Cisplatin

🔴 Red Flag (Important) Information

• Highly nephrotoxic → requires pre- and post-hydration and strict renal monitoring

• Ototoxicity is cumulative and may be irreversible → baseline and repeat audiograms required

• Severe nausea and vomiting common → aggressive antiemetic prophylaxis required

• Myelosuppression is dose-related and cumulative → monitor FBC closely

• Contraindicated in renal impairment, hearing disorders, pregnancy, and lactation

• Live vaccines contraindicated during treatment

🔹 1. Basic Information

Generic name: Cisplatin
Formulation: Solution for injection
Strength: 1 mg/mL
Drug class: Platinum-based antineoplastic agent
Route: Intravenous infusion

🔹 2. Indications (FULL – As per Product Information)

Cisplatin Injection may be used as monotherapy or in combination with other chemotherapeutic agents for the treatment of:

• Metastatic non-seminomatous germ cell carcinoma

• Advanced-stage, refractory ovarian carcinoma

• Advanced-stage, refractory bladder carcinoma

• Refractory squamous cell carcinoma of the head and neck

🔹 3. Dosing & Administration

Single-Agent Therapy (Adults and Children)

• 50–100 mg/m² IV every 3–4 weeks, infused over 6–8 hours, OR

• 15–20 mg/m²/day IV for 5 consecutive days, every 3–4 weeks

Combination Therapy (Common Regimens)

• Testicular cancer: vinblastine, bleomycin, actinomycin D

• Ovarian cancer: cyclophosphamide, doxorubicin, hexamethylmelamine, 5-fluorouracil

• Head and neck cancer: bleomycin, methotrexate

Administration Requirements

• Mandatory hydration before and after treatment

• Avoid aluminium-containing equipment

• Infuse diluted solution within 24 hours of preparation

🔹 4. Dose Modifications

• Bone marrow suppression: Reduce dose

• Repeat dosing only if:

  • Serum creatinine < 140 μmol/L

  • Plasma urea < 9 mmol/L

  • Platelets ≥ 100,000/mm³

  • WBC ≥ 4,000/mm³

🔹 5. Contraindications

• Renal impairment

• Hearing disorders

• Bone marrow depression

• Generalised infections

• Pregnancy and lactation

• Hypersensitivity to cisplatin or other platinum compounds

🔹 6. Monitoring Requirements

Baseline and before each cycle:

• Renal function: creatinine, urea, creatinine clearance

• Electrolytes: magnesium, potassium, calcium, sodium

• FBC: WBC, platelets, haemoglobin

• Audiometry: baseline and periodic

• Liver function tests

• Neurological assessment

🔹 7. Key Adverse Effects

Very Common / Common

• Severe nausea and vomiting

• Nephrotoxicity

• Myelosuppression

• Electrolyte disturbances (↓ Mg²⁺, Ca²⁺, K⁺)

• Fatigue, anorexia, diarrhoea

• Mild alopecia

Serious / Potentially Irreversible

• Ototoxicity (tinnitus, high-frequency hearing loss)

• Peripheral neuropathy

• Anaphylaxis

• Venous thromboembolism

• Cardiovascular events

• Pulmonary embolism

🔹 8. Drug Interactions (Clinically Important)

• Nephrotoxic drugs: aminoglycosides, amphotericin B, loop diuretics

• Ototoxic drugs: aminoglycosides, loop diuretics

• Paclitaxel: ↑ neurotoxicity if cisplatin given first

• Anticonvulsants: reduced serum levels

• Warfarin: monitor INR closely

🔹 9. Use in Special Populations

• Renal impairment: Contraindicated

• Hepatic impairment: Use with caution

• Paediatrics: Can be used; long-term hearing monitoring required

• Elderly: Limited data

• Fertility: May cause permanent infertility in men and women

🔹 10. Duration of Use / When to Stop

Continue until:

• Disease progression, or

• Unacceptable toxicity

Discontinue if:

• Persistent renal dysfunction

• Severe or irreversible neurotoxicity or ototoxicity

• Life-threatening hypersensitivity

• Severe myelosuppression not recovering between cycles

Reference: 

https://labeling.pfizer.com/ShowLabeling.aspx?id=12139