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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Cisplatin: Drug information

Cisplatin: Drug information
(For additional information see "Cisplatin: Patient drug information" and see "Cisplatin: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Myelosuppression:

Cisplatin can cause severe myelosuppression with fatalities due to infections. Monitor blood counts accordingly. Interruption of therapy may be required.

Nausea and vomiting:

Cisplatin can cause severe nausea and vomiting. Use highly effective antiemetic premedication.

Nephrotoxicity:

Cisplatin can cause severe renal toxicity, including acute renal failure. Severe renal toxicities are dose-related and cumulative. Ensure adequate hydration and monitor renal function and electrolytes. Consider dose reductions or alternative treatments in patients with renal impairment.

Peripheral neuropathy:

Cisplatin can cause dose-related peripheral neuropathy that becomes more severe with repeated courses of the drug.

Pharmacologic Category
  • Antineoplastic Agent, Alkylating Agent;
  • Antineoplastic Agent, Platinum Analog
Dosing: Adult

Note: Administer appropriate pretreatment hydration and maintain adequate hydration and urinary output for 24 hours following cisplatin administration. Consider magnesium supplementation as clinically indicated. Cisplatin is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (ASCO [Hesketh 2020]; MASCC/ESMO [Roila 2016]). Cisplatin doses exceeding 100 mg/m2 per treatment course are rarely used and should be verified with the prescriber.

Adrenocortical carcinoma, advanced

Adrenocortical carcinoma, advanced (off-label use): IV: 40 mg/m2 on days 3 and 4 every 4 weeks (in combination with doxorubicin, etoposide, and mitotane) (Fassnacht 2012) or 40 mg/m2 on days 2 and 9 every 4 weeks (in combination with doxorubicin, etoposide, and mitotane) until disease progression or unacceptable toxicity up to a maximum of 6 cycles (Berruti 2005).

Anal carcinoma, squamous cell, metastatic

Anal carcinoma, squamous cell, metastatic (off-label use; based on limited data): IV: 75 mg/m2 on day 1 every 4 weeks (in combination with continuous infusion fluorouracil) (Eng 2014).

Biliary tract cancer, advanced

Biliary tract cancer, advanced (off-label use): IV: 25 mg/m2 over 2 hours on days 1 and 8; repeat cycle every 3 weeks (in combination with gemcitabine) for 4 to 8 cycles (Valle 2010) or 25 mg/m2 on days 1 and 8; repeat cycle every 3 weeks (in combination with durvalumab and gemcitabine) for up to 8 cycles, followed by durvalumab as a single agent until disease progression or unacceptable toxicity (Oh 2022).

Bladder cancer, advanced

Bladder cancer, advanced: IV: 50 to 70 mg/m2 every 3 to 4 weeks; heavily pretreated patients: 50 mg/m2 every 4 weeks.

Bladder cancer, advanced (off-label dosing/combinations):

Locally advanced or metastatic disease:

Dose-dense MVAC regimen: IV: 70 mg/m2 on day 2 every 14 days (in combination with methotrexate, vinblastine, doxorubicin, and growth factor support) until disease progression or unacceptable toxicity (Sternberg 2001; Sternberg 2006).

GC regimen: IV: 70 mg/m2 on day 2 every 28 days (in combination with gemcitabine) for up to 6 cycles (von der Maase 2000). Split-dose cisplatin may be an option in select patients (Kim 2015).

MVAC regimen: IV: 70 mg/m2 on day 2 every 28 days (in combination with methotrexate, vinblastine, and doxorubicin) for up to 6 cycles (von der Maase 2000) or 70 mg/m2 on day 2 every 28 days (in combination with methotrexate, vinblastine, and doxorubicin) until disease progression or unacceptable toxicity (Sternberg 2001; Sternberg 2006) or 70 mg/m2 on day 1 every 28 days (in combination with methotrexate, vinblastine, doxorubicin, and filgrastim) for up to 6 cycles or until loss of clinical benefit (Bamias 2004).

Paclitaxel/gemcitabine/cisplatin (PGC) regimen: IV: 70 mg/m2 on day 2 every 3 weeks (in combination with gemcitabine and paclitaxel; refer to protocol for administration sequence details) for up to 6 cycles or until disease progression or unacceptable toxicity (Bellmunt 2012).

Neoadjuvant treatment:

Note: Patients with non-organ confined disease at cystectomy who did not receive cisplatin-based neoadjuvant chemotherapy should be offered an adjuvant cisplatin-based chemotherapy regimen. Some patients with borderline renal function may be treated with split-dose cisplatin and aggressive hydration (AUA/ASCO/ASTRO/SUO [Chang 2017]).

Dose-dense MVAC regimen: IV: 70 mg/m2 on day 1 or on day 2 every 14 days (in combination with methotrexate, doxorubicin, vinblastine, and pegfilgrastim) for 3 or 4 cycles (Choueiri 2014; Plimack 2014).

GC regimen: IV: 70 mg/m2 on day 1 every 21 days or (split-dose cisplatin) 35 mg/m2 on days 1 and 8 every 21 days (in combination with gemcitabine) for 4 cycles (Dash 2008).

MVAC regimen: IV: 70 mg/m2 on day 2 every 28 days (in combination with methotrexate, vinblastine, and doxorubicin) for 3 cycles (Grossman 2003).

CMV regimen: IV: 100 mg/m2 on day 1 every 21 days (in combination with methotrexate, vinblastine, and leucovorin) for 3 cycles (Griffiths 2011).

Brain metastases, due to breast or non-small cell lung cancers

Brain metastases, due to breast or non-small cell lung cancers (off-label use): IV: 100 mg/m2 on day 1 every 3 weeks (in combination with etoposide) for up to 6 cycles in the absence of disease progression or unacceptable toxicity (Franciosi 1999).

Breast cancer, triple-negative

Breast cancer, triple-negative (off-label use): IV: Neoadjuvant therapy (single agent): 75 mg/m2 on day 1 every 3 weeks for 4 cycles (Silver 2010).

Cervical cancer

Cervical cancer (off-label use): IV: 40 mg/m2 over 4 hours prior to radiation therapy on days 1, 8, 15, 22, 29, and 36 (Rose 2007) or 75 mg/m2 on day 1 every 3 weeks (in combination with fluorouracil and radiation) for 3 cycles (Morris 1999) or 70 mg/m2 on day 1 every 3 weeks for 4 cycles (in combination with fluorouracil; cycles 1 and 2 given concurrently with radiation) (Peters 2000) or 50 mg/m2 on day 1 every 4 weeks (in combination with radiation and fluorouracil) for 2 cycles (Whitney 1999) or 50 mg/m2 on day 1 or day 2 every 3 weeks (in combination with paclitaxel [conventional] and bevacizumab) until disease progression or unacceptable toxicity (Tewari 2014; Tewari 2017) or 50 mg/m2 once every 3 weeks (in combination with paclitaxel [conventional]) for up to 6 cycles in nonresponders, patients with a clinical response could continue beyond 6 cycles (Monk 2009; Moore 2004) or 50 mg/m2 on day 1 every 3 weeks (in combination with topotecan) for a maximum of 6 cycles (in nonresponders) or until disease progression or unacceptable toxicity (Long 2005) or 50 mg/m2 on day 1 or day 2 every 3 weeks (in combination with pembrolizumab and paclitaxel [conventional] ± bevacizumab) for 6 cycles; patients could continue chemotherapy beyond 6 cycles if experiencing clinical benefit without unacceptable toxicity; refer to protocol for further information (Colombo 2021).

Endometrial carcinoma, recurrent, metastatic, or high-risk

Endometrial carcinoma, recurrent, metastatic, or high-risk (off-label use): IV: 50 mg/m2 on day 1 every 3 weeks (in combination with doxorubicin ± paclitaxel) for 7 cycles or until disease progression or unacceptable toxicity (Fleming 2004).

Esophageal, gastroesophageal, and gastric cancers

Esophageal, gastroesophageal, and gastric cancers (off-label uses):

Pembrolizumab/cisplatin/fluorouracil (esophageal or gastroesophageal junction cancer): IV: 80 mg/m2 on day 1 every 3 weeks for a maximum of 6 cycles; continue pembrolizumab and fluorouracil until disease progression, unacceptable toxicity, or (in patients without disease progression) for up to 24 months (Sun 2021). Refer to protocol for further details.

