degrees), thrombocytopenia (including III-IV degrees), nausea (including III-IV degrees), anorexia, stomatitis, vomiting, constipation, diarrhea, abdominal pain, myalgia, increased activity of ACT, ALT and alkaline phosphatase, nail damage, arthralgia, III – IV degree infections;
• Decrease: allergic reactions, fluid retention, neutropenia III – IV degree of severity, neuromotor / neurosensory reactions, desquamation, rash.

Additional side reactions: insomnia, an increase in the concentration of creatinine in the blood.

Docetaxel in combination with cisplatin or carboplatin

In comparison with monotherapy, there is a change in the frequency of occurrence of the following disorders:

• increase: thrombocytopenia (including III-IV degree), nausea (including III-IV degree), diarrhea III-IV degree of severity, anorexia (including III-IV degree), reactions in injection site;
• Decrease: neutropenia (including III-IV degree), anemia (including III-IV degree), infections, febrile neutropenia, skin / allergic reactions, nail damage, fluid retention (including III –IV degree), stomatitis, neuromotor / sensorineural neuropathy, alopecia, myalgia, asthenia.

Additional side reactions: pain, fever in the absence of infection (including III-IV degree).

Docetaxel in combination with prednisone or prednisone

In comparison with monotherapy, there is a change in the frequency of occurrence of the following disorders:

• increase: heart failure, taste disturbances;
• Decrease: alopecia, rash, desquamation, nausea, diarrhea, stomatitis, anemia (including III-IV degrees), infections, arthralgia, vomiting, myalgia, neutropenia (including III-IV degrees), neuromotor / neurosensory reactions, thrombocytopenia, febrile neutropenia, weakness, allergic reactions, anorexia, fluid retention.

Additional side reactions: lacrimation, weakness, shortness of breath, nosebleeds, cough.

Docetaxel in combination with cisplatin and fluorouracil

In comparison with monotherapy, there is a change in the frequency of occurrence of the following disorders:

• increase: anemia (including III-IV degrees), thrombocytopenia (including III-IV degrees), febrile neutropenia, neutropenic infections (even in cases of G-CSF use), nausea, vomiting, anorexia, stomatitis, diarrhea, dysphagia / esophagitis / pain when swallowing;
• reduction: cutaneous desquamation, infections, fluid retention, allergic reactions, neuromotor / neurosensory reactions, myalgia, alopecia, pruritus, rash, nail damage, heart rhythm disturbances.

Additional adverse reactions: myocardial ischemia, conjunctivitis, heartburn, fever in the absence of infection, lethargy, hearing changes, dizziness, dry skin, lacrimation, accentuated venous pattern, cancer pain, weight loss.

The prophylactic use of G-CSF leads to a decrease in the incidence of neutropenic infectious complications / febrile neutropenia.

Post-marketing observations

• lymphatic system and blood: suppression of bone marrow hematopoiesis and other hematological side reactions; disseminated intravascular coagulation syndrome (disseminated intravascular coagulation syndrome), often in combination with multiple organ failure or sepsis;
• neoplasms: very rarely - acute myeloid leukemia and myelodysplastic syndrome;
• nervous system: rarely - convulsions or transient loss of consciousness (may develop during infusion);
• the immune system: rarely - anaphylactic shock (death is possible; in patients who received premedication, these disorders ended in death in very rare cases);
• organ of hearing and vision: rarely - ototoxic effect of the drug with impaired / hearing loss, lacrimation with / without conjunctivitis, transient visual disturbances, cystic edema of the macular region;
• cardiovascular system: rarely - myocardial infarction and venous thromboembolic complications;
• digestive system: rarely - dehydration, intestinal / stomach perforation, colitis, neutropenic enterocolitis, ileus, intestinal obstruction;
• skin and subcutaneous tissues: very rarely - Stevens-Johnson syndrome, cutaneous lupus erythematosus, bullous rash, erythema multiforme, toxic epidermal necrolysis;
• respiratory system: rarely - pulmonary fibrosis, acute respiratory distress syndrome, interstitial pneumonia / lung disease, respiratory failure, radiation pneumonia;
• kidney and urinary tract: deterioration of renal function, renal failure, hyponatremia with dehydration, pneumonia and vomiting;
• biliary tract and liver: rarely - hepatitis (sometimes fatal; more often in the presence of concomitant liver disease);
• general disorders and local reactions: rarely - pulmonary edema, the phenomenon of return in a previously irradiated area of a local radiation reaction.

Overdose

There are few reports of overdose.

Main symptoms: suppression of bone marrow function, mucositis, peripheral neurotoxicity.

There is no data on an antidote to Docetaxel. In cases of overdose, the patient must be hospitalized in a specialized department and the function of vital organs must be carefully monitored. Patients need G-CSF as soon as possible. If necessary, symptomatic treatment is carried out.

special instructions

Due to the high risk of neutropenia, during the period of therapy, careful monitoring of the clinical blood test is required.

Patients of childbearing age, including men, should use reliable contraceptive methods while using the drug. Docetaxel is genotoxic and can lead to impaired male fertility. In this regard, men should refrain from conceiving a child during the period of therapy and for another 6 months after its completion. It is recommended to preserve sperm before starting treatment. If pregnancy occurs during the course, the woman needs to urgently consult a doctor.

Since there is a possibility of hypersensitivity reactions, the condition of patients should be carefully monitored, especially during 1-2 infusions. Hypersensitivity reactions can develop in the very first minutes of drug administration (it is necessary to have equipment / drugs for the treatment of bronchospasm and arterial hypotension). If hypersensitivity reactions appear, immediate discontinuation of the drug is required. If the violations were severe, therapy is not resumed.

