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cisplatin (Rx)Brand and Other Names:

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 1mg/mL
more...

Metastatic Testicular Tumors

Usual dose in combination with other approved chemotherapeutic agents is 20 mg/m²/day IV for 5 days/cycle 

Pretreatment hydration: 1-2 L fluid infused for 8-12 hr before dose

May use concomitant amifostine to decrease nephrotoxicity

Do not repeat course until SCr <1.5 mg/dL [<133 micromoles/L] or BUN <25 mg/dL [<8.93 mmol/L] or WBC >4000/mm³ AND platelets >100 k/mm³

Advanced Bladder Cancer

50-70 mg/m² IV cycle q3-4Weeks, depending on prior radiation therapy or chemotherapy; for heavily pretreated patients, give 50 mg/m²/cycle initially; repeat q4Weeks 

Pretreatment hydration: 1-2 L fluid infused for 8-12 hr before dose

May use concomitant amifostine to decrease nephrotoxicity

Do not repeat course until SCr <1.5 mg/dL [<133 micromoles/L] or BUN <25 mg/dL [<8.93 mmol/L] or WBC >4000/mm³ AND platelets >100 k/mm³

Metastatic Ovarian Carcinoma

75-100 mg/m² IV per cycle q4Weeks with cyclophosphamide (600 mg/m² IV q4Weeks); administer sequentially 

Off-label: 90-270 mg/m² intraperitoneal; retain for 4 hr before draining; repeat q3Weeks (may coadminister systemic Na thiosulfate)

Pretreatment hydration: 1-2 L fluid infused for 8-12 hr before dose

May use concomitant amifostine to decrease nephrotoxicity

Do not repeat course until SCr <1.5 mg/dL [<133 micromoles/L] or BUN <25 mg/dL [<8.93 mmol/L] or WBC >4000/mm³ AND platelets >100 k/mm³

Cancers (Off-label)

Cancer of cervix, endometrium, prostate, esophagus, kidney; non-small cell lung cancer; head & neck squamous cell cancer; osteogenic sarcomas; bone marrow transplants

75-100 mg/m² IV q4Weeks when used with cyclophosphamide 

100 mg/m² IV q4Weeks as single agent

Pretreatment hydration: 1-2 L fluid infused for 8-12 hr before dose

May use concomitant amifostine to decrease nephrotoxicity

Do not repeat course until SCr <1.5 mg/dL [<133 micromoles/L] or BUN <25 mg/dL [<8.93 mmol/L] or WBC >4000/mm³ AND platelets >100 k/mm³

Renal Impairment

CrCl 10-50 mL/min: Decrease dose 50%

CrCl <10 mL/min: Contraindicated

Metastatic Osteogenic Sarcoma (Orphan)

Liposomal cisplatin for inhalation: Treatment of osteogenic sarcoma metastatic to the lung

Orphan indication sponsor

  • Transave, Inc; 11 Deer Park Drive, Suite 117; Monmouth Junction, NJ 08852-1923

Ovarian Cancer (Orphan)

Liposomal ciplatin: Treatment of ovarian cancer

Orphan indication sponsor

  • Transave, Inc; 11 Deer Park Drive, Suite 117; Monmouth Junction, NJ 08852-1923

Squamous Cell Carcinoma (Orphan)

Cisplatin with epinephrine: Treatment of squamous cell carcinoma of the head and neck

Orphan indication sponsor

  • Matrix Pharmaceutical, Inc; 34700 Campus Drive; Fremont, CA 94555-3612

Malignant Melanoma (Orphan)

Cisplatin with epinephrine: Treatment of metastatic malignant melanoma

Orphan indication sponsor

  • Matrix Pharmaceutical, Inc; 34700 Campus Drive; Fremont, CA 94555-3612

Oral Cancers (Orphan)

ChemoThin wafer: Orphan designation for treatment of anatomically accessible oral cancers (lip, tongue, gum, floor of mouth, salivary gland, and other oral cavity)

Sponsor

  • Privo Technologies; 13 Bristol Street, Unit #1; Cambridge, Massachusetts 02141

Monitor

CBC; audiometric testing before each dose

Dosage Forms & Strengths

injectable solution

  • 1mg/mL
more...

Osteogenic Sarcoma/Neuroblastoma (Off-label)

90 mg/m² IV q3Weeks OR 30 mg/m² IV qWeek 

Brain Tumors, Recurrent (Off-label)

60 mg/m² IV qDay for 2 consecutive days q3-4Weeks 

Other Information

Verify any cisplatin dose exceeding 100 mg/m² per regimen

Monitor therapy closely; elderly maybe more susceptible to nephrotoxicity and peripheral neuropathy

Metastatic Testicular Tumors

Usual dose in combination with other approved chemotherapeutic agents is 20 mg/m²/day IV for 5 days/cycle 

Pretreatment hydration: 1-2 L fluid infused for 8-12 hr before dose

May use concomitant amifostine to decrease nephrotoxicity

Do not repeat course until SCr <1.5 mg/dL [<133 micromoles/L] or BUN <25 mg/dL [<8.93 mmol/L] or WBC >4000/mm³ AND platelets >100 k/mm³

Advanced Bladder Cancer

50 -70 mg/m² IV cycle q3-4Weeks, depending on prior radiation therapy or chemotherapy; for heavily pretreated patients, give 50 mg/m²/cycle initially; repeat q4Weeks 

Pretreatment hydration: 1-2 L fluid infused for 8-12 hr before dose

May use concomitant amifostine to decrease nephrotoxicity

Do not repeat course until SCr <1.5 mg/dL [<133 micromoles/L] or BUN <25 mg/dL [<8.93 mmol/L] or WBC >4000/mm³ AND platelets >100 k/mm³

