carboplatin
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carboplatin
[kahr″bo-plat´in]carboplatin
Pharmacologic class: Alkylating agent
Therapeutic class: Antineoplastic
Pregnancy risk category D
FDA Box 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.
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.
car·bo·plat·in
(kar'bō-pla-tin),carboplatin
(kär′bō-plăt′n)carboplatin
A chemotherapeutic agent used to manage advanced ovarian, lung, head and neck and other cancers; it interacts with DNA in a manner similar to that of alkylating agents.Adverse effects
Myelosuppression, nausea, vomiting diarrhoea, hair loss, pain, neurologic complaints.