The drug contains ethanol, which should be taken into account by patients with alcoholism, as well as by patients at risk (with epilepsy and liver disease).

If during the period of therapy there are any visual impairments, a complete ophthalmological examination is indicated (due to the likelihood of cystic edema of the macular region; in cases of its diagnosis, Docetaxel is canceled).

The condition of patients who have severe fluid retention requires careful monitoring. In cases of their appearance, the use of diuretics and the restriction of drinking and salt regimes are indicated.

If severe sensory neuropathy develops, the dose of Docetaxel should be reduced.

During preparation and administration of the solution, its potential toxicity must be taken into account. In case of contact of the solution on the skin / mucous membranes, they must be immediately washed with water.

Influence on the ability to drive vehicles and complex mechanisms

Taking into account the profile of side effects from the organ of vision, nervous and digestive systems, it is not recommended to drive vehicles during the period of therapy.

Application during pregnancy and lactation

According to the instructions, Docetaxel is contraindicated for use during pregnancy and breastfeeding.

Pediatric use

The safety profile for children under 18 has not been studied (there is only limited experience with use). The safety / efficacy of nasopharyngeal cancer therapy for patients aged 1 month to 18 years has not yet been established.

Docetaxel has not been used in children for the following indications: prostate, breast and stomach cancer, as well as non-small cell lung cancer and head and neck cancer, with the exception of poorly differentiated nasopharyngeal cancer (type I – II).

With impaired renal function

There is no information on the use of Docetaxel for severe renal impairment.

For violations of liver function

Patients with ALT / ACT activity> 1.5 VHN (upper limit of normal) or alkaline phosphatase activity> 2.5 VGN Docetaxel is recommended to be prescribed at an initial dose of 75 mg / m ².

With an increase in the concentration of bilirubin in the blood (> 1 ULN) and / or a significant increase in ALT / ACT activity (> 3.5 ULN) in combination with an increase in alkaline phosphatase activity (> 6 ULN), a dose reduction cannot be recommended. Docetaxel can be prescribed to patients in this group only if there are strict indications.

Combined treatment with cisplatin and fluorouracil for gastric cancer was not used in patients with increased ALT / ACT activity (> 1.5 ULN) in combination with an increase in the concentration of bilirubin in the blood (> 1 ULN) and alkaline phosphatase activity (> 2.5 ULN) … Docetaxel can be prescribed to patients in this group only if there are strict indications.

There is no information regarding the use of other combination regimens in patients with impaired renal function.

Use in the elderly

When conducting combination therapy with capecitabine, it is recommended to reduce its dose by 25%.

Drug interactions

Given the likelihood of a pronounced interaction, care must be taken when combined use with substances that induce / inhibit cytochrome P450-3A isoenzymes, or metabolized using cytochrome P450-3A isoenzymes - cyclosporine, troleandomycin, ketoconazole, terfenadine, erythromycin CYP3A, as well as inhibitors - from the group of imidazoles (ketoconazole, itraconazole) and protease inhibitors (ritonavir).

Other possible interactions:

• ketoconazole: significant decrease in docetaxel clearance;
• carboplatin: significant increase in its clearance.

Analogs

Docetaxel analogues are: Docetaxel Sandoz, Docetaxel-Rus, Docetaxel-Phylaxis, Docetera, Novotax, Tautax, Oncodocel, Taxotere.

Terms and conditions of storage

Store in a place protected from light at a temperature of 2-8 ° C. Keep out of the reach of children.

Shelf life:

• concentrate - 2 years;
• solvent - 3 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews of Docetaxel

According to reviews, Docetaxel is an effective drug, while patients note the development of side effects of varying severity.

Docetaxel price in pharmacies

At the moment, the price of Docetaxel is unknown, it is impossible to buy the drug in pharmacies.

Analogs price:

• Docetaxel Sandoz 10 mg / ml (1 bottle): 2 ml - in the range of 2269-4005 rubles; 8 ml - 9378-10 800 rubles; 16 ml –15,000–21,938 rubles;
• Docetaxel-Rus 40 mg / ml (1 bottle): 0.5 ml - in the range of 3900–6295 rubles; 2 ml - 19,900–27,218 rubles; 3 ml - 30 840–34 850 rubles;
• Tautax 20 mg / ml (1 bottle): 1 ml - about 6900 rubles; 2 ml - about 14,700 rubles; 4 ml - about 25,700 rubles; 8 ml - about 55,300 rubles.

Docetaxel: prices in online pharmacies

Drug name Price Pharmacy

Docetaxel Sandoz 10 mg / ml concentrate for preparation of solution for infusion 2 ml 1 pc. 2268 RUB Buy

Docetaxel Sandoz Conc. prigot. solution for inf. 10 mg / ml vial 2 ml No. 1 2270 RUB Buy

Docetaxel Sandoz 10 mg / ml concentrate for preparation of solution for infusion 8 ml 1 pc. RUB 5300 Buy

Docetaxel Sandoz Conc. prigot. solution for inf. 10 mg / ml vial 8 ml No. 1 RUB 8297 Buy

Docetaxel Sandoz 10 mg / ml concentrate for solution for infusion 16 ml 1 pc. RUB 11179 Buy

Docetaxel Sandoz Conc. prigot. solution for inf. 10 mg / ml vial 16 ml No. 1 RUB 13,999 Buy

Maria Kulkes Medical journalist About the author

Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!