Cisplatin

Cisplatin is a prescription medication used to treat Metastatic Testicular Tumors, Advanced Bladder Cancer, and Metastatic Ovarian Carcinoma. 

• Cisplatin is available under the following different brand names: Platinol-AQ

Adult dosage

Injectable solution

• 1mg/mL

Metastatic Testicular Tumors

Adult dosage

• 20 mg/m2/day IV for 5 days repeated every 3 weeks (in combination with bleomycin and etoposide)

Advanced Bladder Cancer

Adult dosage

• 50-70 mg/m2 IV cycle every 3-4 weeks, depending on prior radiation therapy or chemotherapy
• Heavily pretreated patients: 50 mg/m2/cycle initially; repeat every 4 weeks

Metastatic Ovarian Carcinoma

Adult dosage

• 75-100 mg/m2 IV per cycle every 4 weeks with cyclophosphamide (600 mg/m2 IV every 4 weeks); administer sequentially 

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Cisplatin include:

• nausea, 
• vomiting, 
• loss of appetite, 
• diarrhea, 
• loss of taste, and
• temporary hair loss

Serious side effects of Cisplatin include:

• pain, burning, redness at the injection site 
• numbness, tingling, coldness, and blue discoloration of the hands or feet, 
• pain, redness, swelling of the arms or legs, 
• loss of reflexes, 
• loss of balance, 
• trouble walking, 
• muscle cramps or spasms, 
• muscle weakness, 
• neck or back pain, 
• sores in mouth or tongue sores, 
• joint pain, 
• swollen legs or feet, 
• mental or mood changes, 
• headache, 
• fast or irregular heartbeat, 
• blood in urine, 
• vomit that looks like coffee grounds, 
• black or bloody stools, 
• painful or difficult urination, 
• lower back or side pain, 
• vision changes, 
• blurred vision, 
• seeing colors differently, 
• temporary vision loss, 
• chest pain, 
• a jaw or left arm pain, 
• confusion, 
• slurred speech, 
• weakness on one side of the body, 
• seizures, 
• fever, 
• chills, 
• persistent sore throat, 
• cough, 
• rash, 
• itching, 
• swelling of the face, tongue, or throat, 
• severe dizziness, and 
• trouble breathing 

Rare side effects of Cisplatin include:

• none 

If your medical doctor is using this medicine to treat your pain, 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

• Cisplatin has severe interactions with no other drugs.
• Cisplatin has serious interactions with at least 13 other drugs. 
• Cisplatin has moderate interactions with at least 71 other drugs. 
• Cisplatin has minor interactions with the following drugs:
  • magnesium oxide
  • paclitaxel
  • paclitaxel protein-bound
  • vinorelbine
  • vitamin A
  • vitamin E

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Hypersensitivity to cisplatin, other platinum compounds
• Severe myelosuppression, renal impairment, hearing impairment
• Pregnancy, lactation 

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Cisplatin?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Cisplatin?”

Cautions

• An irritant; injection site reactions may occur during administration; local soft tissue toxicity reported following extravasation of cisplatin for injection; severity of local tissue toxicity appears to be related to concentration of drug; closely monitor infusion site during drug administration
• Avoid aluminum needles/equipment
• Pediatric patients, hearing impairment, neuropathy, neuromuscular disease, with neurotoxic agents, with ototoxic agents, elderly
• Risk of cumulative nephrotoxicity (exacerbated by aminoglycoside antibiotics); renal toxicity becomes more prolonged and severe with repeated courses; renal function must return to normal before administering another dose
• Myelosuppression occurs in 25-30%; nadirs in circulating platelets and leukocytes occur between days 18-23 (range 7.5-45) with most patients recovering by day 39; elderly may be more susceptible to myelosuppression
• Development of acute leukemia secondary to therapy reported; in these reports, cisplatin for injection was generally given in combination with other leukemogenic agents
• Cardiac abnormalities, hiccups, elevated serum amylase, rash, alopecia, malaise, asthenia, and dehydration have been reported

Ocular toxicity

• Optic neuritis, papilledema, and cortical blindness were reported in patients receiving standard recommended doses of cisplatin for injection
• Blurred vision and altered color perception reported after use of regimens with higher doses and dose frequencies of cisplatin for injection; the altered color perception manifests as a loss of color discrimination, particularly in the blue-yellow axis and irregular retinal pigmentation of the macular area on fundoscopic exam
• Improvement and/or total recovery usually occurs after discontinuing cisplatin for injection but can be delayed

