cisplatin (Rx)

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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 1mg/mL

Metastatic Testicular Tumors

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

Advanced Bladder Cancer

50-70 mg/m² IV cycle q3-4Weeks, depending on prior radiation therapy or chemotherapy  

Heavily pretreated patients: 50 mg/m²/cycle initially; repeat q4Weeks

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)

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

Dosing Considerations

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 by 25%

CrCl <10 mL/min: Administer 50% of dose

Hemodialysis

  • Partially cleared by hemodialysis
  • Posthemodialysis: Administer 50% of dose
  • Continuous ambulatory peritoneal dialysis: Administer 50% of dose
  • Continuous renal replacement therapy (CRRT): Administer 75% of dose

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

Anal Cancer (Orphan)

Orphan designation for treatment of anal cancer

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

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  

Dosing Considerations

Verify any cisplatin dose exceeding 100 mg/m² per regimen

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

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  

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  

Metastatic Ovarian Carcinoma

75-100 mg/m² IV per cycle q3-4Weeks on Day 1 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)

Dosing considerations

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

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Interactions

Interaction Checker

and cisplatin

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              Serious - Use Alternative (12)

              • adenovirus types 4 and 7 live, oral

                cisplatin decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3mo after cessation of immunosuppressive therapy.

              • amphotericin B deoxycholate

                amphotericin B deoxycholate and cisplatin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

              • bacitracin

                cisplatin and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs

              • cidofovir

                cidofovir and cisplatin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Concomitant use of cidofovir and agents with nephrotoxic potential is contraindicated. Such agents must be discontinued at least 7 days prior to starting therapy with cidofovir.

              • influenza virus vaccine quadrivalent, adjuvanted

                cisplatin decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • influenza virus vaccine trivalent, adjuvanted

                cisplatin decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • palifermin

                palifermin increases toxicity of cisplatin by Other (see comment). Avoid or Use Alternate Drug. Comment: Palifermin should not be administered within 24 hrbefore, during infusion of, or within 24 hr after administration of antineoplastic agents. Coadministration of palifermin within 24 hr of chemotherapy resulted in increased severity and duration of oral mucositis.

              • pyridoxine (Antidote)

                pyridoxine (Antidote) decreases effects of cisplatin by unknown mechanism. Contraindicated.

              • selinexor

                cisplatin, selinexor. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • tafenoquine

                tafenoquine will increase the level or effect of cisplatin by Other (see comment). Avoid or Use Alternate Drug. Tafenoquine inhibits organic cation transporter-2 (OCT2) and multidrug and toxin extrusion (MATE) transporters in vitro. Avoid coadministration with OCT2 or MATE substrates. If coadministration cannot be avoided, monitor for substrate-related toxicities and consider dosage reduction if needed based on product labeling of the coadministered drug.

              • tofacitinib

                cisplatin, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • trilaciclib

                trilaciclib will increase the level or effect of cisplatin by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of trilaciclib (OCT2, MATE1, and MATE-2K inhibitor) with cisplatin. Risk of increased cisplatin kidney exposure and altered net accumulation, which may associate with dose-related nephrotoxicity. Closely monitor for nephrotoxicity.

              Monitor Closely (70)

              • acalabrutinib

                acalabrutinib, cisplatin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.

              • acyclovir

                acyclovir and cisplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • adefovir

                adefovir and cisplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • amikacin

                amikacin and cisplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • belatacept

                belatacept and cisplatin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

              • bendamustine

                bendamustine, cisplatin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • bumetanide

                bumetanide, cisplatin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive ototoxicity.

              • busulfan

                busulfan, cisplatin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • capreomycin

                capreomycin and cisplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • carboplatin

                carboplatin and cisplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

                carboplatin, cisplatin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • carmustine

                carmustine, cisplatin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • chlorambucil

                chlorambucil, cisplatin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • cholera vaccine

                cisplatin decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

              • colistin

                cisplatin and colistin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • cyclophosphamide

                cisplatin, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • cyclosporine

                cisplatin and cyclosporine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • dacarbazine

                cisplatin, dacarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • deflazacort

                cisplatin and deflazacort both decrease serum potassium. Use Caution/Monitor.

