Ixabepilone (Intravenous)

Overview

Ixabepilone injection is in the group of medications called cancer medications or antineoplastic agents. It helps treat metastatic or advanced breast cancer (cancer that's already spread to other areas) after other therapies have failed. This medication is given with another cancer medication known as Capecitabine or alone.

Ixabepilone stops cancer cells from growing, eventually destroying them. Since this medicine will also affect the growth of regular cells, other side effects can occur. Some of them could be serious and you must report them to your healthcare professional straight away.

Ixabepilone is to be administered only by your doctor or under his/her direct supervision.

This medicine comes in the form of a powder for solution and is marketed under the Ixempra brand name.

Conditions Treated

  • Metastatic breast cancer
  • Locally advanced breast cancer

Type Of Medicine

  • Antineoplastic agent

Side Effects

Taking Ixabepilone may cause these side effects: swelling, pain, or redness at injection site, tiredness, weakness, joint or muscle pain, vomiting, nausea, loss of appetite, diarrhea, dizziness, headache, or drowsiness. In some patients, vomiting and nausea may be quite serious. Your doctor can prescribe drugs to relieve or prevent vomiting and nausea. Avoiding food before treatment, eating lots of small meals, or restricting activity may help reduce some of the above effects. If some of these effects worsen or persist, notify your doctor and pharmacist at once.

Temporary loss of hair can occur. Normal growth of hair should return after the end of your treatment.

People using Ixabepilone may suffer severe side effects. Your doctor, however, has prescribed Ixabepilone because he/she has deemed its benefit to you to be greater than its risk. Your risk may be reduced by close monitoring by your healthcare provider.

Ixabepilone can reduce the ability of your body to fight off infections. Notify your doctor at once if you have any of these infection signs, including fever, chills, persistent sore throat, or painful urination.

Painful sores may occur on the throat, mouth, and lips. To reduce this risk, limit hot drinks and foods, carefully brush your teeth, avoid any mouthwash that has alcohol, and frequently rinse your mouth with cool water.

Notify your doctor at once if you suffer any severe side effects, including pale skin, swollen feet, ankles, or hands, fainting, unusual or easy bleeding/bruising, signs of dehydration (e.g. dry mouth, increased thirst, decreased urination), or sudden weight gain.

Ixabepilone can at times affect the function of your nerves (peripheral neuropathy). Notify your doctor at once if you develop numbness, tingling, burning, or pain on the feet or hands.

You may reduce these kinds of nerve issues by avoiding ice and cold drinks and by putting on clothes for warmth. Notify your doctor promptly if your nerve issues start to get in the way of your usual daily activities (including walking, eating, writing, etc.)

Treatment with Ixabepilone can sometimes make your feet or hands suffer a skin reaction known as palmar-plantar erythrodysesthesia (hand-foot syndrome), especially when Ixabepilone is given together with Capecitabine. To reduce or prevent these problems, you should protect your feet and hands from a lot of pressure or heat.

Avoid exposure to too much heat (e.g. long hot baths, hot dishwasher). Avoid pressure on your soles, knees, and elbows by taking long walks, kneeling, and leaning on elbows respectively. Put on loose clothing. Based on how serious your palmar-plantar erythrodysesthesia is, your doctor can prescribe a drug to relieve the symptoms or delay or reduce your next treatment. Notify your doctor promptly if you experience redness, swelling, numbness, pain, or blisters on your feet or hands that affects your normal activities.

Get medical assistance at once if you suffer any of these very serious but rare side effects: fast or irregular heartbeat, chest pain, shortness of breath, black or bloody stools, vision changes, vomit that resembles coffee grounds, sudden confusion, or seizures.

Ixabepilone rarely causes a very severe allergic reaction. However, get medical assistance as soon as possible if you develop any of these symptoms of a severe allergic reaction: face flushing, rash, itching or swelling of the throat/tongue/face, severe dizziness, difficulty with breathing, or tightness in your chest.

Other Ixabepilone side effects not mentioned above may also happen in some people. If you suffer any other effects, see your healthcare professional at once.

Dosage

A nurse or any other qualified healthcare provider will give you Ixabepilone in a hospital or clinic. Ixabepilone is given via a needle positioned in one of the veins.

The amount of Ixabepilone that you'll get depends on several factors, including your weight and height, your overall health or other medical problems, and the condition or cancer you have. Your physician will decide your exact Ixabepilone dosage and schedule.

Ixabepilone is normally given once every three weeks. Every treatment normally takes around three hours. You also may receive drugs to help prevent possible allergies to the injection.

