Cisplatin
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Infusions of Cisplatin
Drugs List
Therapeutic Indications
Uses
Advanced / refractory bladder carcinoma
Carcinoma - cervix
Carcinoma - testes
Lung carcinoma
Metastatic ovarian tumours
Squamous cell carcinoma of head and neck
Unlicensed Uses
Paediatric malignancies
Treatment of osteogenic sarcoma, stage 4 neuroblastoma, some liver tumours, infant brain tumours and intracranial germ-cell tumours in children.
Dosage
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.
Pre-treatment hydration:
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.
Post-treatment hydration:
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.
Adults
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.
Combination therapy:
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.
Administration
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.
Contraindications
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
Auditory disorder
Breastfeeding
Dehydration
Myelosuppression
Pregnancy
Renal impairment
Precautions and Warnings
Acute infection
Recent cranial irradiation
Peripheral neuropathy
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
Pregnancy
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.
Lactation
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.
Counselling
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.
Side Effects
Acute myeloid leukaemia
Alopecia
Altered colour perception
Anaemia
Anaphylactic reaction
Anaphylactoid reaction
Anorexia
Arrhythmias
Asthenia
Blurred vision
Bradycardia
Bronchospasm
Cardiac arrest
Cardiac disorders
Cellulitis
Cerebral arteritis
Cerebral blindness
Cerebrovascular accident
Cortical blindness
Deafness
Decreased serum albumin
Diarrhoea
Dysfunctional ovulation
Dyspnoea
ECG changes
Elevated amylase levels
Elevation of serum iron
Erythema
Extravasation
Facial oedema
Flushing
Gingival platinum line
Gynaecomastia
Haemolytic anaemia
Haemolytic uraemic syndrome
Hearing disturbances
Hiccups
Hyperuricaemia
Hypocalcaemia
Hypokalaemia
Hypomagnesaemia
Hyponatraemia
Hypophosphataemia
Hypotension
Immunosuppression
Inappropriate secretion of antidiuretic hormone
Increase in blood urea nitrogen
Increases in hepatic enzymes (reversible)
Infection
Leucopenia
Lhermitte's sign
Malaise
Memory loss
Microangiopathy
Mucositis
Muscle spasm
Myalgia
Myelodysplastic syndrome
Myeloneuropathy
Myelosuppression
Myocardial infarction
Nausea
Nephrotoxicity
Neurotoxicity
Optic neuritis
Ototoxicity
Pain
Papilloedema
Paraesthesia
Peripheral neuropathy
Phlebitis
Pneumonia
Pruritus
Pulmonary embolism
Pyrexia
Rash
Raynaud's phenomenon
Renal impairment
Respiratory failure
Reversible posterior leucoencephalopathy syndrome (RPLS)
Seizures
Sepsis
Serum bilirubin increased
Serum creatinine increased
Skin necrosis
Slurred speech
Spermatogenesis suppression
Stomatitis
Tachycardia
Taste disturbances
Tetany
Thrombocytopenia
Thromboembolism
Tinnitus
Transient muscle cramps
Tremor
Urticaria
Vomiting
Wheezing
Overdosage
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 ).
Further Information
Last Full Review Date: March 2021
Reference Sources
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
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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