Home Drug Guide Paclitaxel

Drug Guide

Generic Name

Paclitaxel

Brand Names Taxol, Abraxane

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Mitotic inhibitor (taxane)

FDA Approved Indications

  • Ovarian cancer
  • Breast cancer
  • Non-small cell lung cancer
  • Pancreatic cancer
  • Kaposi's sarcoma

Mechanism of Action

Paclitaxel stabilizes microtubules by binding to the β-tubulin subunit, preventing depolymerization, which inhibits mitosis and promotes apoptosis in cancer cells.

Dosage and Administration

Adult: Dose varies based on indication, body surface area, and regimen. Typically 135-175 mg/m² IV infusion over 3 hours every 3 weeks.

Pediatric: Use is not well established; consult specific protocols for pediatric use.

Geriatric: Adjust dosing based on tolerance and comorbidities; monitor for increased toxicity.

Renal Impairment: No specific dose adjustment recommended, but caution advised.

Hepatic Impairment: Reduce dose in severe hepatic impairment; closely monitor hepatic function.

Pharmacokinetics

Absorption: Administered intravenously; no oral absorption data.

Distribution: Widely distributed, highly bound to plasma proteins (~89%).

Metabolism: Primarily metabolized hepatically by CYP2C8 and CYP3A4.

Excretion: Metabolites excreted in feces and urine.

Half Life: Approximately 6 hours, but prolonged in hepatic impairment.

Contraindications

  • Hypersensitivity to paclitaxel or Cremophor EL (for Taxol formulation).

Precautions

  • Severe hypersensitivity reactions, cardiomyopathy, pre-existing neutropenia, liver dysfunction, peripheral neuropathy, myelosuppression, cardiovascular disease.

Adverse Reactions - Common

  • Neutropenia (Very common)
  • Peripheral neuropathy (Common)
  • Nausea and vomiting (Common)
  • Alopecia (Common)
  • Mucositis (Common)

Adverse Reactions - Serious

  • Anaphylactic reactions (Rare)
  • Myocardial ischemia or arrhythmias (Rare)
  • Severe neutropenia leading to infections (Serious)

Drug-Drug Interactions

  • Increased cardiotoxicity with anthracyclines.
  • Increased myelosuppression with other myelosuppressive agents.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor CBC, hepatic function, renal function, and neurological status.

Diagnoses:

  • Risk for infection due to neutropenia.
  • Risk for peripheral neuropathy.

Implementation: Administer slow IV infusion; premedicate with corticosteroids, antihistamines, and H2 antagonists to reduce hypersensitivity reactions.

Evaluation: Assess for adverse effects, treatment response, and toxicity.

Patient/Family Teaching

  • Report any signs of allergic reactions immediately.
  • Use reliable contraception during and for 6 months after treatment.
  • Report signs of infection, neuropathy, or unusual bleeding.

Special Considerations

Black Box Warnings:

  • Severe hypersensitivity reactions, including anaphylaxis.
  • Myelosuppression leading to neutropenia.
  • Peripheral neuropathy.

Genetic Factors: CYP2C8 polymorphisms may affect metabolism.

Lab Test Interference: May cause false elevation in transaminase levels.

Overdose Management

Signs/Symptoms: Severe neutropenia, allergic reactions, cardiovascular collapse.

Treatment: Supportive care; stop paclitaxel infusion; treat symptoms accordingly; consider use of corticosteroids or antihistamines for hypersensitivity.

Storage and Handling

Storage: Store vials at 2-8°C (36-46°F); protect from light.

Stability: Stable for specified period as per manufacturer's instructions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.