Abraxane
Classes
Taxanes
Administration
For storage information, see specific product information within the How Supplied section.
Hazardous Drugs Classification
NIOSH 2016 List: Group 1
NIOSH (Draft) 2020 List: Table 1
Observe and exercise appropriate precautions for handling, preparation, administration, and disposal of hazardous drugs.
Use double chemotherapy gloves and a protective gown. Prepare in a biological safety cabinet or compounding aseptic containment isolator with a closed system drug transfer device. Eye/face and respiratory protection may be needed during preparation and administration.
If nanoparticle albumin-bound (nab) paclitaxel comes in contact with the skin, wash the affected area immediately and thoroughly with soap and water. Following topical exposure, tingling, burning, and redness may occur. If contact occurs with mucous membranes, flush the affected area thoroughly with water.
Emetic Risk
Low
Administer routine antiemetic prophylaxis prior to treatment.
Extravasation Risk
Vesicant
Administer drug through central line.
Visually inspect parenteral product prior to administration; discard if proteinaceous strands, particulate matter, or discoloration are observed.
Administer as an intravenous (IV) infusion over 30 minutes. Limiting the infusion time to 30 minutes reduces the likelihood of infusion-related reactions.
Each single-use 100-mg vial contains approximately 900 mg of human albumin.
Substitution for (or with) other paclitaxel formulations is prohibited. The albumin formulation of nab-paclitaxel significantly affects the volume of distribution, exposure, and clearance of unbound drugs relative to those of solvent-based paclitaxel.
Consider premedication for patients who have had prior hypersensitivity reactions to nab-paclitaxel.
Reconstitution
Slowly inject 20 mL of 0.9% Sodium Chloride Injection, USP onto the inside wall of the vial of lyophilized powder over a minimum of 1 minute.
Do not inject the 0.9% Sodium Chloride Injection, USP direction onto the lyophilized cake as this will cause foaming.
Allow the vial to sit for a minimum of 5 minutes to ensure proper wetting of the lyophilized cake/powder.
Gently swirl and/or invert the vial slowly for at least 2 minutes until complete dissolution occurs; avoid the generation of foam.
If foaming or clumping occurs, allow the solution to stand for at least 15 minutes until the foam subsides.
The reconstituted suspension should be milky and homogenous without visible particles. If particulates or settling are visible, gently invert the vial again to ensure complete resuspension prior to use. Each mL of the reconstituted suspension contains 5 mg/mL of paclitaxel.
Stability after reconstitution: Use immediately if possible. If not used immediately, each reconstituted vial should be replaced in the original carton to protect it from bright light; refrigerate between 2 to 8 degrees C (36 to 46 degrees F) for a maximum of 24 hours. The total combined refrigerated storage time of reconstituted nab-paclitaxel in the vial and in the infusion bag is 24 hours. This may be followed by storage in the infusion bag at ambient temperature (approximately 25 degrees C) and lighting conditions for a maximum of 4 hours.
Dilution
Inject the appropriate amount of reconstituted nab-paclitaxel into an empty, sterile IV bag (plasticized PVC containers, PVC or non-PVC type IV bag).
It is not necessary to use specialized DEHP-free solution containers or administration sets for preparation or administration. However, the use of medical devices containing silicone oil as a lubricant (i.e., syringes and IV bags) may result in the formation of proteinaceous strands.
Stability after dilution: Use immediately if possible. If not used immediately, protect from bright light and refrigerate at 2 to 8 degrees C (36 to 46 degrees F) for a maximum of 24 hours. The total combined refrigerated storage time of reconstituted nab-paclitaxel in the vial and in the infusion bag is 24 hours. This may be followed by storage in the infusion bag at ambient temperature (approximately 25 degrees C) and lighting conditions for a maximum of 4 hours.
