Paclitaxel
Indications
Paclitaxel is a cancer medicine (chemotherapy). It is used to treat breast cancer, ovarian cancer, non-small cell lung cancer and Kaposi's sarcoma related to AIDS, and specialists also use it for some other cancers such as stomach, head and neck, and cervical cancer. It is often given together with other cancer medicines.
How It Works
Cells need structures called microtubules to divide. Paclitaxel locks these microtubules in place so cancer cells cannot complete division, and they die. Because it also affects healthy fast-dividing cells, such as those in bone marrow and hair roots, it causes side effects in those tissues.
Dosage and Administration
As prescribed. Paclitaxel is given only in hospital or a cancer treatment centre, as a drip into a vein (infusion) by trained doctors and nurses. The dose is worked out from body size (surface area), the type of cancer and blood test results, and treatment is repeated in cycles, commonly every 1 to 3 weeks. Before each infusion of standard Paclitaxel, patients usually receive medicines such as a steroid and antihistamines to prevent allergic reactions. Blood counts are checked before each cycle.
Interactions
- Medicines that block the liver enzymes CYP2C8 or CYP3A4, such as Ketoconazole, Gemfibrozil, Clopidogrel, Clarithromycin and Ritonavir, can raise Paclitaxel levels and side effects.
- Medicines that speed up these enzymes, such as Rifampicin, Carbamazepine and Phenytoin, can make it less effective.
- The order of giving Cisplatin and Paclitaxel matters; the care team plans this.
- It can increase the heart effects of Doxorubicin.
- Live vaccines should be avoided during treatment. Tell the care team about all medicines, herbal products and supplements.
Contraindications
- Severe allergy to Paclitaxel, or to polyoxyl 35 castor oil (an ingredient of the standard form).
- Very low white blood cell (neutrophil) count before treatment.
- Pregnancy and breastfeeding.
Side Effects
Common: low blood counts (raising the risk of infection, anaemia and bruising), hair loss, numbness, tingling or burning in the hands and feet, muscle and joint aches, nausea, diarrhoea, mouth sores, tiredness and nail changes. Allergic reactions can occur during the infusion.
Get urgent medical help for: fever of 38°C or higher, chills or other signs of infection; difficulty breathing, chest tightness, swelling of the face or a rash during or after the infusion; chest pain or a very fast, slow or irregular heartbeat; unusual bleeding or bruising; severe diarrhoea or vomiting; or pain, swelling or redness where the drip was placed.
Pregnancy and Lactation
Paclitaxel can harm an unborn baby. Pregnancy must be avoided: women should use effective contraception during treatment and for at least 6 months after the last dose, and men with a partner who could become pregnant for at least 3 months after, or as the care team advises. Do not breastfeed during treatment. It may affect future fertility, so discuss this with the doctor before starting.
Precautions and Warnings
- Regular blood tests are needed; treatment may be delayed or the dose lowered if counts are low.
- Tell the care team about liver disease, heart problems or existing nerve damage.
- Some forms contain alcohol, which may affect driving or interact with other medicines.
- Avoid people with infections where possible and report any sign of infection quickly.
Overdose
Overdose is handled in hospital. It can cause severe bone marrow suppression, nerve damage and mouth sores. There is no specific antidote; supportive care is given.
Therapeutic Class
Antineoplastic agent (taxane chemotherapy).
Storage
Kept by the hospital pharmacy below 25°C in the original carton to protect from light. Prepared infusions are handled by trained staff. Keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.
All brands of Paclitaxel