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Care During Chemotherapy and Beyond

CDDP

Generic Name: Cisplatin

(SIS pla tin)

Trade Names: Platinol®, Platinol®-AQ

Other Name: CDDP

Cisplatin is the generic name for the trade name drug Platinol® and Platinol®-AQ. In some cases, health care professionals may use the trade name Platinol® and Platinol®-AQ, or other names such as CDDP, when referring to the generic drug name cisplatin.

Drug Type:

Cisplatin is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "alkylating agent." (For more detail, see "How Cisplatin Works" section below).

What Cisplatin Is Used For:

  • Treatment of advanced bladder cancer, metastatic ovarian cancer, and metastatic testicular cancer. Testicular, ovarian, bladder, head and neck, esophageal, small and non-small cell lung, breast, cervical, stomach and prostate cancers. Also to treat Hodgkin's and non-Hodgkin's lymphomas, neuroblastoma, sarcomas, multiple myeloma, melanoma, and mesothelioma.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Cisplatin Is Given:

  • Cisplatin is administered through a vein (intravenously or IV) as an infusion.
  • There is no pill form of cisplatin.
  • Cisplatin is an irritant. An irritant is a chemical that can cause inflammation of the vein through which it is given.
  • If cisplatin escapes from the vein it can cause tissue damage. The nurse or doctor who gives cisplatin must be carefully trained. If you experience pain or notice redness or swelling at the IV site while you are receiving cisplatin, alert your health care professional immediately.
  • Before and/or after the cisplatin infusion, extra IV fluids are given and care is taken to ensure adequate hydration before both during and after cisplatin, to protect your kidney function.
  • Cisplatin also has been used as an infusion into the abdominal cavity (contains the abdominal organs).

The amount of cisplatin that you receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer that you have. Your doctor will determine your dose and schedule.

Side Effects:

Important things to remember about cisplatin side effects:

  • Most people do not experience all of the cisplatin side effects listed.
  • Cisplatin side effects are often predictable in terms of their onset, duration, and severity.
  • Cisplatin side effects will improve after therapy is complete.
  • Cisplatin side effects may be quite manageable. There are many options to help minimize or prevent the side effects of cisplatin.
  • There is no relationship between the presence or severity of Cisplatin side effects and effectiveness of cisplatin.

The following side effects are common (occurring in greater than 30%) for patients taking Cisplatin:

  • Nausea and vomiting. Nausea may last up to 1 week after therapy. Anti-nausea medication is given before the infusion, and a prescription is also given for use after.
  • Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia, and/or bleeding. Nadir: Meaning low point, is the point in time between chemotherapy cycles in which you experience low blood counts.
    • Nadir: 18-23 days. Recovery: 39 days
  • Kidney toxicity. Effects on kidney function are dose related, observed 10-20 days after therapy, and are generally reversible.
  • Ototoxicity hearing loss, ringing in the ears.
  • Blood test abnormalities (low magnesium, low calcium, low potassium)

These are less common side effects (occurring in 10-29%) for patients receiving Cisplatin:

  • Peripheral neuropathy: Although less common, a serious side effect of decreased sensation and paresthesia (numbness and tingling of the extremities) may be noted. Sensory loss, numbness and tingling, and difficulty in walking may last for at least as long as therapy is continued. These side effects may become progressively more severe with continued treatment, and your doctor may decide to decrease your dose. Neurologic effects may be irreversible.
  • Loss of appetite
  • Taste changes, metallic taste
  • Increases in blood tests measuring liver function. These return to normal once treatment is discontinued. (see liver problems).
  • Hair loss may cause hair loss; however, this side effect is uncommon.

Not all cisplatin side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When To Contact Your Doctor or Health Care Provider:

Contact your health care provide immediately, day or night, if you should experience any of the following symptoms:

  • Fever of 100.4°F (38°C) or higher or chills (possible signs of infection)

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24 hour period)
  • Diarrhea (4-6 episodes in a 24 hour period)
  • No urine output in a 12 hour period
  • Blood in the urine
  • Pain or burning with urination
  • Unusual bleeding or bruising
  • Black or tarry stools, or blood in your stools or urine
  • Extreme fatigue (unable to carry on self-care activities)
  • Swelling, redness and pain in one leg or arm and not the other
  • Yellowing of the skin or eyes
  • Mouth sores (painful redness, swelling or ulcers)

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

  • Before starting cisplatin treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
  • Cisplatin may be inadvisable if you have a history of severe allergic reaction to cisplatin, carboplatin, other platinum-containing formulations or mannitol.
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking cisplatin.
  • Your fertility, meaning your ability to conceive or father a child, may be affected by cisplatin. Please discuss this issue with your health care provider.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Cisplatin may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
  • For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking cisplatin. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
  • Do not breast feed while taking cisplatin.

Self-Care Tips:

  • To reduce nausea, take anti-nausea medications as prescribed by your doctor, eat small amounts of food frequently.
  • Try dry cereal, toast, or crackers, especially in the morning, to help curb nausea.
  • Maintaining a good fluid intake is very important to help to avoid kidney damage. Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1 teaspoon of baking soda mixed with 8 ounces of water.
  • Use an electric razor and a soft toothbrush to minimize bleeding.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
  • Get plenty of rest.
  • Maintain good nutrition.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Cisplatin:

  • You will be checked regularly by your doctor while you are taking cisplatin, to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC) your electrolytes (such as calcium, magnesium, potassium, and sodium levels) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.
  • Because drug toxicity is seen as numbness and tingling of fingers and toes, a periodic physical examination, which includes a check of your reflexes, is necessary to detect the need for decreased dosages.
  • With high dose therapy hearing tests may be ordered as baseline and monitored at times during therapy.

How Cisplatin Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cell stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.

Cisplatin is classified as an alkylating agent. Alkylating agents are most active in the resting phase of the cell. These drugs are cell cycle non-specific.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Reference:

Cisplatin, Lexicomp Online®. [11/21/2016; Lexi-Drugs. 11/17/2016]. Hudson, Ohio: Lexi-Comp, Inc.; November 21, 2016.

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