Adverse Reactions
neutropenia / Delayed / 34.0-34.0
fatigue / Early / 18.0-18.0
peripheral neuropathy / Delayed / 3.0-17.0
heart failure / Delayed / 0-10.0
macular edema / Delayed / 0-10.0
arthralgia / Delayed / 1.0-8.0
myalgia / Early / 1.0-8.0
asthenia / Delayed / 7.0-8.0
dehydration / Delayed / 0-7.0
vomiting / Early / 4.0-6.0
nausea / Early / 3.0-6.0
diarrhea / Early / 0-6.0
anorexia / Delayed / 5.0-5.0
hypokalemia / Delayed / 0-4.0
fever / Early / 3.0-3.0
cystitis / Delayed / 0-2.0
anemia / Delayed / 1.0-1.0
thrombocytopenia / Delayed / 0-1.0
bradycardia / Rapid / 0-1.0
alopecia / Delayed / 1.0-1.0
stomatitis / Delayed / 1.0-1.0
visual impairment / Early / 0-1.0
keratitis / Delayed / 0-1.0
blurred vision / Early / 0-1.0
headache / Early / 0-1.0
depression / Delayed / 0-1.0
renal failure (unspecified) / Delayed / 1.0-1.0
pancytopenia / Delayed / Incidence not known
thromboembolism / Delayed / Incidence not known
pulmonary embolism / Delayed / Incidence not known
stroke / Early / Incidence not known
cardiac arrest / Early / Incidence not known
thrombosis / Delayed / Incidence not known
pneumothorax / Early / Incidence not known
pulmonary fibrosis / Delayed / Incidence not known
cranial nerve palsies / Delayed / Incidence not known
ileus / Delayed / Incidence not known
GI perforation / Delayed / Incidence not known
pancreatitis / Delayed / Incidence not known
typhlitis / Delayed / Incidence not known
GI obstruction / Delayed / Incidence not known
hepatic encephalopathy / Delayed / Incidence not known
hepatic necrosis / Delayed / Incidence not known
tumor lysis syndrome (TLS) / Delayed / Incidence not known
anaphylactoid reactions / Rapid / Incidence not known
peripheral edema / Delayed / 10.0-43.0
elevated hepatic enzymes / Delayed / 14.0-39.0
constipation / Delayed / 0-16.0
dyspnea / Early / 12.0-12.0
edema / Delayed / 0-10.0
sinus tachycardia / Rapid / 0-10.0
hypertension / Early / 0-10.0
candidiasis / Delayed / 0-10.0
hyperbilirubinemia / Delayed / 7.0-7.0
hypotension / Rapid / 1.0-5.0
pneumonitis / Delayed / 0-4.0
chest pain (unspecified) / Early / 1.0-3.0
bleeding / Early / 2.0-2.0
bone marrow suppression / Delayed / Incidence not known
supraventricular tachycardia (SVT) / Early / Incidence not known
phlebitis / Rapid / Incidence not known
paresis / Delayed / Incidence not known
colitis / Delayed / Incidence not known
conjunctivitis / Delayed / Incidence not known
infection / Delayed / 24.0-24.0
cough / Delayed / 7.0-17.0
dysgeusia / Early / 0-16.0
epistaxis / Delayed / 7.0-15.0
injection site reaction / Rapid / Incidence not known
lacrimation / Early / Incidence not known
Boxed Warning
Bone marrow suppression (e.g., neutropenia, thrombocytopenia) is the dose-limiting toxicity of nanoparticle albumin-bound (nab) paclitaxel. Nab-paclitaxel is contraindicated in patients with a baseline absolute neutrophil count (ANC) of less than 1,500 cells/mm3. Obtain a complete blood count (CBC) panel prior to starting a new cycle of nab-paclitaxel therapy on day 1 in all patients and prior to therapy on day 8 and 15 in patients with non-small cell lung cancer and pancreatic cancer. Do not resume a new cycle of therapy until the ANC is 1,500 cells/mm3 or more and the platelet count is 100,000 cells/mm3 or more. In patients who develop severe neutropenia or thrombocytopenia, hold nab-paclitaxel and reduce the dose of therapy for subsequent cycles as recommended for the particular indication of use and chemotherapy regimen.
Common Brand Names
Abraxane
Dea Class
Rx
Description
Nanoparticle albumin-bound taxane; a microtubule inhibitor
Used for metastatic breast cancer, locally advanced or metastatic NSCLC, and metastatic pancreatic cancer
Do not start a new cycle if ANC is less than 1,500 cells/mm3; myelosuppression requires monitoring and possible adjustments in therapy
Dosing Considerations
Baseline Hepatic Impairment
Metastatic Breast Cancer
Mild hepatic impairment (AST 10 times the upper limit of normal (ULN) or less and total bilirubin 1.5 times ULN or less): No dose adjustment is necessary. Base the need for subsequent dose adjustments on individual patient tolerance.
