Abraxane
Paclitaxel (Abraxane) is a different formulation of the chemotherapy paclitaxel (Taxol) where the chemotherapy is attached to a protein called albumin. It’s an option for cancers like non-small cell lung cancer (NSCLC), pancreatic cancer, and breast cancers, often together with other anticancer medications. It’s given through the vein (IV) once a week or up to once every 3 weeks, depending on your treatment plan. Paclitaxel (Abraxane) can cause side effects such as tiredness, hair loss, and low blood cell counts that can raise your risk for infection.
What is Paclitaxel (Abraxane)?
What is Paclitaxel (Abraxane) used for?
- Locally advanced or metastatic NSCLC, together with platinum-based chemotherapy
- Metastatic pancreatic cancer, along with gemcitabine (Gemzar)
- Metastatic breast cancer, after previous therapy has stopped working
How Paclitaxel (Abraxane) works
Paclitaxel (Abraxane) works by stopping cells from growing and dividing. This medication interferes with substances in cells in your body called microtubules, which are important for maintaining cell structure and normal functioning. By doing so, paclitaxel (Abraxane) prevents fast growing cells (like tumor cells) from spreading.
Paclitaxel (Abraxane) consists of albumin (a protein normally found in your body) attached to paclitaxel. This albumin-bound formulation of paclitaxel lowers the risk of infusion-related reactions that's common for people receiving paclitaxel (Taxol), the version that's not albumin-bound.
Drug facts
| Common Brands | Abraxane |
|---|---|
| Drug Class | Microtubule inhibitor |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
Side effects of Paclitaxel (Abraxane)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Low blood cell counts (up to 74%)
- Feeling very tired (59%)
- Nausea (54%)
- Numbness or tingling (54%)
- Hair loss (50%)
- Swelling in the ankles and feet (46%)
- Diarrhea (44%)
- Fever (41%)
- Vomiting (36%)
- Not feeling hungry (36%)
- Rash (30%)
Less Common Side Effects
- Dehydration
- Weakness
- Changes in taste
- Headache
- Cough
- Mouth sores
- Nose bleeds
- Depression
- Joint and muscle pain
- General pain
- Urinary tract infections
Please note: Side effect information is from studies of people using paclitaxel (Abraxane) with gemcitabine (Gemzar) for pancreatic cancer.
Paclitaxel (Abraxane) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Lower blood cell counts: unusual bleeding or bruising, fever
- Severe infections: fever, trouble catching your breath, pain in the abdomen
- Serious allergic reactions: swelling of the face, lips, or tongue, difficulty swallowing, rash, itching, trouble breathing
- Lung inflammation: cough, trouble catching your breath
The following Paclitaxel (Abraxane) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Black, tarry stools
bloating or swelling of the face, arms, hands, lower legs, or feet
blurred or double vision
chills
loss of taste
lower back or side pain
painful or difficult urination
pale skin
rapid weight gain
sore mouth, tongue, or throat
tightness in the chest
tingling of the hands or feet
troubled breathing with exertion
ulcers, sores, or white spots in the mouth
unusual bleeding or bruising
unusual weight gain or loss
unusual tiredness or weakness
Less common
blood in the urine or stools
burning, tingling, numbness or pain in the hands, arms, feet, or legs
confusion
difficulty with swallowing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fast, pounding, slow, or irregular heartbeat or pulse
general feeling of discomfort or illness
inability to move the arms, legs, or facial muscles
inability to speak
pain in the chest, groin, or legs, especially the calves
pinpoint red spots on the skin
rapid, shallow breathing
sensation of pins and needles
severe, sudden headache
skin itching, rash, or redness
slurred or slow speech
stabbing pain
sudden loss of coordination
sudden, severe weakness or numbness in the arms or legs
sudden, unexplained shortness of breath
sweating
swelling of the face, throat, or tongue
thickening of bronchial secretions
trouble thinking or walking
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Cracked lips
decreased appetite
difficulty with moving
headache
lack or loss of strength
loss of hair
muscle pain or stiffness
pain in the joints
swelling
vomiting
Less common
Bleeding, blistering, burning, coldness, discoloration of the skin, a feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
Rare
Nail changes
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Paclitaxel (Abraxane)
Pros
- Recommended first-choice option for pancreatic cancer and NSCLC, together with other anticancer medications
- Short infusion time
- Usually given once a week or once every 3 weeks
Cons
- Commonly causes fatigue, nausea, and hair loss
- Can cause serious allergic reactions
- Dose might need adjustment if you have liver problems
Pharmacist tips for Paclitaxel (Abraxane)
- Paclitaxel (Abraxane) can cause allergic reactions. Be on the lookout for signs of an allergic reaction during your infusion, such as feeling flushed, dizzy, or itchy, rash, hives, swelling of the lips or tongue, or trouble breathing.
