paclitaxel
Paclitaxel (Taxol) is a chemotherapy medication used to treat many cancers, including breast cancer, ovarian cancer, and lung cancer. It’s commonly used off-label as well for other types of cancers. Typically, paclitaxel (Taxol) is given as an infusion through the veins (IV). It’s likely that you’ll receive it in combination with other anticancer medications. Since paclitaxel (Taxol) can cause serious allergic reactions, your provider will ask you to take medications to prevent reactions before each dose.
What is Paclitaxel (Taxol)?
What is Paclitaxel (Taxol) used for?
- Breast cancer, after surgery or for relapsed or metastatic disease
- Advanced or metastatic non-small cell lung cancer, together with platinum-based chemotherapy
- Ovarian cancer, together with platinum-based chemotherapy as first-choice treatment, or alone after other treatments have stopped working
- AIDS-related Kaposi sarcoma, after first-choice treatment has stopped working
How Paclitaxel (Taxol) works
Paclitaxel (Taxol) is a chemotherapy medication that works by blocking cells from growing. Cells have substances called microtubules inside them, which are important for maintaining cell structure and normal functioning. Paclitaxel (Taxol), also known as a microtubule inhibitor, interferes with normal microtubule growth. By doing so, it stops rapidly dividing cells (like tumor cells) from growing and spreading.
Drug facts
Side effects of Paclitaxel (Taxol)
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 90%)
- Hair loss (87%)
- Feeling numbness and tingling (60%)
- Muscle, bone, or joint pain (60%)
- Nausea and vomiting (52%)
- Allergic reaction (41%)
- Diarrhea (38%)
- Mouth sores (31%)
- Infection (30%)
Less Common Side Effects
- Injection site reactions
Please note: Side effect information is from studies of people who received paclitaxel (Taxol) alone for ovarian or breast cancer. Your side effect experience might be different depending on your cancer and your treatment plan.
Paclitaxel (Taxol) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious allergic reactions: swelling of the face, lips, or tongue, difficulty swallowing, rash, itching, trouble breathing
- Lower blood cell counts (serious infections): unusual bleeding or bruising, fever
- Abnormal heart rhythm: racing heartbeat, feeling lightheaded
The following Paclitaxel (Taxol) 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 or tarry stools
blurred vision
burning, numbness, tingling, or painful sensations
confusion
cough or hoarseness with fever or chills
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
feeling of warmth
fever or chills
lower back or side pain
painful or difficult urination
pale skin
redness of the face, neck, arms, and occasionally, upper chest
shortness of breath
skin rash or itching
sweating
troubled breathing with exertion
ulcers, sores, or white spots in the mouth
unsteadiness or awkwardness
unusual bleeding or bruising
unusual tiredness or weakness
weakness in the arms, hands, legs, or feet
Less common
Blood in the urine or stools
difficult or labored breathing
pinpoint red spots on the skin
shortness of breath (severe)
slow heartbeat
tightness in the chest
Incidence not known
blue lips, fingernails, or skin
difficult or troubled breathing
fainting
fast heartbeat
irregular, fast or slow, or shallow breathing
sudden shortness of breath
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
Bleeding, blistering, burning, coldness, discoloration of the skin, 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
cracked lips
difficulty with swallowing
nausea or vomiting
numbness, burning, or tingling in the hands or feet
pain in the joints or muscles, especially in the arms or legs
thinning of the hair
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 (Taxol)
Pros
- Recommended treatment for breast cancer, NSCLC, and ovarian cancer, along with other chemotherapy medications
- Given weekly to every 3 weeks in an infusion center or clinic, so doesn’t need to be taken every day
Cons
- Commonly causes hair loss
- Can cause serious allergic reactions
Pharmacist tips for Paclitaxel (Taxol)
- You’ll receive premedications, such as acetaminophen (Tylenol), diphenhydramine (Benadryl), corticosteroids, and famotidine (Pepcid AC) to prevent allergic reaction with the paclitaxel (Taxol) infusion. Also, your treatment team will likely start your first few infusions at a slower rate to lower your risk for an allergic reaction to the paclitaxel (Taxol) infusion.
- Alert your care team immediately if you've symptoms of an allergic reaction during your paclitaxel (Taxol) infusion, such as feeling flushed or dizzy, or having trouble breathing. If so, your team will pause the paclitaxel (Taxol) infusion and give supportive medications to manage the reaction. Once your condition improves, your team might restart the infusion at a slower rate and adjust your premedications for future infusions.
- On occasion, paclitaxel (Taxol) can irritate the area around where you’re receiving the infusion, especially if it leaks out of the vein and into the 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 give you a warm compress or other supportive medications to help manage the irritation.
- Paclitaxel (Taxol) can damage the nerves. Let your provider know if you have new or worsening tingling in your hands or feet (peripheral neuropathy). These could be signs of nerve problems due to paclitaxel (Taxol). Your provider might need to lower your dose or have you take a short break from paclitaxel (Taxol) treatment while your nerve symptoms resolve.
- Paclitaxel (Taxol) can affect your white blood cells, which raises your risk for infection. If you have a fever higher than 100.4°F, contact your healthcare team so you can get treatment for infection.
- It’s common to have hair loss (alopecia) with paclitaxel (Taxol) treatment. Generally, your hair will grow back after you stop treatment, but might take 3-6 months to come back. Your hair might also grow back with a different color or texture than before.
- Paclitaxel (Taxol) is transferred through breastmilk, so you should avoid breastfeeding while receiving this medication and for 2 weeks after your last dose.