Moderate hepatic impairment (AST less than 10 times ULN and total bilirubin 1.6 to 3 times ULN): Reduce the dose of nab-paclitaxel to 200 mg/m2; if this dose is tolerated for 2 cycles, consider an increase to the full dose of 260 mg/m2 in subsequent cycles. Base the need for subsequent dose adjustments on individual patient tolerance.
Severe hepatic impairment (AST less than 10 times ULN and total bilirubin 3.1 to 5 times ULN): Reduce the dose of nab-paclitaxel to 200 mg/m2; if this dose is tolerated for 2 cycles, consider an increase to the full dose of 260 mg/m2 in subsequent cycles. Base the need for subsequent dose adjustments on individual patient tolerance.
AST greater than 10 times ULN or total bilirubin greater than 5 times ULN: The use of nab-paclitaxel is not recommended.
Non-Small Cell Lung Cancer (NSCLC)
NOTE: Patients with bilirubin levels above the upper limit of normal were excluded from clinical trials for NSCLC.
Mild hepatic impairment (AST 10 times the upper limit of normal (ULN) or less and total bilirubin 1.5 times ULN or less): No dose adjustment is necessary. Base the need for subsequent dose adjustments on individual patient tolerance.
Moderate hepatic impairment (AST less than 10 times ULN and total bilirubin 1.6 to 3 times ULN): Reduce the dose of nab-paclitaxel to 80 mg/m2; if this dose is tolerated for 2 cycles, consider an increase to the full dose of 100 mg/m2 in subsequent cycles. Base the need for subsequent dose adjustments on individual patient tolerance.
Severe hepatic impairment (AST less than 10 times ULN and total bilirubin 3.1 to 5 times ULN): Reduce the dose of nab-paclitaxel to 80 mg/m2; if this dose is tolerated for 2 cycles, consider an increase to the full dose of 100 mg/m2 in subsequent cycles. Base the need for subsequent dose adjustments on individual patient tolerance.
AST greater than 10 times ULN or total bilirubin greater than 5 times ULN: The use of nab-paclitaxel is not recommended.
Pancreatic Adenocarcinoma
NOTE: Patients with bilirubin levels above the upper limit of normal were excluded from clinical trials for pancreatic cancer.
Mild hepatic impairment (AST 10 times the upper limit of normal (ULN) or less and total bilirubin 1.5 times ULN or less): No dose adjustment is necessary. Base the need for subsequent dose adjustments on individual patient tolerance.
Moderate hepatic impairment (AST less than 10 times ULN and total bilirubin 1.6 to 3 times ULN): The use of nab-paclitaxel is not recommended.
Severe hepatic impairment (AST less than 10 times ULN and total bilirubin 3.1 to 5 times ULN): The use of nab-paclitaxel is not recommended.
AST greater than 10 times ULN or total bilirubin greater than 5 times ULN: The use of nab-paclitaxel is not recommended.
Baseline Renal Impairment
Mild to moderate renal impairment (CrCl 30 to 89 mL/min): No adjustment to the starting dose of nab-paclitaxel is necessary.
Severe renal impairment or end-stage renal disease (CrCl less than 30 mL/min): Insufficient data exist to make dosage recommendations.
Drug Interactions
Abiraterone: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with abiraterone is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and abiraterone is a weak CYP2C8 inhibitor.
Adagrasib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with adagrasib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and adagrasib is a strong CYP3A inhibitor. In vitro, coadministration with both strong and moderate CYP3A inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A inhibitors.
Amiodarone: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with amiodarone is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and amiodarone is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Amobarbital: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with amobarbital is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and amobarbital is a moderate CYP3A4 inducer.
Amoxicillin; Clarithromycin; Omeprazole: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with clarithromycin is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and clarithromycin is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Apalutamide: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with apalutamide is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and apalutamide is a strong CYP3A4 inducer.
Aprepitant, Fosaprepitant: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with a 3-day oral regimen of aprepitant is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and aprepitant, administered orally over 3 days, is a moderate CYP3A4 inhibitor. Single oral doses of aprepitant and intravenous doses of fosaprepitant have not been shown to alter concentrations of CYP3A4 substrates.
Armodafinil: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with armodafinil is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and armodafinil is a weak CYP3A4 inducer.
Asciminib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of asciminib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and asciminib is a weak CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Aspirin, ASA; Butalbital; Caffeine: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with butalbital is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and butalbital is a moderate CYP3A4 inducer.