Ixabepilone often causes nausea, vomiting, and diarrhea. However, it's vitally important that you keep receiving this medication even if you start to feel sick. Your doctor can give you a drug to prevent the side effects.

Grapefruit juice and grapefruit may alter the amount of Ixabepilone that your body absorbs. Don't drink grapefruit juice or eat grapefruit while you're taking Ixabepilone.

Ixabepilone comes with an information leaflet for patients. It's vitally important that you understand this information. Make sure to ask your healthcare provider about anything you don't understand.

Call your healthcare provider for directions if you skip an Ixabepilone injection.

In case of an overdose, call your poison control agency at 1-800-222-1222 or seek emergency medical intervention.

Interactions

Many drugs may interact with Ixabepilone. The list below is just a partial one. Notify your healthcare provider if you're using:

  • Nefazodone
  • Bosentan (Tracleer)
  • Conivaptan (Vaprisol)
  • Imatinib (Gleevec)
  • Dexamethasone (Dexasone, DexPak, Cortastat, Solurex)
  • Isoniazid (tuberculosis treatment)
  • St John's Wort
  • HIV/AIDS medicines, including Saquinavir (Invirase), Etravirine (Intelence), Ritonavir (Kaletra, Norvir), Nevirapine (Viramune), Nelfinavir (Viracept), Indinavir (Crixivan), Fosamprenavir (Lexiva), Efavirenz (Atripla, Sustiva), Delavirdine (Rescriptor), or Atazanavir (Reyataz).
  • Seizure medicines, including Primidone (Mysoline), Phenytoin (Dilantin), Oxycarbazepine (Trileptal), Felbamate (Felbatol), or Carbamazepine (Tegretol, Equetro, Carbatrol).
  • Medicines for treating Narcolepsy, including Modafinil (Progivil), or Armodafinil (Nuvigil)
  • Hepatitis C medicines, including Telaprevir (Incivek), or Boceprevir (Victrelis)
  • Blood pressure or heart medicines, including Qunidine (Quin-G), or Nicardipine (Cardene)
  • A barbiturate, including Secobarbital (Seconal), Butabarbital (Butisol), Phenobarbital (Solfoton), or Pentobarbital (Nembutal)
  • Antibiotics, including Erythromycin (Pediazole, Erythrocin, Ery-Tab, EryPed, E.E.S), Clarithromycin (Biaxin), Rifabutin (Mycobutin), Rifampin (Rifamate, Rifadin, Rifater), Telithromycin (Ketek), or Rifapentine (Priftin)
  • Antifungal medicines, incliuding Voriconazole (Vfend), Ketoconazole (Nizoral), Posaconazole (Noxafil), Miconazole (Oravig), or Sporanox (Itraconazole)

This list of Ixabepilone drug interactions isn't all-inclusive and other medications can interact with Ixabepilone too. Please tell your healthcare provider about all medicines you use, including over-the-counter and prescription medicines, herbal products, and vitamins. Don't begin a new medicine without informing your doctor.

Warnings

It's vitally important that your physician checks your progress regularly to ensure that Ixabepilone is working well. You may require blood tests to check for adverse effects.

Before taking Ixabepilone, inform your pharmacist and doctor if you have allergies to it, or to anything else. This product may have inactive ingredients which may cause allergies or other problems, for example polyoxyethylated castor oil. For more details, ask your pharmacist.

Before using Ixabepilone, tell your pharmacist and doctor about your medical past, especially of: heart problems (such as heart failure, chest pain, or heart attack), bleeding problems, bone marrow problems (such as anemia, low white blood cell count), liver problems, or nerve issues (peripheral neuropathy).

Tell your pharmacist and doctor what other over-the-counter and prescription drugs, nutritional supplements, vitamins, and herbal products you've recently used or intend to use. Make sure to name any of these:

  • Fluconazole (Diflucan)
  • Dexamethasone (Decadron, Dexpak)
  • Delavirdine (Rescriptor)
  • Erythromycin (Erythrocin, Ery-Tab, E-Mycin, E.E.S)
  • Nefazodone
  • Rifampin (in Rifamate, Rifater, Rimactane, Rifadin)
  • Rifabutin (Mycobutin)
  • Verapamil (in Tarka, Verelan, Isoptin, Covera, Calan)
  • Certain antifungals like Itraconazole (Sporanox), Voriconazole (Vfend), and Ketoconazole (Nizoral)
  • Certain antibiotics like Telithromycin (Ketek) and Clarithromycin (Biaxin)
  • Certain seizure medications like Phenytoin (Phenytek, Dilantin), Phenobarbital (Luminal), and Carbamazepine (Tegretol, Epitol, Carbatrol)
  • Protease inhibitors for treating HIV like Saquinavir (Invirase), Nelfinavir (Viracept), Ritonavir (in Kaletra, Norvir), Indinavir (Crixivan), Atazanavir (Reyataz), and Amprenavir (Agenerase)

Your doctor may decide to change your doses of drugs or carefully monitor you for side effects.

