Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (19)
- 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.
- axicabtagene ciloleucel
cisplatin, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. 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
- brexucabtagene autoleucel
cisplatin, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- 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.
- ciltacabtagene autoleucel
cisplatin, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- idecabtagene vicleucel
cisplatin, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- 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.
- lisocabtagene maraleucel
cisplatin, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- 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.
- ropeginterferon alfa 2b
ropeginterferon alfa 2b, cisplatin. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.
- 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.
- tisagenlecleucel
cisplatin, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate 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 (71)
- 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.
- isavuconazonium sulfate
cisplatin and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.
- 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.
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
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
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.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
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  | |
| cisplatin intravenous - | 1 mg/mL vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
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.Loss of taste, diarrhea, nausea, vomiting, or loss of appetite may occur. Nausea and vomiting can be severe. Your doctor may prescribe medication to prevent or relieve nausea and vomiting. Eating several small meals, not eating before treatment, or limiting activity may help lessen some of these effects. If any of these effects last or get worse, tell 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).
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 May 2022. Copyright(c) 2022 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.
Formulary
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