Therapeutic Classification: antineoplastics
Pharmacologic Classification: taxoids
Absorption: IV administration results in complete bioavailability.
Distribution: Widely distributed to tissues.
Protein Binding: 8998%.
Metabolism/Excretion: Highly metabolized by the liver primarily by the CYP2C8 and CYP3A4 isoenzymes; <10% excreted unchanged in urine.
Half-Life: Paclitaxel: 1352 hr; Paclitaxel protein-bound particles (albumin-bound): 27 hr.

Paclitaxel
- Ovarian Cancer
- IV (Adults ): Previously untreated patients: 175 mg/m2 over 3 hr every 3 wk or 135 mg/m2 over 24 hr every 3 wk, followed by cisplatin; Previously treated patients: 135 mg/m2 or 175 mg/m2 over 3 hr every 3 wk.
Hepatic Impairment
- IV (Adults 24-hr infusion): Transaminase levels <2 times ULN and bilirubin levels ≤1.5 mg/dL: 135 mg/m2 over 24 hr. Transaminase levels 2<10 times ULN and bilirubin levels ≤1.5 mg/dL: 100 mg/m2 over 24 hr. Transaminase levels <10 times ULN and bilirubin levels 1.67.5 mg/dL: 50 mg/m2 over 24 hr. Transaminase levels ≥10 times ULN or bilirubin levels >7.5 mg/dL: Avoid use.
Hepatic Impairment
- IV (Adults 3-hr infusion): Transaminase levels <10 times ULN and bilirubin levels ≤1.25 times ULN: 175 mg/m2 over 3 hr. Transaminase levels <10 times ULN and bilirubin levels 1.262 times ULN: 135 mg/m2 over 3 hr. Transaminase levels <10 times ULN and bilirubin levels 2.015 times ULN: 90 mg/m2 over 3 hr. Transaminase levels ≥10 times ULN or bilirubin levels >5 times ULN: Avoid use.
- Breast Cancer
- IV (Adults ): Adjuvant treatment of node-positive breast cancer: 175 mg/m2 over 3 hr every 3 wk for 4 courses administered sequentially to doxorubicin-containing combination chemotherapy; Failure of initial therapy for metastatic disease or relapse within 6 mo of adjuvant therapy: 175 mg/m2 over 3 hr every 3 wk.
Hepatic Impairment
- IV (Adults 3-hr infusion): Transaminase levels <10 times ULN and bilirubin levels ≤1.25 times ULN: 175 mg/m2 over 3 hr. Transaminase levels <10 times ULN and bilirubin levels 1.262 times ULN: 135 mg/m2 over 3 hr. Transaminase levels <10 times ULN and bilirubin levels 2.015 times ULN: 90 mg/m2 over 3 hr. Transaminase levels ≥10 times ULN or bilirubin levels >5 times ULN: Avoid use.
- Non-Small Cell Lung Cancer
- IV (Adults ): 135 mg/m2 over 24 hr every 3 wk, followed by cisplatin.
Hepatic Impairment
- IV (Adults 24-hr infusion): Transaminase levels <2 times ULN and bilirubin levels ≤1.5 mg/dL: 135 mg/m2 over 24 hr. Transaminase levels 2<10 times ULN and bilirubin levels ≤1.5 mg/dL: 100 mg/m2 over 24 hr. Transaminase levels <10 times ULN and bilirubin levels 1.67.5 mg/dL: 50 mg/m2 over 24 hr. Transaminase levels ≥10 times ULN or bilirubin levels >7.5 mg/dL: Avoid use.
- AIDS-Related Kaposi Sarcoma
- IV (Adults ): 135 mg/m2 over 3 hr every 3 wk or 100 mg/m2 over 3 hr every 2 wk (dose ↓/adjustment may be necessary in patients with advanced HIV infection).
Hepatic Impairment
- IV (Adults 3-hr infusion): Transaminase levels <10 times ULN and bilirubin levels ≤1.25 times ULN: 175 mg/m2 over 3 hr. Transaminase levels <10 times ULN and bilirubin levels 1.262 times ULN: 135 mg/m2 over 3 hr. Transaminase levels <10 times ULN and bilirubin levels 2.015 times ULN: 90 mg/m2 over 3 hr. Transaminase levels ≥10 times ULN or bilirubin levels >5 times ULN: Avoid use.
Paclitaxel Protein-Bound Particles (Albumin-Bound)
- Breast Cancer
- IV (Adults ): 260 mg/m2 over 30 min every 3 wk.
Hepatic Impairment
- IV (Adults ): AST levels <10 times ULN and bilirubin levels 1.513 times ULN: 200 mg/m2 over 30 min every 3 wk; may ↑ to 260 mg/m2 for the 3rd course based on individual tolerance; AST levels <10 times ULN and bilirubin levels 3.015 times ULN: 200 mg/m2 over 30 min every 3 wk; may ↑ to 260 mg/m2 for the 3rd course based on individual tolerance; AST levels >10 times ULN or bilirubin levels >5 times ULN: Avoid use.
- Non-Small Cell Lung Cancer
- IV (Adults ): 100 mg/m2 over 30 min on Days 1, 8, and 15 of each 21-day cycle.
Hepatic Impairment
- IV (Adults ): AST levels <10 times ULN and bilirubin levels 1.513 times ULN: 80 mg/m2 over 30 min on Days 1, 8, and 15 of each 21-day cycle; may ↑ to 100 mg/m2 for the 3rd course based on individual tolerance; AST levels <10 times ULN and bilirubin levels 3.015 times ULN: 80 mg/m2 over 30 min on Days 1, 8, and 15 of each 21-day cycle; may ↑ to 100 mg/m2 for the 3rd course based on individual tolerance; AST levels >10 times ULN or bilirubin levels >5 times ULN: Avoid use.