Nivolumab/cisplatin/fluorouracil (esophageal squamous cell carcinoma): IV: 80 mg/m2 on day 1 every 4 weeks until disease progression or unacceptable toxicity; patients could continue nivolumab for up to 2 years (Doki 2022). Refer to protocol for further details.

CF regimen (esophageal or gastroesophageal junction cancer): IV: 100 mg/m2 over 30 minutes on days 1 and 29 (preoperative chemoradiation; in combination with fluorouracil) (Tepper 2008) or 80 mg/m2 on day 1 (in combination with fluorouracil) every 3 weeks for 2 cycles (neoadjuvant chemotherapy prior to surgery) (Alderson 2017).

TCF or DCF regimen (gastric or gastroesophageal junction cancer): IV: 75 mg/m2 on day 1 every 3 weeks (in combination with docetaxel and fluorouracil) until disease progression or unacceptable toxicity (Ajani 2007; Van Cutsem 2006).

Gestational trophoblastic neoplasia, high-risk

Gestational trophoblastic neoplasia, high-risk (off-label use):

EMA-EP regimen: IV: 60 to 80 mg/m2 on day 8 every 2 weeks (in combination with etoposide, methotrexate, leucovorin, and dactinomycin); continue for 2 to 4 treatment cycles after a normal hCG level (Ghaemmaghami 2004).

EP-EMA regimen: EP: IV: 25 mg/m2/dose over 4 hours each for 3 consecutive doses on day 1 (in combination with etoposide), alternating weekly with EMA (etoposide, methotrexate, leucovorin, and dactinomycin) (Newlands 2000).

BEP regimen (for refractory disease): IV: 20 mg/m2 on days 1 to 4 of a 21-day cycle (BEP; in combination with bleomycin, etoposide, and WBC growth factor support); continue for at least 2 treatment cycles after a normal hCG level (Lurain 2005; Lurain 2010).

TP/TE regimen (for refractory disease): IV: 60 mg/m2 over 3 hours on day 1 of a 28-day cycle (TP; in combination with paclitaxel) alternating every 2 weeks with TE (paclitaxel and etoposide); continue until hCG level is normal for at least 8 weeks, or until treatment resistance (plateaued or rising hCG) or unacceptable toxicity (Wang 2008).

Low-dose EP induction regimen (consider prior to EMA/CO in patients with high tumor burden): IV: 20 mg/m2 on days 1 and 2 every week (in combination with etoposide) for 1 to 2 cycles, followed by the EMA-CO regimen (etoposide, methotrexate, leucovorin, dactinomycin, cyclophosphamide, and vincristine) until hCG levels normalize and then for a further 6 to 8 weeks; refer to protocol for further information (Alifrangis 2013).

Head and neck cancer

Head and neck cancer (off-label use):

Locally advanced disease:

In combination with concurrent radiation therapy: IV: 100 mg/m2 on day 1 every 3 weeks for 3 doses (Bernier 2004; Cooper 2004) or (in patients unable to tolerate the higher standard cisplatin dose) 30 mg/m2 once a week for 6 or 7 weeks, until the end of radiation therapy (Ghosh-Laskar 2016; Noronha 2018).

In combination with chemotherapy: IV: 75 mg/m2 on day 1 every 3 weeks (in combination with docetaxel and fluorouracil) for 4 cycles or until disease progression or unacceptable toxicity (if no disease progression after 4 cycles, chemotherapy was followed by radiation) (Vermorken 2007) or 100 mg/m2 on day 1 every 3 weeks (in combination with docetaxel and fluorouracil) for 3 cycles or until disease progression or unacceptable toxicity (chemotherapy was followed by chemoradiation) (Posner 2007).

Metastatic disease: IV: 100 mg/m2 on day 1 every 3 weeks (in combination with fluorouracil and cetuximab) until disease progression or unacceptable toxicity or a maximum of 6 cycles (Vermorken 2008).

Hodgkin lymphoma, relapsed/refractory

Hodgkin lymphoma, relapsed/refractory (off-label use):

DHAP regimen: IV: 100 mg/m2 continuous infusion over 24 hours on day 1 for 2 cycles; median duration between cycle 1 and 2 was 16 days (in combination with dexamethasone and cytarabine) (Josting 2002).

ESHAP regimen: IV: 25 mg/m2 on days 1 to 4 (in combination with etoposide, methylprednisolone, and cytarabine) every 3 to 4 weeks for 3 or 6 cycles (Aparicio 1999).

Malignant pleural mesothelioma

Malignant pleural mesothelioma (off-label use): IV: 75 mg/m2 on day 1 every 3 weeks (in combination with pemetrexed) (Vogelzang 2003) or 75 mg/m2 on day 1 every 3 weeks (in combination with pemetrexed) until disease progression or unacceptable toxicity (Santoro 2008) or 100 mg/m2 on day 1 every 4 weeks (in combination with gemcitabine) (Nowak 2002) or 80 mg/m2 on day 1 every 3 weeks (in combination with gemcitabine) (van Haarst 2002) or 75 mg/m2 on day 1 every 3 weeks (in combination with pemetrexed and bevacizumab) for up to 6 cycles, followed by bevacizumab maintenance therapy until disease progression or unacceptable toxicity (Zalcman 2016). The American Society of Clinical Oncology guidelines for malignant pleural mesothelioma recommend first-line platinum/pemetrexed-based therapy for 4 to 6 cycles (ASCO [Kindler 2018]).

Multiple myeloma

Multiple myeloma (off-label use):

DT-PACE regimen: IV: 10 mg/m2/day administered as a continuous infusion on days 1 to 4 of each cycle; repeat every 4 to 6 weeks (in combination with dexamethasone, thalidomide, doxorubicin, cyclophosphamide, and etoposide) (Lee 2003).

VDT-PACE regimen: IV: 10 mg/m2/day administered as a continuous infusion on days 1 to 4 of each cycle; repeat every 4 to 6 weeks (in combination with bortezomib, dexamethasone, thalidomide, doxorubicin, cyclophosphamide, and etoposide) (Lee 2003; Pineda-Roman 2008).

DCEP regimen: IV: 10 mg/m2/day administered as a continuous infusion on days 1 to 4 every 21 days (in combination with cyclophosphamide, etoposide, and dexamethasone) until disease progression or unacceptable toxicity (Lazzarino 2001; Park 2014).

Neuroendocrine tumors, metastatic carcinoma

Neuroendocrine tumors, metastatic carcinoma (off-label use): IV: 45 mg/m2/day as a continuous infusion on days 2 and 3 every 4 weeks (in combination with etoposide) until disease progression or unacceptable toxicity (Fjällskog 2001; Moertel 1991) or 80 mg/m2 over 30 minutes on day 1 every 3 weeks (in combination with etoposide) for up to 6 cycles (Le Treut 2013).

Non-Hodgkin lymphoma, relapsed/refractory

Non-Hodgkin lymphoma, relapsed/refractory (off-label use):

DHAP regimen (for DLBCL): IV: 100 mg/m2 continuous infusion over 24 hours on day 1 every 3 to 4 weeks for 6 to 10 cycles (in combination with dexamethasone and cytarabine) (Velasquez 1988).

ESHAP regimen: IV: 25 mg/m2/day continuous infusion over 24 hours on days 1 to 4 every 3 to 4 weeks for 6 to 8 cycles (in combination with etoposide, methylprednisolone, and cytarabine) (Velasquez 1994).

R-GDP or GDP regimen: IV: 75 mg/m2 on day 1 (in combination with gemcitabine and dexamethasone ± rituximab) every 3 weeks for 2 to 6 cycles (Crump 2004; Crump 2014).

Non-small cell lung cancer

Non-small cell lung cancer (off-label use): Note: There are multiple cisplatin-containing regimens for the treatment of NSCLC. Several commonly used regimens are listed below:

Adjuvant therapy: IV: 100 mg/m2 on day 1 every 4 weeks (in combination with etoposide) for 3 to 4 cycles (Arriagada 2004) or 100 mg/m2 on day 1 every 4 weeks (in combination with vinorelbine) for 4 cycles (Douillard 2006).