Atazanavir: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with atazanavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and atazanavir is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Atazanavir; Cobicistat: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with atazanavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and atazanavir is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors. (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with cobicistat is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and cobicistat is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Belzutifan: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with belzutifan is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and belzutifan is a weak CYP3A inducer.
Berotralstat: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with berotralstat is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and berotralstat is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Bexarotene: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with bexarotene is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and bexarotene is a moderate CYP3A4 inducer.
Bosentan: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with bosentan is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and bosentan is a moderate CYP3A4 inducer.
Brigatinib: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with brigatinib is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and brigatinib is a weak CYP3A4 inducer.
Butabarbital: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with butabarbital is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and butabarbital is a moderate CYP3A4 inducer.
Butalbital; Acetaminophen: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with butalbital is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and butalbital is a moderate CYP3A4 inducer.
Butalbital; Acetaminophen; Caffeine: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with butalbital is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and butalbital is a moderate CYP3A4 inducer.
Butalbital; Acetaminophen; Caffeine; Codeine: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with butalbital is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and butalbital is a moderate CYP3A4 inducer.
Butalbital; Aspirin; Caffeine; Codeine: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with butalbital is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and butalbital is a moderate CYP3A4 inducer.
Cannabidiol: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with cannabidiol is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and cannabidiol is a weak CYP2C8 inhibitor.
Carbamazepine: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with carbamazepine is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and carbamazepine is a strong CYP3A4 inducer.
Cenobamate: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with cenobamate is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and cenobamate is a moderate CYP3A4 inducer.
Ceritinib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with ceritinib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and ceritinib is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Chloramphenicol: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with chloramphenicol is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and chloramphenicol is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Cholera Vaccine: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to the live cholera vaccine. When feasible, administer indicated vaccines prior to initiating immunosuppressant medications. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to cholera bacteria after receiving the vaccine.
Ciprofloxacin: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with ciprofloxacin is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and ciprofloxacin is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Clarithromycin: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with clarithromycin is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and clarithromycin is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Clobazam: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with clobazam is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and clobazam is a weak CYP3A4 inducer.
Clopidogrel: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with clopidogrel is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and clopidogrel is a moderate CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Cobicistat: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with cobicistat is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and cobicistat is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Conivaptan: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with conivaptan is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and conivaptan is a moderate CYP3A inhibitor. In vitro, coadministration with moderate CYP3A inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A inhibitors.
Crizotinib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with crizotinib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and crizotinib is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Cyclosporine: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with cyclosporine is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and cyclosporine is a moderate CYP3A4 inhibitor. In vitro, the metabolism of paclitaxel is inhibited by cyclosporine at concentrations that exceed those found in vivo following normal therapeutic doses.
Dabrafenib: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with dabrafenib is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and dabrafenib is a moderate CYP3A4 inducer.
Danazol: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with danazol is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and danazol is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Darunavir: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with darunavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and darunavir is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Darunavir; Cobicistat: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with cobicistat is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and cobicistat is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors. (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with darunavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and darunavir is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with cobicistat is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and cobicistat is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors. (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with darunavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and darunavir is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Deferasirox: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with deferasirox is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and deferasirox is a moderate CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Delavirdine: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with delavirdine is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and delavirdine is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Dexamethasone: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with dexamethasone is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and dexamethasone is a weak CYP3A inducer.
Diltiazem: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with diltiazem is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and diltiazem is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Dronedarone: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with dronedarone is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and dronedarone is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Duvelisib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with duvelisib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and duvelisib is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Efavirenz: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with efavirenz is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and efavirenz is a moderate CYP3A4 inducer.
Efavirenz; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with efavirenz is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and efavirenz is a moderate CYP3A4 inducer.
Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with efavirenz is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and efavirenz is a moderate CYP3A4 inducer.
Elagolix: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with elagolix is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and elagolix is a weak-to-moderate CYP3A4 inducer.
Elagolix; Estradiol; Norethindrone acetate: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with elagolix is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and elagolix is a weak-to-moderate CYP3A4 inducer.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with cobicistat is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and cobicistat is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with cobicistat is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and cobicistat is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Enzalutamide: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with enzalutamide is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and enzalutamide is a strong CYP3A4 inducer.