- Pancreatic Adenocarcinoma
- IV (Adults ): 125 mg/m2 over 3040 min on Days 1, 8, and 15 of each 28-day cycle.
Hepatic Impairment
- IV (Adults ): Moderate or severe hepatic impairment: Avoid use.
Paclitaxel
(Generic available)
- Solution for injection: 6 mg/mL
Paclitaxel Protein-Bound Particles (Albumin-Bound)
- Lyophilized powder for injection: 100 mg/vial
- Do not confuse paclitaxel with docetaxel or paclitaxel protein-bound particles.
- Paclitaxel should be administered under the supervision of a physician experienced in the use of cancer chemotherapeutic agents.
- Consider premedication in patients who have had prior hypersensitivity reactions to paclitaxel protein-bound (albumin-bound).
- Dose Reduction for Pancreatic Cancer: Full dose: 125 mm/m2. 1st dose ↓: 100 mm/m2. 2nd dose ↓: 75 mm/m2. If additional dose ↓ required, discontinue therapy.
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 3060 min before paclitaxel, and famotidine 20 mg IV 3060 min before paclitaxel.
- Vesicant: 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 patients extremity and apply dry cold compresses for 20 min 4 times day for 12 days. Initiate hyaluronidase antidote for refractory cases in addition to supportive management. For hyaluronidase, inject 16 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 34 hr.
- Intermittent Infusion: Diluent: Dilute contents of 5 mL (30 mg) vials with 0.9% NaCl, D5W, D5/0.9% NaCl, or dextrose 5% in Ringers solution. Although haziness in solution is normal, inspect for particulate matter or discoloration before use. Protect from light. Use an in-line filter of not >0.22-micron pore size. Solutions are stable for 27 hr at ambient temperature. Do not use PVC containers or administration sets. Concentration: 0.31.2 mg/mL. Rate: Dose for breast cancer, ovarian cancer, or AIDS-related Kaposi sarcoma is administered over 3 hr. Dose for ovarian cancer can also be administered as a 24 hr infusion.
- Y-Site Compatibility:
- acyclovir
- alemtuzumab
- allopurinol
- amikacin
- aminophylline
- ampicillin
- ampicillin/sulbactam
- anidulafungin
- argatroban
- atracurium
- azithromycin
- aztreonam
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- busulfan
- butorphanol
- calcium chloride
- calcium gluconate
- carboplatin
- carmustine
- caspofungin
- cefazolin
- cefepime
- cefotaxime
- cefotetan
- cefoxitin
- ceftazidime
- ceftriaxone
- cefuroxime
- chloramphenicol
- ciprofloxacin
- cisatracurium
- cisplatin
- cladribine
- clindamycin
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- dantrolene
- daptomycin
- daunorubicin
- dexamethasone
- dexmedetomidine
- dexrazoxane
- diltiazem
- diphenhydramine
- dobutamine
- dopamine
- doxorubicin hydrochloride
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- floxuridine
- fluconazole
- fludarabine
- fluorouracil
- foscarnet
- fosphenytoin
- furosemide
- ganciclovir
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- haloperidol
- heparin
- hydralazine
- hydrocortisone
- hydromorphone
- ifosfamide
- imipenem/cilastatin
- insulin regular
- irinotecan
- isoproterenol
- ketorolac
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- meperidine
- meropenem
- mesna
- methadone
- methotrexate
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- minocycline
- mitomycin
- morphine
- moxifloxacin
- nafcillin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- palonosetron
- pamidronate
- pantoprazole
- pemetrexed
- pentamidine
- pentobarbital
- pentostatin
- phenobarbital
- phentolamine
- phenylephrine
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- potassium phosphates
- procainamide
- prochlorperazine
- promethazine
- propofol
- remifentanil
- rituximab
- sodium acetate
- sodium bicarbonate
- sodium phosphates
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- trimethoprim/sulfamethoxazole
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
- Y-Site Incompatibility:
- amiodarone
- amphotericin B deoxycholate
- amphotericin B liposomal
- chlorpromazine
- diazepam
- digoxin
- doxorubicin liposomal
- gemtuzumab ozogamicin
- idarubicin
- indomethacin
- labetalol
- methylprednisolone
- mitoxantrone
- phenytoin
- propranolol
Paclitaxel Protein-Bound Particles (Albumin-Bound)
IV Administration:
- Vesicant: 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 patients extremity and apply dry cold compresses for 20 min 4 times day for 12 days.
- Intermittent Infusion: Reconstitution: Reconstitute by slowly adding 20 mL to each vial over ≥1 min. Direct solution to inside wall of vial to prevent foaming. Allow vial to sit for >5 min to ensure proper wetting of cake/powder. Gently swirl or invert vial for ≥2 min until powder is completely dissolved; avoid foaming. If foaming or clumping occurs, allow vial to stand for 15 min until foaming dissolves. Suspension should be milky and homogenous without visible particles. If particles or settling are visible, gently invert vial to resuspend. Concentration: 5 mg/mL. Inject appropriate amount of reconstituted suspension into empty sterile PVC IV bag. Do not use an in-line filter during administration. Do not administer suspension that is discolored or contains particulate matter. Should be administered immediately but is stable for 8 hr if refrigerated. Discard unused portion.
- Rate: Administer over 30 min.
- Y-Site Compatibility:
- carboplatin
- dexamethasone
- gemcitabine
- granisetron
- palonosetron
PACLitaxel: Taxol,
PACLitaxel protein-bound particles (albumin-bound): Abraxane