Platinol

Plat·i·nol (plt-nôl, -nl)

A trademark for the drug cisplatin.

---

Platinol,

trademark for an antineoplastic (cisplatin).

---

cisplatin Warning - Hazardous drug!

Platinex (UK), Platinol

Pharmacologic class: Alkylating agent, platinum coordination complex

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.
• Drug may cause severe cumulative renal toxicity. Other major dose-related toxicities are myelosuppression, nausea, and vomiting.
• Drug may lead to significant ototoxicity (which may be more pronounced in children), high-frequency hearing loss, and deafness.
• Anaphylactic-like reactions may occur within minutes of administration.
• Use caution to prevent inadvertent overdose. Doses above 100 mg/m²/cycle once every 3 to 4 weeks are rarely used. Avoid inadvertent overdose stemming from confusion with Paraplatin (carboplatin) or failure to differentiate daily doses from total dose per cycle.

Action

Inhibits DNA synthesis by causing intrastrand and interstrand cross-linking of DNA

Availability

Injection: 1 mg/ml in 50-mg and 100-mg vials

⊘Indications and dosages

➣ Metastatic testicular tumors

Adults: 20 mg/m² I.V. daily for 5 days/cycle, repeated q 3 to 4 weeks

➣ Metastatic ovarian cancer

Adults: 75 to 100 mg/m² I.V., repeated q 4 weeks in combination with cyclophosphamide; or 100 mg/m² q 4 weeks as a single agent

➣ Advanced bladder cancer

Adults: 50 to 70 mg/m² I.V. q 3 to 4 weeks as a single agent; dosage depends on whether patient has undergone radiation or chemotherapy.

Off-label uses

• Cervical cancer
• Squamous cell carcinoma

Contraindications

• Hypersensitivity to drug or other platinum-containing compounds
• Severe impairment of renal function
• Severe myelosuppression
• Hearing impairment
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• mild to moderate renal impairment, active infection, myelosuppression, chronic debilitating illness, heart failure, electrolyte abnormalities
• females of childbearing age.

Administration

• Prepare drug with equipment that doesn't contain aluminum.
• Give 2 L of I.V. fluids, as prescribed, 8 to 12 hours before drug infusion to help prevent toxicity.
• Dilute each dose in 2 L of dextrose 5% in 1/4 or 1/2 saline solution or 0.9% normal saline solution. Do not use dextrose 5% in water.
• Infuse each liter over 3 to 4 hours to minimize toxicity. In well-hydrated patients with good renal function, infusions of 100 to 500 ml may be given over 30 minutes.
• Follow facility policy for handling and disposal of antineoplastics.
☞ If solution contacts skin, wash immediately and thoroughly with soap and water. If solution contacts mucosa, flush with water immediately.
• Protect drug from light.

Route	Onset	Peak	Duration
I.V.	Unknown	18-23 days	39 days

Adverse reactions

CNS: malaise, weakness, seizures

EENT: ototoxicity, tinnitus

GI: severe nausea, vomiting, diarrhea

GU: sterility, nephrotoxicity

Hematologic: anemia, leukopenia, thrombocytopenia

Hepatic: hepatotoxicity

Metabolic: hypocalcemia, hypokalemia, hypomagnesemia, hyperuricemia

Skin: alopecia

Other: phlebitis at I.V. site, anaphylaxis

Interactions

Drug-drug. Amphotericin B, loop diuretics: increased risk of hypokalemia and hypomagnesemia

Antineoplastics: additive bone marrow depression

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

Nephrotoxic drugs (such as aminoglycosides): additive nephrotoxicity

Ototoxic drugs (such as loop diuretics): additive ototoxicity

Phenytoin: reduced phenytoin blood level

Drug-diagnostic tests. Aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, uric acid: increased levels

Calcium, magnesium, phosphate, potassium, sodium: decreased levels

Coombs' test: positive result

Patient monitoring

• Before starting therapy and before each subsequent dose, assess renal function test results and CBC with white cell differential.
• Monitor neurologic status, hepatic enzyme and uric acid levels, and audiogram results.
• Monitor urine output closely.

Patient teaching

• Instruct patient to drink 8 oz of water every hour while awake.
☞ Advise patient to promptly report bleeding, bruising, hearing loss, yellowing of skin or eyes, decreased urine output, or suspected infection.
• Tell patient that drug may cause hair loss.
• Instruct female patient to use reliable contraception; drug can harm fetus.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.