Cisplatin

PLATINOL

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Pronunciation: SIS-pla-tin

Cisplatin ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Cisplatin ballicule

Cisplatin PLATINOL mascot mnemonic cartoon — Visual mnemonic: Cisplatin mascot
**“Cis plates”**
"Cis" meaning "on this side"
"Platin" for platinum → platinum-based alkylating-like agent

What it isPlatinum agent forming DNA crosslinks; testicular, ovarian, bladder and head and neck cancer.

Why this oneIt is curative in testicular cancer, one of the few solid tumors cured by chemotherapy.

What limits itCumulative nephrotoxicity requiring aggressive hydration, plus irreversible ototoxicity and peripheral neuropathy. Severe emesis needs triple antiemetics.

Cisplatin molecular structure (skeletal formula) — Molecular structure: Cisplatin

FDA-approved for

cancer (1978)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Nephrotoxicity (dose-related, cumulative; hydrate and monitor renal function/electrolytes); peripheral neuropathy; severe nausea and vomiting (premedicate); and severe myelosuppression with fatal infections.

FDA dosing	Population	Target
Advanced testicular cancer	Adult	20 mg/m2 IV daily x5 days per cycle
Advanced ovarian cancer	Adult	75-100 mg/m2 IV once every 3-4 weeks
Advanced bladder cancer	Adult	50-70 mg/m2 IV once every 3-4 weeks (heavily pretreated: 50 mg/m2 q4wk)

Renal Consider alternative treatment or dose reduction for baseline renal impairment or significant fall in creatinine clearance (per clinical treatment guidelines)

Hepatic Undefined

Instructions

Give pre-treatment IV hydration; maintain hydration and urine output for 24 h after dosing
Premedicate with antiemetics (highly emetogenic); consider additional antiemetics for delayed emesis
Do not use aluminum-containing needles or IV sets (precipitate forms, loss of potency)
Administer by slow IV infusion; monitor site (extravasation causes tissue toxicity)

Available strengths

inj 1 mg/mL

Cautions

Severe hypersensitivity/anaphylaxis; cross-reactivity among platinum agents
Ototoxicity (cumulative; more severe in pediatric patients <5 y)
Ocular toxicity (optic neuritis, papilledema, cortical blindness)
Secondary acute leukemia
Embryo-fetal toxicity; use effective contraception
Injection-site reactions/extravasation tissue injury
Electrolyte wasting (hypomagnesemia, hypokalemia); SIADH

Adverse reactions

Nephrotoxicity
Peripheral neuropathy
Nausea and vomiting
Myelosuppression
Ototoxicity

Pregnancy Can cause fetal harm (human data): transplacental transfer, oligohydramnios, intrauterine growth restriction, preterm birth; neonatal cytopenias and hearing loss reported.

Lactation Present in human milk in low amounts; advise not to breastfeed during treatment.

Cost

Cisplatin (PLATINOL)

Strength		#/mo	generic $/unit	CostPlus
1 mg/mL	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Cisplatin is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entry1999

⚠ BOXED WARNINGS

Nephrotoxicity
Ototoxicity
Myelosuppression
Severe nausea and vomiting

Classes and tags

Clinical profile

Therapeutic safety burden4 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk3 / 4

Legacy pregnancy categoryD

Defining liabilitySevere nephrotoxicity, ototoxicity, neuropathy and emesis require intensive supportive care.

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Memory aids: interaction avatars

OCT2/MATE1 substrate

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