- If you have an allergic reaction, your team will pause the infusion, evaluate your symptoms, and give supportive medications. After you’re feeling better, your team might restart the infusion at a slower rate and add premedications for future infusions to prevent the reaction from happening again. If you have a severe allergic reaction to paclitaxel (Abraxane), your team might choose to switch to a different treatment plan.
- Paclitaxel (Abraxane) can sometimes irritate the area around where you’re receiving the infusion, especially if it leaks out of the vein to surrounding tissue (extravasation). During your infusion, let your treatment team know if you notice redness, pain, swelling, or blistering near your IV site. They might need to pause the infusion and manage the irritation with a warm compress or other supportive medications.
- Paclitaxel (Abraxane) can cause nerve damage, resulting in tingling, numbness, pain, or weakness in the hands or feet (peripheral neuropathy). Let your provider know if you notice new or worsening numbness or tingling, as those could be signs of nerve damage. Your provider might need to lower the paclitaxel (Abraxane) dose or have you take a short break from paclitaxel (Abraxane) treatment so your nerves can heal.
- paclitaxel (Abraxane) can lower the amount of infection-fighting cells (white blood cells) in the body. Your provider might recommend injections to boost your white blood cells, like filgrastim (Neupogen) or pegfilgrastim (Neulasta) to prevent infection, or support you in case of infection. If you feel ill or have a fever higher than 100.4°F, contact your healthcare team so you can get treatment for infection.
- Your hair might fall out (alopecia) with paclitaxel (Abraxane) treatment. Usually, scalp hair is most affected, but you might also lose body hair. Your hair will likely grow back after you stop treatment. It might take 3-6 months for your hair to come back, and it might regrow as a different color or texture than before.
- Paclitaxel (Abraxane) commonly causes upset stomach and diarrhea. Your healthcare team will give you premedications before the paclitaxel (Abraxane) infusion to prevent nausea and vomiting, in addition to medications you can take as needed at home for nausea and vomiting.
- If you have nausea, vomiting, or diarrhea that are disrupting your daily activities, or if you’re having signs of dehydration, like feeling very thirsty, dizzy, or weak, let your provider know. They’ll check on your symptoms and can recommend fluids or other medications to help with your side effects.
- If you’re pregnant or are planning to become pregnant, talk to your provider before starting paclitaxel (Abraxane). Paclitaxel (Abraxane) might affect fertility, and can cause harm to the unborn baby. Females should avoid getting pregnant and use birth control during paclitaxel (Abraxane) treatment and for 6 months after the last dose. Males who have a partner who’s able to become pregnant need to use birth control for at least 3 months after the last dose.
- You should avoid breastfeeding while receiving paclitaxel (Abraxane) treatment and for 2 weeks after your last dose.
Risks and warnings for Paclitaxel (Abraxane)
Paclitaxel (Abraxane) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Low blood cell counts (bone marrow suppression)
- Risk factors: Higher paclitaxel (Abraxane) dose
Paclitaxel (Abraxane) can damage the bone marrow and lower blood cell counts. This can cause fatigue due to low red blood cell (RBC) counts, higher risk of bleeding due to low platelet counts, and higher risk of infection due to low white blood cell (WBC) counts. Let your healthcare team know if you have unusual bleeding or bruising, or signs of infection, like a fever.
Before every infusion, your provider will ask how you’re feeling and check your blood tests to make sure your white blood cell levels are at a safe level. If your blood cell counts are low, your provider will most likely hold off your paclitaxel (Abraxane) infusion to give your blood cells a chance to recover. They might also adjust your dose for future paclitaxel (Abraxane) treatments. If your blood cell counts continue to drop too low, then your provider might consider other medications for you.
Severe infections
- Risk factors: Bile duct blockage | Having a biliary stent | Receiving gemcitabine as part of treatment
Paclitaxel (Abraxane) can raise your risk of serious or life-threatening infections, especially infections in the bloodstream and lungs. Sometimes, this can lead to sepsis. Be sure to stay away from people who are sick and wash your hands often. If you develop symptoms of fever, chills, muscle aches, change in appetite or weight loss, vomiting, or skin rash, tell your provider right away. Check your temperature regularly and let your care team know if you have a fever (temperature of 100.4ºF or higher). Sometimes, the only sign of infection you might experience is a fever.