Advanced or metastatic disease: IV: 100 mg/m2 on day 1 every 4 weeks (in combination with vinorelbine) for 6 to 10 cycles (Kelly 2001) or 100 mg/m2 on day 1 every 4 weeks (in combination with vinorelbine) until disease progression or unacceptable toxicity (Wozniak 1998) or 100 mg/m2 on day 1 every 4 weeks (in combination with gemcitabine) (Comella 2000) or 80 mg/m2 on day 1 every 3 weeks (in combination with gemcitabine) until disease progression or unacceptable toxicity (Ohe 2007) or 75 mg/m2 on day 1 every 3 weeks (in combination with pemetrexed) for up to 6 cycles or until disease progression or unacceptable toxicity (Scagliotti 2008).

Osteosarcoma

Osteosarcoma (off-label use): Adults ≤40 years of age: IV: 60 mg/m2/day (over 4 hours) for 2 days (total of 120 mg/m2/cycle) of weeks 1 and 6 (neoadjuvant therapy) and then 60 mg/m2/day (over 4 hours) for 2 days (total of 120 mg/m2/cycle) of weeks 12 and 17 (adjuvant therapy) in combination with methotrexate, leucovorin, and doxorubicin (Marina 2016; Whelan 2015).

Ovarian cancer, advanced

Ovarian cancer, advanced: IV: 75 to 100 mg/m2 once every 3 to 4 weeks or (off-label combination) 75 mg/m2 every 3 weeks (in combination with paclitaxel) (Ozols 2003).

Intraperitoneal (off-label route): 100 mg/m2 on day 2 of a 21-day treatment cycle (in combination with IV and intraperitoneal paclitaxel) for 6 cycles (Armstrong 2006).

Ovarian germ cell tumors (off-label dosing):

BEP regimen (adjuvant treatment): IV: 20 mg/m2 on days 1 to 5 every 21 days (in combination with bleomycin and etoposide) for 3 cycles (Williams 1994).

EP regimen: IV: 20 mg/m2 on days 1 to 5 every 21 days (in combination with etoposide) for 4 cycles (Culine 2007); while the BEP regimen is preferred in the treatment of ovarian germ cell tumors, EP may be considered if pulmonary toxicity is a concern. Note: Use of this regimen in ovarian germ cell tumors is extrapolated from data in the management of testicular germ cell tumors.

TIP regimen: IV: 25 mg/m2 on days 2 to 5 every 3 weeks (in combination with paclitaxel, ifosfamide, and mesna) for 4 cycles (Kondagunta 2005b). Note: Use of this regimen in ovarian germ cell tumors is extrapolated from data in the management of testicular germ cell tumors.

Pancreatic cancer, locally advanced or metastatic

Pancreatic cancer, locally advanced or metastatic (off-label use; alternative regimen): IV: 50 mg/m2 over 1 hour on days 1 and 15 every 4 weeks (in combination with gemcitabine) (Heinemann 2006).

Penile cancer, metastatic

Penile cancer, metastatic (off-label use): IV: 25 mg/m2 over 2 hours on days 1, 2, and 3 every 3 to 4 weeks (in combination with paclitaxel and ifosfamide) for 4 cycles (Pagliaro 2010).

Primary CNS lymphoma, relapsed or refractory

Primary CNS lymphoma, relapsed or refractory (off-label use; based on limited data): IV: 100 mg/m2 continuous infusion over 24 hours on day 1 every 3 to 4 weeks (in combination with dexamethasone and high-dose cytarabine) for ~6 to 10 cycles in responding patients (Velasquez 1988; McLaughlin 1988).

Prostate cancer, castration-resistant, metastatic, small cell variant or with anaplastic feature

Prostate cancer, castration-resistant, metastatic, small cell variant or with anaplastic feature (off-label use): IV: 25 mg/m2 on days 1, 2, and 3 every 3 weeks (in combination with etoposide, as second-line treatment following first-line treatment with carboplatin and docetaxel) for at least 4 cycles (Aparicio 2013).

Small cell lung cancer

Small cell lung cancer (off-label use):

Limited-stage disease: IV: 60 mg/m2 on day 1 every 3 weeks for 4 cycles (in combination with etoposide and concurrent radiation) (Turrisi 1999) or 80 mg/m2 on day 1 every 3 weeks (in combination with etoposide and sequential radiation therapy) for 4 cycles (Takada 2002) or 80 mg/m2 on day 1 every 4 weeks (in combination with etoposide and concurrent radiation therapy) for 4 cycles (Takada 2002) or 25 mg/m2 on days 1, 2, and 3 every 3 to 4 weeks (in combination with etoposide) for 6 cycles (Evans 1985).

Extensive-stage disease: IV: 80 mg/m2 on day 1 every 3 weeks (in combination with etoposide) for 4 cycles (Lara 2009) or a maximum of 8 cycles (Ihde 1994) or 60 mg/m2 on day 1 every 4 weeks for 4 cycles (in combination with irinotecan) (Lara 2009) or 25 mg/m2 on days 1, 2, and 3 every 3 to 4 weeks (in combination with etoposide) for 6 cycles (Evans 1985).

Testicular cancer, advanced

Testicular cancer, advanced: IV: 20 mg/m2 once daily for 5 days repeated every 3 weeks (in combination with bleomycin and etoposide) (Cushing 2004; Saxman 1998).

Testicular germ cell tumor, metastatic, good-risk (off-label combination): IV: 20 mg/m2 on days 1 to 5 every 3 weeks (in combination with etoposide) for 4 cycles (Culine 2007; Kondagunta 2005a).

Testicular germ cell tumor, metastatic, intermediate or poor-risk (off-label dosing): IV: 25 mg/m2 on days 2 to 5 every 3 weeks (in combination with paclitaxel, ifosfamide, and mesna) for 4 cycles (Kondagunta 2005b) or 20 mg/m2 on days 1 to 5 every 3 weeks (in combination with bleomycin and etoposide) for 4 cycles (Nichols 1998) or 20 mg/m2 on days 1 to 5 every 3 weeks (in combination with etoposide and ifosfamide) for 4 cycles (Nichols 1998) or 20 mg/m2 on days 1 to 5 every 3 weeks (in combination with vinblastine, ifosfamide, and mesna) for 4 cycles (Loehrer 1998).

Thymic carcinoma, locally advanced or metastatic

Thymic carcinoma, locally advanced or metastatic (off-label use; based on limited data):

CODE regimen: IV: 25 mg/m2 on day 1 (in combination with vincristine, doxorubicin, and etoposide) during weeks 1, 2, 4, 6, and 8 (Yoh 2003).

VIP regimen: IV: 20 mg/m2 on days 1 to 4 (in combination with etoposide, ifosfamide, mesna and colony-stimulating growth factor support) every 3 weeks for up to 4 cycles or until disease progression or unacceptable toxicity (Loehrer 2001).

Thymomas, advanced or metastatic

Thymomas, advanced or metastatic (off-label use):

CAP regimen: IV: 50 mg/m2 over at least 1 hour on day 1 every 3 weeks for up to 8 cycles (in combination with cyclophosphamide and doxorubicin) (Loehrer 1994).

ADOC regimen: IV: 50 mg/m2 on day 1 every 3 weeks (in combination with doxorubicin, vincristine, and cyclophosphamide) (Fornasiero 1991).

PE regimen: IV: 60 mg/m2 over 1 hour on day 1 every 3 weeks (in combination with etoposide) for up to 8 cycles (Giaccone 1996).

VIP regimen: IV: 20 mg/m2 on days 1 to 4 (in combination with etoposide, ifosfamide, mesna, and colony-stimulating growth factor support) every 3 weeks for up to 4 cycles or until disease progression or unacceptable toxicity (Loehrer 2001).

Unknown primary, adenocarcinoma

Unknown primary, adenocarcinoma (off-label use): IV: 100 mg/m2 on day 1 every 3 weeks (in combination with gemcitabine) (Culine 2003; Gross-Goupil 2012) or 80 mg/m2 on day 1 every 3 weeks (in combination with docetaxel) for 2 to 6 cycles (Mukai 2010).

