carboplatin: clinical use

Prescribing considerations

• Use only under specialist supervision with facilities to manage severe hypersensitivity and cytotoxic complications.
• Renal function strongly influences clearance and haematological toxicity; impaired function, older age, poor performance status and previous myelosuppressive or cisplatin treatment increase risk.
• Review nephrotoxic, ototoxic, immunosuppressive and myelosuppressive treatment.
• Assess tumour-lysis risk in rapidly proliferating, bulky or highly treatment-sensitive disease.
• Discuss contraception, pregnancy risk and fertility preservation where relevant.

Contraindications and cautions

• Hypersensitivity to carboplatin or an excipient
• Previous severe allergic reaction to carboplatin or another platinum compound
• Severe myelosuppression
• Pre-existing severe renal impairment, unless potential benefit is judged to outweigh risk
• Bleeding tumours
• Concomitant yellow fever vaccination

Monitoring

• Full blood count and recovery from marrow suppression
• Renal function, including an appropriate assessment of filtration
• Liver function and serum electrolytes
• Infusion reactions and extravasation
• Neurological, visual and auditory toxicity, particularly after cisplatin exposure and in children
• Clinical and biochemical features of tumour lysis or hepatic sinusoidal obstruction when indicated

Clinical pharmacology

Carboplatin forms intra-strand and inter-strand DNA crosslinks. It is eliminated mainly by glomerular filtration, making renal function an important determinant of exposure and toxicity.

Formulation and product differences

• The selected product is a clear, colourless sterile concentrate requiring dilution before intravenous infusion.
• Water for injections is the only excipient.
• Compatible dilution fluids include glucose 5% and sodium chloride 0.9%, subject to product handling and storage conditions.
• Aluminium-containing needles, syringes, catheters and administration sets must not contact carboplatin because precipitation and loss of potency can occur.
• Storage requirements differ between vial presentations; consult current product documentation.

Solution for infusion

Route: Intravenous

Strengths: 10 mg/mL