carboplatin (redirected from Paraplatin)

carboplatin /car·bo·pla·tin/ (kahr´bo-plat?in) an antineoplastic used in the treatment of carcinomas of the ovary and numerous other organs.

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carboplatin

a cisplatin analog, but with fewer side-effects. Under investigation in the treatment of cancer in dogs. Myelosuppression limits the dose that can be used.

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carboplatin Warning - Hazardous drug!

Paraplatin-AQ (CA)

Pharmacologic class: Alkylating agent

Therapeutic class: Antineoplastic

Pregnancy risk category D

FDA Boxed Warning

• Give under supervision of physician experienced in cancer chemotherapy, in facility with adequate diagnostic and treatment resources.
• Bone marrow suppression is dose-related and may be severe, resulting in infection and bleeding. Anemia may be cumulative and warrant transfusions.
• Vomiting is a common adverse effect.
• Anaphylactic-like reactions may occur within minutes of administration.

Action

Inhibits DNA synthesis by causing cross-linking of parent DNA strands; interferes with RNA transcription, causing growth imbalance that leads to cell death. Cell-cycle-phase nonspecific.

Availability

Injection: 50-mg, 150-mg, and 450-mg vials

⊘Indications and dosages

➣ Initial treatment of advanced ovarian cancer or palliative treatment of ovarian cancer unresponsive to other chemotherapeutic modalities

Adults: Initially, 300 mg/m² I.V. (given with cyclophosphamide) at 4-week intervals. For refractory tumors, 360 mg/m² I.V. as a single dose; may be repeated at 4-week intervals, depending on response. However, single dose shouldn't be repeated until neutrophil count is at least 2,000/mm³ and platelet count at least 100,000/mm³. Subsequent dosages are based on blood counts.

Dosage adjustment

• Renal impairment
• Reduced bone marrow reserve

Off-label uses

• Advanced endometrial cancer
• Advanced or recurrent squamous cell carcinoma of head and neck
• Relapsed and refractory acute leukemia
• Small-cell lung cancer
• Testicular cancer

Contraindications

• Hypersensitivity to drug, cisplatin, or mannitol
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• hearing loss, electrolyte imbalances, renal impairment, active infections, diminished bone marrow reserve
• females of childbearing age.

Administration

• Premedicate with antiemetics, as prescribed.
• When preparing and administering drug, follow facility protocol for handling cytotoxic drugs.
• Reconstitute powder for injection by adding sterile water for injection, 0.9% sodium chloride injection, or 5% dextrose injection, as appropriate, to provide 10-mg/ml solution. Drug may be further diluted to concentrations as low as 0.5 mg/ml.
• Don't use with needles or I.V. sets containing aluminum.
• Administer I.V. infusion over at least 15 minutes.
• Make sure patient maintains adequate fluid intake.
• Know that drug is given in combination with other agents.

Route	Onset	Peak	Duration
I.V.	Rapid	21 days	28 days

Adverse reactions

CNS: weakness, dizziness, confusion, peripheral neuropathy, cerebrovascular accident

CV: heart failure, embolism

EENT: visual disturbances, ototoxicity

GI: nausea, vomiting, constipation, diarrhea, abdominal pain, stomatitis

GU: gonadal suppression, nephrotoxicity

Hematologic: anemia, leukopenia, thrombocytopenia, neutropenia

Hepatic: hepatitis

Metabolic: hypocalcemia, hypokalemia, hypomagnesemia, hyponatremia

Respiratory: bronchospasm

Skin: alopecia, rash, urticaria, erythema, pruritus

Other: altered taste, hypersensitivity reactions, anaphylaxis

Interactions

Drug-drug. Live-virus vaccines: decreased antibody response to vaccine, increased risk of adverse reactions

Myelosuppressants: additive bone marrow depression

Nephrotoxic or ototoxic drugs (such as aminoglycosides, loop diuretics): additive nephrotoxicity or ototoxicity

Phenytoin: decreased phenytoin blood level

Drug-diagnostic tests. Alkaline phosphatase (ALP), aspartate aminotransferase (AST), blood urea nitrogen, creatinine: increased values

Electrolytes, hematocrit, hemoglobin. neutrophils, platelets, red blood cells, white blood cells: decreased values

Patient monitoring

• Assess for signs and symptoms of hypersensitivity reactions.
• Monitor CBC to help detect drug-induced anemia and other hematologic reactions.
• Monitor ALP, AST, and total bilirubin levels.
• Evaluate fluid and electrolyte balance.

Patient teaching

• Instruct patient to report signs and symptoms of allergic response and other adverse reactions, such as breathing problems, mouth sores, rash, itching, and reddened skin.
• Advise patient to report unusual bleeding or bruising.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Urge patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.
• Instruct patient to drink plenty of fluids to ensure adequate urinary output.
• Provide dietary counseling and refer patient to dietitian as needed if GI adverse effects significantly limit food intake.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.