Important Facts About Paclitaxel

Paclitaxel (paclitaxel) is a commonly used chemotherapy drug used to treat cancer. It is part of a class of drugs called taxanes.

Paclitaxel is one of the most commonly used and effective drugs in the treatment of breast cancer and is effective in all stages of the disease. It is sometimes used to treat other types of cancer, such as ovarian cancer.

If you or someone you know has been prescribed this medicine (or Onxal, another brand name for paclitaxel), there is some basic information to know.

This article explains how paclitaxel works, along with dosage, side effects, and risks.

When using paclitaxel

Chemotherapy taxanes include the drugs taxotere (docetaxel) and paclitaxel. Paclitaxel is a multifunctional drug used to treat breast cancer. It can be used for early-stage breast cancer and metastatic breast cancer (cancer that has spread to other organs).

Often, doctors prescribe it as part of a combination therapy that includes other chemotherapy drugs, such as:

  • Doxorubicin (Adriamycin)
  • Cytoxan (cyclophosphamide)
  • 5-FU (5-fluorouracil)
  • Xeloda (capecitabine)
  • Paraplatin (carboplatin)

While there are standard chemotherapy combinations, your medical team will customize a treatment plan for you based on the characteristics of your cancer and your overall health.

Doctors also use paclitaxel as part of neoadjuvant chemotherapy.

What is neoadjuvant chemotherapy

Neoadjuvant chemotherapy involves shrinking the tumor with chemotherapy before surgical removal.

In addition to breast and ovarian cancer, paclitaxel is used to treat several other cancers, including lung and Kaposi’s sarcomaa rare skin cancer that particularly affects people with HIV and AIDS.

This photo contains something that some people might find graphic or disturbing.

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Kaposi’s sarcoma on the foot.

How Paclitaxel Works

Tumor cells grow through a process called mitosis, the scientific name for cell division. Paclitaxel acts as a mitotic inhibitor, targeting rapidly growing cancer cells to prevent them from dividing.

It interferes with the function of cells by getting inside and attaching to scaffold-like structures called microtubules. Paclitaxel can affect any rapidly dividing cells in your body; this is what causes many of the side effects of chemotherapy treatments.

While you are taking paclitaxel, your provider will monitor you regularly to assess your response to treatment. You should expect intermittent tests to check the size and location of the tumor. Typically, you will have routine blood tests, including a complete blood count (CBC) and comprehensive metabolome (CMP), to monitor your kidney and liver function.

Chemotherapy for Cancer Treatment

preparation and administration

Paclitaxel is a clear, colorless liquid mixed with Cremophor EL (polyoxyethylation castor oil) and administered by intravenous (intravenous) infusion. You will usually get an infusion in a hospital or clinic.

Doctors can give paclitaxel in a number of ways, including:

  • Every two or three weeks
  • once a week
  • slowly over 24 hours

Your paclitaxel dose depends on many factors, including:

  • your height
  • your weight
  • your general health
  • the type of cancer you have

Healthcare providers must administer paclitaxel; if administered improperly, it can cause tissue damage, usually at the IV site.

You may take a medicine like Benadryl (diphenhydramine) before the infusion to reduce your risk of an allergic reaction.

side effect

Paclitaxel is well tolerated by most people, especially at low doses. However, it does have side effects, including:

  • Peripheral neuropathy (nerve damage)
  • Anemia (low red blood cells)
  • Neutropenia (low white blood cells)
  • bone and muscle pain
  • hair loss
  • fatigue
  • nausea
  • Vomit
  • mild diarrhea
  • Amenorrhea (absence of menstruation)

Prevent side effects

There are ways to minimize and prevent some side effects. Before starting treatment with paclitaxel, your healthcare provider may recommend that you take an L-glutamine amino acid supplement to reduce your risk of nerve damage. Research showing its effectiveness is still ongoing, so speak with your care team before starting any new supplement.

Chemotherapy can make the bone marrow less efficient at making new white blood cells, red blood cells, and platelets. A low white blood cell count can make your immune system less efficient and put you at a higher risk of infection.

Neupogen (filgrastim) and Neulasta (pegfilgrastim) are two injectable medicines used to boost the production of white blood cells and help prevent infections.

Neupogen is given daily until the white blood cell count improves. Neulasta is given only once and continues to stimulate the bone marrow from a single dose. The choice between Neupogen and Neulasta depends on factors such as your health and insurance coverage.

The timing of these immune-stimulating drugs is important because ideally they should start making white blood cells before they reach a nadir (called nadir). The first dose is usually given at least 24 hours after the chemotherapy infusion is complete.

Most side effects of chemotherapy go away quickly after treatment ends, although some long-term side effects of chemotherapy may linger. In particular, peripheral neuropathy can sometimes be permanent, and fatigue can sometimes take years to fully improve.


Paclitaxel has common side effects including nausea, vomiting, hair loss, fatigue, nerve damage, and low blood and platelet counts. Sometimes these side effects can be prevented or lessened with supplements and medications that increase blood cells, prevent infection, and reduce the risk of nerve damage.

Neulasta vs Neupogen during chemotherapy

Risks and Contraindications

To avoid dangerous interactions, your medical team may advise you not to drink alcohol. You may also be advised to avoid certain medicines (such as aspirin) that increase the risk of bleeding during treatment with paclitaxel. Your provider knows your situation best, so be sure to raise any concerns directly.

Paclitaxel carries some risks and is not recommended for everyone.

pregnancy and breastfeeding

Paclitaxel may harm a developing fetus if taken during pregnancy. Therefore, you should not receive paclitaxel during pregnancy. Because of the risks of paclitaxel during pregnancy, if you are a sexually active woman of childbearing age, your provider may recommend contraception while you are taking paclitaxel.

In addition, paclitaxel can be passed through breast milk. It is generally recommended that you avoid breastfeeding while receiving paclitaxel and for several weeks after completing treatment.

Paclitaxel has been linked to future infertility. If you are planning to become pregnant, consult your healthcare provider before starting treatment.

Breast Cancer Treatment During Pregnancy


Because chemotherapy drugs can damage the immune system, live vaccines are generally not recommended while receiving paclitaxel. Your weakened immune system during treatment may make you more likely to get sick from vaccinations.

What is a live vaccine?

Live vaccines contain weakened forms of viruses or bacteria. These vaccines introduce small amounts of pathogens to prompt your body to produce antibodies. These antibodies protect you from infection when you are exposed to disease in the future.

FluMist, the flu vaccine, is a nasal spray in a weakened form of the flu virus. This is one of the live vaccines that people with compromised immune systems, including those receiving paclitaxel, should avoid.

However, most vaccines (such as the flu vaccine or the COVID vaccine) are generally safe during chemotherapy. Inactivated vaccines use pre-killed pathogens (bacteria), and many use virus-like substances to stimulate the immune system.

Vaccines may not be as effective when you are receiving chemotherapy. Because your immune system is weak, your body may not be able to mount an adequate immune response to benefit from the vaccine. In most cases, the vaccine is delayed and given after cancer treatment is complete.


While taking paclitaxel, you are susceptible to infections, which can often become very serious and even life-threatening. Chemotherapy reduces the production of white blood cells called neutrophils and leaves your immune system in a weakened state. A low neutrophil count is called neutropenia. This risk of infection may exist even if you receive Neulasta or Neupogen.

Because of this increased risk, call your healthcare provider right away if you develop fever, chills, pain, or redness or swelling at the infusion site. Neutropenic fever is considered a medical emergency.

Common infections in cancer patients

allergic reaction

Some people may have an allergic reaction to paclitaxel or Cremophor EL, so this medication should be avoided. Your healthcare team will monitor you closely while you are receiving paclitaxel and may give you additional medicine to help you if you have a reaction.


Paclitaxel carries some risks. People who are pregnant or breastfeeding should not take paclitaxel because the drug passes through the placenta and breast milk. Also, while taking paclitaxel, you will be more susceptible to infections that can become serious. Therefore, avoid live vaccines and tell your doctor right away of any fever or other signs of illness.


Paclitaxel is a chemotherapy drug used to treat breast, ovarian, lung, and Kaposi’s sarcoma. Side effects such as vomiting, hair loss, fatigue, and nerve damage are common when taking paclitaxel. Some of these side effects can be prevented or lessened with supplements and medications.

Chemotherapy drugs are powerful, so your provider will discuss the risks and benefits with you before giving you the drugs. People who are pregnant, nursing, or allergic to paclitaxel should not take this medication. Also, you are more likely to get serious infections while you are being treated.

VigorTip words

As with any form of chemotherapy, paclitaxel can have an impact on your energy. Eat as healthy as possible, exercise as much as possible, and get plenty of rest during treatment. Also, learn to seek and receive help.

Finally, keep in mind that one of the most common complaints of people with loved ones dealing with cancer is feeling helpless. So asking your loved one to lend a helping hand may help both of you.

Frequently Asked Questions

  • How should I manage the side effects of paclitaxel?

    Chemotherapy targets rapidly growing and dividing cells. Many of the side effects of drugs like paclitaxel are due to damage to healthy cells that also grow and divide rapidly, such as hair follicles and cells lining the digestive tract. Some people experience more side effects than others. Discuss with your healthcare team what you can expect from your treatment plan and how to deal with the side effects you experience.

  • Why does paclitaxel cause bone pain?

    Paclitaxel is associated with pain that often feels like bone or muscle pain. Generally, pain starts one to two days after chemotherapy and goes away within a week. The exact way the drug causes pain isn’t fully understood, but researchers continue to work to learn more. There is currently no standard treatment, but providers are researching a number of pain management strategies.