Paclitaxel

TAXOL

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Pronunciation: pak-li-TAX-el

Paclitaxel ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Paclitaxel ballicule

Paclitaxel TAXOL / PTX mascot mnemonic cartoon — Visual mnemonic: Paclitaxel mascot
**“Pac attacks all (dividing cells)”**

What it isTaxane chemotherapy that stabilizes microtubules and arrests mitosis; used across breast, ovarian, lung, and other cancers.

Why this oneAlbumin-bound paclitaxel avoids the Cremophor vehicle and its premedication burden.

What limits itBone-marrow suppression and cumulative peripheral neuropathy limit treatment; solvent-based infusion can cause severe hypersensitivity.

Paclitaxel molecular structure (skeletal formula) — Molecular structure: Paclitaxel

FDA-approved for

cancer (1992)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Severe myelosuppression — do not administer to patients with baseline neutrophil count <1,500 cells/mm3

FDA dosing	Population	Start	Target
Metastatic breast cancer	Adults	260 mg/m2 IV over 30 min q3wk	260 mg/m2 q3wk
NSCLC (+ carboplatin)	Adults	100 mg/m2 IV over 30 min days 1, 8, 15 of each 21-day cycle	same
Pancreatic adenocarcinoma (+ gemcitabine)	Adults	125 mg/m2 IV over 30-40 min days 1, 8, 15 of each 28-day cycle	same

Renal No starting-dose adjustment required for renal impairment

Hepatic No adjustment for mild; reduce starting dose for moderate-severe; not recommended if AST >10x ULN or bilirubin >5x ULN

Instructions

Do not substitute for other paclitaxel products
Closely monitor infusion site for extravasation/infiltration

Available strengths

inj 6 mg/mL

Contraindications

Baseline neutrophil count <1,500 cells/mm3

Cautions

Severe myelosuppression / neutropenia
Sensory neuropathy
Sepsis (with gemcitabine)
Pneumonitis
Severe hypersensitivity reactions
Increased toxicity in hepatic impairment
Embryo-fetal toxicity

Adverse reactions

Alopecia
Neutropenia
Sensory neuropathy
Abnormal ECG
Fatigue/asthenia
Myalgia/arthralgia
AST and alkaline phosphatase elevation
Anemia
Nausea
Infections
Diarrhea

Pregnancy Can cause fetal harm based on mechanism and animal findings

Lactation Undefined

Cost

Paclitaxel (TAXOL)

Strength		#/mo	generic $/unit	CostPlus
6 mg/mL	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Paclitaxel is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entry2002

⚠ BOXED WARNINGS

Severe hypersensitivity reactions
Bone marrow suppression

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk3 / 4

Legacy pregnancy categoryD

Defining liabilityMyelosuppression and agent-specific hepatic, cardiac, pulmonary, neurologic or reproductive toxicity require oncology monitoring.

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Memory aids: interaction avatars

CYP2C8 substrate

P-gp substrate (sensitive)

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