Parenteral Manual

Oxaliplatin

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
ELOXATIN
Classification: 
Antineoplastic - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
January 2021
Indications: 
  • Under investigation for treatment of recurrent solid tumors in children
  • Treatment of advanced colorectal cancer in adults; also has been used in a variety of other solid tumors in adults

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • 5 mg/mL preservative free aqueous solution (10 mL, 20 mL and 40 mL vials)
  • Store at room temperature, protect from light
  • Further diluted in D5W to a final volume of 250-500 mL (0.2-0.7 mg/mL), stable 24 hours at room temperature or 48 hours refrigerated.
Compatibility: 
  • Solutions Compatible:  dextrose solutions ONLY
  • Additives/Above Cassette Compatible: do not mix with other drugs or IV solutions
  • Y-site Compatible: leucovorin
  • Incompatible: chloride-containing solutions, (i.e, NO sodium chloride solutions. Use D5W to flush lines before and after administration). Do not use aluminum-containing needles, syringes or IV sets.  Incompatible with alkaline drugs or solutions (ie bicarbonate containing solutions).

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO

IV Intermittent Infusion

Yes

Usual dilution: 0.2 - 0.7 mg/mL

Infusion time: 2 - 6 hours

IV Continuous Infusion YES
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric: (investigational):  

  • 130 mg/m2 IV every 21 days
  • <12 months of age: 4.3 mg/kg IV every 21 days

Adult: (protocol dependent):

  • 130 mg/m2 IV every 3 weeks,
  • 85 mg/m2 IV every 2 weeks,
  • 30 mg/m2 /day x 5 days every 3 weeks

** dosage may differ according to protocol

Renal Impairment:

  • Not recommended in patients with severe renal impairement (< 30 mL/minute/1.73m2)
Potential hazards of parenteral administration: 
  • Nausea, vomiting, diarrhea, abdominal cramping
  • Hypersensitivity reaction (rare): follow anaphylactic precautions; can occur with any cycle, however incidence increases as cycle number increases (generally after 6 cycles)
  • Pharyngolaryngeal dysethesia (< 2%): infusion-related, self-limiting; prevent by extending infusion time to 6 hours with future doses.
  • Acute Peripheral sensory neuropathy: sensory dysesthesia, paresthesia and hypoesthesia of the limbs, mouth, throat and larynx. Jaw spasm, abnormal tongue sensation, dysarthria, eye pain, and a feeling of chest pressure have also been observed.
    • Occurs within hours or 1 to 2 days of dosing and reversible (usually resolves within 14 days)
    • Primarily peripheral, sensory neuropathy that frequently recurs with further dosing. 
  • Persistent neuropathy: paresthesias, dysesthesias, hypoesthesias and altered proprioception
    • Later onset (over 14 days) and more persistent. Can occur without prior acute neuropathy events
    • Can interfere with daily activities (e.g. buttoning clothing, holding objects, writing)
    • Occurs in most patients receiving oxaliplatin with 5-FU/LV. 
    • Lhermittes sign and urinary retention are seen rarely. 
    • Symptoms may improve in some patients upon discontinuation of oxaliplatin.
  • QT prolongation and torsades de pointes have been reported 
  • Neutropenia, thrombocytopenia, anemia (not common)
  • Nephrotoxicity <5% (severe <1%)
  • Fever
  • Hepatotoxicity (rare) - increased transaminases, veno-occlusive disease.
  • Posterior reversible encephalopathy syndrome (rare)  
  • Pulmonary toxicity including pneumonitis, pulmonary fibrosis (rare).  Pulmonary toxicity may present with dyspnea, cough, and/or hypoxia 
  • Rhabdomyolysis (rare)  - For further information on management of dose-specific side effects, refer to treatment regimen or the oncology pharmacist.
Notes: 
  • Extravasation risk: irritant. If extravasation occurs, follow CHEO extravasation guidelines
  • Oxaliplatin is a radiation sensitizer
  • Dysethesias can be triggered or exacerbated by exposure to cold (including ice chips and cold drinks)
  • Pharyngolaryngeal dysethesia: usually no treatment required; resolves within hours of onset. Symptoms may be precipitated or exacerbated by exposure to cold temperatures (activities such as, touching cold surface, drinking cold liquid should be avoided).  If patient very distressed, a benzodiazepine may be used to relieve anxiety as long as there is no decrease in oxygen saturation. 
  • The use of calcium gluconate or magnesium sulfate infusions pre- and/or post-oxaliplatin treatment do not appear to reduce or protect against oxaliplatin-induced neurotoxicity
  • Gabapentin may be effective in some patients to reduce oxaliplatin neuropathy. 
References: 
  1. Oxaliplatin Product Monograph. Sandoz Canada Inc. Last revised 8Nov2018. Accessed 13Jan2021.
  2. BC Cancer Chemotherapy Preparation and Stability Chart version 2.00. BC Cancer Agency. Accessed 13Jan2021.
  3. Oxaliplatin Monograph – Cancer Drug Manual. BC Cancer Agency. Accessed 13Jan2021.
  4. Oxaliplatin Monograph. Cancer Care Ontario. Accessed 11Jan2021

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