cisplatin: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
cisplatin: clinical details
Prescribing considerations
- Specialist-unit administration is required, with facilities to recognise and manage anaphylaxis.
- Assess renal, haematological, neurological and auditory status before treatment; cumulative toxicity is clinically important.
- Ensure adequate hydration and urine output, accounting for fluid balance and total sodium exposure.
- Review nephrotoxic, ototoxic, myelosuppressive and renally eliminated medicines.
- Discuss contraception and potential gonadal toxicity, offering fertility-preservation advice where appropriate.
Contraindications and cautions
- Hypersensitivity to cisplatin, formulation components or other platinum compounds
- Pre-existing renal impairment or hearing impairment under the selected SmPCs
- Myelosuppression or dehydration
- Breastfeeding
- Concurrent yellow fever vaccination
- Prophylactic phenytoin under the Sandoz product SmPC
Monitoring
- Renal function and urine output
- Serum sodium, potassium, magnesium and calcium
- Full blood count and liver function
- Baseline and symptom-triggered audiometry; consider ongoing paediatric follow-up because hearing loss may be delayed
- Regular neurological assessment for cumulative sensory or motor neuropathy
- Infusion site and signs of hypersensitivity during administration
Clinical pharmacology
Cisplatin is a non-cell-cycle-specific platinum compound that forms DNA cross-links. Platinum species distribute widely, bind extensively to plasma proteins and are eliminated mainly through the kidneys; tissue accumulation contributes to prolonged and cumulative toxicity.
Formulation and product differences
- Selected products are clear, colourless to pale-yellow concentrates containing cisplatin 1 mg/mL and require dilution before intravenous use.
- Vial volumes and sodium content differ between products; not every listed pack size may be marketed.
- The Hospira product specifies a latex-free vial stopper.
- Aluminium-containing preparation or administration equipment must not contact cisplatin because a platinum precipitate can form.
- Compatible diluents, dilution volumes and in-use storage instructions differ; follow the selected product SmPC.
cisplatin preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 1 mg/mL
Injection
Route: Parenteral
Strengths: 1 mg/mL
cisplatin interactions
The oncology team should review all medicines, vaccines and supplements. Important examples include:
Aminoglycosides, amphotericin B, some cephalosporins and contrast media
May increase kidney toxicity; aminoglycosides can also increase hearing damage.
Loop diuretics
May increase hearing and kidney toxicity, particularly when renal function is impaired.
Warfarin and other oral anticoagulants
The anticoagulant response may change, so more frequent INR monitoring may be needed.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.