Names and pronunciation
(kar-boe-pla′-tin)
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Individual generic drug information
Extracted information for CARBOplatin only.
(kar-boe-pla′-tin)
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Func. class.: Antineoplastic alkylating agent
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Chem. class.: Platinum coordination compound
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Do not confuse: CARBOplatin/CISplatin
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ACTION: Produces interstrand DNA cross-links and, to a lesser extent, DNA- protein cross-links; activity is not cell- cycle–phase specific
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USES: Advanced ovarian cancer in combination with other agents; palliative treatment of ovarian carcinoma recurrent after treatment with other antineoplastic agents
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Extracted information for CARBOplatin only.
CONTRAINDICATIONS: Preg- nancy, breastfeeding, hypersensitivity, sig- nificant bleeding, aluminum products used to prepare or administer CARBOplatin
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Black Box Warning: Severe bone mar- row depression, platinum compound hy- persensitivity (anaphylaxis) Precautions: Geriatric patients, radia- tion therapy within 1 mo, other cancer chemotherapy within 1 mo, renal/hepatic disease, hearing impairment, infection Black Box Warning: Anemia, chemo- therapy-induced nausea/vomiting; requires a specialized care setting and an experi- enced clinician Black Box Warning: Give antiemetic 30-60 min prior to product and prn for vomiting IV route • Do not use needles or IV adminis- tration sets that contain aluminum; may cause precipitate or loss of po- tency • Use cytotoxic handling procedures • Store protected from light at room temperature; reconstituted vials stable for 24 hr at room temperature, solutions further diluted in D5W or NS are stable for 8 hr at room temperature. Paraplatin multidose (10 mg/mL) vials stable for up to 14 days after entry into vial • Reconstitute CARBOplatin 50, 150, or 450 mg with 5, 15, or 45 mL, respec- tively, of sterile water for injection, D5W, or NaCl (10 mg/mL); then further dilute with the same solution to 0.5-4 mg/mL; give over 15 min-1 hr (intermittent IN- FUSION) • Continuous IV INFUSION give over 24 hr; max dose based on (GFR = 125 mg/mL) Solution compatibilities: D5/0.2% NaCl, D5/0.45% NaCl, D5/0.9% NaCl, 0.9% NaCl, D5W, sterile water for injection Y-site compatibilities: Acyclovir, alfent- anil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amio- darone, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin-sulbactam, anidulafungin, aten- olol, atracurium, azithromycin, aztreo- nam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, caspofungin, ceFAZo- lin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cef- TRIAXone, cefuroxime, cimetidine, cipro- floxacin, cisatracurium, CISplatin, cladrib- ine, clindamycin, codeine, cyclophosphamide, cycloSPORINE, cytar abine, DAPTOmycin, DAUNOrubicin, dexamethasone, dexmedetomidine, dex razoxane, digoxin, diltiaZEM, diphen hydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epiRUBicin, ertapenem, erythromycin, esmolol, etopo- side, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gatifloxacin, gem- citabine, gentamicin, granisetron, halo- peridol, heparin, hydrocortisone, HYDRO- morphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamri- none, insulin (regular), irinotecan, iso- proterenol, ketorolac, labetalol, levoFLOX- acin, levorphanol, lidocaine, linezolid injection, LORazepam, magnesium sulfate, mannitol, melphalan, meperidine, meropenem, mesna, methohexital, metho- trexate, methylPREDNISolone, metoclo- pramide, metoprolol, metroNIDAZOLE, micafungin, midazolam, milrinone, mino- cycline, mitoXANTRONE, mivacurium, morphine, nafcillin, nalbuphine, nalox- one, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ofloxacin, ondansetron, oxaliplatin, PACLi- taxel, palonosetron, pamidronate, pan- curonium, pantoprazole, PEMEtrexed, pentamidine, PENTobarbital, PHENobarbi- tal, phenylephrine, piperacillin, piperacil- lin-tazobactam, potassium chloride, potas- sium phosphates, prochlorperazine, promethazine, propofol, propranolol, raNITIdine, remifentanil, riTUXimab, rocuronium, sargramostim, sodium ace- tate, sodium bicarbonate, sodium phos- phates, succinylcholine, SUFentanil, sulfa- methoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiotepa, ticarcil- lin, ticarcillin-clavulanate, tigecycline, tiro- fiban, TNA, tobramycin, topotecan, TPN, trastuzumab, trimethobenzamide, vanco- mycin, vasopressin, vecuronium, verapa mil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine Black Box Warning: To be used only in a specialized care setting by a person ex- perienced in the use of chemotherapeutic products Black Box Warning: Bone marrow de- pression: CBC, differential, platelet count weekly; withhold product if neutrophil count is <2000/mm3 or platelet count is <100,000/mm3; notify prescriber of results; calcium, magnesium, phosphate, potassium, sodium, uric