Paclitaxel

Paclitaxel Brand Names- Onxol | Taxol

What is Paclitaxel

Paclitaxel is a semisynthetic antineoplastic agent.

It is a diterpenoid taxane derivative from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel was first discovered in 1971 as a result of the National Cancer Institute (NCI) screening program for natural cytotoxic products.

Procurement and stability issues hindered the availability of paclitaxel for clinical use. Paclitaxel injection is very insoluble in water and requires formulation with Cremophor EL and ethanol.

In 1991, an agreement between Bristol-Myers Squibb and the NCI led to the development alternative sources of paclitaxel.

Paclitaxel has subsequently been isolated from other members of the Taxus genus and is produced by Taxomyces andreannae, a fungal endophyte isolated from the inner bark of the Pacific yew.

Indications

1. bladder cancer
2. breast cancer
3. endometrial cancer
4. esophageal cancer
5. head and neck cancer
6. Kaposi’s sarcoma
7. non-small cell lung cancer (NSCLC)
8. ovarian cancer
9. penile cancer
10. peripheral blood stem cell (PBSC) mobilization
11. small cell lung cancer (SCLC)
12. thymic carcinoma
13. thymoma

Side Effects

1. abdominal pain
2. alopecia
3. anaphylactic shock
4. anemia
5. anemia
6. angioedema
7. anorexia
8. arthralgia
9. arthralgia
10. ascites
11. asthenia
12. ataxia
13. atrial fibrillation
14. AV block
15. back pain
16. bleeding
17. bone marrow suppression
18. bradycardia
19. candidiasis
20. chest pain (unspecified)
21. chills
22. confusion
23. conjunctivitis
24. constipation
25. diaphoresis
26. diarrhea
27. dizziness
28. dyspnea
29. edema
30. elevated hepatic enzymes
31. encephalopathy
32. erythema
33. esophagitis
34. exfoliative dermatitis
35. fever
36. flushing
37. headache
38. hearing loss
39. hepatic encephalopathy
40. hepatic necrosis
41. hyperbilirubinemia
42. hyperesthesia
43. hypertension
44. hypotension
45. ileus
46. infection
47. injection site reaction
48. lacrimation
49. leukoencephalopathy
50. leukopenia
51. leukopenia
52. maculopapular rash
53. malaise
54. myalgia
55. myalgia
56. myocardial infarction
57. nail discoloration
58. nausea
59. neutropenia
60. neutropenia
61. paresthesias
62. peripheral neuropathy
63. peripheral neuropathy
64. phlebitis
65. photopsia
66. pleural effusion
67. pneumonitis
68. pruritus
69. pulmonary embolism
70. pulmonary fibrosis
71. radiation recall reaction
72. rash
73. renal failure (unspecified)
74. scotomata
75. seizures
76. serious hypersensitivity reactions or anaphylaxis
77. sinus tachycardia
78. Stevens-Johnson syndrome
79. stomatitis
80. supraventricular tachycardia (SVT)
81. syncope
82. thrombocytopenia
83. thrombocytopenia
84. thromboembolism
85. tinnitus
86. tissue necrosis
87. toxic epidermal necrolysis
88. typhlitis
89. ventricular tachycardia
90. vertigo
91. vomiting

Monitoring Parameters

• CBC with differential
• ECG
• LFTs
• serum bilirubin (total and direct)

Contraindications

• accidental exposure
• alcoholism
• angina
• AV block
• bone marrow suppression
• bradycardia
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• children
• dental disease
• dental work
• driving or operating machinery
• extravasation
• geriatric
• heart failure
• hepatic disease
• herpes infection
• infection
• intramuscular administration
• intramuscular injections
• Kaposi’s sarcoma
• myocardial infarction
• neutropenia
• ocular exposure
• peripheral neuropathy
• polyoxyethylated castor oil hypersensitivity
• pregnancy
• radiation therapy
• requires a specialized care setting
• requires an experienced clinician
• serious hypersensitivity reactions or anaphylaxis
• subcutaneous administration
• taxane hypersensitivity
• thrombocytopenia
• vaccination
• varicella
• viral infection

