Paclitaxel (Taxol)

Paclitaxel is a chemotherapy drug. It is also known by its original brand name, Taxol. The drug is made from the needles of a particular type of yew tree. It works by stopping cancer cells separating into two new cells, so it blocks the growth of the cancer. It is a treatment for various types of cancer, including

• Ovarian cancer
• Breast cancer
• Non small cell lung cancer.
• AIDS related Kaposi's sarcoma

Sometimes it is combined with other anti cancer drugs.

One type of paclitaxel is combined with a protein called albumin to form a drug called Abraxane. This drug tends to cause fewer side effects than other types of paclitaxel. But it is not suitable for all the cancers that paclitaxel is used to treat.

You usually have paclitaxel as an injection into a vein. It can cause an allergic reaction. To try to prevent this, you have a steroid injection and tablets before the paclitaxel drip. You also have an antihistamine (such as chlorphenamine) into a vein about an hour before your treatment. You will also have a medicine to prevent heartburn, for example, ranitidine or cimetidine. Abraxane does not usually cause an allergic reaction so you don't need the anti allergy drugs with abraxane.

You can have paclitaxel through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for paclitaxel depends on which cancer you have. You can find out about how doctors plan chemotherapy in the chemotherapy section.

Paclitaxel side effects are listed below. You can use the underlined links to find out more about each side effect. Where there is no link, use the search box at the top of the page or go to our cancer drugs side effects section.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery 
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Numbness or tingling in fingers and toes in between 3 to 8 out of 10 people (30 to 80%) depending on the dose – it can be severe in 3 to 15 out of 100 people (3 to 15%) and can cause difficulty with fiddly things such as doing up buttons. It starts within a few days or weeks and usually goes within a few months of finishing treatment
• Aching joints (arthralgia) and muscles (myalgia) affects about 6 out of 10 people (60%) – it may start a couple of days after treatment and last for about 5 days
• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal from 6 months to a year after their treatment finishes
• Mild allergic reactions occur in more than 3 out of 10 people (34%) – this usually shows as a rash or a red face
• Feeling or being sick is generally very well controlled with anti sickness injections and tablets, so tell your doctor or nurse if you still have sickness – they can give you other anti sickness medicines
• Hair loss (alopecia) may be complete and includes all body hair but your hair will grow back after your treatment ends – a cold cap may help to stop you losing your hair. Cold caps are not suitable for all types of cancer, so talk to your doctor or nurse about whether it may help you
• Low blood pressure during the treatment – your nurse will check your blood pressure regularly
• Mouth sores and ulcers
• Diarrhoea – drink plenty of fluids and if diarrhoea becomes severe or lasts more than a couple of days, tell your doctor or nurse because you could get dehydrated
• This drug may harm a baby developing in the womb so it is not advisable to become pregnant or father a child when having paclitaxel – talk to your doctor or nurse about contraception before you start treatment if there is any chance that you or your partner could become pregnant
• You should not breast feed while having this drug as it may come through in the breast milk
• You may feel a bit tipsy because the paclitaxel drip contains alcohol to help dissolve the drug – it is the equivalent of a large glass of wine or a pint of beer

Between 1 and 10 in every 100 people have one or more of these.

• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Mild skin rashes or nail changes
• Slowing down of the heart rate (bradycardia)
• Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working
• Loss of fertility – you may not be able to get pregnant or father a child after treatment with this drug so it is important to talk to your doctor before starting treatment if having a baby is important to you
• Women may stop having periods (amenorrhoea) but this may only be temporary

Fewer than 1 in 100 people have these.

• An immediate severe allergic reaction during the paclitaxel drip – your nurse will give you steroids and other medicines before treatment to try to stop this happening but let your nurse know if you feel hot or have any skin rashes, itching, dizziness, headaches, shivering, breathlessness, anxiety, flushing of the face, or a sudden need to pass urine
• Abdominal pain
• High blood pressure - your nurse will check your blood pressure regularly during treatment
• Blood clots - let your doctor or nurse know straight away if you have any redness, swelling or pain in your legs, or any chest pain or breathlessness
• Damage to heart muscle, which is usually temporary but for a small number of people may be permanent – your doctor will check your heart before and after your treatment
• High bilirubin levels
• Muscle weakness in arms and hands, and legs
• Itching
• A high temperature (fever)
• Changes in lung tissue may lead to a cough or breathlessness
• Build up of fluid, leading to swelling in arms and legs
• Headaches
• Hearing or sight (visual) disturbances
• Dizziness or fits (seizures)
• Loss of appetite
• More severe skin reactions, including loss of finger or toenails - these are very rare, but the manufacturers recommend that you wear sun protection on hands and feet during your course of treatment

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements, and over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.