acid, CCr, biliru- bin; CCr <60 mL/min may be responsible for increased bone marrow suppression; assess frequently for infection and treat active infection before use Black Box Warning: Nausea/vomiting: may occur a few hours after administra- tion; antiemetics are used; give fluids, food as tolerated C • Renal studies: BUN, creatinine, serum uric acid; urine CCr prior to, during ther- apy; I&O ratio; report fall in urine output to <30 mL/hr • Hepatic studies prior to, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly; jaundice of skin, sclera; dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea Black Box Warning: Anaphylaxis: hypo- tension, rash, pruritus, wheezing, tachy cardia may occur within a few minutes of use; notify prescriber after discontinuing; resuscitation equipment, corticosteroids, EPINEPHrine should be available • Peripheral neuropathy: may be in- creased in geriatric patients • Beers: use with caution in older adults; may exacerbate or cause syndrome of in- appropriate antidiuretic hormone secre- tion or hyponatremia
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SIDE EFFECTS CNS: Central neurotoxicity, peripheral neu- ropathy, dizziness, confusion CV: Cardiac abnormalities (fatal CV events), stroke, HF, embolism EENT: Tinnitus, hearing loss GU: Nephrotoxicity GI: Severe nausea, vomiting, diarrhea, weight loss, mucositis, anorexia, consti- pation, taste change HEMA: Thrombocytopenia, leukopenia, neu- tropenia, anemia INTEG: Dermatitis, rash META: Hypomagnesemia, hypocalce- mia, hypokalemia, hyponatremia, hyperuricemia SYST: Anaphylaxis, hypersensitivity
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INTERACTIONS • Do not use with or within 3 mo of live virus vaccines Increase: nephrotoxicity or ototoxicity— aminoglycosides, amphotericin B Increase: toxicity—radiation, bone mar- row suppressants; monitor for blood counts often Increase: myelosuppression—myelo- suppressives Decrease: phenytoin levels; monitor levels Drug/Lab Test Increase: AST, BUN, alkaline phosphatase, bilirubin, creatinine Decrease: platelets, neutrophils, WBC, RBC, HB/Hct, calcium, potassium, mag- nesium, phosphate
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Extracted information for CARBOplatin only.
DOSAGE AND ROUTES Advanced ovarian cancer: • Adults: IV: For patients with previously untreated ovarian cancer, 300 mg/m2 on day 1 in combination with cyclophospha- mide (600 mg/m2 IV on day 1), repeated q4wk × 6 cycles. For patients with recur- rent ovarian cancer, give CARBOplatin 360 mg/m2 on day 1, repeated q4wk ALL with ifosfamide, etoposide, rituximab (unlabeled): • Adults ≤21: IV: CARBOplatin 635 mg/m2 on day 3 with ifosfamide 3000 mg/m2/day IV on days 3, 4, 5 (each dose mixed with mesna 600 mg/m2 IV, then mesna 600 mg/ m2 IV over 15 min at 3, 6, 9, and 12 hr after the start of ifosfamide) and etoposide 100 mg/m2/day IV on days 3, 4, 5, repeated each cycle. Rituximab 375 mg/m2 IV on days 1 and 3 of cycles 1 and 2 and on day 3 only of cycle 3. Treatment was given up to a maximum of 3 cycles. Colony-stimulating factors were initiated on day 6 of each cycle, and intrathecal chemotherapy was also given as appropriate Relapsed Wilms tumor with etoposide and ifosfamide (unlabeled): • Adults ≤21 yr, adolescents, and children: IV: Ifosfamide 1800 mg/m2/day × 5 days (on days 0, 1, 2, 3, 4), CAR- BOplatin 400 mg/m2/day IV × 2 days (on days 0, 1), and etoposide 100 mg/m2/day IV × 5 days (on days 0, 1, 2, 3, 4), repeated q21day C Neuroblastoma with etoposide, cyclophosphamide, and DOXOrubicin (unlabeled): • Infants/children: IV: In cycles 1 and 7: CARBOplatin 560 mg/m2 on day 1 (18 mg/ kg/day in children <12 kg) plus etoposide 120 mg/m2/day IV on days 1, 2, 3 (4 mg/ kg/day in children <12 kg). Cycles 2 and 6: CARRBOplatin 560 mg/m2 on day 1 (18 mg/kg/day <12 kg) plus cyclophospha- mide 1000 mg/m2 IV on day 1 (33 mg/kg/ day in children <12 kg) and DOXOrubicin 30 mg/m2 IV on day 1 (1 mg/kg/day in children <12 kg). Cycles 3 and 5: Cyclo- phosphamide 1000 mg/m2 IV on day 1 (33 mg/kg/day in children <12 kg) plus etoposide 120 mg/m2/day IV on days 1, 2, 3 (4 mg/kg/day in children <12 kg). Cycle 4: CARBOplatin 560 mg/m2 IV on day 1 (18 mg/kg/day in children <12 kg) plus etoposide 120 mg/m2/day IV on days 1, 2, 3 (4 mg/kg/day in children <12 kg) and DOXOrubicin 30 mg/m2 IV on day 1 (1 mg/kg/day in children <12 kg). Cycle 8: Cyclophosphamide 1000 mg/m2 IV on day 1 (33 mg/kg/day in children <12 kg) plus DOXOrubicin 30 mg/m2 IV on day 1 (1 mg/kg/day in children <12 kg). All cycles given at 3-wk intervals. Patients given an additional 4 cycles. Patients with unfavor- able biologic features received 8 cycles Renal dose Adult: (single agent) IV INF CCr 41-59 mL/ min 250 mg/m2; CCr 16-40 mL/min 200 mg mg/m2; do not use if CCr <15 mL/min
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Available forms: Solution for injection 10 mg/mL (50 mg/5 mL, 150 mg/15 mL, 450 mg/45 mL, 600 mg/60 mL)
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Administer:
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Extracted information for CARBOplatin only.
