Several parenteral drugs are formulated with Cremophor EL (BASF), which is polyethoxylated castor oil. Some patients develop a pseudoallergic hypersensitivity reaction that can be life-threatening.
Cremophor is a surfactant which can help solubilize an emulsion of a nonpolar drug in an aqueous solution.
Drugs that have been formulated with Cremophor include:
(1) paclitaxel (Taxol)
(2) miconazole
(3) vitamin K
(4) Sandimmune
Some drugs originally formulated with Cremophor have been reformulated as a lipid emulsion or with an albumin coating.
Mechanism of hypersensitivity: direct complement activation
Clinical features of the hypersensitivity reaction:
(1) A hypersensitivity reaction appears in a susceptible individual soon after starting an infusion.
(2) The reaction stops once administration stops.
(3) No reaction occurs to the drug formulated to be Cremophor-free.
(4) Occasionally the patient will report a hypersensitivity reaction to another drug formulated with Cremophor EL.
Differential diagnosis:
(1) allergy to another component of the drug formulation
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