              • dengue vaccine

                cisplatin decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

              • denosumab

                cisplatin, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

              • dichlorphenamide

                dichlorphenamide and cisplatin both decrease serum potassium. Use Caution/Monitor.

                dichlorphenamide, cisplatin. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

              • didanosine

                didanosine, cisplatin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced risk of peripheral neuropathy.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                cisplatin and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • erdafitinib

                erdafitinib increases levels of cisplatin by decreasing renal clearance. Modify Therapy/Monitor Closely. Consider alternatives that are not OCT2 substrates or consider reducing the dose of OCT2 substrates based on tolerability.

              • ethotoin

                cisplatin decreases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              • fingolimod

                cisplatin increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .

              • foscarnet

                cisplatin and foscarnet both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • fosphenytoin

                cisplatin decreases levels of fosphenytoin by unknown mechanism. Use Caution/Monitor.

              • furosemide

                furosemide, cisplatin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive ototoxicity.

              • gentamicin

                cisplatin and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • hydroxyurea

                cisplatin, hydroxyurea. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.

              • ifosfamide

                cisplatin, ifosfamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • influenza A (H5N1) vaccine

                cisplatin decreases effects of influenza A (H5N1) vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce immune response to H5N1 vaccine.

              • influenza virus vaccine (H5N1), adjuvanted

                cisplatin decreases effects of influenza virus vaccine (H5N1), adjuvanted by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce immune response to H5N1 vaccine.

              • ioversol

                cisplatin and ioversol both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • lomustine

                cisplatin, lomustine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • meningococcal group B vaccine

                cisplatin decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.

              • methotrexate

                cisplatin and methotrexate both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • neomycin PO

                cisplatin and neomycin PO both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • nitazoxanide

                nitazoxanide, cisplatin. Either increases levels of the other by Mechanism: plasma protein binding competition. Use Caution/Monitor.

              • ofatumumab SC

                ofatumumab SC, cisplatin. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

              • olaparib

                cisplatin and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity.

              • ospemifene

                cisplatin, ospemifene. Either increases levels of the other by plasma protein binding competition. Modify Therapy/Monitor Closely.

              • oxaliplatin

                cisplatin and oxaliplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • paromomycin

                cisplatin and paromomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • pentamidine

                cisplatin and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • peramivir

                cisplatin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • phenytoin

                cisplatin decreases levels of phenytoin by unknown mechanism. Use Caution/Monitor.

              • polymyxin B

                cisplatin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • pyridoxine

                pyridoxine decreases effects of cisplatin by unknown mechanism. Use Caution/Monitor. Use of pyridoxine, vitamin B6 with cisplatin and altretamine (hexamethylmelamine) may not be advisable.

              • rituximab

                cisplatin and rituximab both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Potential for renal toxicity when used in combination with cisplatin.

              • rituximab-hyaluronidase

                cisplatin and rituximab-hyaluronidase both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Potential for renal toxicity when used in combination with cisplatin.

              • siponimod

                siponimod and cisplatin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • sipuleucel-T

                cisplatin decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

              • sodium sulfate/?magnesium sulfate/potassium chloride

                sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of cisplatin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

              • sodium sulfate/potassium sulfate/magnesium sulfate

                sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of cisplatin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

              • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

                cisplatin and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • streptomycin

                cisplatin and streptomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • streptozocin

                cisplatin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

                cisplatin, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • tacrolimus

                cisplatin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • tenofovir DF

                cisplatin and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

                cisplatin increases levels of tenofovir DF by decreasing elimination. Use Caution/Monitor.

              • thiotepa

                cisplatin, thiotepa. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • tobramycin

                cisplatin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • tobramycin inhaled

                tobramycin inhaled and cisplatin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

              • topotecan

                topotecan, cisplatin. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Use alternatives if available. Additive myelosuppression.

              • trastuzumab

                trastuzumab, cisplatin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • trastuzumab deruxtecan

                trastuzumab deruxtecan, cisplatin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • vancomycin

                cisplatin and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • voclosporin

                voclosporin, cisplatin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

              • zidovudine

                cisplatin, zidovudine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of myelosuppression.

              Minor (6)

              • magnesium oxide

                cisplatin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

              • paclitaxel

                cisplatin increases levels of paclitaxel by decreasing renal clearance. Minor/Significance Unknown.