Assess:
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Evaluate: • Therapeutic response: decreasing size of tumor, spread of malignancy
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report ringing/roaring in the ears; numbness, tingling in face, extremities; weight gain • Pregnancy/breastfeeding: that im- potence or amenorrhea can occur; that this is reversible after treatment is discontinued; to notify prescriber if preg- nancy is suspected or planned; that con- traception should be used if patient is fertile; not to breastfeed during treat- ment • To avoid OTC products with aspirin, NSAIDs, alcohol; not to receive live virus vaccines during treatment or for 3 mo after completion of treatment • To notify prescriber immediately of fever, fatigue, sore throat, bleeding, bruising, chills, back pain, dyspnea, tingling in extremities, blood in stools, urine, emesis • To avoid crowds, persons with known infections; to avoid the use of razors, stiff-bristle toothbrushes HIGH ALERT
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Extracted information for CARBOplatin only.
PHARMACOKINETICS Initial half-life 2-6 hr, postdistribution half-life 2½-6 hr, not bound to plasma proteins, excreted by the kidneys
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Filter the extracted dose blocks for this individual drug.
Advanced ovarian cancer:
• Adults ≤21 yr, adolescents, and children: IV: Ifosfamide 1800 mg/m2/day × 5 days (on days 0, 1, 2, 3, 4), CAR- BOplatin 400 mg/m2/day IV × 2 days (on days 0, 1), and etoposide 100 mg/m2/day IV × 5 days (on days 0, 1, 2, 3, 4), repeated q21day C Neuroblastoma with etoposide, cyclophosphamide, and DOXOrubicin (unlabeled):
Candidate age grouping · source page 235
Advanced ovarian cancer:
• Infants/children: IV: In cycles 1 and 7: CARBOplatin 560 mg/m2 on day 1 (18 mg/ kg/day in children <12 kg) plus etoposide 120 mg/m2/day IV on days 1, 2, 3 (4 mg/ kg/day in children <12 kg). Cycles 2 and 6: CARRBOplatin 560 mg/m2 on day 1 (18 mg/kg/day <12 kg) plus cyclophospha- mide 1000 mg/m2 IV on day 1 (33 mg/kg/ day in children <12 kg) and DOXOrubicin 30 mg/m2 IV on day 1 (1 mg/kg/day in children <12 kg). Cycles 3 and 5: Cyclo- phosphamide 1000 mg/m2 IV on day 1 (33 mg/kg/day in children <12 kg) plus etoposide 120 mg/m2/day IV on days 1, 2, 3 (4 mg/kg/day in children <12 kg). Cycle 4: CARBOplatin 560 mg/m2 IV on day 1 (18 mg/kg/day in children <12 kg) plus etoposide 120 mg/m2/day IV on days 1, 2, 3 (4 mg/kg/day in children <12 kg) and DOXOrubicin 30 mg/m2 IV on day 1 (1 mg/kg/day in children <12 kg). Cycle 8: Cyclophosphamide 1000 mg/m2 IV on day 1 (33 mg/kg/day in children <12 kg) plus DOXOrubicin 30 mg/m2 IV on day 1 (1 mg/kg/day in children <12 kg). All cycles given at 3-wk intervals. Patients given an additional 4 cycles. Patients with unfavor- able biologic features received 8 cycles Renal dose Adult: (single agent) IV INF CCr 41-59 mL/ min 250 mg/m2; CCr 16-40 mL/min 200 mg mg/m2; do not use if CCr <15 mL/min
Candidate age grouping · source page 235