Erlotinib: (Moderate) The use of taxane-based chemotherapy with erlotinib appears to be one of the risk factors for gastrointestinal (GI) perforation with erlotinib. Monitor for symptoms of GI perforation (e.g., severe abdominal pain, fever, nausea, and vomiting) if coadministration of erlotinib with a taxane chemotherapy agent is necessary.
Erythromycin: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with erythromycin is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and erythromycin is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Eslicarbazepine: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with eslicarbazepine is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and eslicarbazepine is a moderate CYP3A4 inducer.
Etravirine: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with etravirine is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and etravirine is a moderate CYP3A4 inducer.
Fedratinib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with fedratinib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and fedratinib is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Fluconazole: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with fluconazole is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and fluconazole is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Fluoxetine: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with fluoxetine is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate; fluoxetine is a weak inhibitor of CYP3A4, but its metabolite norfluoxetine is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Fosamprenavir: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with fosamprenavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and fosamprenavir is a moderate CYP3A inhibitor. In vitro, coadministration with both strong and moderate CYP3A inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A inhibitors.
Fosphenytoin: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with fosphenytoin is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and fosphenytoin is a strong CYP3A4 inducer.
Gemfibrozil: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with gemfibrozil is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and gemfibrozil is a strong CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Glycerol Phenylbutyrate: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with glycerol phenylbutyrate is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and glycerol phenylbutyrate is a weak CYP3A inducer.
Grapefruit juice: (Major) Advise patients to avoid grapefruit juice while taking nab-paclitaxel due to the risk of increased paclitaxel exposure. Nab-paclitaxel is a CYP3A4 substrate and grapefruit juice is a strong CYP3A4 inhibitor.
Idelalisib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with idelalisib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and idelalisib is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Imatinib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with imatinib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and imatinib is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Indinavir: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with indinavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and indinavir is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Isavuconazonium: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with isavuconazonium is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and isavuconazonium is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Isoniazid, INH; Pyrazinamide, PZA; Rifampin: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with rifampin is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 and CYP2C8 substrate. Rifampin is a strong CYP3A4 inducer and a moderate inducer of CYP2C8.
Isoniazid, INH; Rifampin: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with rifampin is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 and CYP2C8 substrate. Rifampin is a strong CYP3A4 inducer and a moderate inducer of CYP2C8.
Itraconazole: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with itraconazole is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and itraconazole is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Ketoconazole: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with ketoconazole is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and ketoconazole is a strong CYP3A4 inhibitor. In vitro, coadministration with ketoconazole increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Lansoprazole; Amoxicillin; Clarithromycin: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with clarithromycin is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and clarithromycin is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Lapatinib: (Moderate) Monitor for an increase in nab-paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with lapatinib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and lapatinib is a weak CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Lefamulin: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with oral lefamulin is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and oral lefamulin is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Leflunomide: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with leflunomide is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and leflunomide is a moderate CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Lenacapavir: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with lenacapavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and lenacapavir is a moderate CYP3A inhibitor. In vitro, coadministration with both strong and moderate CYP3A inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A inhibitors.
Lesinurad: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with lesinurad is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and lesinurad is a weak CYP3A4 inducer.
Lesinurad; Allopurinol: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with lesinurad is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and lesinurad is a weak CYP3A4 inducer.
Letermovir: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with letermovir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate. Letermovir is a moderate CYP3A4 inhibitor; however, when given with cyclosporine, the combined effect on CYP3A4 substrates is similar to a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Levoketoconazole: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with ketoconazole is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and ketoconazole is a strong CYP3A4 inhibitor. In vitro, coadministration with ketoconazole increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Lonafarnib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with lonafarnib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and lonafarnib is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Lopinavir; Ritonavir: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with ritonavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and ritonavir is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors. (Moderate) Monitor for paclitaxel-related adverse reactions during coadministration with lopinavir as concurrent use may increase exposure to paclitaxel. Paclitaxel is a substrate for the transporter organic anion-transporting polypeptide (OATP1B1); lopinavir is an OATP1B1 inhibitor.
Lorlatinib: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with loraltinib is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and loraltinib is a moderate CYP3A4 inducer.
Lumacaftor; Ivacaftor: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with lumacaftor; ivacaftor is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and lumacaftor is a strong CYP3A4 inducer.
Lumacaftor; Ivacaftor: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with lumacaftor; ivacaftor is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and lumacaftor is a strong CYP3A4 inducer.