Metastatic Ovarian Carcinoma

75-100 mg/m² IV per cycle q4Weeks with cyclophosphamide (600 mg/m² IV q4Weeks); administer sequentially 

Unlabeled: 90-270 mg/m² intraperitoneal; retain for 4 hr before draining; repeat q3Weeks (may coadminister systemic Na thiosulfate)

Pretreatment hydration: 1-2 L fluid infused for 8-12 hours before doseMay use concomitant amifostine to decrease nephrotoxicity

Do not repeat course until SCr <1.5 mg/dL [<133 micromoles/L] or BUN <25 mg/dL [<8.93 mmol/L] or WBC >4000/mm³ AND platelets >100 k/mm³

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Interactions

Interaction Checker

cisplatin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
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            Adverse Effects

            >10%

            Nausea (76-100%)

            Vomiting (76-100%)

            Nephrotoxicity (28-36%)

            Ototoxicity, especially in children (31%)

            Myelosuppression (25-30%)

            Anaphylaxis (1-20%)

            Alopecia

            Frequency Not Defined

            Cerebral herniation

            Encephalopathy

            Leukoencephalopathy and reversible posterior leukoencephalopathy syndrome

            Seizure

            Peripheral neuropathy (dose and duration dependent)

            Diarrhea

            Electrolyte changes

            Hyperuricemia

            Hepatotoxicity

            Local tissue irritation

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            Warnings

            Black Box Warnings

            The drug should be administered under the supervision of an experienced cancer chemotherapy physician

            Severe nephrotoxicity, myelosuppression, and nausea and vomiting are dose related

            Significant ototoxicity, manifested by tinnitus and occasionally deafness, reported in children

            Anaphylactic-like reactions have occurred. Facial edema, bronchoconstriction, tachycardia, and hypotension may occur within minutes of cisplatin administration

            Failure to differentiate daily doses from total dose per treatment cycle may result in cisplatin overdose

            Contraindications

            Hypersensitivity to cisplatin, other platinum compounds

            Severe myelosuppression, renal impairment, hearing impairment

            Pregnancy, lactation

            Cautions

            Irritant; injection site reactions may occur during administration; use extravasation precautions

            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

            Cardiac abnormalities, hiccups, elevated serum amylase, rash, alopecia, malaise, asthenia, and dehydration have been reported

            Avoid pregnancy

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            Pregnancy & Lactation

            Pregnancy Category: D

            Lactation: excreted in breast milk; do not nurse

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Platinum coordination compound that inhibits DNA synthesis; cross-links and denatures strands of DNA; disrupts DNA function by covalently binding to DNA bases; can also produce DNA intrastrand cross-linking and breakage

            Not a true alkylating agent

            Pharmacokinetics

            Half-life elimination (terminal): 24hr to 47 days

            Protein bound: >90%

            Excretion: Urine (90%); feces (10%)

            Clearance: 15 L/hr/m²

            Vd: 11 L/m²

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            Administration

            IV Incompatibilities

            Solution: Na-bicarb 5%, D5W(?)

            Additive: fluorouracil, mesna, paclitaxel(?), thiotepa

            Y-site: amifostine, amphotericin B cholesteryl-SO4, cefepime, piperacillin/tazobactam, thiotepa

            IV Compatibilities

            Solution: dextrose-saline, NS, 1/2NS, other saline concentrations

            Additive: carboplatin, cyclophosphamide w/ etoposide, etoposide, floxuridine, floxuridine w/ leucovorin, hydroxyzine, ifosfamide, leucovorin, MgSO4, mannitol, ondansetron

            Syringe: bleomycin, cyclophosphamide, doxapram, doxorubicin, droperidol, fluorouracil, furosemide, heparin, leucovorin, methotrexate, metoclopramide, mitomycin, vinblastine, vincristine

            Y-site (partial list): allopurinol, aztreonam, bleomycin, chlorpromazine, cladribine, cyclophophamide, dexamethasone Na-succinate, diphenhydramine, doxorubicin, doxorubicin liposomal, etoposide phosphate, filgrastim, fludarabine, fluorouracil, furosemide, gemcitabine, granisetron, heparin, leucovorin, linezolid, lorazepam, melphalan, methotrexate, methylprednisolone Na-succinate, metoclopramide, mitomycin, morphine, ondansetron, paclitaxel, prochlorperazine edisylate, propofol, sargramostim, vinblastine, vincristine, vinorelbine

            IV Preparation

            Further dilution stability is dependent on chloride ion concentration & should be mixed in solutions of NS (at least 0.3% NaCl)

            Further dilution in NS, D5/½NS or D5/NS to a concentration of 0.05-2 mg/mL are stable for 72 hr at 4-25°C in combination with mannitol

            May administer 12.5-50 g mannitol/L

            Standard dilution: dose/250-1000 mL NS, D5W/NS or D5/½NS

            IV Administration

            Perform pretreatment hydration

            Do not use aluminum-containing needles or IV administration sets that may come in contact with carboplatin (aluminum can react causing precipitate formation & loss of potency)

            Administration rate has varied from a 15-120 min infusion, 1 mg/min infusion, 6-8 hr infusion, 24 hr 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 & to enhance efficacy

            Extravasation Management

            Large extravasations (>20 mL) of concentrated solutions (>0.5 mg/mL) produce tissue necrosis

            Tx is not recommended unless a large amount of highly concentrated solution is extravasated

            Mix 4 mL of 10% sodium thiosulfate with 6 mL SWI; inject 1-4 mL through existing IV line cannula; administer 1 mL for each mL extravasated; inject SC if needle is removed

            Storage

            Store intact vials at 15-25°C (59-77°F)

            Protect from light

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • Compare formulary status to other drugs in the same class.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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