Names and pronunciation
(ox-al-i′plat-in) Eloxatin
Source page 991
Loading InternPractice…
Individual generic drug information
Extracted information for oxaliplatin only.
(ox-al-i′plat-in) Eloxatin
Source page 991
Func. class.: Antineoplastic
Source page 991
Chem. class.: 3rd-generation plati- num analog, alkylating agent
Source page 991
ACTION: Forms crosslinks, thereby inhibiting DNA replication and transcrip- tion; not specific to cell cycle
Source page 991
USES: Metastatic carcinoma of the colon or rectum in combination with 5-FU/leucovorin
Source page 991
Extracted information for oxaliplatin only.
CONTRAINDICATIONS: Preg- nancy, breastfeeding, radiation therapy or chemotherapy within 1 mo, thrombo- cytopenia, smallpox vaccination
Source pages 991, 992
Black Box Warning: Hypersensitivity to this product or other platinum products Precautions: Children, geriatric patients, pneumococcus vaccination, renal disease Black Box Warning: Anaphylaxis: wheezing, tachycardia, facial swelling, fainting, rash, dyspnea, hives; discon- tinue product, report to prescriber; resus- citation equipment should be nearby with epinephrine, corticosteroids • Pulmonary fibrosis: cough, crackles, dyspnea, pulmonary infiltrate; discontinue immediately; death may occur • Reversible posterior leukoencepha- lopathy syndrome: assess for headache, seizures, diarrhea, infection, abnormal vision, change in mental functioning; dis- continue immediately • Monitor temperature; may indicate be- ginning infection • Hepatic studies before each cycle (bilirubin, AST, ALT, LDH) as needed or monthly • Bleeding: hematuria, guaiac, bruising or petechiae, mucosa or orifices; obtain pre- scription for viscous lidocaine (Xylocaine) • All medications PO if possible; avoid IM inj when platelets <100,000/mm3 • Pregnancy/breastfeeding: do not use in pregnancy, breastfeeding, use contraception
Source pages 992, 993, 994
SIDE EFFECTS CNS: Peripheral neuropathy, fatigue, headache, dizziness, insomnia, reversible posterior leukoencephalopathy syndrome CV: Cardiac abnormalities, throm- boembolism EENT: Decreased visual acuity, tinni- tus, hearing loss GI: Severe nausea, vomiting, diarrhea, weight loss, stomatitis, anorexia, gastro- esophageal reflux, constipation, dyspep- sia, mucositis, flatulence GU: Hematuria, dysuria, creatinine HEMA: Thrombocytopenia, leukopenia, pancytopenia, neutropenia, anemia, hemolytic uremic syndrome INTEG: Rash, flushing, extravasation, redness, swelling, pain at inj site META: Hypokalemia RESP: Fibrosis, dyspnea, cough, rhinitis, URI, pharyngitis SYST: Anaphylaxis, angioedema
Source page 993
INTERACTIONS • Increase: QT prolongation: class Ia/III antidysrhythmias, monitor ECG Increase: bleeding risk—NSAIDs, alco- hol, anticoagulants, platelet inhibitors, thrombolytics, salicylates Increase: oxaliplatin toxicity—tannins Increase: myelosuppression—myelo- suppressive agents, radiation, taxanes, tofacitinib Increase: nephrotoxicity—aminoglyco- sides, loop diuretics Decrease: antibody response—inacti- vated vaccines Drug/Lab Test Increase: ALT, AST, bilirubin, creatinine Decrease: potassium, neutrophils, WBC, platelets
Source page 993
Extracted information for oxaliplatin only.
