PAK-li-tax-el
High Alert
Absorption: IV administration results in complete bioavailability.
Distribution: Widely distributed to tissues.
Protein Binding: 89–98%.
Half-Life: Paclitaxel: 13–52 hr; Paclitaxel protein-bound particles (albumin-bound): 27 hr.
Contraindicated in:
Neutrophil count ≤1500 cells/mm3 (for patients with ovarian, lung, breast, or pancreatic cancer) or ≤1000 cells/mm3 (for patients with AIDS-related Kaposi sarcoma)
;Use Cautiously in:
CV: ECG changes, edema, hypotension, bradycardia
Derm: alopecia, STEVENS-JOHNSON SYNDROME (SJS), TOXIC EPIDERMAL NECROLYSIS (TEN)
GI: ↑liver enzymes, diarrhea, mucositis, nausea, vomiting, pancreatitis
GU: renal failure
Hemat: anemia, neutropenia, thrombocytopenia
Local: injection site reactions
MS: arthralgia, myalgia
Neuro: peripheral neuropathy, dizziness, headache, seizures
Resp: cough, dyspnea, interstitial pneumonia, PULMONARY EMBOLISM, PULMONARY FIBROSIS
Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), SEPSIS
Drug-drug:
Paclitaxel
Hepatic Impairment
Hepatic Impairment
Hepatic Impairment
Hepatic Impairment
Hepatic Impairment
Paclitaxel Protein-Bound Particles (Albumin-Bound)
Hepatic Impairment
Hepatic Impairment
Hepatic Impairment
Paclitaxel
(Generic available)Paclitaxel Protein-Bound Particles (Albumin-Bound)
Monitor for hypersensitivity reactions continuously during the 1st 30 min and frequently thereafter. These occur frequently (19%), usually during the 1st 10 min of paclitaxel infusion, after the 1st or 2nd dose. Most common manifestations are dyspnea, flushing, tachycardia, rash, hypotension, and chest pain. If these occur, stop infusion and notify health care provider. Treatment may include bronchodilators, epinephrine, antihistamines, and corticosteroids. Keep these agents and resuscitative equipment close by in the event of an anaphylactic reaction. Other manifestations of hypersensitivity reactions include flushing and rash. Patients experiencing hypersensitivity reactions should not be rechallenged with paclitaxel.
Lab Test Considerations:
Monitor CBC and differential before and periodically during therapy. The nadir of leukopenia occurs in 11 days, with recovery by days 15–21. If neutrophil counts <500/mm3 for ≥1 wk,↓ dose by 20% for subsequent courses.
Monitor CBC and differential frequently, including before starting therapy and prior to dosing on Day 1 (for breast cancer), 8, and 15 (for NSCLC and pancreatic cancer). For Breast Cancer: If severe neutropenia (ANC <500 cells/mm3 for ≥7 days),↓ dose to 220 mg/m2. If recurrence of severe neutropenia,↓ dose to 180 mg/m2. For NSCLC: If neutropenic fever (ANC <500/mm3 with fever >38°C) OR delay of next cycle by >7 days for ANC <1500/mm3 OR ANC <500/mm3 for >7 days,↓ dose on 1st occurrence to 75 mg/m2 and on 2nd occurrence, ↓ dose to 50 mg/m2. For 3rd occurrence, discontinue therapy. If severe neutropenia (ANC <500 cells/mm3 for ≥7 days),↓ dose in subsequent courses. If platelet count <50,000/mm3, for 1st occurrence, ↓ dose to 75 mg/m2. Discontinue therapy at 2nd occurrence. For Pancreatic Cancer: On Day 1, if ANC <1500 cells/mm3 OR platelet count <100,000 cells/mm3, hold next dose until recovery. On Day 8, if ANC 500–<1000 cells/mm3 OR platelet count 50,000–<75,000 cells/mm3,↓ dose one level; on Day 8, if ANC <500 cells/mm3 OR <50,000 cells/mm3, hold dose. On Day 15, if Day 8 doses were ↓ or given without modification and ANC 500–<1000 cells/mm3 OR platelet count 50,000–<75,000 cells/mm3,↓ dose one level from Day 8. On Day 15, if Day 8 doses were ↓ or given without modification and ANC <500 cells/mm3 OR platelet count <50,000 cells/mm3, hold doses. On Day 15, if Day 8 doses were held and ANC ≥1000 cells/mm3 OR platelet count ≥75,000 cells/mm3,↓ dose one level from Day 1. On Day 15, if Day 8 doses were held and ANC 500–<1000 cells/mm3 OR platelet count 50,000–<75,000 cells/mm3,↓ dose two levels from Day 1. On Day 15, if Day 8 doses were held and ANC <500 cells/mm3 OR platelet count <50,000 cells/mm3, hold doses.
Paclitaxel should be administered under the supervision of a physician experienced in the use of cancer chemotherapeutic agents.
Paclitaxel
IV Administration:
Pretreatment is recommended for all patients and should include dexamethasone 20 mg PO (10 mg for patients with advanced HIV disease) 12 hr and 6 hr before paclitaxel, diphenhydramine 50 mg IV 30–60 min before paclitaxel, and famotidine 20 mg IV 30–60 min before paclitaxel.
Paclitaxel is a vesicant. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient's extremity and apply dry cold compresses for 20 min 4 times day for 1–2 days. Initiate hyaluronidase antidote for refractory cases in addition to supportive management. For hyaluronidase, inject 1–6 mL (150 units/mL) into existing IV line; usual dose is 1 mL for each 1 mL of extravasated drug; if needle/cannula has been removed, inject SUBQ in a clockwise manner around area of extravasation; may repeat several times over the next 3–4 hr.
Paclitaxel Protein-Bound Particles (Albumin-Bound)
IV Administration:
Paclitaxel protein bound particles is an irritant. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient's extremity and apply dry cold compresses for 20 min 4 times day for 1–2 days.
Advise patient to notify health care provider immediately of rash, difficulty breathing, or symptoms of hypersensitivity reaction occurs.
Instruct patient to notify health care provider promptly if fever; chills; cough; hoarseness; sore throat; signs of infection; lower back or side pain; painful or difficult urination; bleeding gums; bruising; petechiae; blood in stools, urine, or emesis; dyspnea; or orthostatic hypotension occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to avoid falls. Caution patient not to drink alcoholic beverages or to take medication containing aspirin or NSAIDs; may precipitate gastric bleeding.