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Pharmacologic class: Alkylator
Therapeutic class: Antineoplastic
Pregnancy risk category D
FDA Box Warning
• Anaphylaxis may occur within minutes of administration. Epinephrine, corticosteroids, and antihistamines have been used to relieve symptoms.
Unclear. Thought to form reactive platinum complexes that inhibit DNA synthesis through formation of interstrand and intrastrand cross-linking of DNA molecules. Cell-cycle-phase nonspecific.
Powder for reconstitution for injection, lyophilized: 5 mg/ml in 50-mg and 100-mg single-use vials
Solution for injection: 5 mg/ml in 10-ml, 20-ml, and 40-ml single-use vials
Indications and dosages
➣ Metastatic cancer of colon or rectum, given with 5-fluorouracil (5-FU) and leucovorin
Adults: On day 1, 85 mg/m2 oxaliplatin I.V. infusion and 200 mg/m2 leucovorin; give both drugs simultaneously over 2 hours, followed by 400 mg/m2 I.V. bolus of 5-FU over 2 to 4 minutes, then 600 mg/m2 5-FU I.V. as 22-hour continuous infusion. On day two, 200 mg/m2 leucovorin I.V. infusion over 2 hours, followed by 400 mg/m2 5-FU I.V. bolus over 2 to 4 minutes, then 600 mg/m2 5-FU I.V. as 22-hour continuous infusion.
• Hypersensitivity to drug or platinum products
Use cautiously in:
• radiation therapy
• recent pneumococcal or smallpox vaccination
• elderly patients
• pregnant or breastfeeding patients
☞ Follow facility policy for preparing, handling, and administering mutagenic, teratogenic, and carcinogenic drugs.
• Premedicate patient with antiemet-ics, as prescribed.
• Reconstitute with sterile water or dextrose 5% in water (D5W)-never with normal saline solution or other solutions containing chloride.
• Further dilute reconstituted drug in 250 to 500 ml of D5W.
• Infuse over 2 hours simultaneously with leucovorin, but in a separate I.V. bag.
• Don't use administration sets or needles that contain aluminum.
☞ Be aware of importance of using leucovorin rescue with this drug.
☞ Avoid extravasation, which may cause necrosis and other severe reactions.
• Know that treatment cycles are usually repeated every 2 weeks.
CNS: headache, dizziness, fatigue, insomnia, peripheral neuropathy
CV: cardiac abnormalities
EENT: decreased visual acuity, hearing loss, tinnitus, rhinitis, pharyngitis
GI: severe nausea, vomiting, diarrhea, constipation, dyspepsia, gastroesoph-ageal reflux, mucositis, flatulence, stomatitis, anorexia
GU: hematuria, dysuria
Hematologic: anemia, thrombocytopenia, leukopenia, pancytopenia, neutropenia, hemolytic uremic syndrome
Respiratory: dyspnea, cough, upper respiratory infection, pulmonary fibrosis
Skin: alopecia, rash, flushing, extravasation, redness, swelling, angioedema
Other: weight loss, increased cold sensitivity, pain at injection site, anaphylaxis
Drug-drug. Aminoglycosides, loop diuretics: increased risk of nephrotoxicity
Aspirin, nonsteroidal anti-inflammatory drugs: increased risk of bleeding
Live-virus vaccines: decreased antibody response to vaccine
Myelosuppressants: increased bone marrow depression
Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, bilirubin, creatinine: increased levels
Hemoglobin, neutrophils, platelets, white blood cells: decreased levels
Drug-behaviors. Alcohol use: increased risk of bleeding
☞ Monitor I.V. site frequently to avoid extravasation.
• Monitor CBC, blood chemistry, and kidney and liver function tests before each treatment cycle.
☞ Watch closely for blood dyscrasias, hemolytic uremic syndrome, serious pulmonary problems, and anaphylaxis.
• Conduct complete neurologic exam before and after each dose.
• Monitor vital signs and ECG. Evaluate cardiovascular and respiratory status closely.
• Assess patient's comfort level. Keep him warm during infusion to minimize neurologic effects.
• Watch for signs and symptoms of toxicity (paresthesia, nausea, vomiting).
• Inform patient that chemotherapy drugs can cause many adverse effects.
• Tell patient he'll receive drug from trained health care professionals in hospital setting.
☞ Instruct patient to inform nurse immediately if drug contacts his skin, eyes, or mouth.
• Advise patient to notify nurse if pain or redness occurs at I.V. site.
• Instruct patient to stay warm and avoid iced drinks to minimize neurologic symptoms.
☞ Tell patient to report itching, hives, swelling of hands or face, chest tightness, difficulty breathing, unsteadiness, severe diarrhea or vomiting, or tingling sensation in hands, arms, legs, or feet.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.