Unknown primary, squamous cell carcinoma

Unknown primary, squamous cell carcinoma (off-label use; based on limited data): IV: 75 mg/m2 on day 1 every 3 weeks (in combination with fluorouracil ± docetaxel) for 3 cycles (Pointreau 2009) or 20 mg/m2 on days 1 to 5 every 4 weeks (in combination with fluorouracil) until disease progression or unacceptable toxicity (Kusaba 2007).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Kidney impairment prior to treatment initiation:

Altered kidney function:

Note: Due to nephrotoxicity concerns, alternative agents may be preferred in patients with baseline kidney impairment when clinically appropriate. The manufacturer's labeling suggests consideration of alternative treatments or dose reductions for patients with impaired CrCl, but does not provide specific adjustments. Limited data are available, and the optimal approach to cisplatin dose adjustment is not established. In addition to the recommendations provided below, other general adjustments (Aronoff 2007; Kintzel 1995; Lichtman 2007) or cancer-specific adjustments (Carles 2006; Plimack 2014) have also been described.

Therapy with curative intent (Krens 2019):

CrCl ≥60 mL/minute: IV: No dosage adjustment necessary.

CrCl 50 to <60 mL/minute: IV: Administer 75% of the usual indication-specific recommended dose.

CrCl 40 to <50 mL/minute: IV: Administer 50% of the usual indication-specific recommended dose.

CrCl <40 mL/minute: Use is not recommended.

Therapy with palliative intent (Krens 2019):

CrCl ≥60 mL/minute: IV: No dosage adjustment necessary.

CrCl 50 to <60 mL/minute: IV: Administer 75% of the usual indication-specific recommended dose.

CrCl <50 mL/minute: Use is not recommended.

Hemodialysis, intermittent (thrice weekly): Poorly dialyzable due to rapid and high degree of protein binding (Boucher 2019; Gorodetsky 1995; Hirai 2000).

Note: Although use of cisplatin is generally not recommended in patients with chronic kidney disease (CKD) due to the risk of nephrotoxicity, for patients with irreversible CKD receiving hemodialysis, the concern of nephrotoxicity is no longer relevant and although not routinely recommended, administration of cisplatin in these patients (using various strategies) has been reported (Amagai 2019; Boucher 2019; Chang 2013; Hirai 2000; Hirakawa 2017; Marnitz 2011; Tomita 2001; Zahra 2008). A commonly recommended approach is described below:

Therapy with curative intent: IV: Administer 50% of the usual indication-specific recommended dose (Horie 2018; Janus 2010; Krens 2019; Marnitz 2011; Tomita 2001). Although removal by dialysis is not likely to be substantial, administer cisplatin after hemodialysis (or on a nondialysis day) to allow for cisplatin to distribute into the tissue (Horie 2018; Janus 2010).

Therapy with palliative intent: Use is not recommended (Krens 2019).

Peritoneal dialysis: Not significantly dialyzed (Eads 2016):

Therapy with curative intent: IV: Although not routinely recommended, if necessary, administer 50% of the usual indication-specific recommended dose. However, nephrotoxicity is likely in patients with residual kidney function; avoid use in patients with significant residual kidney function (expert opinion).

Therapy with palliative intent: Use is not recommended (expert opinion).

CRRT: Use is not recommended, as cisplatin is a nephrotoxin that could prevent the return of or worsen kidney function (expert opinion).

PIRRT (eg, sustained, low-efficiency diafiltration): Use is not recommended, as cisplatin is a nephrotoxin that could prevent the return of or worsen kidney function (expert opinion).

Nephrotoxicity during treatment: Cisplatin-induced nephrotoxicity most commonly presents as acute kidney injury (AKI) and/or as electrolyte disturbances (eg, hypomagnesemia, Fanconi-like syndrome, salt-wasting hyponatremia) (Manohar 2018). Patients that develop AKI (eg, SCr >2 times baseline) may require discontinuation of therapy; however, re-treatment may be considered after recovery from AKI if cisplatin is considered life-saving or life-extending. For patients experiencing electrolyte disturbances, if continued use of cisplatin is considered clinically appropriate (ie, patient receiving cisplatin with curative intent and responding to therapy), cisplatin may be continued with appropriate electrolyte repletion. However, if concurrent AKI occurs or electrolyte abnormalities persist even with aggressive supplementation, consider discontinuation of cisplatin therapy and administration of appropriate supportive care (Perazella 2022).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. However, cisplatin undergoes nonenzymatic metabolism and predominantly renal elimination. Dosage adjustment is likely not necessary (Krens 2019).

Dosing: Pediatric

(For additional information see "Cisplatin: Pediatric drug information")

Note: Dosing units variable (mg/kg, mg/m2); use caution. Dosing and frequency may vary by protocol and/or treatment phase; refer to specific protocol. Cisplatin is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (POGO [Dupuis 2011]; POGO [Paw Cho Sing 2019]).

TO PREVENT POSSIBLE OVERDOSE, VERIFY ANY CISPLATIN DOSE EXCEEDING 100 mg/m2 PER COURSE (eg, every 3 to 4 week cycle). Pretreatment hydration is recommended.

Germ cell tumors

Germ cell tumors: Limited data available:

Cushing 2004:

Infants: IV: 0.7 mg/kg on days 1 to 5 of a 21-day cycle (in combination with bleomycin and etoposide).

Children and Adolescents: IV: 20 mg/m2 on days 1 to 5 of a 21-day cycle (in combination with bleomycin and etoposide).

Pinkerton 1986: Children and Adolescents: IV: 100 mg/m2on day 1 of a 21-day cycle (in combination with bleomycin and vinblastine or etoposide).

Lopes 2016: Children and Adolescents:

Intermediate risk: PE regimen: IV: 35 mg/m2 on days 1, 2, and 3 of a 21-day cycle for 3 cycles (weeks 1, 4, and 7) in combination with etoposide; a fourth cycle may be considered depending on response.

High risk: PEI regimen: IV: 35 mg/m2 on days 1, 2, and 3 of a 21-day cycle for 4 cycles (weeks 1, 4, 7, and 11) in combination with etoposide and ifosfamide; a fifth or sixth cycle may be considered depending on response.

Hepatoblastoma

Hepatoblastoma: Limited data available:

Continuous IV infusion:

Infants and Children <10 kg: PLADO regimen: IV infusion: 2.7 mg/kg/day continuous infusion over 24 hours on day 1 of a 21-day cycle in combination with doxorubicin for 4 to 6 cycles (Pritchard 2000).

Children ≥10 kg and Adolescents:

Monotherapy: Standard risk: IV infusion: 80 mg/m2/day continuous infusion over 24 hours every 2 weeks on day 1.

Combination therapy: PLADO regimen: IV infusion: 80 mg/m2/day continuous infusion over 24 hours on day 1 of a 21-day cycle in combination with doxorubicin (Perilongo 2004; Perilongo 2009; Pritchard 2000) or doxorubicin and sorafenib (Schmid 2012).

Intermittent infusion (over 6 hours), C5V(D) regimen:

Infants and Children <10 kg: IV: 3 to 3.3 mg/kg over 6 hours on day 1 of a 21-day cycle for 4 to 8 cycles in combination with vincristine and fluorouracil and/or doxorubicin (Douglass 1993; Katzenstein 2022; Malogolowkin 2008; Ortega 2000).

Children ≥10 kg and Adolescents: IV: 90 to 100 mg/m2 over 6 hours on day 1 of a 21-day cycle for 4 to 8 cycles in combination with vincristine and fluorouracil and/or doxorubicin (Douglass 1993; Katzenstein 2022; Malogolowkin 2008; Ortega 2000).

Medulloblastoma

Medulloblastoma: Limited data available: Children ≥3 years and Adolescents: IV: 75 mg/m2 every 6 weeks on either day 0 of chemotherapy cycle in combination with vincristine and cyclophosphamide or day 1 of chemotherapy cycle in combination with lomustine and vincristine for 8 cycles (Packer 2006; Packer 2013).

Medulloblastoma/PNET, relapsed or refractory

Medulloblastoma/PNET, relapsed or refractory: Very limited data available: Children and Adolescents: IV: 60 mg/m2 on day 0 every 4 weeks (in combination with irinotecan, vincristine, cyclophosphamide, and etoposide) (Kim 2013).

Neuroblastoma, high-risk

Neuroblastoma, high-risk: Limited data available: Infants, Children, and Adolescents: IV: 50 mg/m2 on days 0 to 3 of a 21-day cycle in combination with etoposide (cycles 3 and 5) (Kreisman 2013; Naranjo 2011) or 50 mg/m2 on days 1 to 4 in combination with etoposide (cycles 3, 5, and 7) (Kushner 1994).

