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Pharmacologic class: Alkylating agent, platinum coordination complex
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.
• 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.
Inhibits DNA synthesis by causing intrastrand and interstrand cross-linking of DNA
Injection: 1 mg/ml in 50-mg and 100-mg multidose 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.
• Cervical cancer
• Squamous cell carcinoma
• Hypersensitivity to drug or other platinum-containing compounds
• Severe impairment of renal function
• Severe myelosuppression
• Hearing impairment
• Pregnancy or breastfeeding
Use cautiously in:
• mild to moderate renal impairment, active infection, myelosuppression, chronic debilitating illness, heart failure, electrolyte abnormalities
• females of childbearing age.
• 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.
CNS: malaise, weakness, seizures
EENT: ototoxicity, tinnitus
GI: severe nausea, vomiting, diarrhea
GU: sterility, nephrotoxicity
Hematologic: anemia, leukopenia, thrombocytopenia
Metabolic: hypocalcemia, hypokalemia, hypomagnesemia, hyperuricemia
Other: phlebitis at I.V. site, anaphylaxis
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
• 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.
• 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.
cisplatinA chemotherapeutic that forms covalent bonds and crosslinks with DNA, which is used for head and neck, ovarian, testicular, and bladder cancers and lymphomas.
Nephrotoxicity, nausea, sensory neuropathy.
Management for adverse effects
• Nephrotoxicity: adequate hydration to maintain renal flow and high chloride concentration.
• Nausea: ondansetron, a selective antagonist of serotonin S3 receptors.
• Neuropathy: amifostine, growth factors, glutathione, Org 2766, acetyl-L-carnitine, vitamin E have all been tried; per Cochrane review, none proved effective; more studies are needed.
cisplatinCis-platinum, diaminedichloride, Platinol A chemotherapeutic that forms covalent bonds and crosslinks with DNA, which is used for head & neck, ovarian, testicular, bladder CAs, lymphomas Adverse effects Nephrotoxicity, nausea, neurotoxicity
cisplatinAn anticancer drug. Like any drug that damages cells it has side effects. Cisplatin can cause progressive kidney impairment. The drug is on the WHO official list.
Patient discussion about cisplatin
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