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Ixabepilone

(iks-uh-BEP-uh-lone)

Trade/other name(s): Ixempra

Why would this drug be used?

This chemotherapy drug is given alone or along with the chemotherapy pill capecitabine (Xeloda) to treat breast cancer. It is used when certain other chemotherapy medicines have not worked. Ixabepilone is also being studied for treating other types of cancer.

How does this drug work?

Ixabepilone belongs to the class of drugs called epothilones. When cells divide (and multiply) structures called microtubules are needed to pull the chromosomes apart into the new cells. Ixabepilone stops the microtubules from forming so that the cells are stuck in the middle of dividing. When this happens, the cells die. Because cancer cells divide more quickly than normal cells, they are more likely than normal cells to be affected by this drug.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have ever had a serious reaction to Cremophor, other forms of castor oil, or the drug Taxol (Taxol also contains Cremophor).
  • If you have any liver problems. Ixabepilone is broken down by the liver. If the liver doesn't work well, it can take longer for the body to get rid of the drug, and raises the risk of serious side effects.
  • If you have ever had a heart problem.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if taken at the time of conception or during pregnancy. Men and women who are taking this drug need to use some kind of birth control. It is important to check with your doctor about what kinds of birth control can work with this medicine.
  • If you are breast-feeding. The drug may pass into breast milk and affect the baby.
  • If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Certain medications can interfere with the breakdown (metabolism) of ixabepilone, leading to an increase in serious side effects. These include:

  • antifungal medications: ketoconazole, itraconazole, and voriconazole
  • antiviral medications: atazanavir, saquinavir, ritonovir, amprenavir, indinavir, nelfinavir, and delaviridine
  • antibiotics: Clarithromycin, erythromycin, and telithromycin
  • antidepressant: nefazodone

Other drugs can lower blood levels of ixabepilone, so that it is less likely to work against the cancer. These are:

  • dexamethasone
  • phenytoin (Dilantin)
  • carbemazepine (Tegretol)
  • phenobarbital
  • rifampin, rifampicin, and rifabutin
  • St. John's Wort, an herbal supplement, can also decrease ixabepilone levels (this would make it less likely to work against the cancer).

Interactions with foods

Grapefruit and grapefruit juice can cause drug levels to get too high (leading to an increase in serious side effects).

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

It is given into a vein (IV) over 3 hours every 3 weeks.

This drug is mixed with a substance called Cremophor, which can cause severe allergic reactions. A reaction may start with symptoms like a rash, trouble breathing, and flushing (the skin gets red and feels warm). In serious reactions, the blood pressure can drop, so that the patient feels lightheaded or even passes out. Some people also have chest pain and irregular heartbeat. To help prevent this reaction, patients are given an antihistamine like diphenhydramine (Benadryl) and an H-2 blocker (like ranitidine/Zantac) at least one hour before the ixabepilone is given.

If symptoms of an allergic reaction start during an infusion, the chemotherapy is usually stopped while drugs are given to treat the reaction. To prevent further reactions, an extra drug (such as dexamethasone, a corticosteroid) will be given before the next treatment.

Precautions

Serious allergic reactions can happen when this drug is given. Tell your doctor or nurse right away if you notice itching, raised welts on the skin, chest tightness or pain, erratic heartbeat, trouble breathing, or if you feel hot, flushed, lightheaded, or dizzy during or after getting the drug.

The liquid that is used to dilute ixabepilone also contains a small amount of ethanol (alcohol). This can cause people to feel sleepy or even a little drunk.

This drug can cause low blood counts. In a few cases, fatal infections have occurred in patients taking ixabepilone because of low white blood cell counts. Patients on this drug should have their blood counts checked regularly. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, diarrhea, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Ixabepilone can damage nerves (called neuropathy), which can cause numbness, tingling, a burning sensation, or even pain in the hands or feet. This can be more of a problem in someone who had diabetes or neuropathy before treatment is started. Tell your doctor if you notice this.

This drug may cause heart problems, such as chest pain (angina), weakening of the heart muscle, and irregular heart beat. So far, these problems were only seen when ixabepilone was given along with the chemotherapy pill capecitabine. Call your doctor if you notice chest pain, trouble breathing, dizziness, heart palpitations, swelling of legs or feet, or sudden weight gain.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • low white blood cell count with increased risk of infection*
  • numbness, tingling, burning, or pain in the hands or feet (neuropathy)*
  • fatigue (tiredness)
  • joint and muscle pain
  • nausea and vomiting
  • mouth sores and mouth pain
  • diarrhea
  • hair loss

When ixabepilone was given with capecitabine, the following problems were also seen frequently (some of these were just as common as when capecitabine was given by itself)

  • hand-foot syndrome (redness, pain, and blistering of the palms of the hands and the soles of the feet)
  • loss of appetite
  • abdominal pain
  • constipation

Less common

  • low red blood cell count (anemia) with increased risk of fatigue*
  • low platelet count with increased risk of bleeding*
  • allergic reactions*
  • chest pain*
  • loss of appetite (more commonly seen when ixabepilone was given with capecitibine)
  • weight loss (more commonly seen when ixabepilone was given with capecitibine)
  • abdominal pain (more commonly seen when ixabepilone was given with capecitibine)
  • constipation (more commonly seen when ixabepilone was given with capecitibine)
  • heartburn and reflux
  • problems with taste
  • headache
  • dizziness
  • shortness of breath
  • rash
  • feeling itchy (pruritis)
  • fever and infections
  • flushing

Rare

  • weakening of the heart muscle*
  • irregular or rapid heart beat*
  • hand-foot syndrome (this happened much more when ixabepilone was given with capecitibine; see "Common" section)
  • watery eyes
  • dehydration (this happened more when ixabepilone was given with capecitibine)
  • skin changes (peeling or becoming darker)
  • fever with low white blood cells (this is known as febrile neutropenia)

*See Precautions section for more information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 2007

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 12/03/2009
Last Revised: 12/03/2009