Common questions about Paclitaxel (Taxol)
It’s likely you’ll lose your hair while receiving treatment with paclitaxel (Taxol). This is because paclitaxel (Taxol) works against cells in the body that divide rapidly, including tumor cells. But chemotherapy can also damage some normal cells that grow quickly, like hair cells. Usually, hair loss starts within the first few weeks of treatment. Hair can fall out in clumps, and can affect hair on all parts of the body. If you’re concerned about losing your hair while taking paclitaxel (Taxol), talk to your provider. They can talk with you about options for dealing with hair loss, such as using cooling caps or resources for lower-cost or free wigs.
Paclitaxel (Taxol) can cause nerve damage, leading to discomfort, pain, numbness, and tingling in the hands and feet (peripheral neuropathy). Talk with your provider if your symptoms are disrupting your daily activities. They can recommend medications to help with peripheral neuropathy. They might also adjust the paclitaxel (Taxol) dose or give you a longer break between treatments to help relieve your side effects.
Diarrhea is a common paclitaxel (Taxol) side effect. Try to stay well-hydrated and eat small, frequent meals. If you’re having many more stools per day than normal, talk with your healthcare team. They’ll check on your symptoms and potential causes of the diarrhea, and might recommend medications to prevent diarrhea.
How long you receive paclitaxel (Taxol) depends on how well you tolerate the medication, your overall treatment plan, and how well paclitaxel (Taxol) works against your cancer. You should take paclitaxel (Taxol) as instructed by your healthcare team to make sure the treatment can work at its best against your cancer.
Paclitaxel (Taxol) hasn't been well-studied in human pregnancy. Animal studies suggest that it can harm unborn babies. But limited research in people shows that babies born to mothers who've received taxane-based chemotherapy (like paclitaxel (Taxol)) during pregnancy didn't experience any more harm compared to babies born to mothers who didn't receive such treatment. If you’re pregnant or plan to become pregnant, talk to your provider about the risk and benefits of taking paclitaxel (Taxol) in pregnancy.
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Risks and warnings for Paclitaxel (Taxol)
Paclitaxel (Taxol) 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.
Serious allergic reactions
- Risk factors: First or second paclitaxel (Taxol) infusion
Paclitaxel (Taxol) can cause serious allergic reactions, including symptoms such as dizziness, trouble breathing, swelling in your lips or tongue, itching, or hives. In rare cases it could be fatal. Usually, these reactions happened with the first or second paclitaxel (Taxol) infusion. To prevent a serious reaction, your provider will give you pretreatment medications, including a corticosteroid, an antihistamine, and a histamine-2 (H2) blocker.
If you have a reaction to paclitaxel (Taxol), 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 (Taxol), you might need to go to the hospital for monitoring. After a severe reaction to paclitaxel (Taxol), your provider might recommend desensitization, where you’ll be closely monitored while you get small doses of paclitaxel (Taxol) slowly to help you tolerate treatment. Or, they might change your treatment plan altogether.
Only given under care of trained healthcare provider
Paclitaxel (Taxol) should only be given by a trained healthcare provider in a facility that is licensed to give this medication. Because of the risk of serious side effects, such as allergic reaction, the facility needs to be equipped to treat those complications.
Low blood cell counts (bone marrow suppression)
- Risk factors: Higher paclitaxel (Taxol) dose
Paclitaxel (Taxol) can damage the bone marrow and cause low blood cell counts. This can lead to fatigue due to low red blood cells, higher risk of bleeding due to low platelets, and higher risk of infection due to low white blood cell 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 check your blood tests to make sure your white blood cell levels are at a safe level. If your white blood cell counts are low, your provider will delay your infusion. They might also adjust your dose for future treatments if your blood cell counts go too low. You won’t be able to receive paclitaxel (Taxol) if your neutrophil count is too low (less than 1,500 cells/mm3 in most cases).
Abnormal heart rhythm
In very rare situations, people receiving paclitaxel (Taxol) developed abnormal heart rhythms, which required a pacemaker in some cases. Let your provider know if you feel a racing or fluttering heart beat, or dizziness. They can check your heart rhythm to make sure paclitaxel (Taxol)’s still safe for you.
Harm to the unborn baby
Based on animal studies, paclitaxel (Taxol) can cause harm to an unborn baby. Talk with your provider if you’re pregnant or plan to become pregnant before starting treatment with this medication.
Paclitaxel (Taxol) dosage
Interactions between Paclitaxel (Taxol) 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.
- Abametapir
- Abiraterone Acetate
- Adenovirus Vaccine
- Amiodarone
- Bacillus of Calmette and Guerin Vaccine, Live
- Bexarotene
- Candesartan
- Carbamazepine
- Ceritinib
- Cholera Vaccine, Live
- Cisplatin
- Clopidogrel
- Conivaptan
- Crizotinib
- Dengue Tetravalent Vaccine, Live
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Ethinyl Estradiol
- Fluconazole
- Fosnetupitant
- Fosphenytoin
- Idarubicin
- Infliximab
- Influenza Virus Vaccine, Live
- Ketoconazole
- Leflunomide
- Netupitant
- Nilotinib
- Oxcarbazepine
- Pazopanib
- Phenobarbital
- Phenytoin
- Pixantrone
- Poliovirus Vaccine, Live
- Selpercatinib
- Smallpox Vaccine
- St John's Wort
- Teriflunomide
- Testosterone
- Tretinoin
- Typhoid Vaccine, Live
- Valspodar
- Yellow Fever Vaccine
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Dalfopristin
- Lapatinib
- Quinupristin
Paclitaxel (Taxol) 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 (Taxol) will not be safe for you to take.
- Hypersensitivity to polyoxyl 35 castor oil
- Baseline absolute neutrophil count less than 1500 cells/mm3, or less than 1000 cells/mm3 in people with Kaposi’s sarcoma
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