Osteosarcoma

Osteosarcoma: Limited data available: Children and Adolescents: IV: 60 mg/m2/day for 2 days at weeks 2, 7, 25, and 28 (neoadjuvant) or weeks 5, 10, 25, and 28 (adjuvant) in combination with doxorubicin (Goorin 2003).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Note: In adult patients, the manufacturer(s) recommend that repeat courses of cisplatin should not be given until serum creatinine is <1.5 mg/dL and/or BUN is <25 mg/dL and use is contraindicated in preexisting renal impairment. Consult protocols for specific renal impairment dosing adjustments. The following adjustments have been recommended:

Aronoff 2007: Infants, Children, and Adolescents:

GFR >50 mL/minute/1.73 m2: No dosage adjustment necessary.

GFR 10 to 50 mL/minute/1.73 m2: Administer 75% of dose.

GFR <10 mL/minute/1.73 m2: Administer 50% of dose.

Hemodialysis: Partially cleared by hemodialysis: Administer 50% of dose posthemodialysis.

Peritoneal dialysis: Administer 50% of dose.

Continuous renal replacement therapy (CRRT): Administer 75% of dose.

Katzenstein 2019: Hepatoblastoma: Infants, Children, and Adolescents:

GFR >60 mL/minute/1.73 m2: No dosage adjustment necessary.

GFR <60 mL/minute/1.73 m2: Omit cisplatin dose from regimen until GFR is >60 mL/minute/1.73 m2.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, cisplatin undergoes nonenzymatic metabolism and predominantly renal elimination; therefore, dosage adjustment is likely not necessary.

Dosing: Older Adult

Refer to adult dosing. Select dose cautiously and monitor closely; patients ≥65 years of age may be more susceptible to nephrotoxicity and peripheral neuropathy.

Dosing: Obesity: Adult

American Society of Clinical Oncology guidelines for appropriate systemic therapy dosing in adults with cancer with a BMI ≥30 kg/m2 : Utilize patient's actual body weight (full weight) for calculation of BSA- or weight-based dosing; manage regimen-related toxicities in the same manner as for patients with a BMI <30 kg/m2; if a dose reduction is utilized due to toxicity, may consider resumption of full weight-based dosing (or previously tolerated dose level) with subsequent cycles only if dose escalations are allowed in the prescribing information, if contributing underlying factors (eg, hepatic or kidney impairment) are sufficiently resolved, AND if performance status has markedly improved or is considered adequate (ASCO [Griggs 2021]).

Dosing: Adjustment for Toxicity: Adult

Consider alternative treatments or dose reductions for toxicities.

Hematologic toxicity: May require treatment interruption and/or dosage reduction.

Hypersensitivity: Discontinue cisplatin immediately (and manage appropriately) for severe hypersensitivity reactions; do not rechallenge with cisplatin in patients with a history of severe hypersensitivity reactions. Ensure supportive equipment and medications for management of severe hypersensitivity reactions are available during cisplatin administration.

Neurotoxicity: Consider discontinuing cisplatin if symptomatic grade 3 or 4 peripheral neuropathy develops.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous [preservative free]:

Generic: 50 mg/50 mL (50 mL); 100 mg/100 mL (100 mL); 200 mg/200 mL (200 mL)

Solution Reconstituted, Intravenous [preservative free]:

Generic: 50 mg (1 ea)

Generic Equivalent Available: US

Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Generic: 1 mg/mL (10 mL, 50 mL, 100 mL)

Administration: Adult

Cisplatin is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (ASCO [Hesketh 2020]; MASCC/ESMO [Roila 2016]). Administer appropriate pretreatment hydration and maintain adequate hydration and urinary output for 24 hours following cisplatin administration.

IV: Cisplatin has been infused over 30 minutes to 4 hours, at a rate of 1 mg/minute, or as a continuous infusion (off-label rates); infusion rate varies by protocol (refer to specific protocol for infusion details). Do not administer as a rapid IV injection. Also refer to specific protocol for information regarding recommended concomitant hydration, diuretics, and (for combination regimens) the administration sequence.

Intraperitoneal (off-label route): Solution was prepared in warmed saline and infused as rapidly as possible through an implantable intraperitoneal catheter (Armstrong 2006).

Needles or IV administration sets that contain aluminum should not be used in the preparation or administration; aluminum may react with cisplatin resulting in precipitate formation and loss of potency.

Vesicant (at higher concentrations); ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.

Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); initiate sodium thiosulfate antidote; elevate extremity.

Sodium thiosulfate 1/6 M solution: Inject 2 mL into existing IV line for each 100 mg of cisplatin extravasated; then consider also injecting 1 mL as 0.1 mL subcutaneous injections (clockwise) around the area of extravasation, may repeat subcutaneous injections several times over the next 3 to 4 hours (Ener 2004).

Dimethyl sulfoxide (DMSO) may also be considered an option: Apply to a region covering twice the affected area every 8 hours for 7 days; begin within 10 minutes of extravasation; do not cover with a dressing (ESMO/EONS [Perez Fidalgo 2012]).

Administration: Pediatric

Cisplatin is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (POGO [Dupuis 2011]; POGO [Paw Cho Sing 2019]).

Pretreatment hydration is recommended prior to cisplatin administration; adequate posthydration and urinary output (eg, >100 mL/hour in adults) should be maintained for 24 hours after administration.

IV: Infuse over 6 to 8 hours; has also been infused over 30 minutes to 3 hours, at a rate of 1 mg/minute, or as a continuous infusion; infusion rate varies by protocol (refer to specific protocol for infusion details)

Needles or IV administration sets that contain aluminum should not be used for administration; aluminum may react with cisplatin resulting in precipitate formation and loss of potency.

Vesicant (at higher concentrations); ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); initiate sodium thiosulfate antidote; elevate extremity. Dimethyl sulfoxide (DMSO) may also be considered an option (See Management of Drug Extravasations for more details).

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2016 [group 1]).

Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2016; USP-NF 2020).

Use: Labeled Indications

Bladder cancer, advanced: Treatment of advanced bladder cancer.

Ovarian cancer, advanced: Treatment of advanced ovarian cancer.

Testicular cancer, advanced: Treatment of advanced testicular cancer.

Use: Off-Label: Adult

Adrenocortical carcinoma (advanced); Anal carcinoma, squamous cell (metastatic); Biliary tract cancer (advanced); Brain metastases (due to breast or non-small cell lung cancers); Breast cancer (triple-negative); Cervical cancer; Endometrial carcinoma (recurrent, metastatic, or high-risk); Esophageal cancer; Gastric cancer; Gestational trophoblastic neoplasia, high-risk; Head and neck cancer (locally advanced or metastatic disease); Hodgkin lymphoma; Malignant pleural mesothelioma; Multiple myeloma; Neuroendocrine tumors (metastatic carcinoma); Non-Hodgkin lymphoma (relapsed/refractory); Non-small cell lung cancer; Osteosarcoma; Pancreatic cancer (locally advanced or metastatic); Penile cancer (metastatic); Primary CNS lymphoma (relapsed or refractory); Prostate cancer, castration-resistant (metastatic); Small cell lung cancer (extensive-stage disease); Small cell lung cancer (limited-stage disease); Thymic carcinoma (locally advanced or metastatic); Thymomas (advanced or metastatic); Unknown primary, adenocarcinoma; Unknown primary, squamous cell carcinoma

Medication Safety Issues
Sound-alike/look-alike issues:

CISplatin may be confused with CARBOplatin, oxaliplatin

Platinol may be confused with Patanol

High alert medication:

This medication is in a class the Institute for Safe Medication Practices (ISMP) includes among its list of drug classes which have a heightened risk of causing significant patient harm when used in error.