Interactions

• Amlodipine; Celecoxib
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amprenavir
• Apalutamide
• Aprepitant, Fosaprepitant
• Atazanavir
• Atazanavir; Cobicistat
• Barbiturates
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Boceprevir
• Bortezomib
• Bosentan
• Cabozantinib
• Carbamazepine
• Carboplatin
• Celecoxib
• Cenobamate
• Ceritinib
• Clarithromycin
• Cobicistat
• Conivaptan
• Crizotinib
• Cyclophosphamide
• Cyclosporine
• Daclatasvir
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Deferasirox
• Delavirdine
• Diclofenac
• Diclofenac; Misoprostol
• Diflunisal
• Diltiazem
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Disulfiram
• Doxorubicin
• Dronedarone
• Duvelisib
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elbasvir; Grazoprevir
• Elexacaftor; tezacaftor; ivacaftor
• Eltrombopag
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Emapalumab
• Enzalutamide
• Epirubicin
• Erlotinib
• Erythromycin
• Erythromycin; Sulfisoxazole
• Esomeprazole; Naproxen
• Etodolac
• Etravirine
• Famotidine; Ibuprofen
• Fedratinib
• Fenofibrate
• Fenofibric Acid
• Fenoprofen
• Filgrastim, G-CSF
• Fluconazole
• Fluoxetine
• Fluoxetine; Olanzapine
• Flurbiprofen
• Fluvoxamine
• Fosamprenavir
• Gadobenate Dimeglumine
• Gemfibrozil
• Glecaprevir; Pibrentasvir
• grapefruit juice
• Hydantoins
• Hydrocodone; Ibuprofen
• Ibuprofen
• Ibuprofen; Oxycodone
• Ibuprofen; Pseudoephedrine
• Idelalisib
• Imatinib
• Indinavir
• Indomethacin
• Isavuconazonium
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Itraconazole
• Ixabepilone
• Ketoconazole
• Ketoprofen
• Ketorolac
• Lansoprazole; Naproxen
• Lapatinib
• Ledipasvir; Sofosbuvir
• Lefamulin
• Leflunomide
• Letermovir
• Live Vaccines
• Lopinavir; Ritonavir
• Lorlatinib
• Lumacaftor; Ivacaftor
• Meclofenamate Sodium
• Mefenamic Acid
• Meloxicam
• Metronidazole
• Mitotane
• Nabumetone
• Naproxen
• Naproxen; Pseudoephedrine
• Naproxen; Sumatriptan
• Nefazodone
• Nelfinavir
• Netupitant, Fosnetupitant; Palonosetron
• Nevirapine
• Nicardipine
• Nonsteroidal antiinflammatory drugs
• Ombitasvir; Paritaprevir; Ritonavir
• Omeprazole; Amoxicillin; Rifabutin
• Oritavancin
• Oxaprozin
• Palifermin
• Pazopanib
• Penicillamine
• Piroxicam
• Posaconazole
• Ribociclib
• Ribociclib; Letrozole
• Rifabutin
• Rifampin
• Rifapentine
• Ritonavir
• Rofecoxib
• Rolapitant
• Rufinamide
• Sapropterin
• Saquinavir
• Simeprevir
• Sofosbuvir; Velpatasvir; Voxilaprevir
• Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
• Sulindac
• Tbo-Filgrastim
• Telaprevir
• Telithromycin
• Telotristat Ethyl
• Teriflunomide
• Thalidomide
• Tolmetin
• Tolvaptan
• Trametinib
• Trandolapril; Verapamil
• Trimethoprim
• Tuberculin Purified Protein Derivative, PPD
• Tucatinib
• Valdecoxib
• Vemurafenib
• Verapamil
• Voriconazole
• Zafirlukast
• Zonisamide