Renal toxicity

• Ensure adequate hydration before, during, and after administration; measure serum creatinine, blood urea nitrogen, creatinine clearance, and serum electrolytes including magnesium before initiating therapy, and as clinically indicated; consider magnesium supplementation as clinically needed
• Consider alternative treatments or reduce dose for patients with baseline renal impairment or who develop significant reductions in creatinine clearance during treatment

Peripheral neuropathy

• The drug can cause dose-related peripheral neuropathy that becomes more severe with repeated courses of the drug; neurologic symptoms have been reported to occur after a single dose
• Neuropathy can also have a delayed onset from 3-8 weeks after the last dose of cisplatin for injection; manifestations include paresthesias in a stocking-glove distribution, areflexia, and loss of proprioception and vibratory sensation
• Neuropathy may progress further even after stopping treatment; peripheral neuropathy may be irreversible in some patients
• Perform a neurological examination before initiating therapy, at appropriate intervals during therapy, and after completion of therapy; consider discontinuation of cisplatin for injection for patients who develop symptomatic peripheral neuropathy; geriatric patients may be more susceptible to peripheral neuropathy

Nausea and vomiting

• Cisplatin for injection is a highly emetogenic antineoplastic agent; premedicate with anti-emetic agents; without antiemetic therapy, marked nausea and vomiting occur in almost all patients treated with cisplatin for injection and may be so severe that the drug must be discontinued
• Nausea and vomiting may begin within 1 to 4 hours after treatment and last up to 72 hours; maximal intensity occurs 48 to 72 hours after administration
• Various degrees of vomiting, nausea, and/or anorexia may persist for up to 1 week after treatment; delayed nausea and vomiting (begins or persists 24 hours or more after chemotherapy) has occurred in patients attaining complete emetic control on the day of injection therapy
• Consider the use of additional anti-emetics following infusion

Myelosuppression

• Potential fatalities due to infection (secondary to myelosuppression) reported
• Perform standard hematologic tests before initiating therapy, before each subsequent course, and as clinically indicated; closely monitor patients for the development of signs and symptoms of infection during and after treatment with cisplatin for injection; for patients who develop severe myelosuppression, consider dose modifications and manage according to clinical treatment guidelines

Hypersensitivity

• Therapy can cause severe hypersensitivity reactions, including anaphylaxis and death; manifestations have included facial edema, wheezing, tachycardia, hypotension; hypersensitivity reactions have occurred within minutes of administration to patients with prior exposure to cisplatin
• Severe hypersensitivity reactions require immediate discontinuation of cisplatin for injection and aggressive therapy; patients with a history of severe hypersensitivity reactions should not be rechallenged with cisplatin for injection
• Cross-reactivity between platinum-based antineoplastic agents reported; cases of severe hypersensitivity reactions have recurred after rechallenging patients with a different platinum agent

Ototoxicity

• Cisplatin for injection can cause ototoxicity, which is cumulative and may be severe; consider audiometric and vestibular function monitoring
• Ototoxic effects may be more severe and detrimental in pediatric patients receiving cisplatin for injection, particularly in patients less than 5 years of age; consider audiometric and vestibular function monitoring in all patients receiving cisplatin for injection; the prevalence of hearing loss in pediatric patients is particularly high and is estimated to be 40% to 60%
• Earlier detection of hearing loss can limit the potential impact of hearing impairment on a pediatric patient’s cognitive and social development

Pregnancy and Lactation

• Based on human data from published literature, cisplatin can cause fetal harm when administered to pregnant women; data demonstrates the transplacental transfer of cisplatin
• Exposure associated with oligohydramnios, intrauterine growth restriction, and preterm birth; cases of neonatal acute respiratory distress syndrome, cytopenias, and hearing loss reported
• Verify the pregnancy status of females of reproductive potential before initiating before initiation of cisplatin for injection

Contraception

• Females: Advise females of reproductive potential to use effective contraception during treatment and for 14 months following the last dose
• Males: Advise male patients with female partners of reproductive potential to use effective contraception during treatment and for 11 months after the last dose

Infertility

• Females: Use associated with cumulative dose-dependent ovarian failure, premature menopause, and reduced fertility
• Males: Use associated with a cumulative dose-dependent impairment of spermatogenesis (oligospermia, azoospermia; possibly irreversible) and reduced fertility. 

Lactation

• Limited data from published literature report the presence of drugs in human milk; because of potential for serious adverse reactions in a breastfed child and because of potential for tumorigenicity, advise lactating women not to breastfeed during treatment