Cisplatin

Cytostatic · Alkylating agent

Indications

Various neoplastic diseases.

Dosage

Metastatic testicular tumours: Adults: 20 mg/m² daily for 5 consecutive days (days 1 to 5) every 3rd wk for 4 courses. 30 units of bleomycin on the 2nd day of each wk for 12 consecutive doses. 0.2 mg/kg body weight of vinblastine on days 1 and 2 of every 3rd wk four courses. Metastatic ovarian tumours: Once every 3 wk 50 mg/m² and 500 mg/m² of cyclophosphamide. As a single agent: 100 mg/m² by intravenous route every 4th wk. Children: Not recommended.

Administration

IV: Pretreatment hydration with 1-2 Litre of fluid is recommended prior to cisplatin administration, adequate hydration and urinary output (>100 mL/hour). Should be maintained for 24 hours after administration. Aluminium containing IV infusion sets and needles should not be used due to binding with platinum. Rate of administration has varied from a 15 to 120 mins infusion, 1 mg/min infusion, 6-8 hour infusion, 24 hour infusion or per protocol. Maximum rate of infusion: 1 mg/min in patients with CHF. When administered as sequential infusions, taxane derivatives (docetaxel, paclitaxel) should be administered before platinum derivatives to limit myelosuppression and to enhance efficacy. Standard IV dilution: Dose 250-1000 mL NS, D5/NS or D5/0.45% NaCl; stable for 72 hours at 4°C to 25°C (in combination with mannitol). Compatibility: Stable in D5¼NS, D5½NS, D5NS, ¼NS, 1/3NS, ½NS, NS;…

Adverse Effects

Nausea, vomiting, diarrhoea, renal impairment, leucopenia, thrombocytopenia, anaemia, aneilema, tinnitus, hearing loss, anaphylactic reactions (e.g. drug eruption); elevated GOT, GPT, ALP; malaise, dizziness, calvities, flush, oedema. Sepsis, myelosuppression, blood dyscrasias, electrolyte disturbances, arrhythmias, bradycardia, tachycardia, dyspnoea, pneumonia, respiratory failure, hyperuricaemia, inj site reactions. Reports of renal failure, ototoxicity, neuropathies, anaphylaxis.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: History of allergic reactions. Peripheral neuropathy. Severe renal or hearing impairment, severe myelosuppression, dehydration. Precautions: Mild to moderate renal or hearing impairment. Monitor renal, hepatic and audiometric function, blood counts and serum electrolytes before each course. Ensure adequate hydration before and after. Monitor neurological function. Discontinue in case of elevated BUN and serum creatinine and decreased CrCl.

Interactions

Anti-neoplastic agents, radiotherapy, oral anti coagulants, paclitaxel, live vaccines, aminoglycosides, loop diuretics, other nephrotoxic or ototoxic agents, bleomycin, methotrexate, phenytoin, aluminium.

Advice to Patient

This medication is administered intravenously. Inform prescriber immediately if there is pain/burning/itching/redness/swelling at infusion site. Contact prescriber if there is difficulty in breathing or swallowing, rash, hives, loss of hearing, unusual bruising or bleeding, unusual fatigue, muscle cramps or twitching, chills, fever, chest pain, palpitations, pain/numbness/tingling in extremities. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Take small, frequent meals to maintain good nutritional status. For severe nausea and vomiting, consult prescriber for a suitable antiemetic medication. Avoid highly crowded places to prevent infection. Do not get vaccinated without consulting prescriber. Using soft toothbrush, cotton swabs, regular mouth care may help to prevent mouth sores.

Pharmacokinetics

Metabolism: Nonenzymatic; inactivated (in both cell and bloodstream) by sulfhydryl groups. Half-life elimination: Children: Free drug: 1.3 hours; Total platinum: 44 hours. Adults: Initial: 14 to 49 minutes; Beta: 0.7 to 4.6 hours; Gamma: 24 to 127 hours. Excretion: Urine (>90%); feces (minimal).

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.