oxaliplatin: clinical use

Prescribing considerations

• Restrict preparation and administration to specialist oncology services experienced with cytotoxic therapy.
• Assess renal function, baseline marrow reserve, peripheral neuropathy, previous platinum hypersensitivity and medicines that increase neurological, cardiac or muscle toxicity.
• Review persistent sensory symptoms and their functional effect before further administration.
• Use antiemetic prophylaxis and provide clear instructions for urgent reporting of infection, gastrointestinal toxicity and mucositis.

Contraindications and cautions

• Hypersensitivity to oxaliplatin or an excipient.
• Breastfeeding.
• Baseline myelosuppression before the initial course.
• Pre-existing peripheral sensory neuropathy causing functional impairment.
• Severe renal impairment.

Monitoring

• Full blood count with differential before treatment and subsequent courses.
• Renal and liver function, hydration and electrolytes.
• Neurological examination before administrations and periodic assessment of cold-triggered and cumulative neuropathy.
• Infusion reactions and the venous access site during administration.
• ECG and electrolyte status where QT-prolongation risk is present.
• New pulmonary symptoms, severe gastrointestinal toxicity, bleeding, haemolysis or muscle injury.

Clinical pharmacology

Oxaliplatin undergoes non-enzymatic biotransformation to active and inactive platinum species. Active derivatives form intra-strand and inter-strand DNA cross-links, disrupting DNA synthesis. Platinum distributes rapidly into tissues, binds irreversibly to blood components and is eliminated predominantly in urine; exposure increases as renal function declines.

Formulation and product differences

• The selected product is a clear, colourless concentrate for intravenous infusion containing oxaliplatin, lactose monohydrate and water for injection.
• It must be diluted with glucose 5%; sodium chloride and other chloride-containing or alkaline solutions are incompatible.
• Do not administer undiluted, use aluminium-containing injection equipment, or mix with other medicines in the same infusion bag.
• The product is single-use and requires cytotoxic handling and disposal procedures.

Solution for infusion

Route: Intravenous

Strengths: 5 mg/mL