DOSAGE AND ROUTES Dosage protocols may vary Colorectal cancer • Adult: IV 85 mg/m2 concurrently via Y-site with leucovorin (500 mg/m2 IV) over 2 hr, followed 1 hr later by fluoro- uracil (500 mg/m2 IV bolus) on days 1, 15, and 29. On days 8, 22, and 36, ad- minister leucovorin (500 mg/m2 IV over 2 hr) without oxaliplatin, followed 1 hr later by fluorouracil (500 mg/m2 IV bo- lus). Repeat every 8 wk (56 days) for a total of 3 cycles (24 wk) Renal dose • Adult: IV CCr <30 mL/min, reduce starting dose to 65 mg/m2
Source page 992
Available forms: Powder for inj 50, 100-mg single-use vials (5 mg/mL); solu- tion for inj 50 mg/10 mL, 100 mg/20 mL, 200 mg/40 mL
Source page 992
Administer: Intermittent IV INFUSION route • Use oxaliplatin first if using 5-FU also • Do not use ice during infusion, may make reactions worse • Premedicate with antiemetics includ- ing 5HT3 blockers, with or without dexa- methasone; prehydration not needed • Do not reconstitute or dilute with sodium chloride or any chloride-containing sol; do not use aluminum equipment during any preparation or administration; will degrade platinum; do not refrigerate unopened pow- der or sol; do not freeze; protect from light • Use cytotoxic handling procedures; prepare in biologic cabinet using gown, gloves, mask; do not allow product to come in contact with skin; use soap and water if contact occurs • EPINEPHrine, antihistamines, cortico- steroids for hypersensitivity reaction • Lyophilized powder: reconstitute vial 50 mg/10 mL or 100 mg/20 mL sterile water for inj or D5W; after reconstitution, sol may be stored for ≤24 hr in refrigera- tor; after dilution in 250-500 mL D5W, may store ≤24 hr in refrigerator or 6 hr at room temperature; infuse over 2 hr Y-site compatibilities: Alfentanil, amifos- tine, amikacin, aminocaproic acid, amio- darone, amphotericin B colloidal, ampho- tericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin-sulbac- tam, anidulafungin, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, ceFAZolin, cefotaxime, cefoTEtan, cefOXitin, cefTAZi- dime, ceftizoxime, cefTRIAXone, cefurox- ime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophospha- mide, cycloSPORINE, cytarabine, dacarba- zine, DACTINomycin, DAPTOmycin, DAU- NOrubicin, dexamethasone, digoxin, diltiaZEM, diphenhydrAMINE, DOBUTa- mine, DOCEtaxel, dolasetron, DOPamine, doxacurium, DOXOrubicin, doxycycline, droperidol, enalaprilat, ePHEDrine, EPI- NEPHrine, epiRUBicin, ertapenem, eryth- romycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fluda- rabine, foscarnet, fosphenytoin, furose- mide, gatifloxacin, gemcitabine, gemtu- zumab, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrAL- AZINE, hydrocortisone, HYDROmor- phone, hydrOXYzine, IDArubicin, ifos- famide, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoprotere- nol, ketorolac, labetalol, leucovorin, levo- FLOXacin, levorphanol, lidocaine, line- zolid, LORazepam, magnesium sulfate, mannitol, meperidine, meropenem, mesna, metaraminol, methyldopate, meth- ylPREDNISolone, metoclopramide, meto- prolol, metroNIDAZOLE, midazolam, mil- rinone, minocycline, mitoMYcin, mitoXANTRONE, mivacurium, morphine, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, PACLitaxel, palonosetron, pancuronium, PEMEtrexed, pentamidine, pentazocine, phenylephrine, piperacillin, polymyxin B, potassium chloride/phosphates, procain- amide, prochlorperazine, promethazine, propranolol, quiNIDine, quinupristin-dal- fopristin, raNITIdine, rocuronium, sodium acetate/phosphates, succinylcho- line, SUFentanil, sulfamethoxazole-tri methoprim, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin, ticarcil- lin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, topotecan, tri- methobenzamide, vancomycin, vasopres- sin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
Source pages 992, 993
Extracted information for oxaliplatin only.
Assess: • Bone marrow depression: CBC, differ- ential, platelet count each cycle; withhold product if WBC is <4000/mm3 or platelet count is <100,000/mm3; notify prescriber of results • Renal/hepatic studies: BUN, creati- O nine, serum uric acid, urine CCr before, electrolytes during therapy; dose should not be given if BUN >19 mg/dL; creati- nine <1.5 mg/dL; I&O ratio; report fall in urine output of <30 mL/hr; LFTs
Source page 993
Evaluate: • Therapeutic response: decreased tu- mor size, spread of malignancy
Source page 994
CLINICAL CONSIDERATIONS
Source page 993
Patient and caregiver information: • To report signs of infection: increased temperature, sore throat, flulike symptoms • To report signs of anemia: fatigue, headache, faintness, SOB, irritability • To report bleeding; to avoid use of razors, commercial mouthwash • To avoid aspirin, ibuprofen, NSAIDs, alcohol; may cause GI bleeding • To report any changes in breathing, coughing • To report numbness, tingling in face or extremities, poor hearing, or joint pain or swelling • Not to receive live virus vaccines dur- ing treatment • Dysesthesias: to avoid contact with cold (air, ice, liquid) • To use contraception during treatment and for 4 mo after; that product may cause infertility HIGH ALERT
Source page 994
Extracted information for oxaliplatin only.
PHARMACOKINETICS Metabolized in liver, excreted in urine; after administration, 15% of platinum in systemic circulation, 85% either in tis- sues or being eliminated in urine; half- life 390 hr; protein binding >90%
Source page 993
Filter the extracted dose blocks for this individual drug.
Dosage protocols may vary Colorectal cancer
• Adult: IV 85 mg/m2 concurrently via Y-site with leucovorin (500 mg/m2 IV) over 2 hr, followed 1 hr later by fluoro- uracil (500 mg/m2 IV bolus) on days 1, 15, and 29. On days 8, 22, and 36, ad- minister leucovorin (500 mg/m2 IV over 2 hr) without oxaliplatin, followed 1 hr later by fluorouracil (500 mg/m2 IV bo- lus). Repeat every 8 wk (56 days) for a total of 3 cycles (24 wk) Renal dose
Candidate age grouping · source page 992
Dosage protocols may vary Colorectal cancer
• Adult: IV CCr <30 mL/min, reduce starting dose to 65 mg/m2
Candidate age grouping · source page 992