Home Drug Guide Cisplatin

Drug Guide

Generic Name

Cisplatin

Brand Names Platinol, Platinol-aq

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Platinum-based alkylating-like agent

FDA Approved Indications

Testicular cancer
Ovarian cancer
Bladder cancer
Lung cancer (non-small cell and small cell)
Cervical cancer

Mechanism of Action

Cisplatin forms platinum-DNA adducts that inhibit DNA synthesis and function, leading to apoptosis of cancer cells.

Dosage and Administration

Adult: Dependent on specific indication and regimen; typically 50-100 mg/m² IV every 3-4 weeks

Pediatric: Based on body surface area; dosing varies per protocol

Geriatric: Use with caution; decreased renal function common in elderly affecting dosing

Renal Impairment: Reduce dose; monitor renal function closely

Hepatic Impairment: No specific adjustment, but monitor hepatic function

Pharmacokinetics

Absorption: Administered intravenously; negligible oral absorption.

Distribution: Widely distributed, crosses blood-brain barrier under certain conditions.

Metabolism: Minimal metabolism, mostly unchanged in urine.

Excretion: Primarily renal excretion; half-life approximately 20-30 minutes in plasma, longer in urine due to excretion.

Half Life: Approximately 20-124 hours depending on method of calculation and renal function.

Contraindications

Hypersensitivity to cisplatin or other platinum compounds

Precautions

Pre-existing renal impairment, hearing impairment, peripheral neuropathy, electrolyte disturbances, pregnancy/lactation

Adverse Reactions - Common

Nausea and vomiting (Very common)
Nephrotoxicity (Common)
Ototoxicity (Uncommon)
Peripheral neuropathy (Uncommon)
Myelosuppression (Common)

Adverse Reactions - Serious

Severe nephrotoxicity leading to renal failure (Uncommon)
Anaphylactic reactions (Rare)
Secondary malignancies (myelodysplastic syndrome, leukemia) (Very rare)

Drug-Drug Interactions

Other nephrotoxic agents (e.g., aminoglycosides, NSAIDs)
Ototoxic drugs (e.g., aminoglycosides)
Cumulative myelosuppressive agents

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor renal function (BUN, creatinine), electrolytes, hearing, peripheral nerves, blood counts.

Diagnoses:

Risk for impaired kidney function
Risk for infection due to myelosuppression
Risk for peripheral neuropathy

Implementation: Pre-hydration protocols, administer antiemetics, monitor vital signs and labs closely.

Evaluation: Assess renal function, hematologic status, neurotoxicity, and effectiveness of therapy.

Patient/Family Teaching

Maintain adequate hydration to prevent nephrotoxicity.
Report any signs of hearing loss, numbness, or tingling.
Use antiemetics as prescribed to control nausea.
Avoid nephrotoxic drugs and NSAIDs.

Special Considerations

Black Box Warnings:

Nephrotoxicity, ototoxicity, severe allergic reactions, intense nausea and vomiting

Genetic Factors: Some genetic polymorphisms may affect toxicity profiles, but routine testing is not standard.

Lab Test Interference: May affect renal function and electrolyte panels.

Overdose Management

Signs/Symptoms: Severe nephrotoxicity, neurotoxicity, profound bone marrow suppression.

Treatment: Supportive care including hydration, chelation therapy with agents like calcium disodium edetate for platinum toxicity, and symptomatic treatment.

Storage and Handling

Storage: Store in original container at controlled room temperature, away from moisture and light.

Stability: Stable until expiration date on packaging.