Tell your healthcare provider what herbal medicines you're using. Make sure to mention St. John's Wort if you're using it.

Tell your healthcare provider if you've ever had diabetes or have it now; or if you've ever had any condition that brings on numbness, tingling or burning in your feet or hands, or if you've ever had heart disease.

Inform your physician if you're pregnant, intend to get pregnant, or if you're nursing an infant. You shouldn't get pregnant while receiving this medication. Discuss with your doctor birth control options that'll work for you. Call up your physician if you get pregnant while receiving Ixabepilone. This medication may put the fetus at risk.

It's not yet known if this medication passes into a mother's milk. Due to the potential risk to the baby, it's not advisable to breastfeed while using Ixabepilone.

You need to know that Ixabepilone contains alcohol and can cause drowsiness. Do not use machines or drive a car until you understand how Ixabepilone affects you. Discuss with your doctor the safe intake of medications or alcohol that may interfere with your judgment and thinking while you're receiving Ixabepilone injections.

Do not receive vaccinations or immunizations without your doctor's consent, and stay away from people who've recently received flu vaccine or polio vaccine inhaled via the nose. Clean your hands properly to prevent infections from spreading.

Check with your physician at once if you experience painful, burning, numb, or tingling sensations in your feet, legs, hands, or arms. These symptoms may indicate a condition known as peripheral neuropathy.

Ixabepilone injection may temporarily reduce your white blood cell count, increasing your chances of developing an infection. It may also reduce your platelet count, which means your blood clotting will be affected. If this happens, there are some precautions you should take, especially when you have low blood cell counts, to decrease the risk of bleeding or infection:

  • If possible, avoid people carrying infections. Consult your doctor promptly if you think you're developing some kind of infection or have chills or fever, hoarseness or cough, side pain or lower back pain, or have difficult or painful urination.
  • See your doctor at once if you experience any unusual bleeding/bruising, tarry, black stools, blood in the stools or urine, or red pinpoint spots on the skin.
  • Be cautious when using a standard dental floss, toothpick, or toothbrush. Your dentist, medical doctor, or nurse can recommend other methods to clean your gums and teeth. Before you have any dental work carried out, consult your doctor.
  • Don't touch inside your nose or your eyes unless you've just cleaned your hands and haven't touched anything else for the time being.
  • Be careful to not cut yourself when handling sharp objects like nail cutters or safety razors.
  • Don't participate in contact sports or any situation where injury or bruising may occur.

Ixabepilone may cause severe allergic reactions, for example anaphylaxis. Anaphylaxis may be fatal and requires urgent medical care. Tell your doctor at once if you develop a rash, itching, trouble with breathing, chest pain, or swelling of the throat/tongue/face after you receive Ixabepilone.

See your doctor promptly if you have difficulty with breathing, chest pain, a pounding or fast heartbeat, or abnormal weight gain. These symptoms may indicate a serious heart condition.

Storage

Since Ixabepilone is given only by a trained healthcare provider or under their close supervision, you don't need to keep it at home.

Summary

Tell your physician if you've ever had or have liver disease. He or she will order some lab tests to assess your liver function prior to and during treatment. If these tests reveal that you've got liver issues, your doctor may decide to not give you Ixabepilone together with Capecitabine. Receiving treatment with these medications may cause severe side effects or even death in anyone who has liver disease.

You shouldn't receive Ixabepilone if you've got allergies to it, or to an ingredient known as synthetic castor oil (Cremophor). You may be unable to receive this medication if you have severely low white blood cell or platelet counts, or severe liver disease.

Before you use Ixabepilone, notify your physician if you have heart disease, liver disease, diabetes, nerve problems, weak immunity, or bone marrow suppression.

Ixabepilone can reduce blood cells that assist your body to fight infections. Stay away from people with infections. You may need blood tests often. Visit your physician regularly.

Let your physician known at once if you experience signs of infection, including chills, fever, body aches, pale skin, flu symptoms, easy bleeding or bruising, or sores in the throat and mouth.

  • Discuss with your doctor the risks of getting an Ixabepilone injection.
  • Don't take Ixabepilone if you're pregnant. It might harm the unborn child.
  • Don't take grapefruit juice or eat grapefruit while receiving Ixabepilone.
  • Avoid taking any alcoholic drink while under treatment with Ixabepilone.