Mavacamten: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with mavacamten is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and mavacamten is a moderate CYP3A inducer.
Methohexital: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with methohexital is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and methohexital is a moderate CYP3A4 inducer.
Mifepristone: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with mifepristone is necessary due to the risk of increased plasma concentrations of paclitaxel. The clinical significance of this interaction with the short-term use of mifepristone for termination of pregnancy is unknown. Nab-paclitaxel is a CYP3A4 and CYP2C8 substrate. Mifepristone is a strong CYP3A4 inhibitor and a moderate inhibitor of CYP2C8. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Mitapivat: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with mitapivat is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and mitapivat is a weak CYP3A inducer.
Mitotane: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with mitotane is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and mitotane is a strong CYP3A4 inducer.
Mobocertinib: (Moderate) Monitor for decreased efficacy of paclitaxel if coadministration with mobocertinib is necessary due to the risk of decreased plasma concentrations of paclitaxel. Paclitaxel is a CYP3A substrate and mobocertinib is a weak CYP3A inducer.
Modafinil: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with modafinil is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and modafinil is a moderate CYP3A4 inducer.
Nafcillin: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with nafcillin is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and nafcillin is a moderate CYP3A4 inducer.
Nefazodone: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with nefazodone is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and nefazodone is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Nelfinavir: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with nelfinavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and nelfinavir is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Netupitant, Fosnetupitant; Palonosetron: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with netupitant is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and netupitant is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Nevirapine: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with nevirapine is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and nevirapine is a weak CYP3A inducer.
Nicardipine: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with nicardipine is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and nicardipine is a weak CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Nilotinib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with nilotinib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and nilotinib is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Niraparib; Abiraterone: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with abiraterone is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and abiraterone is a weak CYP2C8 inhibitor.
Nirmatrelvir; Ritonavir: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with ritonavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and ritonavir is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Odevixibat: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with odevixibat is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and odevixibat is a weak CYP3A inducer.
Olanzapine; Fluoxetine: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with fluoxetine is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate; fluoxetine is a weak inhibitor of CYP3A4, but its metabolite norfluoxetine is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Olutasidenib: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with olutasidenib is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and olutasidenib is a weak CYP3A inducer.
Omaveloxolone: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with omaveloxolone is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A and CYP2C8 substrate and omaveloxolone is a weak CYP3A and CYP2C8 inducer.
Omeprazole; Amoxicillin; Rifabutin: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with rifabutin is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and rifabutin is a moderate CYP3A4 inducer.
Oritavancin: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with oritavancin is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer.
Oxcarbazepine: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with oxcarbazepine is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and oxcarbazepine is a weak CYP3A4 inducer.
Pentobarbital: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with pentobarbital is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and pentobarbital is a CYP3A4 inducer.
Pexidartinib: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with pexidartinib is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and pexidartinib is a moderate CYP3A4 inducer.
Phenobarbital: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with phenobarbital is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and phenobarbital is a strong CYP3A4 inducer.
Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with phenobarbital is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and phenobarbital is a strong CYP3A4 inducer.
Phenytoin: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with phenytoin is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and phenytoin is a strong CYP3A4 inducer.
Pirtobrutinib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with pirtobrutinib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and pirtobrutinib is a moderate CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Posaconazole: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with posaconazole is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and posaconazole is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Primidone: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with primidone is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and primidone is a strong CYP3A4 inducer.
Ribociclib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with ribociclib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and ribociclib is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Ribociclib; Letrozole: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with ribociclib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and ribociclib is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Rifabutin: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with rifabutin is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and rifabutin is a moderate CYP3A4 inducer.
Rifampin: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with rifampin is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 and CYP2C8 substrate. Rifampin is a strong CYP3A4 inducer and a moderate inducer of CYP2C8.
Rifapentine: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with rifapentine is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and rifapentine is a strong CYP3A4 inducer.
Ritlecitinib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with ritlecitinib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and ritlecitinib is a moderate CYP3A inhibitor. In vitro, coadministration with both strong and moderate CYP3A inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A inhibitors.
Ritonavir: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with ritonavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and ritonavir is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Saquinavir: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with saquinavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and saquinavir is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
SARS-CoV-2 (COVID-19) vaccines: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to the SARS-CoV-2 virus vaccine. When feasible, administer indicated vaccines prior to initiating immunosuppressant medications. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to SARS-CoV-2 virus after receiving the vaccine.
