cisplatin

Warnings and precautions

Black Box Warning:  Bone marrow sup- pression, platinum compound hypersen- sitivity Precautions: Geriatric patients, vacci- nation, infections, extravasation, periph- eral neuropathy, radiation therapy Black Box Warning: Chemotherapy- induced nausea/vomiting, children, nephro- toxicity, ototoxicity; requires a specialized care setting and an experienced clinician, peripheral neuropathy Black Box Warning: Use EPINEPHrine, antihis­tamines, corticosteroids immediately for hypersensitivity reaction • Antiemetic 30-60 min prior to product and prn; allopurinol to maintain uric acid levels, alkalinization of urine; di- uretic (furosemide 40 mg IV) or manni- tol after infusion Intermittent IV INFUSION route • Check solution for particulate and color, do not use if present or if dis­colored • Dilute 10 mg/10 mL or 50 mg/50 mL sterile water for injection, withdraw pre- scribed dose; dilute ½ dose with 1000 mL D50.2NaCl, D50.45NaCl with 37.5 g manni- tol; IV INFUSION is given over 3-4 hr; use a 0.45-μm filter; total dose 2 L over 6-8 hr; check site for irritation, phlebitis Continuous IV INFUSION route • Give over 24 hr × 5 days Y-site compatibilities: Acyclovir, alfent- anil, allopurinol, amikacin, aminophylline, amiodarone, ampicillin, ampicillin- sulbactam, anidulafungin, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, bu- prenorphine, butorphanol, calcium chlo- ride/gluconate, carmustine, caspofungin, ceFAZolin, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, cefti- zoxime, cefTRIAXone, cefuroxime, chlor- proMAZINE, cimetidine, ciprofloxacin, cisatracurium, cladribine, clindamycin, codeine, cyclophosphamide, cycloSPO- RINE, cytarabine, DACTINomycin, DAPTOmycin, DAUNOrubicin, dexametha- sone, dexmedetomidine, dexrazoxane, di- goxin, diltiaZEM, diphenhydrAMINE, C DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, dro- peridol, enalaprilat, ePHEDrine, EPI- NEPHrine, epiRUBicin, ertapenem, eryth- romycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, flucon- azole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gatifloxacin, gemcitabine, gentamicin, gly- copyrrolate, granisetron, haloperidol, heparin, hydrocortisone, HYDROmor- phone, IDArubicin, ifosfamide, imipenem- cilastatin, inamrinone, indomethacin, irinotecan, isoproterenol, ketorolac, la- betalol, leucovorin, levoFLOXacin, levor- phanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, melphalan, meperidine, meropenem, methohexital, methotrexate, methylPREDNISolone, metoclopramide, metoprolol, metroNI­ DAZOLE, midazolam, milrinone, mino­ cycline, mitoMYcin, mitoXANTRONE, mivacurium, nafcillin, naloxone, nesiritide, niCAR­dipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ofloxacin, on- dansetron, oxaliplatin, PACLitaxel, palono- setron, pamidronate, pancuronium, PEMEtrexed, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phenyleph- rine, phenytoin, piperacillin, polymyxin B, potassium chloride/phosphates, procain- amide, prochlorperazine, promethazine, propofol, propranolol, quiNIDine, quinu- pristin-dalfopristin, raNITIdine, remifent- anil, riTUXimab, sargramostim, sodium acetate/bicarbonate/phosphates, succinyl- choline, SUFentanil, sulfamethoxazole-­ trimethoprim, tacrolimus, teniposide, theophylline, thiopental, ticarcillin, ticar- cillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, topotecan, trastuzumab, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid Black Box Warning: Bone marrow depression: CBC, differential, platelet count weekly; withhold product if WBC is <4000 or platelet count is <100,000; notify prescriber of results Black Box Warning: Renal toxicity: BUN, creatinine, serum uric acid, urine CCr prior to, electrolytes during therapy; dose should not be given if BUN <25 mg/dL; creatinine <1.5 mg/dL; I&O ratio; report fall in urine output of <30 mL/hr; toxicity is cumulative; withhold until renal function returns to normal Black Box Warning: Anaphylaxis: wheezing, tachycardia, facial swelling, fainting; discontinue product, report to prescriber; resuscitation equipment should be nearby, may occur within min- utes; often EPINEPHrine, corticosteroids, antihistamines may alleviate symptoms •  Infection: monitor temperature; may indicate beginning infection; report signs of infection, cough, sore throat, fever • Hepatotoxicity: report jaundice, dark urine, clay-colored stools, pruritus, ­abdominal pain • Hepatic studies prior to, during therapy (bilirubin, AST, ALT, LDH) as needed • Bleeding: hematuria, guaiac, bruising, petechiae, mucosa, or orifices q8hr; obtain prescription for viscous lidocaine (Xylocaine) Black Box Warning: Ototoxicity: more common in genetic variants TPMT 3B and 3C in children; use audiometric testing baseline and prior to each dose; tinnitus or loss of high-frequency sounds is usu- ally first indication of ototoxicity • Comprehensive oral hygiene • RPLS: Headache, change in eyesight, confusion, seizures, increased B/P, usu- ally occurs a few hours up to a year after treatment starts, discontinue treatment •  Hyperuricemia in lymphoma: increase fluid intake to 2-3 L/day to prevent urate deposits, calculi formation, promote elim- ination of product; usually occurs between 3-5 days after a dose, may use allopurinol Black Box Warning: Ototoxicity: to re- port loss of hearing, ringing, or roaring in the ears • To maintain adequate fluids; to report decreased urine output, flank pain • That hair may be lost during treat- ment; a wig or hairpiece may make pa- tient feel better; that new hair may be different in color, texture • To report numbness, tingling in face or extremities; poor hearing; joint pain, swelling • Not to receive vaccinations during treatment • Pregnancy/breastfeeding: to use con- traception during treatment and for 4 mo after treatment; that product may cause infertility; not to breastfeed

Source pages 286, 287, 288, 289