Administration issues:

Cisplatin doses >100 mg/m2 once every 3 to 4 weeks are rarely used and should be verified with the prescriber.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Central nervous system: Neurotoxicity (peripheral neuropathy is dose and duration dependent)

Gastrointestinal: Nausea and vomiting (76% to 100%)

Genitourinary: Nephrotoxicity (28% to 36%; acute renal failure and chronic renal insufficiency)

Hematologic & oncologic: Anemia (≤40%), leukopenia (25% to 30%; nadir: Day 18 to 23; recovery: By day 39; dose related), thrombocytopenia (25% to 30%; nadir: Day 18 to 23; recovery: By day 39; dose related)

Hepatic: Increased liver enzymes

Otic: Ototoxicity (children 40% to 60%; adults 10% to 31%; as tinnitus, high frequency hearing loss)

1% to 10%: Local: Local irritation

<1%, postmarketing, and/or case reports: Alopecia (mild), ageusia, anaphylaxis, autonomic neuropathy, bradycardia (Schlumbrecht 2015), bronchoconstriction, cardiac arrhythmia, cardiac failure, cerebral arteritis, cerebrovascular accident, dehydration, diarrhea, dysgeusia (Rehwaldt 2009), extravasation, heart block, hemolytic anemia (acute), hemolytic-uremic syndrome, hiccups, hypercholesterolemia, hyperuricemia, hypocalcemia, hypokalemia, hypomagnesemia, hyponatremia, hypophosphatemia, hypotension, increased serum amylase, ischemic heart disease, leukoencephalopathy, Lhermitte's sign, mesenteric ischemia (acute; Morgan 2011), myocardial infarction, neutropenic enterocolitis (Furonaka 2005), optic neuritis, pancreatitis (Trivedi 2005), papilledema, peripheral ischemia (acute), phlebitis (Tokuda 2015), reversible posterior leukoencephalopathy syndrome, seizure, SIADH, skin rash, tachycardia, tetany, thrombosis (aortic; Fernandes 2011), thrombotic thrombocytopenic purpura, vasospasm (acute arterial; Morgan 2011), vision color changes, vision loss

Contraindications

Severe hypersensitivity to cisplatin or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Bone marrow suppression: Cisplatin may cause severe myelosuppression; fatalities due to infection (secondary to myelosuppression) have been reported. Fever has been reported in patients with neutropenia. Geriatric patients may be at higher risk for hematologic toxicity.

• Extravasation: Cisplatin is a vesicant at higher concentrations, and an irritant at lower concentrations; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. Monitor infusion site during administration. Local soft tissue toxicity has been reported following cisplatin extravasation; the severity of the local tissue toxicity appears to be related to the cisplatin concentration. Cisplatin infusion solutions at a concentration >0.5 mg/mL may result in tissue cellulitis, fibrosis, necrosis, pain, edema, and erythema.

• GI toxicity: Cisplatin can cause severe nausea and vomiting; use highly effective antiemetic premedication. Nausea and vomiting are dose-related and may be immediate and/or delayed, usually lasting up to 72 hours, although may persist for up to 1 week. Diarrhea may also occur.

• Hypersensitivity: Cisplatin may cause severe hypersensitivity reactions, including anaphylaxis (some fatal). Manifestations of hypersensitivity include facial edema, wheezing, tachycardia, and hypotension. Hypersensitivity reactions have occurred within minutes of administration (in patients with prior cisplatin exposure). Ensure supportive equipment and medications for management of severe hypersensitivity reactions are available. Cross-reactivity between platinum-based antineoplastic agents has been reported; severe hypersensitivity reactions have recurred following rechallenge with a different platinum agent (case reports).

• Nephrotoxicity: Cisplatin can cause severe renal toxicity, including acute renal failure. Severe renal toxicities are dose related and cumulative. Ensure adequate hydration (before, during, and following cisplatin administration). Acute renal failure may be prolonged and severe with repeat cisplatin courses. The onset of nephrotoxicity usually begins during the second week following a cisplatin dose. Patients with renal impairment at baseline, geriatric patients, those taking other nephrotoxic medications, and/or patients who are not well hydrated may be at higher risk for nephrotoxicity.

• Neurotoxicity: Cisplatin may cause dose-related peripheral neuropathy that becomes more severe with repeated cisplatin courses. Neurotoxicity has been reported following a single cisplatin dose. Neuropathy may be delayed, with an onset occurring 3 to 8 weeks after the last cisplatin dose. Neuropathy manifestations include paresthesias with a stocking-glove distribution, areflexia, and loss of proprioception and vibratory sensation. Neuropathy may progress following cisplatin discontinuation. In some patients, peripheral neuropathy may be irreversible. Geriatric patients may be more susceptible to peripheral neuropathy. Seizures, loss of motor function, loss of taste, leukoencephalopathy, and posterior reversible leukoencephalopathy syndrome have also been described.

• Ocular toxicity: Optic neuritis, papilledema, and cortical blindness have been reported in patients receiving standard recommended cisplatin doses. Blurred vision and altered color perception have been reported after the use of regimens with higher or more frequent cisplatin doses. Altered color perception manifests as a loss of color discrimination, particularly in the blue-yellow axis and irregular retinal pigmentation of the macular area on fundoscopic exam. Improvement and/or total recovery usually occurs following cisplatin discontinuation, although may be delayed.

• Ototoxicity: Cisplatin may cause cumulative and severe ototoxicity. Ototoxicity is manifested by tinnitus, high-frequency (4,000 to 8,000 Hz) hearing loss, and/or decreased ability to hear normal conversational tones. Ototoxicity may occur during or after treatment; may be unilateral or bilateral. Deafness following the initial cisplatin dose has been reported. Vestibular toxicity has also been reported. Ototoxic effects may be more severe and/or detrimental in pediatric patients, particularly those <5 years of age. The prevalence of hearing loss in pediatric patients is estimated to be 40% to 60%. Additional risk factors for ototoxicity include simultaneous cranial irradiation, treatment with other ototoxic medications, and/or renal impairment. Certain genetic variations in the thiopurine S-methyltransferase (TPMT) gene may be associated with an increased risk of ototoxicity in children administered conventional cisplatin doses (Pussegoda 2013). Controversy may exist regarding the role of TPMT variants in cisplatin ototoxicity (Ratain 2013; Yang 2013); the association has not been consistent across populations and studies. Children without the TPMT gene variants may still be at risk for ototoxicity. Cumulative dose, prior or concurrent exposure to other ototoxic agents (eg, aminoglycosides, carboplatin), prior cranial radiation, younger age, and type of cancer may also increase the risk for ototoxicity in children (Knight 2005; Landier 2014). An international grading scale (SIOP Boston scale) has been developed to assess ototoxicity in children (Brock 2012). Sodium thiosulfate (Pedmark) is approved to reduce the risk of ototoxicity from cisplatin infusions that are ≤6 hours in duration when used to treat localized nonmetastatic solid tumors in pediatric patients.

• Secondary malignancies: Secondary malignancies, including acute leukemias, have been reported with cisplatin, usually when used in combination with other chemotherapy agents.

• Tumor lysis syndrome: Hyperuricemia has been reported with cisplatin; consider antihyperuricemic therapy to reduce uric acid levels.

Disease-related concerns:

• Myasthenia gravis: Use with caution in patients with myasthenia gravis; may exacerbate condition (Mehrizi 2012).

Special populations:

• Older adult: Select dose cautiously and monitor closely in older adult patients; they may be more susceptible to hematologic toxicity, infections, nephrotoxicity, and/or peripheral neuropathy.

Other warnings/precautions:

• Medication safety: Doses >100 mg/m2/cycle (once every 3 to 4 weeks) are rare; verify with the prescriber. At the approved dose, cisplatin should not be administered more frequently than once every 3 to 4 weeks. Exercise caution to avoid inadvertent overdose due to potential sound-alike/look-alike confusion between CISplatin and CARBOplatin or prescribing practices that fail to differentiate daily doses from the total dose per cycle.

Warnings: Additional Pediatric Considerations

Compared to older patients, pediatric patients, especially those <5 years of age, are at increased risk for the development of ototoxicity that has been observed to be more severe and/or detrimental due to speech and language development during this time. The prevalence of hearing loss in pediatric patients is estimated to be 40% to 60%. Cumulative dose, prior or concurrent exposure to other ototoxic agents (eg, aminoglycosides, carboplatin), prior or concurrent cranial irradiation, younger age, and type of cancer may increase the risk for ototoxicity in children (Knight 2005; Landier 2014). To assess ototoxicity, an international grading scale (SIOP Boston scale) has been developed to (Brock 2012). Sodium thiosulfate (Pedmark) is approved to reduce the risk of ototoxicity from cisplatin infusions that are ≤6 hours in duration when used to treat localized nonmetastatic solid tumors in pediatric patients.

