Taxol-Paclitaxel

Patient Education Quick Reference Guide Diablo Valley Oncology/Hematology Medical Group Phone Number: 925-677-5041

Description

Your chemotherapy treatment is called paclitaxel (PAK-li-TAX-el) or Taxol® (TAX-all). It is commonly used to treat breast cancer and has also been used to treat other diseases. Paclitaxel prevents cancer cells from dividing and growing, and can eventually cause the cancer cells to shrink and die.

What Do I Need to Know Before Starting Treatment?

Be sure to tell your healthcare provider about any prescription or over-the-counter products you are taking, including dietary supplements, vitamins, herbal medicines and homeopathic remedies. Use an effective birth control method while you are taking paclitaxel. Paclitaxel can cause harm to a fetus, so be sure to tell your healthcare provider right away if you or your partner becomes pregnant. Avoid breastfeeding during treatment. It is not known if paclitaxel passes into breast milk. Some chemotherapy drugs can cause sterility. Talk with your healthcare provider about your options if you want to have children in the future. Do not get any immunizations or vaccinations while taking paclitaxel without the approval of your healthcare provider. Chemotherapy can sometimes cause changes in the amount of electrolytes in your body, such as sodium, potassium and magnesium. Your healthcare provider will check your blood for these changes and will treat any problems that are found.

What Do I Need to Know Before Starting Paclitaxel?

Paclitaxel can cause an allergic reaction. Your healthcare provider will give you medicine before your treatment to reduce your risk of an allergic reaction. Tell your healthcare provider right away if you have trouble breathing or sudden swelling, hives or rash during your treatment. In rare cases, the reaction caused by paclitaxel can be severe and life-threatening. Paclitaxel can cause skin irritation if it accidentally leaks out of your vein during the infusion. Tell your healthcare provider right away if you have redness, pain, burning or swelling around the injection site during your treatment. In rare cases, paclitaxel can cause the heart to beat in an irregular pattern. Tell your healthcare provider if you notice that your heart is beating faster or slower than usual or if it is beating erratically. Sometimes this irregular pattern can require a pacemaker. In very rare cases, paclitaxel can cause Stevens-Johnson syndrome or toxic epidermal necrolysis, two serious skin conditions. Tell your healthcare provider immediately if you have swelling around the eyes, a rash that is severe or a rash that looks like pimples or blisters on the skin, in the mouth or on the genitals. Your treatment can interact with other medicines, including:
  • Phenytoin (Dilantin®), phenobarbital (Luminal®) or carbamazepine (Tegretol®)
  • Rifabutin (Mycobutin®), rifampin (Rifadin®) or isoniazid
  • St. John’s wort
  • Fluconazole (Diflucan®), itraconazole (Sporanox®), ketoconazole (Nizoral®), voriconazole (Vfend®) or posaconazole (Noxafil®)
  • Aprepitant (Emend®)
  • Fluvoxamine (Luvox®)
  • Amiodarone (Cordarone® or Nexterone®)
  • Verapamil (Verelan®, Calan® or Covera-HS®), diltiazem (Cardizem®) or nifedipine (Procardia XL®, Procardia®, or Adalat® CC)
  • Drugs used to treat HIV, such as atazanavir (Reyataz®), indinavir (Crixivan), nelfinavir (Viracept®), ritonavir (Norvir®) or saquinavir (Invirase®)
  • Clarithromycin (Biaxin®), erythromycin (E-mycin®) or telithromycin (Ketek®)
  • Cyclosporine (Gengraf®, Neoral® or Sandimmune®), sirolimus (Rapamune®) or tacrolimus (Prograf®)
  • Grapefruit juice or starfruit
  • Rosiglitazone (Avandia®)
  • Montelukast (Singulair®)
Please note this list is a summary and does not contain all possible drug interactions. Contact your healthcare provider if you are taking any medications that can interact with your treatment. You should not take this treatment if you are allergic to paclitaxel, other drugs that contain Cremophor EL® (polyoxyethylated castor oil), such as cyclosporine injection (Sandimmune®) or teniposide (Vumon®), or any components of these drugs.

How Is the Treatment Given?

Your healthcare provider will give you your treatment by injection into a vein. The dose you receive will be based on your weight and height. Your healthcare provider will determine the number of treatments you receive. You may be given a medicine called dexamethasone (dex-a-METH-a-sone) to take by mouth at home before your treatment. Dexamethasone prevents certain side effects caused by paclitaxel. If you are given this medicine, make sure you take it as directed. If you miss a dose or take the medicine at the wrong time, tell your healthcare provider before your treatment. You may be given medicines to help prevent and control nausea and vomiting before you receive your treatment. These medicines may be given either by mouth or by injection into a vein. If you are given any medicine to take at home, do not share it with others. Sharing this medication with anyone else could be harmful.

When Should I Call My Healthcare Provider?

