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Oxaliplatin infusion

Updated 2 Feb 2023 | Platinum Compounds


Infusions of oxaliplatin.

Drugs List

  • oxaliplatin 100mg/20ml concentrate for solution for infusion
  • oxaliplatin 200mg/40ml concentrate for solution for infusion
  • oxaliplatin 50mg/10ml concentrate for solution for infusion
  • Therapeutic Indications


    Metastatic colorectal cancer
    Post-surgery adjuvant treatment of colon cancer

    In combination with 5-fluorouracil and folinic acid in:

    Adjuvant treatment of stage III (Duke's C) colon cancer after complete resection of primary tumour.
    Treatment of metastatic colorectal cancer.


    Due to the complexity and specialist nature of dosage regimens for the treatment of malignant disease, specific dosing information on this agent is not included.

    Doses may vary significantly if this agent is used as monotherapy or different combinations.

    When using this agent, specialist literature, national guidelines, cancer networks protocols and Trust chemotherapy protocols should be consulted.

    Patients with Renal Impairment

    Mild to moderate impairment - Creatinine clearance more than 30 ml per minute
    Treatment may be initiated at the normally recommended dose.

    One manufacturer recommends dosing patients with mild to moderate renal impairment at 85 mg/square metre.

    Additional Dosage Information

    Neurological symptoms
    Patients who develop acute laryngopharyngeal dysaesthesia, during or within several hours after a 2-hour infusion: Next oxaliplatin infusion should be administered over 6 hours.

    Other neurological symptoms the following dosage adjustments should be based on duration and severity of these symptoms.

    Longer than 7 days and are troublesome: Subsequent dose should be reduced as follows:

    Metastatic: From 85 mg/square metre to 65 mg/square metre.
    Adjuvant: From 85 mg/square metre to 75 mg/square metre.

    Paraesthesia without functional impairment persisting until the next cycle, the subsequent dose should be reduced:

    Metastatic: From 85 mg/square metre to 65 mg/square metre.
    Adjuvant: From 85 mg/square metre to 75 mg/square metre.

    Paraesthesia with functional impairment persists until the next cycle, oxaliplatin should be discontinued.

    If these symptoms improve following discontinuation of therapy, resumption of therapy may be considered.

    For oxaliplatin and 5-fluorouracil combination (with/without folinic acid), the usual dosage changes apply for any 5-fluorouracil associated toxicities.

    Haematological toxicity:
    Neutrophils are less than 1.5 x 10 to the power of 9 per litre and/or platelets less than 50 x 10 to the power of 9 per litre, administration of the next course of therapy should be postponed until values return to acceptable levels.
    When used together with 5-fluorouracil:
    Grade 3 to 4 neutropenia (i.e. neutrophils less than 1 x 10 to the power of 9 per litre), febrile neutropenia (neutrophils less than 1 x 10 to the power of 9 per litre, temperature of greater than 38.3 degrees celsius or a sustained temperature of greater than 38 degrees celsius for more than 1 hour), or grade 3 to 4 thrombocytopenia (platelets less than 50 x 10 to the power of 9 per litre) occurs, reduce the dose of oxaliplatin in addition to adjustment of the dose of 5-fluorouracil to:

    Metastatic: From 85 mg/square metre to 65 mg/square metre.
    Adjuvant: From 85 mg/square metre to 75 mg/square metre.

    Gastrointestinal symptoms
    Grade 4 diarrhoea when oxaliplatin is given together with 5-fluorouracil, reduce the dose of oxaliplatin in addition to adjustment of the 5-fluorouracil dose to:

    Metastatic: From 85 mg/square metre to 65 mg/square metre.
    Adjuvant: From 85 mg/square metre to 75 mg/square metre.

    Mucositis or stomatitis (with/without neutropenia): Next treatment should be delayed until recovery to grade 1 or less, and/or neutrophil count is more than or equal to 1.5 x 10 to the power of 9 per litre).


    For intravenous infusion.

    Oxaliplatin should always be administered before fluoropyrimidines e.g. 5-fluorouracil.


    Children under 18 years
    Neutrophil count below 2 x 10 to the power of 9 / L at baseline
    Platelet count below 100 x 10 to the power of 9 / L at baseline
    Long QT syndrome
    Peripheral neuropathy
    Renal impairment - creatinine clearance below 30 ml/minute
    Torsade de pointes

    Precautions and Warnings

    Family history of long QT syndrome
    History of treatment with anthracyclines
    Electrolyte imbalance
    History of torsade de pointes
    Renal impairment

