Paclitaxel and Enasidenib: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Enasidenib
Paclitaxel
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Altered (increased/reduced) PACLitaxel exposure and an increased risk of PACLitaxel-related adverse effects or reduced efficacy of PACLitaxel
Interaction Deep Dive
Avoid coadministration of enasidenib and PACLitaxel. Enasidenib is an OATP1B1, OATP1B3 inhibitor and a CYP3A4 inducer. Coadministration of enasidenib and PACLitaxel (OATP1B1, OATP1B3 and CYP3A4 substrate with NTI) may either increase the exposure of PACLitaxel or decrease the exposure of PACLitaxel, for which minimal concentration changes may lead to serious toxicities or may lead to reduced efficacy of PACLitaxel. If coadministration cannot be avoided, modify the dosage of PACLitaxel as recommended and as clinically indicated1. In vitro studies showed that PACLitaxel was metabolized to 2 minor metabolites, 3'-p-hydroxyPACLitaxel and 6-alpha, 3'-p-dihydroxyPACLitaxel, by CYP3A4. The pharmacokinetics of PACLitaxel may be altered as a result of interactions in vivo with compounds that are inducers of CYP3A4 23.
Why it happens (mechanism)
Inhibition of OATP1B1-efflux transport of PACLitaxel; inhibition of OATP1B3-efflux transport of PACLitaxel; induction of CYP3A4-substrate metabolism of PACLitaxel
Literature reports
3 reports — tap to read
a) Coadministration of rosuvastatin 10 mg (OATP1B1, OATP1B3, and BCRP substrate) after multiple doses of enasidenib 100 mg (OATP1B1, OATP1B3, and BCRP inhibitor) increased rosuvastatin Cmax by 366% and AUC(0 to infinity) by 244% 1.
b) In the drug interaction studies, midazolam (a sensitive CYP3A4 substrate) AUC (0 to inf) and Cmax decreased by 43% and 23%, respectively, following concomitant use of multiple doses of enasidenib 100 mg with a single intravenous dose of midazolam 0.03 mg/kg. The decrease in midazolam exposure following oral administration of midazolam is expected to be larger than that following intravenous administration of midazolam. This is due to induction of CYP3A4 first pass metabolism by enasidenib and the reduced bioavailability of the midazolam oral formulation compared to the midazolam intravenous formulation 1.
c) In vitro studies showed that PACLitaxel was metabolized to 2 minor metabolites, 3'-p-hydroxyPACLitaxel and 6-alpha, 3'-p-dihydroxyPACLitaxel, by CYP3A4. The pharmacokinetics of PACLitaxel may be altered as a result of interactions in vivo with compounds that are inducers of CYP3A4 23.
Common questions
Can I take Paclitaxel and Enasidenib together?
Altered (increased/reduced) PACLitaxel exposure and an increased risk of PACLitaxel-related adverse effects or reduced efficacy of PACLitaxel Always confirm with your pharmacist or prescriber before making any change.
How serious is the Paclitaxel and Enasidenib interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Paclitaxel or Enasidenib need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: IDHIFA(R) oral tablets, enasidenib oral tablets. Bristol-Myers Squibb (per FDA), Princeton, NJ, 2023. DailyMed
- Product Information: PACLITAXEL intravenous injection, paclitaxel intravenous injection. Fresenius Kabi (per Dailymed), Lake Zurich, IL, 2024. DailyMed
- Product Information: PACLITAXEL PROTEIN-BOUND PARTICLES (ALBUMIN-BOUND) intravenous injection lyophilized powder for suspension, paclitaxel protein-bound particles (albumin-bound) intravenous injection lyophilized powder for suspension. Sandoz Inc (per Dailymed), Princeton, NJ, 2024. DailyMed
Keep reading about Enasidenib
Keep reading about Paclitaxel
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist