Cisplatin

Indications

Cisplatin is a cancer medicine (chemotherapy). It is used, often together with other cancer medicines or radiotherapy, for:

• Testicular cancer
• Ovarian and cervical cancer
• Bladder cancer
• Lung cancer
• Head and neck cancer
• Some other cancers, such as cancer of the food pipe (oesophagus) and stomach

How It Works

Cisplatin contains platinum. It sticks to the genetic material (DNA) inside cells and stops it from being copied, so cancer cells cannot divide and they die. Healthy cells that divide quickly, such as those in the bone marrow, can also be affected.

Dosage and Administration

Cisplatin is given only in hospital, as a drip (infusion) into a vein by a doctor or nurse trained in chemotherapy. The dose is worked out by the cancer specialist from body size, kidney function and the treatment plan, and is given as prescribed, usually in cycles a few weeks apart. Plenty of fluid is given through the drip before and after each dose to protect the kidneys, along with medicines to prevent sickness. Blood tests and hearing checks are done during treatment.

Interactions

• Aminoglycoside antibiotics (such as Gentamicin), Vancomycin, Amphotericin B and strong water tablets (such as Furosemide) can add to kidney damage or hearing loss.
• It can lower the levels of Phenytoin, so seizure control may need checking.
• Live vaccines (such as yellow fever or oral polio) should not be given during treatment.
• Other cancer medicines and radiotherapy can add to the effect on blood counts.
• Tell the cancer team about every medicine, including herbal products.

Contraindications

• Allergy to Cisplatin or other platinum medicines (such as Carboplatin)
• Serious kidney problems
• Existing hearing loss
• Very low blood counts from bone marrow problems
• Dehydration
• Breastfeeding

Side Effects

Common side effects include strong nausea and vomiting (which can last a few days), loss of appetite, tiredness, kidney strain, low magnesium and potassium in the blood, ringing in the ears or hearing loss, numbness or tingling in the hands and feet, low blood counts (raising the risk of infection, bleeding and anaemia), and hair thinning.

Get urgent medical help if there is:

• Fever of 38°C or more, chills or other signs of infection
• Vomiting so bad that fluids cannot be kept down, or passing very little urine
• Unusual bleeding or bruising
• Swelling of the face, wheezing or difficulty breathing during or after the drip
• Fits, sudden vision changes, chest pain or sudden weakness on one side

Pregnancy and Lactation

Cisplatin can seriously harm an unborn baby. Women and men should use reliable contraception during treatment and for the period the doctor advises afterwards. Tell the doctor straight away if pregnancy happens. Do not breastfeed during treatment.

Precautions and Warnings

• Kidney function, blood salts and blood counts are checked before each cycle.
• Hearing may be tested, especially in children and people who already have hearing problems.
• Drink plenty of fluids as advised by the hospital team.
• Avoid people with infections where possible and report fever promptly.
• Cisplatin may reduce fertility; this can be discussed before treatment starts.

Overdose

Overdose is a hospital emergency. It can cause kidney failure, deafness, severe vomiting, nerve damage and dangerously low blood counts. There is no specific antidote; treatment is supportive and given in hospital.

Therapeutic Class

Antineoplastic (anticancer) medicine, platinum compound.

Storage

Kept by the hospital pharmacy below 25°C, protected from light. It must not be put in the fridge or frozen, because the medicine can form crystals. Keep out of the reach of children.