Cisplatin

Product: 
Cisplatin
Formalary: 
Specialty Formalary
Category: 
Oncology
Trade Name: 
Platinol, CDDP
Packing: 
Vial
Potency: 
10mg/10ml
In Treatment of: 
Cisplatin is used to treat testicular, bladder, and ovarian cancers that have spread. It also can be used to treat several other cancers, such as lung cancer.
Adverse Effects: 
You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them. Common 1. kidney damage* 2. decreased blood levels of magnesium, potassium, and calcium 3. nausea* 4. vomiting* 5. low white blood cell count with increased risk of infection* 6. low platelet count with increased risk of bleeding* 7. low red blood cell count (anemia), which can make you tired, dizzy, or easily out of breath* 8. taste changes, including metallic taste of foods and rarely loss of taste 9. sensation of pins and needles or numbness in hands and/or feet caused by irritation of nerves, which usually goes away when treatment is stopped* 10. swelling in hands, feet, or legs* 11. fetal changes if pregnant during treatment Less common 1. tiredness (fatigue) 2. hearing loss, which may be permanent* 3. poor balance due to inner ear damage* 4. trouble walking and weakness of legs and feet due to nerve damage* 5. loss of appetite 6. hair thinning or loss (may include face and body hair as well as scalp hair) 7. diarrhea 8. sterility (inability to have children) Rare 1. severe allergic reaction* 2. uncontrolled muscle jerking due to changes in blood chemistry 3. seizures due to changes in blood chemistry 4. blindness or vision changes, which usually go away when treatment stopped 5. chest pain and heart attack 6. second cancer, which may happen years later* 7. death due to infection or other causes
Contraindication: 
Who should not take cisplatin IV? Check with your physician if you have any of the following: Conditions: Numbness, Tingling or Pain of Hands or Feet, Sudden Blindness and Pain Upon Moving the Eye, Brain-Capillary Leak Syndrome, Toxicity to Organs of Hearing, Hearing Loss, Heart Attack, Stroke, Inflammation of Arteries that Carry Blood in the Brain, Occasional Numbness, Prickling, or Tingling of Fingers and Toes, Thrombotic Thrombocytopenic Purpura, Kidney Damage, Kidney Disease, Feel Like Throwing Up, Throwing Up, High Amount of Uric Acid in the Blood, Abnormal Liver Function Tests, Pregnancy, A Mother who is Producing Milk and Breastfeeding, Severe Infection, Acute Form of Leukemia, Low Amount of Magnesium in the Blood, Low Amount of Calcium in the Blood, Low Amount of Sodium in the Blood, Low Amount of Potassium in the Blood, Hemolytic Anemia, Syndrome characterized by Anemia and Renal Failure, Decreased Function of Bone Marrow, Anemia, Decreased Blood Platelets, Decreased White Blood Cells Allergies: PLATINUM COMPLEXES
Special Precaution: 
This drug is given into the vein (IV). If the drug leaks out of the vein and under the skin, it may damage the tissue, causing pain, ulceration, and scarring. Tell the doctor or nurse right away if you notice redness, pain, swelling or other symptoms at or near the IV.  Cisplatin can damage the kidneys. This risk is reduced by checking your kidney function before you get the drug, giving you extra fluids by vein, and asking you to drink extra fluids for a few days after the drug is given. This extra fluid helps to flush the medicine out of your system and protect your kidneys. Call your doctor if you see blood in your urine, or if you notice swelling in your feet or ankles.  This drug can damage your hearing and inner ear (balance), and occasionally cause deafness. Let your doctor know if you notice ringing in your ears, trouble hearing high-pitched sounds, or trouble with your balance. Your doctor may test your hearing before and during treatment.  You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor will give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.  Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs such as the liver and kidneys. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it completely. Keep all your appointments for lab tests and doctor visits.  Cisplatin can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.  This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.  This drug may lower your red blood cell count. If this occurs, it is usually a few months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.  Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Cisplatin may affect your immune system. This could make vaccinations ineffective, or even lead to serious infections if you get live virus vaccines during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.  This drug can cause allergic reactions in some people while the drug is being given. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), fever or chills, hives, nausea, itching, headache, coughing, tightness in the throat, shortness of breath, trouble swallowing, or swelling of the face, tongue, or eyes. Tell your doctor or nurse right away if you notice any of these symptoms as you are being given the drug.  This drug may damage certain nerves in the body, and lead to a problem called peripheral neuropathy. This can cause numbness, weakness, pain, or sensations of burning or tingling, usually in the hands or feet. Constipation can also occur. These symptoms can sometimes worsen to include trouble walking or holding things in your hands. Let your doctor know right away if you notice any of them. If your symptoms are severe enough, this drug may need to be stopped or the dose reduced until they get better. In some people, the damage is permanent.  Because of the way this drug acts on cells in the body, it may increase your long-term risk of getting a second type of cancer, such as leukemia. This is rare, but if it does occur it would likely be years after the drug is used. If you are getting this drug, your doctor feels this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor.  Avoid pregnancy during and for at least a few months after treatment. Talk with your doctor about this.