Call your healthcare provider right away if you have any of the following symptoms:
  • Shaking chills or fever of 100.5 degrees F or higher
  • Unusual bleeding, easy bruising or pinpoint red spots on your skin
  • Vomiting that is severe or that lasts several hours
  • Painful or frequent urination or blood in your urine
  • Diarrhea that causes an additional four bowel movements a day, diarrhea that lasts more than one day, diarrhea at night or diarrhea with fever, cramps or bloody stools
  • Constipation that lasts more than two to three days or constipation with abdominal pain
  • Irregular or rapid heart beat, chest pain, chest tightness or shortness of breath
  • Swelling around the eyes
  • A severe rash or rash that looks like pimples or blisters on the skin, in the mouth or on the genitals
  • Dizziness or feeling lightheaded
  • Inability to eat or weight loss
 

What Are the Possible Side Effects?

All drugs can cause side effects, but every person reacts differently to each drug. The following chart lists the possible side effects that can occur with your treatment, how to recognize and minimize symptoms and possible treatments. The side effects are grouped by how often the side effect occurs: Common (occurs in more than 25 percent of patients), Less Common (occurs in 5 to 25 percent of patients) or Rare (occurs in less than 5 percent of patients).
Side Effect How to Minimize Side Effect Possible Treatments
Risk of Infection (Common)
  • Fever and chills
  • Painful urination
  • Sore throat and cough
  • Nasal congestion
  • Swelling or redness of the skin at the site of a wound
  • Wash your hands often.
  • Brush and floss your teeth daily.
  • Clean cuts right away with warm water, soap and antiseptic.
  • When your white blood cell count is low, stay away from crowds and people with colds or other illnesses.
  • You may be given an antibiotic to treat or prevent infection or a medicine to increase your white blood cell count.
  • Your healthcare provider may decrease your dose or delay further treatment.
Nausea/Vomiting (Common. Symptoms are generally mild to moderate but can be severe.)
  • Feeling queasy or sick to your stomach
  • Eat small, frequent meals and bland foods— such as bananas, rice, applesauce and toast.
  • Eat food cold or at room temperature so the smell of food will not bother you.
  • Avoid fried, spicy or fatty foods.
  • Eat and drink slowly.
  • Drink plenty of liquids during the day, but to avoid bloating, drink small amounts of liquid during meals
  • You will be given medicine to help reduce nausea and vomiting.
Neuropathy (Common. Symptoms are generally mild to moderate but can be severe.)
  • Numbness or tingling feeling in the hands or feet
  • Muscle cramps
  • Loss of balance
  • Difficulty buttoning buttons or picking up objects
  • Decreased awareness of heat or cold in fingertips and toes
  • Difficulty hearing
  • Try to avoid the cold or extreme heat.
  • Wear mittens or gloves, socks and scarves.
  • If your fingers are numb, be careful with sharp objects.
  • Beware of hot coffee mugs, pots and pans and dishwater—you may not feel the heat until you are burned.
  • If you feel unsteady, be careful on stairs and in the shower.
  • Your healthcare provider may decrease your dose or delay further treatment.
Mouth Sores and Pain (Less Common. Symptoms are generally mild to moderate.)
  • Pain, swelling and redness of the mouth, tongue and throat
  • “Coated tongue”
  • Difficulty talking, swallowing or eating
  • Bleeding ulcers and infection
  • Brush teeth two to four times a day using a soft bristle brush and fluoride toothpaste.
  • Use non-waxed dental floss daily.
  • Ask your healthcare provider to recommend a mouthwash that does not contain alcohol.
  • Sip water during the day and use sugar-free candy or gum to keep your mouth wet.
  • Eat food cold or at room temperature.
  • Eat soft or pureed food.
  • Avoid food that is acidic, spicy, salty, dry or rough, such as toast.
  • You may be given medicine to help treat pain.
  • You may be given medicine to treat fungal or viral infections.
Diarrhea (Less Common. Symptoms are generally mild to moderate but can be severe.)
  • Loose or watery stools several times a day
  • Abdominal cramping, gas and bloating
  • Eat small, frequent meals and bland foods— such as bananas, rice, applesauce and toast.
  • Avoid caffeine; alcohol; raw fruits and vegetables; raw eggs; undercooked meats; spicy, fatty and greasy foods; milk and dairy products; foods that cause gas, such as beans and other legumes; high fiber and high-fat foods; foods left un-refrigerated for more than two hours (one hour for egg dishes and cream or mayonnaise-based foods); bulk laxatives; and stool softeners.
  • Drink eight to ten glasses of clear liquids every day.
  • Your healthcare provider may prescribe medicine to help treat diarrhea.
Fluid Retention (Less Common. Symptoms are generally mild to moderate but can be severe.)
  • Swelling around the eyes, lower legs, ankles, feet or abdominal area
  • Slight weight gain
  • Check your weight regularly.
  • Try to avoid eating salty foods, as this can cause fluid retention.
  • You may be given a diuretic (water pill) to reduce the amount of fluid in your body.
  • Your healthcare provider may decrease your dose or delay further treatment.
Anemia (Less Common)
  • Fatigue or weakness
  • Dizziness
  • Pale skin
  • Feeling out of breath
  • Feeling cold
  • Plan rest periods throughout the day.
  • Organize daily activities so that you conserve your energy.
  • Try to eat a well balanced diet and drink plenty of fluids.
  • Stand up slowly to avoid getting dizzy.
  • You may be given medicine to increase your red blood cell count.
  • Your healthcare provider may decrease your dose or delay further treatment.
Risk of Bleeding (Rare)
  • Unusual bleeding, easy bruising
  • Black or tar-like stools
  • Blood in your urine
  • Pinpoint red spots on your skin
  • Bleeding gums or nosebleeds
  • Avoid aspirin and aspirin-like drugs, such as ibuprofen.
  • Use caution with sharp objects, such as razors and nail cutters.
  • Avoid activities that can cause cuts, bumps and bruises.
  • You may be given medicine to increase your platelet count.
  • Your healthcare provider may decrease your dose or delay further treatment.
The following side effects are known to occur with paclitaxel but were not specifically reported in the clinical trial.
Alopecia or Hair Loss (Common. Usually causes complete hair loss.)
  • More than normal amount of hair loss in your brush, in the shower or on your pillow after sleeping
  • Loss of body hair
Alopecia cannot be prevented but here are tips to help with hair loss:
  • Use a soft hairbrush. Do not use brush rollers, color treat your hair or get a permanent.
  • Avoid daily hair washing, use a mild shampoo and avoid using a hairdryer, or use a low setting if you must use one.
  • Have your hair cut short; this will make it look fuller.
  • Your insurance might cover a wig. If you would like a wig, ask your healthcare provider for a prescription for a “hair prosthesis”. Your hair color and style can be better matched if you shop for a wig before losing a lot of hair.
  • Use sunscreen or wear a hat or scarf to protect your scalp from the sun.
Nail Changes (Rare. Symptoms are generally mild.)
  • Darkening of the nails that usually grows out with the nail
  • Vertical or horizontal bands on the nails
  • Trim nails often and keep them clean.
  • Wear gloves for cleaning and gardening to minimize damage and prevent infection.
  • Don’t wear nail polish or false fingernails until the nails have grown out and returned to normal.
  • You may be given an antibiotic if there is an infection in the nail bed.
Constipation (Rare)
  • Difficulty in passing stools
  • Decrease in the normal frequency of bowel movements
  • Small, hard dry stools
  • Bloating, gas, cramps and pain
 