Metabolism/Transport Effects

Substrate of OCT2

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy

Abrocitinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Alpha-Lipoic Acid: May diminish the therapeutic effect of CISplatin. Risk C: Monitor therapy

Aminoglycosides: CISplatin may enhance the nephrotoxic effect of Aminoglycosides. CISplatin may enhance the neurotoxic effect of Aminoglycosides. Risk X: Avoid combination

Baricitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Baricitinib. Risk X: Avoid combination

BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Products: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of BCG Products. Risk X: Avoid combination

Brincidofovir: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Brincidofovir. Risk C: Monitor therapy

Chloramphenicol (Ophthalmic): May enhance the adverse/toxic effect of Myelosuppressive Agents. Risk C: Monitor therapy

Cladribine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk X: Avoid combination

Cladribine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Cladribine. Risk X: Avoid combination

CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor therapy

Coccidioides immitis Skin Test: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the diagnostic effect of Coccidioides immitis Skin Test. Management: Consider discontinuing cytotoxic chemotherapy several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider therapy modification

COVID-19 Vaccine (Adenovirus Vector): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Adenovirus Vector). Management: Administer a 2nd dose using an mRNA COVID-19 vaccine (at least 4 weeks after the primary vaccine dose) and a bivalent booster dose (at least 2 months after the additional mRNA dose or any other boosters). Risk D: Consider therapy modification

COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor therapy

COVID-19 Vaccine (mRNA): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider therapy modification

COVID-19 Vaccine (Subunit): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Subunit). Risk C: Monitor therapy

COVID-19 Vaccine (Virus-like Particles): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Virus-like Particles). Risk C: Monitor therapy

Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider therapy modification

Dengue Tetravalent Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Dengue Tetravalent Vaccine (Live). Risk X: Avoid combination

Denosumab: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and cytotoxic chemotherapy. If combined, monitor patients for signs/symptoms of serious infections. Risk D: Consider therapy modification

Deucravacitinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Risk X: Avoid combination

Fexinidazole: Myelosuppressive Agents may enhance the myelosuppressive effect of Fexinidazole. Risk X: Avoid combination

Filgotinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Fosphenytoin-Phenytoin: Platinum Derivatives may decrease the serum concentration of Fosphenytoin-Phenytoin. Risk C: Monitor therapy

Inebilizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Inebilizumab. Risk C: Monitor therapy

Influenza Virus Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating chemotherapy if possible. If vaccination occurs less than 2 weeks prior to or during chemotherapy, revaccinate at least 3 months after therapy discontinued if immune competence restored. Risk D: Consider therapy modification

Leflunomide: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents, such as cytotoxic chemotherapy. Risk D: Consider therapy modification

Lenograstim: Antineoplastic Agents may diminish the therapeutic effect of Lenograstim. Management: Avoid the use of lenograstim 24 hours before until 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider therapy modification

Lipegfilgrastim: Antineoplastic Agents may diminish the therapeutic effect of Lipegfilgrastim. Management: Avoid concomitant use of lipegfilgrastim and myelosuppressive cytotoxic chemotherapy. Lipegfilgrastim should be administered at least 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider therapy modification

Loop Diuretics: May enhance the nephrotoxic effect of CISplatin. Loop Diuretics may enhance the ototoxic effect of CISplatin. Risk C: Monitor therapy

Natalizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Natalizumab. Risk X: Avoid combination

Netilmicin (Ophthalmic): CISplatin may enhance the nephrotoxic effect of Netilmicin (Ophthalmic). Risk X: Avoid combination

Ocrelizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ocrelizumab. Risk C: Monitor therapy

Ofatumumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ofatumumab. Risk C: Monitor therapy

Olaparib: Myelosuppressive Agents may enhance the myelosuppressive effect of Olaparib. Risk C: Monitor therapy

Palifermin: May enhance the adverse/toxic effect of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Risk D: Consider therapy modification

Pidotimod: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Pidotimod. Risk C: Monitor therapy

Pimecrolimus: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Pneumococcal Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Risk X: Avoid combination

Polymethylmethacrylate: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the potential for allergic or hypersensitivity reactions to Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider therapy modification

Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy

Rabies Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider therapy modification

Ropeginterferon Alfa-2b: Myelosuppressive Agents may enhance the myelosuppressive effect of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider therapy modification

Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination

Ruxolitinib (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ruxolitinib (Topical). Risk X: Avoid combination

Sipuleucel-T: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants, such as cytotoxic chemotherapy, prior to initiating sipuleucel-T therapy. Risk D: Consider therapy modification

Sphingosine 1-Phosphate (S1P) Receptor Modulator: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk C: Monitor therapy

Tacrolimus (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Tacrolimus (Topical). Risk X: Avoid combination

Talimogene Laherparepvec: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid combination

Taxane Derivatives: Platinum Derivatives may enhance the myelosuppressive effect of Taxane Derivatives. Administer Taxane derivative before Platinum derivative when given as sequential infusions to limit toxicity. Management: Administer paclitaxel before cisplatin, when given as sequential infusions, to limit toxicity. Problems associated with other taxane/platinum combinations are possible, although unsubstantiated. Administering the taxane before platinum is likely warranted Risk D: Consider therapy modification

Tertomotide: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Tertomotide. Risk X: Avoid combination

Tofacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Tofacitinib. Risk X: Avoid combination

Topotecan: Platinum Derivatives may enhance the adverse/toxic effect of Topotecan. Management: Consider administering platinum derivatives after topotecan when possible to minimize toxicity or using lower doses if administering platinum derivatives prior to topotecan. Monitor for hematologic toxicity (eg, neutropenia, thrombocytopenia). Risk D: Consider therapy modification

Trilaciclib: May increase the serum concentration of CISplatin. Risk C: Monitor therapy

Typhoid Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Typhoid Vaccine. Risk X: Avoid combination

Upadacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Upadacitinib. Risk X: Avoid combination

Vaccines (Inactivated/Non-Replicating): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of chemotherapy when possible. Patients vaccinated less than 14 days before initiating or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification

Vaccines (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Vaccines (Live) may diminish the therapeutic effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Vinorelbine: CISplatin may enhance the adverse/toxic effect of Vinorelbine. Specifically, the combination may be associated with a higher risk of granulocytopenia. Risk C: Monitor therapy

Yellow Fever Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Yellow Fever Vaccine. Risk X: Avoid combination

Reproductive Considerations

Verify pregnancy status prior to treatment initiation in patients who could become pregnant.

Patients who could become pregnant should use effective contraception during treatment and for 14 months after the last cisplatin dose. Patients with partners who could become pregnant should use effective contraception during treatment and for 11 months after the last cisplatin dose.

Cisplatin has been associated with cumulative dose-dependent ovarian failure, premature menopause, impairment of spermatogenesis (oligospermia, azoospermia; possibly irreversible), and reduced female and male fertility. Recommendations are available for fertility preservation of male and female patients to be treated with anticancer agents (ASCO [Oktay 2018]; Klipstein 2020).

Pregnancy Considerations

Cisplatin crosses the human placenta (Köhler 2015).

Outcome data following maternal use of cisplatin during pregnancy are available (Bernardini 2022; NTP 2013; Pei 2022; Song 2018; Wang 2022; Zagouri 2013). Cisplatin may cause fetal harm if administered during pregnancy. Adverse events associated with cisplatin containing regimens include oligohydramnios, intrauterine growth restriction, and preterm birth; acute respiratory distress syndrome, cytopenias, and hearing loss have been reported in the neonate. Children with in utero exposure to cisplatin should be monitored for hearing loss (Amant 2019).

The European Society for Medical Oncology has published guidelines for diagnosis, treatment, and follow-up of cancer during pregnancy. The guidelines recommend referral to a facility with expertise in cancer during pregnancy and encourage a multidisciplinary team (obstetrician, neonatologist, oncology team) approach. In general, if chemotherapy is indicated, it should be avoided in the first trimester and there should be a 3-week time period between the last chemotherapy dose and anticipated delivery (for adequate maternal and fetal bone marrow recovery), and chemotherapy should not be administered beyond week 33 of gestation. When indicated, chemotherapy may be administered during the second or third trimester at the same dose and schedule as recommended for nonpregnant patients (Amant 2019; ESMO [Peccatori 2013]).