Interaction: 
Cisplatin may injure or damage the kidneys, especially if given with other drugs that can harm the kidneys, or even drugs that are removed from the body by the kidneys, such as:  aminoglycosides (a type of antibiotic that is usually given in the vein, such as gentamicin, tobramycin, amikacin, streptomycin, and others)  non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others  blood pressure medicines in the ACE inhibitor group, like lisinopril, enalopril, captopril  anti-viral drugs like acyclovir (Zovirax)  There are many more such drugs, so be sure your doctor knows all the drugs you take. Talk to the doctor or nurse before you start any new medicine, even non-prescription drugs.  Drugs that can cause hearing loss, such as aminoglycoside antibiotics (see examples above) and certain ""water pills"" -- the diuretics furosemide (Lasix) and ethacrynic acide (Edecrin) -- may worsen any hearing loss from cisplatin.  Probenecid can raise the blood level of cisplatin in the body and cause serious harm.  Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with cisplatin. These include:  vitamin E  non-steroidal anti-inflammatory drugs (see above examples)  warfarin (Coumadin)  ticlopidine (Ticlid)  clopidogrel (Plavix)  Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take.  Cisplatin may cause anti-seizure drugs such as phenytoin (Dilantin) to leave the body faster. Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine. Interactions with foods No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem. Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.
Dosages: 
Usual Adult Dose for Testicular Cancer 20 mg/m2 intravenously once a day for 5 days per cycle (in combination with other antineoplastic drugs) Usual Adult Dose for Ovarian Cancer 75 to 100 mg/m2 intravenously once every 4 weeks (in combination with cyclophosphamide for the treatment of metastatic ovarian cancer). Alternatively, 100 mg/m2 intravenously once every 4 weeks may be administered (as a single agent for the treatment of metastatic ovarian cancer). If the ovarian cancer remains confined to the peritoneal cavity, the following regimens may be used: 60 to 90 mg/m2 in 2 liters of 0.9% sodium chloride solution or lactated Ringer's injection intraperitoneally once. Alternatively, 90 to 270 mg/m2 in 2 liters of 0.9% sodium chloride solution or lactated Ringer's injection intraperitoneally once may be administered (to be given with intravenous sodium thiosulfate to reduce the risk of nephrotoxicity associated with this relatively high dose). Usual Adult Dose for Bladder Cancer 50 to 70 mg/m2 intravenously once every 3 to 4 weeks (as a single agent for the treatment of advanced bladder cancer in patients WITHOUT history of extensive X-radiation or chemotherapy). Alternatively, 50 mg/m2 intravenously over 6 to 8 hours every 4 weeks may be administered (as a single agent for the treatment of advanced bladder cancer in patients WITH history of extensive X-radiation or chemotherapy) Usual Adult Dose for Neuroblastoma 60 to 100 mg/m2 once every 3 to 4 weeks Usual Adult Dose for Osteogenic Sarcoma 60 to 100 mg/m2 once every 3 to 4 weeks Usual Adult Dose for Brain/Intracranial Tumor 60 mg/m2 once a day for two consecutive days every 3 to 4 weeks Usual Adult Dose for Bone Marrow Transplantation Continuous infusion: High Dose: 55 mg/m2/day for 72 hours (Total Dose = 165 mg/m2) Usual Adult Dose for Blood Cell Transplantation Continuous infusion: High Dose: 55 mg/m2/day for 72 hours (Total Dose = 165 mg/m2) Usual Adult Dose for Non-Small Cell Lung Cancer 60 to 100 mg/m2 intravenously on day one every 21 days (in combination with other antineoplastic drugs) Usual Adult Dose for Cervical Cancer (In combination with radiation therapy) 40 mg/m2 IV weekly Maximum dose: 70 mg/week Cisplatin is given 4 hours before radiation therapy on weeks 1 through 6 (In combination with paclitaxel) 75 mg/m2 IV on day 2 The cycle is repeated every 21 days. (In combination with other chemotherapeutic agents as a part of the BIP regimen) 50 mg/m2 IV on day 2 The cycle is repeated every 21 days. (In combination with other chemotherapeutic agents as a part of various regimens) 50 to 200 mg/m2 IV on day 1 Renal Dose Adjustments According to the manufacturer and the FDA, cisplatin is contraindicated in patients with preexisting renal impairment. However, if the benefits of this drug outweigh its risks for this patient, the following guidelines may be useful: Some clinicians have suggested the use of 75% of the regularly recommended dosage for patients with a creatinine clearance ranging from 10 to 50 mL/min. Some clinicians have suggested the use of 50% of the regularly recommended dosage for patients with a creatinine clearance below 10 mL/min. Liver Dose Adjustments Data not available Dose Adjustments Dosages of cisplatin may depend upon the specific indication for its use, and whether other cytotoxic agents are co administered.

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