  • Drink plenty of fluids to help loosen your bowels. Drink warm or hot liquids if you do not have mouth sores.
  • Your healthcare provider may suggest eating foods that are high in fiber, such as bran, vegetables, whole wheat breads and fruit.  Add prunes or prune juice, which act like laxatives.
  • Exercise can help loosen bowels.
  • Your healthcare provider may recommend a stool softener.
Anorexia or Appetite Loss
  • Not having an appetite
  • Feeling too nauseated to eat
  • Metallic or medicinal taste
  • Change in taste causing dislike for certain foods
  • Try eating six to eight small meals or snacks each day instead of three larger meals.
  • Vary your diet and try new foods and recipes.
  • Take a walk before meals, when possible. This may make you feel hungrier.
  • Eat with friends or family. When eating alone, listen to the radio or watch TV.
  • Cook dinners ahead of time and freeze them in small portions so that cooking smells are minimized.
  • Let others help with food, but ask that foods be prepared in small portions that can be frozen. And don’t hesitate to let them know which foods to avoid.
  • Add mild spices to change flavor.
  • It might be helpful to have a program, such as Meals on Wheels, deliver food to you.
Radiation Recall
  • Redness, tenderness or swelling on areas of the skin that have previously been treated with radiation
  • May include wet sores, peeling skin or discoloration after the skin has healed
  • Stay out of the sun and avoid tanning beds.
  • If you are in the sun, wear protective clothing and use sunscreen with an SPF of 30 or higher.
  • You may be given a corticosteroid to reduce swelling.
  What Are the Other Possible Side Effects? The chart below lists additional side effects found with this treatment. It does not list all possible side effects. For more information, talk with your healthcare provider. Common Side Effects
  • Muscle or joint pain
  • Weakness
 

Less Common Side Effects

  • Injection site reactions
  • Skin or whites of the eyes turn yellow
  • Low blood pressure
 

Rare Side Effects

  • High blood pressure
  • Heart failure or heart attack
  • Pneumonia, blood clots in the lung or respiratory failure
  • Dizziness or headache
  • Seizures
  • Vision changes, eye irritation or increased tearing
  • Decreased hearing or ringing in ears
  • Liver failure
  • Decreased kidney function