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Paclitaxel

(pak-lit-tax-uhl)

Trade/other name(s): Taxol, Onxol, Paxene

Why would this drug be used?

This drug is used to treat breast, lung, and ovarian cancers, as well as Kaposi sarcoma. Your doctor may also use it to treat other types of cancer.

How does this drug work?

Paclitaxel is a type of chemotherapy drug known as a taxane. It is thought to work by interfering with microtubules, which are part of the internal scaffolding needed by cells when they are dividing into 2 cells. Over time, this leads to cell death. 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 any medicines, dyes, additives, or foods.
  • If you have any type of liver disease (including hepatitis). This drug is cleared from the body mainly by the liver. Reduced liver function might result in more drug staying in the body, which could lead to worse side effects. Your doctor may need to adjust your dose.
  • If you have any other medical conditions such as kidney disease, heart disease, diabetes, gout, high blood pressure, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause problems with the fetus if taken at the time of conception or during pregnancy. Men and women who are taking this drug should use some kind of birth control during treatment. Check with your doctor about what kinds of birth control can be used with this medicine. In pregnant women, treatment with this drug should be used only if the potential benefit to the mother outweighs the risk to the fetus.
  • If you are breast-feeding. While no studies have been done, this drug may pass into breast milk and affect the baby. Breast-feeding is not recommended during treatment with this drug.
  • If you think you might want to have children in the future. This drug may affect fertility. Talk with your doctor about the possible risk with this drug and the 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

Paclitaxel may interact with a number of drugs and supplements, which may either raise or lower the level of paclitaxel in your blood. Tell your doctor if you are taking any of the following:

  • TB drugs rifampin or rifabutin
  • anti-seizure drugs phenytoin, phenobarbital, carbamazepine
  • cyclosporine (used to prevent organ rejection)
  • anti-fungal drugs itraconazole or ketoconazole
  • anti-depressants such as nefazodone, fluoxetine, and others
  • antibiotics erythromycin, clarithromycin, ciprofloxacin
  • anti-viral drugs for HIV, such as ritonavir, nelfinavir, indinavir, efavirenz, nevirapine, and others
  • St. John's wort (herbal supplement)

If you are taking the blood thinner warfarin (Coumadin), paclitaxel may increase its effect. Your doctor may want to watch you more closely.

Research on interactions with other drugs is incomplete at this time. Check with your doctor, nurse, or pharmacist about your other medicines, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

Grapefruit or grapefruit juice may change the level of paclitaxel in your blood. Check with your doctor, nurse, or pharmacist about whether these or other foods may be a problem.

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

How is this drug taken or given?

Paclitaxel is given by an injection in a vein, usually over a 3-hour period, every 3 weeks. Sometimes, smaller doses are given weekly and infused over a shorter time. Rarely, it is given by an infusion over 24 hours. The dose depends on your weight, how well your liver is working, the side effects you are having, and how often the medicine is given.

You will likely get medicines to lessen the chance you will have an allergic reaction to this drug. This will include a steroid medicine, dexamethasone, to take the night before and on the morning of treatment. The antihistamine medicines diphenhydramine (Benadryl) and either cimetidine (Tagamet) or ranitidine (Zantac) are usually given about an hour before the infusion. You will also likely get an anti-nausea medicine before the paclitaxel, especially if the medicine is being given every 3 weeks.

Precautions

This drug can cause allergic reactions in some people when the drug is given, especially with the first few treatments. While you will be given medicine ahead of time to lower this risk, reactions are still possible. Mild reactions may consist of fever, chills, skin itching, or feeling flushed. More serious reactions happen rarely, but can be dangerous. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), chest tightness, shortness of breath, back pain, or swelling of the face, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms during or after being given the drug.

In rare cases during an intravenous (IV) infusion, the drug may leak out of the vein and under the skin, where it may damage the tissue, causing pain, open sores, and scarring. Tell the nurse right away if you notice redness, pain, or swelling at or near the IV site.

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

This drug may cause sores in the mouth or on the lips, which often occur within the first few weeks after starting treatment. This can cause mouth pain, bleeding, or even trouble eating. Your doctor or nurse can suggest ways to reduce this, such as changing the way you eat or how you brush your teeth. If needed, your doctor can prescribe medicine to help with the pain.

This drug can cause diarrhea, which in some cases may be severe. If left unchecked, this can lead to dehydration and chemical imbalances in the body. Your doctor may prescribe medicine to help prevent or control this side effect. Make sure you get the medicine right away, so that you will have it at home when you need it. Take the medicine as prescribed.

This drug may cause damage to certain nerves in the body, which can lead to a condition called peripheral neuropathy. This can cause numbness, weakness, pain, burning, or tingling, usually in the hands or feet. These are sometimes related to being exposed to hot or cold temperatures. These symptoms can get worse, so that you have trouble walking or holding things in your hands. Let your doctor know right away if you notice any of these symptoms. If your symptoms are severe enough, this drug may need to be stopped or the dose reduced until they get better.

This drug may increase liver enzyme levels in your blood. Your doctor will likely check your liver function with blood tests on a regular basis. The drug may need to be stopped if the changes are severe. If you have liver metastasis or other liver problems before starting treatment, the doctor may need to monitor you more carefully.

This drug can cause a condition known as hand-foot syndrome, in which a person may experience pain, numbness, tingling, reddening, or swelling in the hands or feet. Peeling, blistering, or sores on the skin in these areas are also possible. Let your doctor know right away if you notice any of these symptoms.

In rare cases, this drug can affect the heart rhythm, which could be serious and might even require the placement of a pacemaker. Tell your doctor or nurse right away if you feel your heart may be beating abnormally or if you have chest pain or feel short of breath, lightheaded, or dizzy.

Your doctor will likely test your blood frequently throughout your treatment, looking for possible effects of the drug on blood counts or on blood chemistry levels. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting a serious, or even life-threatening, infection. 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, or bringing up sputum.

This drug may lower your red blood cell count. If this occurs, it is usually a few months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

In rare cases, 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.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. This drug may affect your immune system, which could make vaccinations ineffective, or could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

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 serious infection*
  • mild allergic reaction (fever, flushing, itching, rapid heart rate)*
  • numbness, tingling, or pain in the hands, feet, or elsewhere*
  • nausea and/or vomiting*
  • diarrhea*
  • hair loss, including hair on the face and body
  • lowered red blood cell count (anemia) *

Less common

  • sores in the mouth or on the lips*
  • muscle or joint pain
  • pain, redness or swelling at the infusion site
  • fever
  • low blood pressure during infusion
  • feeling weak
  • feeling tired
  • change in how things taste
  • loss of appetite
  • skin rash
  • abnormal blood tests which suggest that the drug is affecting the liver* (Your doctor will discuss the importance of this finding, if any.)

Rare

  • low blood platelet count with increased risk of bleeding*
  • serious allergic reaction (might include shortness of breath, chest pain, throat swelling, dizziness)*
  • redness, pain, swelling, or blisters on hands or feet (hand-foot syndrome)*
  • retaining fluid (may include swelling in hands or feet, weight gain, less urine output)
  • nails changing color or becoming brittle
  • changes in heart rhythm*
  • darkening of skin where prior radiation was given (radiation recall)
  • excess tears from the eyes
  • death from allergic reactions, infections, liver damage, or other causes*

*See the "Precautions" section for more detailed 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 1992.

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: 12/18/2009
Last Revised: 12/18/2009