Paclitaxel

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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

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