A long-term observational research study is collecting information about the diagnosis and treatment of cancer during pregnancy. For additional information about the pregnancy and cancer registry or to become a participant, contact Cooper Health (1-877-635-4499).

Breastfeeding Considerations

Cisplatin is present in breast milk.

Data related to the presence of cisplatin in breast milk are available from multiple case reports (Ben-Baruch 1992; Damoiseaux 2022; de Vries 1989; Egan 1985; Hays 2013; Lanowska 2011).

• Breast milk samples were obtained in 3 of 8 patients administered cisplatin during pregnancy (16 to 23 weeks' gestation). Cisplatin was present in breast milk during the first days of lactation. Concentrations were 1% to 9% of the maternal serum concentration (Lanowska 2011).

• Cisplatin 100 mg IV was administered to a lactating patient 2 years postpartum. Maternal serum and breast milk were sampled 2, 6, and 18 hours after the dose. Platinum breast milk concentrations were ~10 times lower than those in the maternal plasma (Ben-Baruch 1992).

• Breast milk was sampled in a patient following a single dose of cisplatin 70 mg IV at 6 weeks postpartum. Platinum breast milk concentrations decreased from ~16 ng/mL to ~4 ng/mL from ~4 to ~57 hours after the dose. Platinum was not detected in breast milk sampled ~66 hours and ~70 hours after the cisplatin infusion (Hays 2013).

• In a patient administered cisplatin 90 mg on days 1 and 2 of a regimen with bleomycin and etoposide administered for 4 cycles, every 21 days (postpartum age not stated). Breast milk was collected daily over several weeks during 2 cycles of therapy, providing a total of 98 samples. The highest platinum concentrations were observed following the second dose of the second cycle (~60 ng/mL). Although concentrations decreased over time, all platinum concentrations in breast milk were higher in the second cycle than in the first, suggesting cisplatin accumulates in breast milk. The relative infant dose (RID) of cisplatin decreased to <1% within 24 hours following the second dose of each cycle; however, the RID never decreased to <0.1% over the study period. Although the authors note breastfeeding is generally considered acceptable when the RID of a medication is <5% to 10%, it is not known if low cumulative doses of cisplatin may adversely affect a breastfed infant. The cumulative RID was calculated to be ~5% and ~8% following cycle 1 and cycle 2, respectively. It was noted a patient would have to pump and discard 14 days of breast milk following the second cycle to reach a cumulative RID of <1% (Damoiseaux 2022).

• Platinum was not detected in breast milk following an infusion of cisplatin 130 mg over 26 hours to a patient 7 months postpartum. Breast milk and maternal plasma sampling occurred at intervals from 0.5 to 71.25 hours after starting the infusion. The peak maternal plasma concentration was 2,990 ng/mL (Egan 1985).

Based on a survey of 96 patients treated with chemotherapy during pregnancy, treatment for cancer prior to delivery may lead to difficulty initiating breastfeeding or maintaining an adequate milk supply postpartum; this was reported in 1 of 3 patients on a cisplatin containing regimen (Stopenski 2017).

Due to the potential for serious adverse reactions in the breastfed infant, breastfeeding is not recommended by the manufacturer. Breastfeeding should be avoided in patients taking platinum compounds, including cisplatin (Pistilli 2013).

Dietary Considerations

Some products may contain sodium.

Monitoring Parameters

Monitor blood counts (prior to cisplatin initiation, prior to each subsequent treatment course, and as clinically indicated). Monitor serum creatinine, BUN, CrCl, and serum electrolytes (calcium, magnesium, potassium, and sodium) prior to treatment initiation and as clinically indicated. Consider audiometric and vestibular testing, particularly in all pediatric patients receiving cisplatin (pediatric patients should receive audiometric testing at baseline, prior to each dose, and for several years after discontinuing therapy). Perform a neurological examination prior to cisplatin initiation, as appropriate during therapy, and following completion of cisplatin therapy. Monitor closely for signs/symptoms of infection (during and after cisplatin treatment), hypersensitivity reactions, neuropathy, ocular toxicity, tumor lysis syndrome, and secondary malignancies. Monitor infusion site during administration.

The American Society of Clinical Oncology hepatitis B screening and management provisional clinical opinion (ASCO [Hwang 2020]) recommends hepatitis B virus (HBV) screening with hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), total Ig or IgG, and antibody to hepatitis B surface antigen (anti-HBs) prior to beginning (or at the beginning of) systemic anticancer therapy; do not delay treatment for screening/results. Detection of chronic or past HBV infection requires a risk assessment to determine antiviral prophylaxis requirements, monitoring, and follow-up.

Mechanism of Action

Cisplatin inhibits DNA synthesis by the formation of DNA cross-links; denatures the double helix; covalently binds to DNA bases and disrupts DNA function; may also bind to proteins; the cis-isomer is 14 times more cytotoxic than the trans-isomer; both forms cross-link DNA but cis-platinum is less easily recognized by cell enzymes and, therefore, not repaired. Cisplatin can also bind two adjacent guanines on the same strand of DNA producing intrastrand cross-linking and breakage.

Pharmacokinetics

Distribution: IV: 11 to 12 L/m2

Protein binding: Plasma platinum: >90%

Metabolism: Nonenzymatic; inactivated (in both cell and bloodstream) by sulfhydryl groups; covalently binds to glutathione and thiosulfate

Half-life elimination:

Children: Free drug: 1.3 hours; Total platinum: 44 hours

Adults: Cisplatin: 20 to 30 minutes; Platinum: ≥5 days

Excretion: Cisplatin: Urine (13% to 17% within 1 hour); Platinum: Urine (35% to 51%)

Pricing: US

Solution (CISplatin Intravenous)

50 mg/50 mL (per mL): $0.37 - $0.87

100 mg/100 mL (per mL): $0.23 - $0.48

200 mg/200 mL (per mL): $0.43 - $0.60

Solution (reconstituted) (CISplatin Intravenous)

50 mg (per each): $600.00

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Abiplatin (IL, TW);
  • Accocit (CR, DO, GT, HN, NI, PA, SV);
  • Bioplatino (PE);
  • Blastolem (CO, CR, DO, GT, HN, NI, PA, SV);
  • Blastolem RU (MX);
  • Cesalin (BD, LK);
  • Cisacor (ZA);
  • Ciscan (ID);
  • Cisly (LU);
  • Cispatin (KR);
  • Cisplan (KR);
  • Cisplat (IN);
  • Cisplatin (ID, IN, NZ);
  • Cisplatin Ebewe (HU);
  • Cisplatin medac (LU);
  • Cisplatin Teva (HU);
  • Cisplatine-Lilly (LU);
  • Cisplatino (CO, EC, PE);
  • Cisplatinum Cytosafe-Delta West (LU);
  • Cisplatyl (FR, SA);
  • Cisteen (PH, ZW);
  • Citoplatino (IT);
  • Citoplax (BR);
  • Cytoplatin (EG, LB, VE);
  • Fangtan (CN);
  • Incel (PY);
  • Kemocarb (VN);
  • Kemoplat (IN, PH, SG, TW, ZW);
  • Lederplatin (DK);
  • Noveldexis (CR, DO, GT, HN, MX, NI, PA, SV);
  • Oncotin (PH);
  • P&U Cisplatin (ZA);
  • Placis (JO, TH, TR);
  • Platamine (AE, BH, CY, HR, IQ, IR, IT, JO, LB, LY, OM, SA, SY, YE);
  • Platiblastin (CH, DE);
  • Platicept (ES);
  • Platicin (LK);
  • Platidiam (BG, HN, HU, PL, RU);
  • Platimit (HR);
  • Platin (PH);
  • Platinex (BD, HR, IT);
  • Platinol (AR, AT, BE, CH, EE, FI, GR, LU, SE, UY);
  • Platistil (PT);
  • Platistin (FI, SE);
  • Platistine (LU);
  • Platol (ET, MY, ZW);
  • Platosin (GB, HK, KR, MY, PK, RO, TH, VE, ZA);
  • Randa (JP);
  • Sicatem (PY);
  • Sinplatin (BG, HK, RO);
  • Tecnoplatin (MX);
  • Unistin (EG)


For country code abbreviations (show table)
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