Paclitaxel

Atazanavir without ritonavir is not recommended when coadministered with paclitaxel due to CYP2C8 inhibition and narrow therapeutic index.

Paclitaxel is highly dependent on CYP2C8 for clearance with narrow therapeutic index. EVOTAZ use is not recommended with paclitaxel due to potential for increased plasma concentrations.

Myelosuppression more profound when paclitaxel given after cisplatin; paclitaxel clearance decreased approximately 33% when administered following cisplatin.

Increased hematotoxicity has been reported when cyclophosphamide was administered after paclitaxel infusion.

Plasma levels of doxorubicin and its active metabolite doxorubicinol may be increased when used in combination with paclitaxel.

When given prior to doxorubicin hydrochloride, increases plasma concentrations of doxorubicin and its metabolites. Administer doxorubicin prior to paclitaxel if used concomitantly.

Increased paclitaxel exposure possible; no dosage adjustment needed but monitor for adverse reactions.

Atazanavir without ritonavir is not recommended when coadministered with paclitaxel due to CYP2C8 inhibition and narrow therapeutic index.

No clinically meaningful pharmacokinetic effect; however, some patients receiving bevacizumab with paclitaxel and carboplatin showed lower paclitaxel exposure after four cycles compared to baseline.

No clinically meaningful effect on paclitaxel pharmacokinetics observed; however, some patients receiving bevacizumab with paclitaxel and carboplatin showed lower paclitaxel exposure at Day 63 compared to Day 0.

No clinically meaningful effect on paclitaxel pharmacokinetics overall, but 3 of 8 patients receiving bevacizumab with paclitaxel and carboplatin showed lower paclitaxel exposure at Day 63 compared to Day 0.

No clinically meaningful effect on paclitaxel pharmacokinetics observed, but some patients receiving bevacizumab with paclitaxel and carboplatin had lower paclitaxel exposure after four cycles compared to baseline.

No clinically meaningful overall effect on pharmacokinetics; however, 3 of 8 patients receiving bevacizumab with paclitaxel and carboplatin had lower paclitaxel exposure at Day 63 compared to Day 0.

No clinically meaningful effect observed overall, but 3 of 8 patients receiving bevacizumab with paclitaxel and carboplatin had lower paclitaxel exposure at Day 63 compared to Day 0, unlike controls.

Bexarotene decreased paclitaxel exposure (AUC) by 19%. When combined with carboplatin, paclitaxel exposure was increased 2-fold.

CYP3A4 substrate; caution should be exercised when administering paclitaxel concomitantly.

CYP3A4 inducer; caution should be exercised when administering paclitaxel concomitantly.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4.

Increased hematotoxicity reported when cyclophosphamide administered after paclitaxel infusion.

Deferasirox inhibits CYP2C8 resulting in increased paclitaxel concentration. Monitor for exposure related toxicity.

CYP3A4 substrate; diazepam may interfere with its metabolism, leading to potential drug-drug interaction.

CYP3A4 substrate; caution should be exercised when administering paclitaxel concomitantly.

Administration of epirubicin immediately prior to or after paclitaxel increases systemic exposure of epirubicin and its metabolites. Monitor for additive hematologic and gastrointestinal toxicity.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4.

Increased exposure of chemotherapeutic agent; no dosage adjustment needed but monitor for adverse effects.

Increased exposure possible via CYP3A4 inhibition, but no dosage adjustment needed. Monitor for adverse reactions.

MultiHance may compete for MOAT transporter and prolong systemic exposure of paclitaxel.

CYP2C8 inhibitor; caution should be exercised when administering paclitaxel concomitantly.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4. Potential interactions between paclitaxel, a substrate of CYP3A4, and protease inhibitors (ritonavir, saquinavir, indinavir, and nelfinavir), which are substrates and/or inhibitors of CYP3A4, have not been evaluated in clinical trials.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4.

Lapatinib increases paclitaxel systemic exposure by 23% in cancer patients. Monitor paclitaxel levels and consider dose adjustment.

Exposure to paclitaxel may be increased when coadministered with leflunomide. Monitor and adjust dose as required.

Exposure of paclitaxel may be increased in patients taking leflunomide. Monitor and adjust dose as required.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4.

CYP3A4 inhibitor; caution should be exercised when administering paclitaxel concomitantly.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4. Potential interactions between paclitaxel, a substrate of CYP3A4, and protease inhibitors (ritonavir, saquinavir, indinavir, and nelfinavir), which are substrates and/or inhibitors of CYP3A4, have not been evaluated in clinical trials.

Chemotherapy agent metabolized by CYP3A4; systemic exposure can increase with AKYNZEO; caution and monitoring advised.

CYP2C8 substrate; caution should be exercised when administering paclitaxel concomitantly.

CYP3A4 and CYP2C8 inducer; caution should be exercised when administering paclitaxel concomitantly.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4. Potential interactions between paclitaxel, a substrate of CYP3A4, and protease inhibitors (ritonavir, saquinavir, indinavir, and nelfinavir), which are substrates and/or inhibitors of CYP3A4, have not been evaluated in clinical trials.

CYP2C8 substrate; caution should be exercised when administering paclitaxel concomitantly.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4. Potential interactions between paclitaxel, a substrate of CYP3A4, and protease inhibitors (ritonavir, saquinavir, indinavir, and nelfinavir), which are substrates and/or inhibitors of CYP3A4, have not been evaluated in clinical trials.

CYP3A4 substrate; caution should be exercised when administering paclitaxel concomitantly.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4.

Teriflunomide may increase exposure of paclitaxel. Monitor patients and adjust dose as required.

Paclitaxel causes peripheral neuropathy and concomitant use with thalidomide can cause additive effect; should be used with caution.

Caution should be exercised when paclitaxel is concomitantly administered with known substrates (e.g., midazolam, buspirone, felodipine, lovastatin, eletriptan, sildenafil, simvastatin, and triazolam), inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin), and inducers (e.g., rifampin and carbamazepine) of CYP3A4.