Which sclerosing agents may prevent the recurrence of malignant pleural effusions?

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Various agents, including talc, doxycycline, bleomycin sulfate (Blenoxane), zinc sulfate, and quinacrine hydrochloride, can be employed to sclerose the pleural space and effectively prevent recurrence of the malignant pleural effusion.

Talc is the most effective sclerosing commercially available agent and can be administered as slurry through chest tubes or pleural catheters. Although a systematic review suggested that direct insufflation of talc via thoracoscopy was more effective than talc slurry, both were equally effective in a 2005 prospective trial of malignant effusions. [55] Importantly, talc particles tend to occlude the small drainage holes in small pleural catheters. Therefore, pleural catheters should be at least 10-12F if intended for talc pleurodesis.

Doxycycline and bleomycin are also effective in most patients and can be administered more easily through small-bore catheters, although they are somewhat less effective and substantially more expensive than talc.


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