              • paclitaxel protein bound

                cisplatin increases levels of paclitaxel protein bound by decreasing renal clearance. Minor/Significance Unknown.

              • vinorelbine

                cisplatin, vinorelbine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown.

              • vitamin A

                vitamin A, cisplatin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Antioxidants such as vitamin A enhance the efficacy, and reduce toxicity, of antineoplastic drugs.

              • vitamin E

                vitamin E, cisplatin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Antioxidants such as vitamin E enhance the efficacy, and reduce toxicity, of antineoplastic drugs.

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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

              Blood and lymphatic system disorders: Coombs-positive hemolytic anemia. hemolytic uremic syndrome, thrombotic thrombocytopenic purpura

              Cardiovascular disorders: Venous thromboembolism, arterial thromboembolism, myocardial infarction, cerebrovascular accident, thrombotic microangiopathy, cerebral arteritis, pericardial effusion, cardiac failure, ventricular dysfunction, Raynaud’s phenomenon

              Eye disorders: Optic neuritis, papilledema, cortical blindness, blurred vision, color blindness, retinal pigmentation

              Gastrointestinal disorders: Nausea, vomiting, anorexia, diarrhea, stomatitis, gastrointestinal perforation, pancreatitis, hiccups

              General disorders: Asthenia, malaise

              Hepatobiliary disorders: Elevations of aminotransferases, lactate dehydrogenase, and bilirubin; hepatic failure

              Hypersensitivity: Anaphylaxis, facial edema, wheezing, tachycardia, and hypotension

              Local Site Reactions: Tissue cellulitis, fibrosis, necrosis, pain, edema, and erythema

              Metabolism and nutrition disorders: Hypomagnesemia, often requiring magnesium supplementation; hyperuricemia, other electrolyte abnormalities (hypocalcemia, hyponatremia, hypokalemia, and hypophosphatemia), Syndrome of Inappropriate Antidiuretic Hormone Excretion (SIADH), dehydration, tumor lysis syndrome, increased serum amylase

              Musculoskeletal disorders: Muscle cramps (localized, painful, involuntary skeletal muscle contractions of sudden onset and short duration)

              Nervous system disorders: Peripheral neuropathy, encephalopathy, loss of motor function, loss of taste, leukoencephalopathy, reversible posterior leukoencephalopathy syndrome, progressive multifocal leukoencephalopathy, seizures, Lhermitte’s sign, dorsal column myelopathy, autonomic neuropathy, seizures, involuntary skeletal muscle contractions, tetany (with hypocalcemia and hypomagnesemia)

              Ototoxicity: Tinnitus, hearing loss, deafness, vestibular toxicity

              Renal and urinary disorders: Nephrotoxicity including renal failure, renal electrolyte wasting, azotemia, decreased creatinine clearance

              Respiratory disorders: Pneumonitis/interstitial lung disease, pulmonary embolism

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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; 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 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 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 prior to 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

              • Drug can cause dose-related peripheral neuropathy that becomes more severe with repeated courses of drug; neurologic symptoms have been reported to occur after a single dose
              • Neuropathy can also have a delayed onset from 3-8 weeks after 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 drug must be discontinued
              • Nausea and vomiting may begin within 1 to 4 hr after treatment and last up to 72 hr; 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 day of injection therapy
              • Consider 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 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 potential impact of hearing impairment on a pediatric patient’s cognitive and social development
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              Pregnancy & Lactation

              Pregnancy

              Based on human data from published literature, cisplatin can cause fetal harm when administered to pregnant women; data demonstrates 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 prior to 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

              Animal data

              • Cisplatin for injection administration to animals during and after organogenesis resulted in teratogenicity; a published study in mice showed placental transfer of cisplatin increased with placenta maturation

              Lactation

              Limited data from published literature report the presence of drug 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

              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.