Lung inflammation
Paclitaxel (Abraxane) can cause very rare, but serious and potentially life-threatening lung damage. If you have a new or worsened cough, trouble breathing, or fevers, let your healthcare team know right away. Your provider will probably have you stop taking paclitaxel (Abraxane) while they do scans to check on your lungs. If the scans show signs of lung damage, your provider might have you stop taking paclitaxel (Abraxane).
Serious allergic reactions
- Risk factors: Allergy to taxane medications
Paclitaxel (Abraxane) can cause serious allergic reactions, which in rare cases could be fatal. During your infusion, let your provider know if you feel dizzy, short of breath, swelling in your lips or tongue, itching, or hives. Those could be a sign of an allergic reaction. If you have a reaction to paclitaxel (Abraxane), your treatment team will pause the infusion and give medications to treat the reaction. Once your symptoms improve, your team might try to restart the infusion at a slower rate. If you have a severe reaction to paclitaxel (Abraxane), you might need to go to the hospital for monitoring. Your provider might also have you stop taking paclitaxel (Abraxane) and update your treatment plan.
Nerve problems (neuropathy)
Paclitaxel (Abraxane) can cause discomfort, pain, numbness, and tingling in the hands and feet (peripheral neuropathy). In studies, people usually developed these symptoms over the first 4 to 5 months of treatment, and the symptoms went away about a month after stopping the medication. Talk with your provider if your symptoms are disrupting your daily activities. They can recommend medications to help with peripheral neuropathy. They might also lower the paclitaxel (Abraxane) dose or give you a longer break between treatments to help relieve your side effects. If you continue to experience nerve problems with paclitaxel (Abraxane), your provider might consider switching you to a different medication.
Liver problems problems
If you have liver problems, your provider will need to adjust your paclitaxel (Abraxane) dose to lower your risk of side effects. Let your healthcare team know if you have a history of liver problems, or if you develop yellowing of the skin, brown or dark urine, or pain in the right upper part of your stomach. Those could be signs of liver problems. Your provider will check liver tests before each treatment, and adjust your dose if they notice signs of liver problems on your lab tests.
Risk of viral infection
The albumin in paclitaxel (Abraxane) is a protein from human blood, so in theory, there’s a possibility of infection with viruses or other protein diseases with paclitaxel (Abraxane) treatment. There haven’t been any reports of any such infections with paclitaxel (Abraxane) and your risk is extremely low. But talk to your provider if you’re concerned about this possible side effect.
Harm to the unborn baby
Paclitaxel (Abraxane) can cause harm to unborn babies. If you’re a female able to have children, you’ll need to do a pregnancy test before starting paclitaxel (Abraxane). Use effective birth control while taking the medication and for 6 months after the last dose. If you’re male and have a partner who’s able to get pregnant, you must use condoms while taking paclitaxel (Abraxane) and for 3 months after the last dose.
Paclitaxel (Abraxane) dosage
Typical dosage for Paclitaxel (Abraxane)
Your provider will determine your dose of paclitaxel (Abraxane) based on your body surface area (BSA) in units of m2, which takes into consideration height and weight. Your dose will be infused through the veins (IV) by a healthcare provider.
- NSCLC: The typical dose is 100 mg/m2 infused IV on days 1, 8, and 15 of each 21-day cycle.
- Metastatic pancreatic cancer: The typical dose is 125 mg/m2 infused IV on days 1, 8, and 15 of each 28-day cycle.
- Metastatic breast cancer: The typical dose is 260 mg/m2 infused IV once every 3 weeks.
Your dose of paclitaxel (Abraxane) might be different if you’ve liver problems or if you experience serious side effects.
Interactions between Paclitaxel (Abraxane) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Varicella Virus Vaccine, Live
- Zoster Vaccine, Live
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Adenovirus Vaccine
- Bacillus of Calmette and Guerin Vaccine, Live
- Cholera Vaccine, Live
- Dengue Tetravalent Vaccine, Live
- Ethinyl Estradiol
- Idarubicin
- Influenza Virus Vaccine, Live
- Poliovirus Vaccine, Live
- Smallpox Vaccine
- Testosterone
- Tretinoin
- Typhoid Vaccine, Live
- Yellow Fever Vaccine
Paclitaxel (Abraxane) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Paclitaxel (Abraxane) will not be safe for you to take.
- Blood neutrophil count less than 1500 cells/mm3
