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Paclitaxel Protein-Bound Suspension

(pak-lit-tax-uhl)

Trade/other name(s): Abraxane, nanoparticle albumin-bound paclitaxel, nab-paclitaxel, ABI-007

Why would this drug be used?

This drug is used to treat breast cancer, non-small cell lung cancer (NSCLC), and pancreatic cancer. 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 faster than normal cells, they are more likely than normal cells to be affected by this drug.

Standard paclitaxel has to be dissolved in another medicine in order for it to be given into the blood, but this other medicine increases the risk of allergic reactions. Nab-paclitaxel consists of paclitaxel bound to a protein called albumin, allows the drug to be given without the need for the other medicine. This makes the risk of an allergic reaction lower than with standard paclitaxel.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including 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, lung 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 breastfeeding. While no studies have been done in humans, this drug may pass into breast milk and affect the baby. Breastfeeding 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

Nab-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)

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?

Nab-paclitaxel is given by infusion into a vein (IV) over about 30 minutes. It is typically given once every 3 weeks for breast cancer, once a week for NSCLC, and once a week for 3 weeks, followed by a week off, for pancreatic cancer.

The dose will depend on the type of cancer you have, how tall you are, how much you weigh, your blood counts, and how well you do when taking the drug.

Precautions

This drug may cause damage to certain nerves in the body, which can lead to a condition called sensory neuropathy. This can cause numbness, pain, or sensations of burning or tingling, usually in the hands or feet. These are sometimes triggered by being exposed to hot or cold temperatures. These symptoms can sometimes progress to include trouble walking or holding things in your hands. Let your doctor know right away if you notice any of them. The doctor may stop the drug or give you less of it until your symptoms get better.

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward, which can lead to dehydration and chemical imbalances. 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’s important to have these medicines on hand and to take them as prescribed.

This drug may cause sores in the mouth or on the lips, often 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 help, 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 could lead to dehydration and chemical imbalances in the body. Your doctor may prescribe medicine to help prevent or control this side effect. It is very important that you take this medicine as prescribed. 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 can affect the heart rhythm, which in rare cases can be serious. 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.

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.

Your doctor will test your blood often during your treatment, looking for effects of the drug on blood cell 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. Keep all your appointments for lab tests and doctor visits.

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. The risk of this is higher if it is given in combination with another chemotherapy drug. If this occurs, it is usually a month or more 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. The risk of this is higher if it is given in combination with another chemotherapy drug. This can occur in the weeks after the drug is given, and it 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 vaccines 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.

Rarely, this drug can cause lung inflammation (known as pneumonitis) when used with the chemotherapy drug gemcitabine to treat pancreatic cancer. This can cause trouble breathing, and can sometimes be severe enough to be life threatening. Tell your doctor or nurse right away if you begin to have trouble breathing or have a dry cough that will not go away.

This drug can cause allergic reactions in some people when the drug is given, especially with the first few treatments. Mild reactions may consist of fever, chills, skin itching, or feeling flushed. More serious reactions happen rarely, but can be life threatening. 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.

Due to potential harm to the fetus, don’t get pregnant while on this drug. Men should not father a child while taking this drug. Check with your doctor about what kinds of birth control to use.

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*
  • Numbness, tingling, or pain in the hands, feet, or elsewhere*
  • Nausea/vomiting*
  • Diarrhea*
  • Hair loss (can include the body as well as the scalp)
  • Feeling weak
  • Feeling tired
  • Poor appetite
  • Fever
  • Infections (of the lungs, mouth, blood and other sites), some serious
  • Muscle or joint pain

Less common

  • Sores in the mouth or on the lips*
  • Retaining fluid (may include swelling in hands or feet)
  • Shortness of breath
  • Eye problems, like blurred vision, which tend to go away when drug is stopped
  • Rash
  • Low red blood cell count (anemia)*
  • Abnormal blood tests which suggest that the drug is affecting the liver (Your doctor will discuss the importance of this finding, if any.)*

Rare

  • Lowered blood platelet count with increased risk of bleeding*
  • Changes in heart rhythm*
  • Low blood pressure
  • Allergic reaction (fever, flushing, itching, rapid heart rate), which can sometimes worsen into trouble breathing, swelling throat or mouth, and dizziness*
  • Pain, redness or swelling at the infusion site
  • Nails changing color or becoming brittle
  • Cough*
  • Excess tears from the eyes
  • Dehydration
  • Abnormal blood tests which suggest that the drug is affecting the kidneys (Your doctor will discuss the importance of this finding, if any.)
  • Loss of vision due to swelling inside the eyeball (cystoid macular edema)
  • Lung inflammation (pneumonitis), which can make it hard to breathe*
  • Blood clots in the heart (heart attack), brain (stroke), or lungs (pulmonary embolus)
  • Heart failure, especially in those with existing heart damage
  • Deaths due to liver damage, infection, allergic reaction, blood clots, lung inflammation, or other causes

*See the “Precautions” section for more detailed information.

There are 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 2005.

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: 12/20/2013
Last Revised: 12/20/2013