- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Infusions of Cisplatin
Advanced / refractory bladder carcinoma
Carcinoma - cervix
Carcinoma - testes
Metastatic ovarian tumours
Squamous cell carcinoma of head and neck
Treatment of osteogenic sarcoma, stage 4 neuroblastoma, some liver tumours, infant brain tumours and intracranial germ-cell tumours in children.
Treatment should be administered by individuals experienced in the use of anti-neoplastic therapy.
Whilst the doses stated below are those recommended by the manufacturer, local cancer network protocols for the relevant indication should be consulted.
Induction of diuresis is required.
Pre-treat 2 to 12 hours prior to cisplatin, with at least 1 litre of fluid (0.9% sodium chloride or glucose 4% in one-fifth normal saline (0.18%) or sodium chloride 0.9% / glucose 5% (1:1) over a 2 hour period.
Diuresis may be aided by the infusion of 37.5g of mannitol (375ml of a 10% solution) by side-arm drip either after the hydration infusion or during the last 30 minutes of that infusion.
Treatment should be followed by administering another 2 litres of fluid (0.9% saline or dextrose 4% in sodium chloride 0.18% or sodium chloride 0.9% / glucose 5% (1:1) over a period of 6 to 12 hours.
Adequate hydration should be maintained for 24 hours following infusion.
Patients should drink large quantities of liquids for 24 hours after the cisplatin infusion to ensure adequate urine secretion.
Diuresis may be aided by the infusion of 37.5g of mannitol (375ml of a 10% solution) or by administration of a diuretic if the renal functions are normal.
Single agent therapy:
The recommended dose is 50 to 120mg/square metre as a single infusion once every 3 to 4 weeks, or 15 to 20 mg/square metre as infusion daily for 5 consecutive days every 3 to 4 weeks.
Dosage regimes vary from 20mg/square metre upwards as infusion every 3 to 4 weeks.
For cervical cancer, the recommended dose is 40mg per meter square weekly for 6 weeks.
A repeat course of cisplatin should not be given until the serum creatinine is below 1.5mg/100ml and/or blood urea is below 9mmol/L.
Cisplatin infusion should be given as an intravenous infusion over 1 to 2 hours in 1 to 2 litres of a diluent recommended by the manufacturer.
Infusion should be over 6 to 8 hours to decrease gastrointestinal and renal toxicities.
Blood urea above 9mmol/L
Leucocyte count below 4 x 10 to the power of 9 / L
Platelet count below 100 x 10 to the power of 9/ L
Precautions and Warnings
Recent cranial irradiation
Administration of live vaccines is not recommended
Some formulations contain more than 1mmol (23mg) sodium per dose
Advise ability to drive/operate machinery may be affected by side effects
Consider diuretic if inadequate urinary output
Give pre-treatment counselling and consideration of sperm cryopreservation
Accidental contact of soln with skin/mucous membranes-rinse well with water
Consult local policy on the safe use of anti-cancer drugs
If extravasation occurs follow local policy & seek expert help immediately
May interact with aluminium metal - avoid contact with aluminium hardware
Must be diluted before use
Staff: Not to be handled by pregnant staff
Treatment to be administered by or under supervision of specialist
Monitor renal function at baseline and prior to each dose
Monitor serum electrolytes before and during treatment
Maintain adequate hydration and urinary output for 24 hrs after infusion
Monitor auditory function
Monitor for signs of neurological toxicity
Monitor full blood counts weekly
Monitor hepatic function regularly
Monitor hydration status
Periodic neurological examination
Prophylactic antiemetic recommended before each dose
Advise patient to consult doctor before any self medication
May cause impaired fertility
Male & female: Contraception required during & for 6 months after treatment
Concomitant use of nephrotoxic drugs may seriously impair kidney function. Care should be taken when treating patients with acute bacterial or viral infections. Cisplatin produces cumulative nephrotoxicity which may be potentiated by aminoglycoside antibiotics, administered simultaneously or 1-2 weeks after treatment with cisplatin.
Since renal toxicity is cumulative, cisplatin should not be given more frequently than once every 3 - 4 weeks.
Nephrotoxicity can be prevented by maintaining adequate hydration before, during and after the intravenous infusion of cisplatin. Hydration and urinary output should be monitored. The use of mannitol to induce diuresis and hence minimise the hazards of renal toxicity should be considered.
Repeat courses of cisplatin should not be given unless serum creatinine levels are below 1.5mg/100ml or blood urea is below 9mmol/L and blood counts are at an acceptable level.
Peripheral blood counts should be monitored weekly as severe thrombocytopenia and leucopenia may occur. Repeat courses of cisplatin should not be given until circulating blood elements are at an acceptable level. Repeat courses of cisplatin should not be given until white blood cells greater than 4.0 x 10 to the power of 9 /L and platelets greater than 100 x 10 to the power of 9/L.
Cisplatin-induced nephrotoxicity may occur with predisposition of Hyperuricamia and Hyperalbuminaemia.
Audiometry should be performed prior to initiating therapy as ototoxicity is cumulative and is more likely to occur in higher doses. Subsequent doses of cisplatin should not be given until an audiometric analysis indicates that auditory acuity is within normal tracts.
Extravasation causes severe necrosis patients should be carefully monitored during infusion.
Advise patients to talk to their doctor or pharmacist before taking over the counter products that contain antihistamines because they may mask ototoxicity symptoms such as dizziness and tinnitus.
Pregnancy and Lactation
Cisplatin is contraindicated during pregnancy.
The manufacturer does not recommended using Cisplatin during pregnancy.
Animal studies have shown teratogenic effects. Available data following use in human pregnancy may cause a toxic effect on the foetus. Cisplatin should not be used during pregnancy till clinically justified by a clinician based on individual risk-benefit assessment.
Cisplatin is contraindicated for use in breastfeeding.
Use of Cisplatin when breastfeeding is contraindicated by the manufacturer.
Cisplatin is present in human breast milk at concentrations similar to maternal levels.
Patients should be advised to talk to their doctor or pharmacist before taking over the counter products that contain antihistamines because they may mask ototoxicity symptoms such as dizziness and tinnitus. Patients should also be advised that they should not self-medicate with aspirin or NSAIDs.
Male and female patients should be advised take contraceptive precautions during treatment and for at least 6 months after treatment.
Male patients who wish to become fathers in the future should be advised about cryo-conservation of their sperm prior to treatment.
Patient should be advises that the ability to drive or operate machinery may be affected by side effects.
Acute myeloid leukaemia
Altered colour perception
Decreased serum albumin
Elevated amylase levels
Elevation of serum iron
Gingival platinum line
Haemolytic uraemic syndrome
Inappropriate secretion of antidiuretic hormone
Increase in blood urea nitrogen
Increases in hepatic enzymes (reversible)
Reversible posterior leucoencephalopathy syndrome (RPLS)
Serum bilirubin increased
Serum creatinine increased
Transient muscle cramps
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: March 2021
Summary of Characteristics: Cisplatin 1mg/ml Concentrate for solution for infusion. Accord Healthcare Ltd. Revised January 2020.
Summary of Characteristics: Cisplatin 1mg per 1 ml Injection BP. Sandoz. Revised October 2020.
Summary of Characteristics: Cisplatin 1mg/ml Sterile Concentrate. Hospira. Revised June 2020.
Summary of Characteristics: Cisplatin 1mg/ml Sterile Concentrate. Teva. Revised February 2019.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 12 March 2021
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Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.