[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Microtubule inhibitors](https://durgical.com/en/pharmacology/classes/microtubule-inhibitors/) › Paclitaxel

[Pharmacology](https://durgical.com/en/pharmacology/) · [Microtubule inhibitors](https://durgical.com/en/pharmacology/classes/microtubule-inhibitors/)

# Paclitaxel

A taxane that freezes microtubules so cells cannot divide. Used in ovarian, breast and lung cancer; premedication is needed to prevent allergic reactions.

Updated 2026-11-01

- Class: [Microtubule inhibitors](https://durgical.com/en/pharmacology/classes/microtubule-inhibitors/)
- Target: β-tubulin (taxane site, inside the microtubule)
- ATC code: L01CD01
- WHO Model List of Essential Medicines

## ⚠ High-alert medication

An error with this medicine can cause serious harm: double checks and protocols are used.

◆**β-tubulin (taxane site, inside the microtubule)**Paclitaxel

ⓘ The structure shows paclitaxel bound to bovine α/β-tubulin; the taxane pocket is on β-tubulin, facing the inside of the microtubule.

**Target in 3D:** β-tubulin (taxane site, inside the microtubule). PDB structure 1JFF (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/1JFF) · Drag to rotate · pinch to zoom

## Mechanism of action

Paclitaxel binds β-tubulin inside assembled microtubules, promotes their assembly and prevents them from breaking down. The rigid, abnormal bundles cannot reorganise into a working spindle, so cells arrest in mitosis and die. The same loss of microtubule dynamics in long nerve axons produces sensory neuropathy.

- Paclitaxel binds β-tubulin inside the microtubule
- Microtubules are stabilised and cannot disassemble
- No dynamic spindle: mitotic arrest and cell death

## Pharmacokinetics

**Absorption**
Intravenous infusion only.

**Distribution**
Wide, with slow release back from tissues.

**Metabolism**
Liver, by CYP2C8 and CYP3A4.

## Indications

- Ovarian carcinoma: first line with cisplatin, and later lines. [Ovarian cancer →](https://durgical.com/en/conditions/ovarian-cancer/)
- Breast cancer: adjuvant after doxorubicin-containing chemotherapy in node-positive disease, and metastatic disease. [Breast cancer →](https://durgical.com/en/conditions/breast-cancer/)
- Non-small cell lung cancer, first line with cisplatin. [Lung cancer →](https://durgical.com/en/conditions/lung-cancer/)
- AIDS-related Kaposi sarcoma, second line.

## Adverse effects

### Common

- Hair loss in almost all patients
- Neutropenia
- Peripheral sensory neuropathy
- Joint and muscle pain
- Low heart rate or blood pressure during the infusion; injection-site reactions

### Serious (rare, important)

- Anaphylaxis and severe hypersensitivity, sometimes fatal despite premedication
- Severe neutropenia with infection (dose-limiting)
- Severe cardiac conduction abnormalities

## Contraindications

- Hypersensitivity to paclitaxel or to other drugs formulated in polyoxyl 35 castor oil
- Low baseline neutrophil count

## Key interactions

**Cisplatin**
Paclitaxel given after cisplatin is cleared more slowly and causes more myelosuppression; paclitaxel goes first.

**Doxorubicin**
Paclitaxel given first raises doxorubicin levels; doxorubicin goes first.

**CYP2C8 or CYP3A4 inhibitors (e.g. gemfibrozil) and inducers (e.g. rifampicin)**
Can raise or lower paclitaxel exposure.

## What is monitored

- Neutrophil count before each cycle
- Vital signs during the infusion, especially the first hour
- Symptoms of neuropathy
- ECG monitoring if conduction problems appear

## Administration and safety

- Premedication with a corticosteroid, an antihistamine (H1) and an H2 blocker before every dose.
- Prepared in glass, polypropylene or polyolefin containers and given through non-PVC (polyethylene-lined) tubing, to avoid leaching of the plasticiser DEHP.
- Given through an in-line microporous filter.
- Hazardous drug: prepared and given following hazardous-drug handling procedures (impervious gloves, no skin contact) and disposed of as cytotoxic waste.

## Nursing care

- Independent double check of drug, patient, route and cycle before giving it (high-alert medicine).
- Confirm the premedication was given; stay with the patient at the start of the infusion with emergency drugs ready.
- Watch for flushing, breathlessness, chest tightness, rash or low blood pressure; stop the infusion if they appear.
- Blood count before each cycle; fever with neutropenia is treated as an emergency.
- Teaching: hair loss is expected; report numbness, tingling or burning in hands and feet.

## Pregnancy and breastfeeding

Can cause fetal harm; pregnancy is avoided during treatment.

## Memory aid

TAXanes «TAX» the microtubule into staying still: frozen spindles. «Premedicate, filter, no PVC» is the paclitaxel bedside routine.

## Test yourself

Think of the answer, then tap the question to see it.

## How does paclitaxel's action on microtubules differ from that of vincristine?

Paclitaxel stabilises microtubules and stops their disassembly; vincristine prevents them from assembling.

## Which three drug groups are given as premedication before paclitaxel?

A corticosteroid (e.g. dexamethasone), an H1 antihistamine (e.g. diphenhydramine) and an H2 blocker.

## Why is paclitaxel given through non-PVC tubing?

Its solvent can leach the plasticiser DEHP from PVC bags and sets.

## When paclitaxel and cisplatin are combined, which is given first, and why?

Paclitaxel first: given after cisplatin it is cleared more slowly and causes more myelosuppression.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/paclitaxel/)

## Related drugs

- [Docetaxel](https://durgical.com/en/pharmacology/docetaxel/)
- [Vincristine](https://durgical.com/en/pharmacology/vincristine/)
- [Cisplatin](https://durgical.com/en/pharmacology/cisplatin/)
- [Carboplatin](https://durgical.com/en/pharmacology/carboplatin/)

## Related conditions

- [Ovarian cancer](https://durgical.com/en/conditions/ovarian-cancer/)
- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)
- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)

[← Back to the class: Microtubule inhibitors](https://durgical.com/en/pharmacology/classes/microtubule-inhibitors/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - PACLITAXEL injection, solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ea28753a-8631-460a-bfdc-b101eb8ac84a) (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 70 (McGraw Hill, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01CD01) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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