NAME OF DRUG
cisplatin

CLASSIFICATION

Cytotoxic Agent- non-vesicant

ALTERNATE NAMES

PLATINOL, cis-diamine, dichloroplatinum

INDICATIONS

• treatment of solid tumors (e.g. testicular, ovarian, bladder, lung)

PHARMACOLOGY

• cisplatin disrupts and unwinds the DNA double helix
• the elimination of cisplatin is biphasic with an initial half-life of 25-50 minutes and a subsequent half-life of 58-73 hours
• a portion (25-45%) is renally excreted; the extent of biliary or intestinal excretion is unknown

RECONSTITUTION AND STABILITY

• ALL cytotoxic agents are prepared in pharmacy and will be sent to the ward with a label indicating storage conditions and the expiry date. All cytotoxic waste including bags, sets, tubing, gloves, etc. must be properly disposed of in the cytotoxic waste containers on the nursing unit.

COMPATIBILITY

• compatible with NS, D5S, D51/2S, 3% sodium chloride
• compatible with furosemide, mannitol and potassium chloride
• incompatible with sodium bicarbonate and other alkaline solutions
• DO NOT USE ANY ALUMINUM-CONTAINING APPARATUS FOR PREPARATION OR ADMINISTRATION AS A BLACK PRECIPITATE WILL FORM

ROUTES OF ADMINISTRATION

• IV intermittent - in 50-100mL of compatible IV solution, over 15-30 minutes
• IV infusion - in 1-2L of compatible IV solution, over 6-24 hours (administration over 24 hours may decrease nausea, vomiting and nephrotoxicity)

VH & HSC ADMINISTRATION POLICY

A Parenteral Chemotherapy/Immunotherapy pre-printed order form (PPO # 45) must be used for prescribing if this cytotoxic agent
is not already on an existing PPO.

A - Not to be administered by the direct IV route
G - Cytotoxic Agents - See Drug Table G for specific administration guidelines.
H - The IV infusion rate must be controlled by an automated infusion control device

DOSAGE

Dose and schedule depend on protocol and patient response.

Intermittent:

• doses range up to 125 mg/m² as a single dose every 2-4 weeks

Daily: 

• 15-40mg/m² daily for 3 to 5 days every 3-4 weeks

Impaired renal function:

• if creatinine clearance is 10 to 50 mL/min, decrease dose by 25%
• if creatinine clearance is less than 10 mL/min, decrease dose by 50%

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• anaphylaxis is immediate but rare (See Appendix VIII)
• other hypersensitivity reactions:  facial edema, wheezing, tachycardia and hypotension
• extravasation (see Appendix VII for extravasation protocol for non-vesicants)

IMPORTANT IMPLICATIONS

• bone marrow depression - mild, transient and usually occurs about 1 week after drug administration
• severe nausea and vomiting occurring within a few hours of drug administration may be reduced with antiemetics and by giving the drug as a 24 hour infusion
• nephrotoxicity can be severe and irreversible; usually occurs 1-2 weeks after drug administration
• to reduce the risk of nephrotoxicity, the patient should be pre-hydrated with 1-2 litres of fluid 8-12 hours before therapy; continue IV hydration for at least 24 hours post therapy
• irreversible high frequency ototoxicity - monitor auditory function during therapy
• monitor serum magnesium

VGH Site only:
Notify security -84 immediately upon accidental spillage.
DO NOT ATTEMPT CLEAN-UP

• See also Appendix VI

Rev. May 2006