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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

              BRAND FORM. UNIT PRICE PILL IMAGE
              cisplatin intravenous
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              cisplatin intravenous
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              cisplatin intravenous
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              cisplatin intravenous
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              cisplatin intravenous
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              cisplatin intravenous
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              cisplatin intravenous
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              1 mg/mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              cisplatin intravenous

              CISPLATIN - INJECTION

              (sis-PLAT-in)

              COMMON BRAND NAME(S): Platinol-AQ

              WARNING: Cisplatin may cause severe kidney problems, nerve problems, and severe nausea and vomiting. Nerve problems may occur during treatment or weeks after stopping treatment. Your risk of these problems increases with higher doses or longer treatment with cisplatin. Tell your doctor right way if you develop any of the following symptoms: change in the amount of urine, numbness/tingling of arms/legs, loss of reflexes, loss of balance, trouble walking, nausea, or vomiting.This medication decreases bone marrow function, an effect that may lead to a low number of blood cells such as red cells, white cells, and platelets. This effect can cause anemia, decrease your body's ability to fight an infection, or cause easy bruising/bleeding. Tell your doctor right away if you develop any of the following symptoms: unusual tiredness, pale skin, easy bruising/bleeding, or signs of infection (such as sore throat that doesn't go away, fever, chills).

              USES: Cisplatin is used to treat various types of cancer. It is a chemotherapy drug that contains platinum. It is used to slow or stop cancer cell growth.

              HOW TO USE: This medication is usually given by injection into a vein by a health care professional. The dosage is based on your medical condition, body size, and response to treatment.During treatment with this medication, it is important that you take in more fluids than usual and pass urine frequently to help avoid kidney side effects. Intravenous fluids should be given with this medication. Also, ask your doctor how much fluid you should drink and follow these instructions carefully.If this medication comes into contact with your skin, wash your skin right away and completely with soap and water.

              SIDE EFFECTS: See also Warning section.Nausea, vomiting, loss of appetite, diarrhea, and loss of taste may occur. Nausea and vomiting can be quite severe and persistent. Drug therapy is used to prevent or relieve nausea and vomiting. Not eating before your treatment may help relieve vomiting. Changes in diet such as eating several small meals or limiting activity may help lessen some of these effects. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.Temporary hair loss may occur. Normal hair growth should return after treatment has ended.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: pain/burning/redness at the injection site, muscle cramps/spasms/weakness, ringing in the ears, hearing loss, joint pain, mental/mood changes (such as confusion), headache, blood in urine, painful/difficult urination, lower back/side pain.Vision changes (such as blurred vision, vision loss, seeing colors differently) may occur with cisplatin use. Normal vision usually returns after the end of treatment. Consult your doctor or pharmacist for more details and report this side effect right away if it occurs.Get medical help right away if you have any very serious side effects, including: chest pain, pain/redness/swelling of arms or legs, seizures.Rarely, this medication may increase the risk of getting other cancers (such as leukemia). Consult your doctor for more details.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using cisplatin, tell your doctor or pharmacist if you are allergic to it; or to carboplatin; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, decreased bone marrow function/blood cell disorders (such as anemia, leukopenia, thrombocytopenia), hearing problems, mineral imbalance (low blood levels of sodium, potassium, magnesium, calcium, phosphate), numbness/tingling of arms/legs, kidney stones, gout.Do not have immunizations/vaccinations without the consent of your doctor and avoid contact with people who have recently received oral polio vaccine.Use caution with sharp objects like safety razors or nail cutters and avoid activities such as contact sports to lower the chance of getting cut, bruised or injured.Wash your hands well to prevent the spread of infections.Older adults may be more sensitive to the side effects of this drug, especially kidney problems, nerve problems (numbness/tingling of arms/legs), and decreased bone marrow function.Children may be more sensitive to the side effects of this drug, especially hearing loss.This medication can affect fertility in both males and females. Ask your doctor for more details.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using cisplatin. Cisplatin may harm an unborn baby. Your doctor should direct you to get a pregnancy test before starting this medication. Women using this medication should use reliable forms of birth control during treatment and for 14 months after stopping treatment. Men using this medication should use reliable forms of birth control during treatment and for 11 months after stopping treatment. If you or your partner become pregnant, talk to your doctor right away about the risks and benefits of this medication.This drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: aminoglycoside antibiotics (such as gentamicin, neomycin), amphotericin B, anti-seizure medications (such as phenytoin), certain "water pills" (loop diuretics such as furosemide, bumetanide), nalidixic acid.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Lab and/or medical tests (such as kidney/liver function, complete blood count, blood mineral levels, hearing tests) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

              MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule.

              STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

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

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              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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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.