Secobarbital: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with secobarbital is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and secobarbital is a moderate CYP3A4 inducer.
Selpercatinib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with selpercatinib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and selpercatinib is a moderate CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Sodium Phenylbutyrate; Taurursodiol: (Moderate) Monitor for decreased efficacy and/or increased paclitaxel-related adverse reactions if coadministration with taurursodiol is necessary. Concomitant use may alter nab-paclitaxel exposure. Paclitaxel is a CYP3A and CYP2C8 substrate and taurursodiol is a weak CYP3A inducer and CYP2C8 inhibitor. The net effect on paclitaxel exposure is unknown.
Sotorasib: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with sotorasib is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and sotorasib is a moderate CYP3A4 inducer.
Spironolactone: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with spironolactone is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and spironolactone is a weak CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Spironolactone; Hydrochlorothiazide, HCTZ: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with spironolactone is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and spironolactone is a weak CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
St. John's Wort, Hypericum perforatum: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with St. John's Wort is necessary due to
Stiripentol: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions or decreased efficacy of nab-paclitaxel if coadministration of nab-paclitaxel with stiripentol is necessary due to the risk of altered plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate. Stiripentol is a weak CYP2C8 inhibitor, as well as being both an inhibitor and inducer of CYP3A4. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by inhibitors of CYP3A4 and CYP2C8.
Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with trimethoprim is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and trimethoprim is a weak CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Tazemetostat: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with tazemetostat is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and tazemetostat is a weak CYP3A4 inducer.
Tecovirimat: (Moderate) Monitor for decreased efficacy of nab-paclitaxel or an increase in paclitaxel-related adverse reactions if coadministration with tecovirimat is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 and CYP2C8 substrate. Tecovirimat is a weak CYP3A4 inducer and a weak CYP2C8 inhibitor.
Telotristat Ethyl: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with telotristat is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and telotristat is a weak CYP3A4 inducer.
Teriflunomide: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with teriflunomide is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and teriflunomide is a moderate CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Tipranavir: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with tipranavir is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and tipranavir is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Trandolapril; Verapamil: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with verapamil is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and verapamil is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Trimethoprim: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with trimethoprim is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP2C8 substrate and trimethoprim is a weak CYP2C8 inhibitor. In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8.
Tuberculin Purified Protein Derivative, PPD: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Tucatinib: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with tucatinib is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and tucatinib is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Verapamil: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with verapamil is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and verapamil is a moderate CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Vonoprazan; Amoxicillin; Clarithromycin: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with clarithromycin is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and clarithromycin is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Voriconazole: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with voriconazole is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and voriconazole is a strong CYP3A4 inhibitor. In vitro, coadministration with both strong and moderate CYP3A4 inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A4 inhibitors.
Voxelotor: (Moderate) Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with voxelotor is necessary due to the risk of increased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A substrate and voxelotor is a moderate CYP3A inhibitor. In vitro, coadministration with both strong and moderate CYP3A inhibitors increased paclitaxel exposure; however, the concentrations used exceeded those found in vivo following normal therapeutic doses. The pharmacokinetics of paclitaxel may also be altered in vivo as a result of interactions with CYP3A inhibitors.
Zanubrutinib: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with zanubrutinib is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and zanubrutinib is a weak CYP3A4 inducer.
How Supplied
Abraxane/Paclitaxel/Paclitaxel, albumin-bound (human) Intravenous Inj Pwd F/Susp: 100mg
Maximum Dosage
260 mg/m2 IV.
Geriatric260 mg/m2 IV.
AdolescentsSafety and efficacy have not been established.
ChildrenSafety and efficacy have not been established.
InfantsSafety and efficacy have not been established.
NeonatesSafety and efficacy have not been established.
Mechanism Of Action
Paclitaxel is a microtubule inhibitor that promotes the assembly of microtubules from tubulin dimers and stabilizes microtubules by preventing depolymerization. This stability results in the inhibition of the normal dynamic reorganization of the microtubule network that is essential for vital interphase and mitotic cellular functions. Paclitaxel induces abnormal arrays or bundles of microtubules throughout the cell cycle and multiple asters of microtubules during mitosis.
