{"id":1737,"date":"2023-06-25T17:40:08","date_gmt":"2023-06-25T17:40:08","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/cisplatin\/"},"modified":"2023-06-25T19:42:15","modified_gmt":"2023-06-25T19:42:15","slug":"cisplatin","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/cisplatin\/","title":{"rendered":"Cisplatin"},"content":{"rendered":"

<\/p>\n

Cisplatin<\/h1>\n

CLINICAL USE<\/h3>\n

Antineoplastic agent:Testicular and metastatic ovarian tumours Cervical tumours Lung carcinoma Bladder cancer<\/p>\n

DOSE IN NORMAL RENAL FUNCTION<\/h3>\n

Single agent therapy: 50\u2013120 mg\/m 2 as a single dose every 3\u20134 weeks or 15\u201320 mg\/m2 daily for 5 days every 3\u20134 weeksCombination therapy: 20 mg\/m 2 and upward, every 3\u20134 weeks<\/p>\n

PHARMACOKINETICS<\/h3>\n
  • Molecular weight                           :300<\/li>\n
  • %Protein binding                           :>90<\/li>\n
  • %Excreted unchanged in urine     : 27\u201345<\/li>\n
  • Volume of distribution (L\/kg)       :0.5<\/li>\n
  • half-life \u2013 normal\/ESRD (hrs)      :0.3\u20131 (terminal T\u00bd 2\u20135 days)\/\u2013
    \n

    DOSE IN RENAL IMPAIRMENT<\/h3>\n

    GFR (mL\/MIN)<\/h4>\n<\/li>\n
  • 20 to 50     : See \u2018Other Information\u2019<\/li>\n
  • 10 to 20     : See \u2018Other Information\u2019<\/li>\n
  • <10           : See \u2018Other Information\u2019
    \n

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES<\/h3>\n<\/li>\n
  • CAPD                :Unknown dialysability. Dose as in GFR <10 mL\/min<\/li>\n
  • HD                     :Not dialysed. Dose as in GFR <10 mL\/min<\/li>\n
  • HDF\/high flux   :Dialysed. Dose as in GFR<\/li>\n
  • <10           : mL\/min<\/li>\n
  • CAV\/VVHD      :Unknown dialysability. Dose as in GFR 10 to 20 mL\/min
    \n

    IMPORTANT DRUG INTERACTIONS<\/h3>\n

    Potentially hazardous interactions with other drugsAminoglycosides: increased risk of nephrotoxicity and possibly ototoxicity with aminoglycosides, capreomycin, polymyxins or vancomycinAntipsychotics: avoid concomitant use with clozapine, increased risk of agranulocytosisCytotoxics: increased pulmonary toxicity with bleomycin and methotrexate<\/p>\n

    ADMINISTRATION<\/h3>\n

    Reconstition<\/h4>\n

    Water for injection to form a 1 mg\/mL solution<\/p>\n

    Route<\/h4>\n

    IV infusion<\/h4>\n

    Rate of Administration<\/h4>\n

    Over 6\u20138 hours<\/p>\n

    Comments<\/h4>\n

    Pre-treatment hydration, with 1\u20132 litres of fluid infused for 8\u201312 hours prior to cisplatin dose, is recommended in order to initiate diuresis. The drug is then well diluted in 2 litres sodium chloride 0.9% or glucose-saline solutions to ensure hydration and maintain urine output. Adequate hydration must be maintained during the following 24 hours, with potassium and magnesium supplementation given as necessaryCisplatin solutions react with aluminium \u2013 do not use equipment containing aluminium<\/p>\n

    OTHER INFORMATION<\/h4>\n

    Dose modification depends not only on the degree of renal dysfunction, but also on the intended dose and the therapeutic end-point. In general, any patient with a GFR<70 mL\/min should be highlighted as \u2018at risk\u2019 from cisplatin renal toxicity. Kintzel PE, Dorr RT. Anticancer drug renal toxicity and elimination: dosing guidelines for altered renal function. Cancer Treat Rev. 1995; 21: 33\u201364GFR (mL\/min) Dose<60 100%50\u201360 75%40\u201350 50%<40 AvoidBennett <50 100%10\u201350 75%<\/li>\n

  • <10           : and<\/li>\n
  • HD                     : 50%An alternative approach is to consider changing to carboplatin, which can be dosed specifically according to GFRNon-enzymatically transformed into multiple metabolites. Good uptake of cisplatin in the kidneys, liver and intestine. Distributes into third spaces such as ascites and pleural fluid. Elimination of intact drug and metabolites is via the urine. In the first 24 hrs 20\u201380% is excretedOtotoxicity, nephrotoxicity and myelosuppression reported. Check hearing, renal function and haematology before treatment and before each subsequent courseToxicity is also associated with cumulative doses of cisplatin Hypomagnesaemia, hypocalcaemia and hyperuricaemia observedThe addition of mannitol to the infusion may aid diuresis and protect the kidneys.<\/li>\n","protected":false},"excerpt":{"rendered":"

    Cisplatin CLINICAL USE Antineoplastic agent:Testicular and metastatic ovarian tumours Cervical<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-1737","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1737","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=1737"}],"version-history":[{"count":1,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1737\/revisions"}],"predecessor-version":[{"id":2850,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1737\/revisions\/2850"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=1737"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=1737"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=1737"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}