    Administration of live vaccines is not recommended
    Correct electrolyte disorders before treatment
    Advise ability to drive/operate machinery may be affected by side effects
    Give pre-treatment counselling and consideration of sperm cryopreservation
    Concentrate must be diluted and used as an infusion
    If extravasation occurs follow local policy & seek expert help immediately
    Never rechallenge treatment after a hypersensitivity reaction
    Reducing the infusion rate may minimise severity of infusion reactions
    Treatment to be administered by or under supervision of specialist
    Monitor full blood count and differential WBC before and during therapy
    Perform ECG before and during treatment
    Pre-treatment neurological examination recommended
    Monitor closely patient with pre-existing renal impairment
    Monitor serum electrolytes
    Periodic neurological examination
    Advise patient paraesthesias may persist up to 3 years after treatment ends
    Advise patient to report any new or worsening respiratory symptoms
    Advise patient to report headaches, seizures, confusion, visual disturbance
    Advise patient to seek medical help if diarrhoea/emesis/neutropenia occur
    Discontinue if a serious infection develops
    Discontinue if intestinal ischaemia occurs
    Discontinue if signs of gastro-intestinal ulceration occur
    If mucositis/stomatitis occurs, delay next treatment until recovery
    May reduce effectiveness of vaccinations during treatment
    Predisposition QT prolongation: Counsel patient on symptoms of arrhythmias
    Prophylactic antiemetic recommended before each dose
    Risk of developing opportunistic infections
    Discontinue at first signs of microangiopathic haemolytic anaemia
    Discontinue if posterior reversible encephalopathy syndrome (PRES) develops
    Discontinue if serious allergic or anaphylactic reaction occurs
    Discontinue if severe haematological toxicity develops until event resolves
    Discontinue if signs of disseminated intravascular coagulation occur
    Discontinue if unexplained respiratory symptoms occur
    Discontinue immediately if rhabdomyolysis occurs
    Reduce dose or discontinue if neurological symptoms develop and persist
    May cause impaired fertility
    Female: Contraception required during and for 4 months after treatment
    Male: Contraception required during and for 6 months after treatment

    Posterior Reversible Encephalopathy Syndrome (PRES)
    Posterior reversible encephalopathy syndrome (PRES) has been reported in some patients treated with oxaliplatin. If patients present with symptoms indicating PRES such as headache, altered mental state, seizures and visual disturbances, an MRI should be performed. If PRES is diagnosed oxaliplatin treatment should be discontinued and adequate blood pressure and seizure control administration is advisable. The safety of reinstating treatment in patients previously experiencing PRES is unknown.

    Pregnancy and Lactation


    Oxaliplatin is contraindicated during pregnancy.

    The manufacturer recommends that oxaliplatin is not used during pregnancy. There is currently limited information on the safety of use in human pregnancy. Reproductive toxicity was observed in animal studies and has been shown to be mutagenic and clastogenic in mammalian test systems.


    Oxaliplatin is contraindicated during breastfeeding.

    The manufacturer recommends that breastfeeding is contraindicated during oxaliplatin treatment. It is not known whether oxaliplatin is excreted into breast milk. Due to the potential for serious adverse reactions in the infant, women should not breastfeed during therapy. Hale (2014) suggests breastfeeding is not advisable for many days (more than 20 to 30 days) and should probably be discontinued, unless milk platin could be measured.

    Side Effects

    Abdominal pain
    Allergic reaction
    Back pain
    Bone pain
    Deep vein thrombosis (DVT)
    Erythematous rash
    Febrile neutropenia
    Feeling of tightness in chest
    Gastro-intestinal haemorrhage
    Gastroesophageal reflux
    Haemolytic anaemia
    Hand-foot syndrome
    Hepatobiliary disorders
    Immunologically mediated thrombocytopenia
    Increase in alkaline phosphatase
    Increase in lactate dehydrogenase
    Increases in hepatic enzymes
    Injection site reactions
    Interstitial lung disease
    Intestinal obstruction
    Loss of vision(transient)
    Metabolic acidosis
    Micturition disorders
    Muscle cramps
    Nail disorders
    Neutropenic sepsis
    Optic neuritis
    Peripheral neuropathy
    Posterior reversible encephalopathy syndrome (PRES)
    Prolongation of QT interval
    Pulmonary embolism
    Pulmonary fibrosis
    Rectal haemorrhage
    Reduced visual acuity
    Renal impairment
    Sensory disturbances
    Serum bilirubin increased
    Serum creatinine increased
    Upper respiratory tract infection
    Visual disturbances
    Weight changes


    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 ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: October 2019

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press [Accessed on 4th October 2019].

    Martindale: The Complete Drug Reference, 39th edition (2017) ed. Sweetman, S. Pharmaceutical Press, London.

    Medications and Mothers' Milk, 16th Edition (2014) Hale, T. Hale Publishing, Amarillo, Texas.

    Summary of Product Characteristics: Oxaliplatin 5mg/ml powder for solution for infusion. Accord UK Limited. Revised March 2019.
    Summary of Product Characteristics: Oxaliplatin 5mg/ml concentrate for solution for infusion. Sun Pharmaceuticals UK Limited. Revised February 2019.

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