Paclitaxel is hydrophobic and must be formulated in a solvent (Cremophohr EL) to increase solubility and bioavailability. Albumin carries water-insoluble molecules in the human body. Nanoparticle albumin-bound (nab) technology improves tumor penetration via albumin receptor-mediated (gp60) endothelial transcytosis.
Pharmacokinetics
Nab-paclitaxel is administered intravenously. In patients with solid tumors, nab-paclitaxel is extensively protein bound (94%) to plasma proteins and is evenly distributed into blood cells and plasma. In a within-patient comparison study, the fraction of unbound paclitaxel was significantly higher with nab-paclitaxel than with solvent-based paclitaxel (6.2% vs. 2.3%), contributing to significantly higher unbound paclitaxel exposure with nab-paclitaxel compared to solvent-based paclitaxel even when total exposure is comparable. The mean volume of distribution is 1,741 liters, indicating extensive extravascular distribution and/or tissue binding. The volume of distribution is 53% higher for nab-paclitaxel (260 mg/m2 IV over 30 minutes) compared to paclitaxel (175 mg/m2 IV over 3 hours). At 0.31 to 1.15 times the maximum approved recommended dosage, the mean total clearance of paclitaxel ranges from 13 to 30 liters/hour/m2, and the mean terminal elimination half-life ranges from 13 to 27 hours. Clearance was 43% higher for nab-paclitaxel (260 mg/m2 IV over 30 minutes) compared to paclitaxel (175 mg/m2 IV over 3 hours); there were no differences in terminal half-lives. Nab-paclitaxel undergoes extensive nonrenal clearance. After a 30-minute infusion, 4% of a 260 mg/m2 dose of nab-paclitaxel was recovered in the urine as unchanged paclitaxel, with less than 1% as either 6-alpha-hydroxypaclitaxel and 3'-p-hydroxypaclitaxel. Approximately 20% of the total dose is eliminated in the feces.
Affected Cytochrome P450 (CYP450) isoenzymes and drug transporters: CYP2C8, CYP3A4
Paclitaxel is primarily metabolized via CYP2C8 to 6-alpha-hydroxypaclitaxel in vitro; it also has 2 minor metabolites via CYP3A4 (3'-p-hydroxypaclitaxel and 6-alpha,3'-para-dihydroxypaclitaxel). In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by several agents (i.e., ketoconazole, verapamil, diltiazem, quinidine, dexamethasone, cyclosporine, teniposide, etoposide, and vincristine), but the concentrations exceeded those found in vivo at therapeutic doses; testosterone, 17-alpha-ethinyl estradiol, retinoic acid, and quercetin also inhibited the in vitro formation of 6-alpha hydroxypaclitaxel. Substrates, inhibitors, and inducers of CYP2C8 and/or CYP3A4 may affect the pharmacokinetics of paclitaxel.
Paclitaxel exhibited linear drug exposure (AUC) across clinical doses ranging from 80 mg/m2 to 300 mg/m2 after IV administration of nab-paclitaxel. In patients with solid tumors, paclitaxel concentrations declined in a biphasic manner after IV administration of nab-paclitaxel, with an initial rapid decline representing distribution to the peripheral compartment and the slower second phase representing drug elimination. The pharmacokinetics of paclitaxel in nab-paclitaxel were independent of the duration of IV infusion.
Pregnancy And Lactation
Pregnancy should be avoided by females of reproductive potential during nab-paclitaxel treatment and for at least 6 months after the last dose. Although there are no adequately controlled studies in pregnant humans, nab-paclitaxel can cause fetal harm or death when administered during pregnancy based on its mechanism of action and animal studies. Women who are pregnant or who become pregnant while receiving nab-paclitaxel should be apprised of the potential hazard to the fetus. In animal reproduction studies, administration of nab-paclitaxel to pregnant rats during organogenesis resulted in embryo-fetal toxicity at doses approximately 2% of the maximum recommended human dose (MRHD) on a mg/m2 basis. These toxicities included intrauterine mortality, increased resorptions (up to 5-fold), reduced numbers of litters and live fetuses, reduced fetal body weight, and increased fetal anomalies such as soft tissue and skeletal malformations (e.g. eye bulge, folded retina, microphthalmia, dilation of brain ventricles).
Due to the potential for serious adverse reactions in nursing infants from nab-paclitaxel, advise women to discontinue breast-feeding during treatment and for 2 weeks after the final dose. It is not known whether nab-paclitaxel is present in human milk, although many drugs are excreted in human milk.