Parenteral Manual

CISplatin

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): 
CDDP, PLATINOL, CISPLATINUM, DDP
Classification: 
Antineoplastic, alkylator - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
November 2023
Indications: 

- Brain tumors                         - Germ cell tumors                        - Osteosarcoma

- Hepatic tumors                      - Neuroblastoma

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: 
  • Available as a 1 mg/mL solution. Protect from light
  • Use only IV sets and needles which do not contain aluminum
  • Diluted solutions stable for 24 hours at room temperature
Compatibility: 
  • Solutions Compatible: must have at least 0.3% NaCl, for example:  D5W/0.45% NaCl, 2/3-1/3, D5W/NS and 0.9% NaCl 
  • Additives/Above Cassette Compatible: KCl, mannitol, magnesium sulfate
  • Y-site Compatible: allopurinol, bleomycin, cyclophosphamide, dexamethasone, diphenhydramine, doxorubicin, droperidol, filgrastim, fluorouracil, furosemide, heparin, hydromorphone, leucovorin, lorazepam, methotrexate, metoclopramide, morphine,  ondansetron, ranitidine, vinblastine, vincristine

INCOMPATIBLE: Stability of cisplatin is dependent upon the presence of chloride ions, do not administer in chloride-free solutions such as plain D5W,  amifostine, amphotericin B, mesna, sodium bicarbonate

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: in 250-500 mL of fluid
May use less volume but adequate hydration must be co-infused

Infusion time: over 1-6 hours (varies according to protocol)
IV Continuous Infusion NO
Dosage: 

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

  • 60 - 120 mg/m2 Q 3-4 weeks
  • 20 - 40 mg/m2/day x 3-5 days (up to a total of 200 mg/m2) Q 3 weeks (doses > 120 mg/m2 per course should be verified)
  • Use mg/kg dose for infants < 6 months

Dosage adjustment in renal impairment: 

  • Do GFR and check protocol for dosage modifications.  A rough guideline follows:
    • Creatinine 135 - 185 umol/L-  give 50% dose
    • Creatinine >185 umol/L-  do not administer cisplatin
    • In children, if GFR <60 mL/min/1.73m2- do not administer cisplatin
Potential hazards of parenteral administration: 

Immediate (within a few minutes to hours):

  • Nausea and/or vomiting - generally severe; premedicate with antiemetics, replace gastric losses, record intake and output
  • Anaphylactic-like reactions - within a few minutes of administration - monitor closely for wheezing, facial edema
  • If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.

Delayed (within a few weeks or months):

  • Moderate bone marrow suppression (leukopenia, thrombocytopenia, anemia)
  • Nephrotoxicity (cumulative) enhanced by inadequate hydration/concomitant use of nephrotoxic drugs (eg. aminoglycosides, amphotericin B)                               
  • High-frequency ototoxicity (cumulative); may be enhanced by ototoxic drugs (i.e. furosemide, aminoglycosides)
  • Peripheral neuropathies, seizures, loss of taste
  • Renal tubular defects - hypocalcemia, hypomagnesemia, hypokalemia, hypophosphatemia - monitor serum electrolytes, uric acid

**Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

Notes: 
  • Monitor renal function - GFR and/or creatinine clearance (should be greater than 60 mL/min/1.73 m2) prior to each treatment
  • Hydrate for at least 3 - 12 hours prior to cisplatin.  Continue hydration for at least 24 hours post infusion (usually   2.5 - 3 L/m2/day).
  • Ensure urine outflow of 80 mL/m2/hr, urine specific gravity of <1.010
  • Electrolytes (Mg, K) will likely need to be supplemented in hydration solutions and after administration
  • Perform audiogram pre-therapy, and with every 2 doses
  • Nephrotoxic drugs (ie, aminoglycosides, amphotericin, ethacrynic acid, furosemide, NSAIDS, ifosfamide, high-dose methotrexate) should be avoided concurrently with cisplatin.

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