Paclitaxel

Paclitaxel is a antineoplastic taxane medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Ovarian cancer, including advanced disease in combination regimens or after failure of platinum-containing therapy.
• Breast cancer, including adjuvant treatment in selected patients and treatment of metastatic disease when clinically appropriate.
• Non-small cell lung cancer in combination chemotherapy for patients who are not candidates for curative surgery or radiotherapy.
• AIDS-related Kaposi sarcoma after failure of prior systemic therapy.

Paclitaxel injection is given only by intravenous infusion under specialist supervision. The dose and infusion schedule depend on the cancer type, body surface area, treatment regimen, blood counts, liver function, previous adverse reactions and other medicines being used. Premedication to reduce allergic reactions is commonly required. Follow the oncologist’s prescribed regimen exactly; do not self-administer or change the schedule.

• Common: low white blood cells, anaemia, low platelets, hair loss, nausea, vomiting, diarrhoea, mouth sores, loss of appetite, tiredness, muscle or joint pain.
• Common: numbness, tingling or burning pain in the hands or feet due to peripheral neuropathy.
• Infusion-related reactions: flushing, rash, itching, shortness of breath, chest tightness, low blood pressure or swelling.
• Serious: severe infection or fever with low white blood cells, severe allergic reaction, severe or worsening neuropathy, heart rhythm problems, liver enzyme abnormalities, severe skin reactions, lung inflammation and tissue injury if the injection leaks outside the vein.

Use extra caution in people with low blood cell counts, active infection, liver impairment, pre-existing nerve disease, heart rhythm problems, previous severe allergy to paclitaxel or similar products, or those receiving other chemotherapy. Regular blood counts and clinical monitoring are needed before and during treatment. Use only under the guidance of a registered doctor or pharmacist, preferably an oncology specialist/team.

• Medicines that inhibit or induce CYP2C8 or CYP3A4 enzymes may change paclitaxel exposure; examples include some azole antifungals, macrolide antibiotics, protease inhibitors, rifampicin, carbamazepine, phenytoin and phenobarbital.
• Cisplatin may increase bone marrow suppression if given before paclitaxel; oncology protocols specify the correct sequence.
• Doxorubicin exposure may increase depending on timing; follow the prescribed chemotherapy schedule.
• Other bone marrow-suppressing medicines or radiotherapy can increase the risk of low blood counts and infection.
• Live vaccines should generally be avoided during chemotherapy because of infection risk and reduced vaccine response.
• St John’s wort and grapefruit products may affect drug-metabolising enzymes; ask the treating team before using herbal products or major diet changes.

• Known severe hypersensitivity to paclitaxel or to formulation components such as polyoxyl castor oil in conventional paclitaxel injection.
• Severely low baseline neutrophil count; treatment should not start until blood counts are adequate according to the oncology protocol.
• Uncontrolled serious infection or any condition where the treating oncologist considers cytotoxic chemotherapy unsafe.

Paclitaxel can harm an unborn baby and is generally avoided during pregnancy unless the specialist decides the potential benefit justifies the risk. Effective contraception is needed during treatment and for a period after the last dose as advised by the oncology team. Breastfeeding is not recommended during treatment and for at least 2 weeks after the last dose, because the medicine may harm the infant.

Store paclitaxel injection as directed on the product label, usually at controlled room temperature, protected from light and kept in the original carton until use. Do not use if the vial is damaged or the solution is abnormal. Dilution, storage after dilution and disposal of cytotoxic waste must be handled by trained healthcare staff according to hospital policy.