Carboplatin

Carboplatin is an anti-cancer medication indicated for the initial treatment of advanced ovarian carcinoma in established combination with other approved chemotherapeutic agents. One established combination regimen consists of carboplatin injection and cyclophosphamide. Carboplatin injection is also indicated for the palliative treatment of patients with ovarian carcinoma recurrent after prior chemotherapy, including patients who have been previously treated with cisplatin.

Adult and Pediatric Dosage Forms and Strengths

Lyophilized powder for reconstitution

• 150 mg

Injectable solution

• 10 mg/mL (in vials of 50, 150, 450, and 600 mg)

Dosage Considerations – Should be Given as Follows:

Advanced Ovarian Carcinoma

• Single agent: 360 mg/m² intravenously (IV) every 4 weeks
• Combination treatment: 300 mg/m² IV (plus cyclophosphamide 600 mg/m² IV) every 4 weeks

General Dosing Guidelines, Pediatric

Solid Tumor

• 300-600 mg/m² intravenously (IV) every 4 weeks

Sarcoma (bone/soft tissue)

• 400 mg/m²/day for 2 days every 21 days

Brain tumor

• 175 mg/m² once/week for 4 weeks with a 2 weeks recovery period between courses

Bone marrow transplant preparative regimen

• 500 mg/m²/day x 3 days

Retinoblastoma

• 1-2 mL subconjunctival injection of 10 mg/mL solution per dose

Dose Modifications

For SI units: Count in US units x 10^6/L

Give full dose if

• Platelets 50-100,000
• Neutrophils 500-2,000

Give 125% if

• Platelets greater than 100,000
• Neutrophils greater than 2,000

Give 75% if

• Platelets less than 50,000
• Neutrophils less than 500

Geriatric: Calvert formula should be used to calculate dosing

Renal Impairment

• CrCl 41-59 mL/minute: 250 mg/m² intravenously (IV) on day 1
• CrCl 16-40 mL/minute: 200 mg/m² IV on day 1
• CrCl less than15 mL/minute: Not recommended

Hepatic Impairment

• Dose adjustment may not be necessary; not studied

Administration

• Do not repeat dose until ANC greater than 2000 AND platelets greater than 100,000
• Infuse over more than 15 minutes
• Monitor: Complete blood count (CBC) weekly

Other Indications and Uses

• Off-label: testicular cancer, head and neck cancer, cervix cancer, small cell lung cancer, progressive diffuse large B-cell lymphoma

Common side effects of carboplatin include:

• Numbness and tingling in the extremities
• Immune hypersensitivity reaction
• Elevated bilirubin
• Visual disturbance
• Ear infection
• Pain
• Allergic reactions

Serious side effects of carboplatin include:

• Bleeding and reduced blood cells, including reduced red blood cells (anemia) and platelets (needed for proper blood clotting)
• Unusual bruising or bleeding
• Black tarry stools
• Blood in the urine
• Infection
• Life-threatening allergic reaction
• Kidney and liver problems
• Loss of hearing or ringing in the ears

Postmarketing side effects of carboplatin reported include:

• Dehydration
• Swelling and sores inside the mouth

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Carboplatin has no known severe interactions with other drugs.
• Serious interactions of carboplatin include:
  • adenovirus types 4 and 7 live, oral
  • amphotericin B deoxycholate
  • bacitracin
  • cidofovir
  • influenza virus vaccine trivalent, adjuvanted
  • palifermin
  • tofacitinib
• Carboplatin has moderate interactions with at least 50 different drugs.
• Mild interactions of carboplatin include:
  • vitamin A
  • vitamin E

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

Warnings

The drug should be administered under the supervision of an experienced cancer chemotherapy physician. Increased risk of allergic reactions in patients previously exposed to platinum. The allergic reaction may occur within minutes of carboplatin administration.

Bone marrow suppression, which may be severe and may result in infection or bleeding, is dose related. Reduce dosage in patients with bone marrow suppression and impaired renal function. Anemia is cumulative. Vomiting is a frequent adverse effect and is dose related.

This medication contains carboplatin. Do not take carboplatin if you are allergic to carboplatin or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Severe hypersensitivity to carboplatin, other platinum compounds, mannitol
• Severe myelosuppression, significant bleeding
• Severe renal dysfunction
• Pregnancy/lactation

Effects of Drug Abuse

• None

Short-Term Effects

• See "What Are Side Effects Associated with Using Carboplatin?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Carboplatin?"

Cautions

• Pediatric patients, elderly, renal impairment, hearing impairment, neuropathy, neuromuscular disease, prior cisplatin treatment, concomitant neurotoxic agents, concomitant ototoxic agents.
• Avoid aluminum needles/intravenous sets for preparation/administration.
• Less nephrotoxic than cisplatin.
• Avoid pregnancy.
• Abnormal liver function tests reported with high doses.
• Risk of neuropathy increases in patients over 65 years and patients treated previously with the drug.
• Ototoxicity may occur.
• Caution in patients with renal impairment; patients with renal failure are at increased risk for bone marrow suppression.

Pregnancy and Lactation

• Use carboplatin during pregnancy only in LIFE-THREATENING emergencies when no safer drug is available. Thjere is positive evidence of human fetal risk.
• It is not known if carboplatin is excreted in breast milk; do not nurse.