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Cisplatin

(sis-plat-in)

Trade/other name(s): Platinol, CDDP

Why would this drug be used?

Cisplatin is used to treat testicular, bladder, and ovarian cancers that have spread. It also can be used to treat several other cancers, such as lung cancer.

How does this drug work?

Cisplatin is a platinum-compound chemotherapy drug that acts as an alkylating agent. Cisplatin stops cancer cells from growing, causing them to die.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you have ever had kidney stones. Your doctor may need to give you extra fluids and watch certain lab work more closely.
  • If you have ever taken any type of radiation or chemotherapy, especially cisplatin or other platinum-containing medicines. Your doctor will want to watch you more closely for certain side effects.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • If you are breast-feeding. The drug passes into breast milk and may harm the baby.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Cisplatin may injure or damage the kidneys, especially if given with other drugs that can harm the kidneys, or even drugs that are removed from the body by the kidneys, such as:

  • aminoglycosides (a type of antibiotic that is usually given in the vein, such as gentamicin, tobramycin, amikacin, streptomycin, and others)
  • non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
  • blood pressure medicines in the ACE inhibitor group, like lisinopril, enalopril, captopril
  • anti-viral drugs like acyclovir (Zovirax)
  • There are many more such drugs, so be sure your doctor knows all the drugs you take. Talk to the doctor or nurse before you start any new medicine, even non-prescription drugs.

Drugs that can cause hearing loss, such as aminoglycoside antibiotics (see examples above) and certain "water pills" -- the diuretics furosemide (Lasix) and ethacrynic acide (Edecrin) -- may worsen any hearing loss from cisplatin.

Probenecid can raise the blood level of cisplatin in the body and cause serious harm.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with cisplatin. These include:

  • vitamin E
  • non-steroidal anti-inflammatory drugs (see above examples)
  • warfarin (Coumadin)
  • ticlopidine (Ticlid)
  • clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take.

Cisplatin may cause anti-seizure drugs such as phenytoin (Dilantin) to leave the body faster.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Cisplatin is given by an infusion into the vein over at least an hour, although it is sometimes given over a much longer time. Your dose will depend on the type of cancer being treated, your size, and how well your kidneys are working.

Sometimes you will be given other medicines that will help flush the medicine out quickly through the kidneys. You will also get fluids by vein to help protect the kidneys, and medicine to prevent or stop nausea or vomiting. Before and after the medicine you will need to drink 2 to 3 quarts of liquid a day (an 8 oz. glass of water or fluid every hour while awake) to help protect your kidneys. Your doctor will check your kidney function, blood counts, and hearing before giving you the medicine.

Precautions

This drug is given into the vein (IV). If the drug leaks out of the vein and under the skin, it may damage the tissue, causing pain, ulceration, and scarring. Tell the doctor or nurse right away if you notice redness, pain, swelling or other symptoms at or near the IV.

Cisplatin can damage the kidneys. This risk is reduced by checking your kidney function before you get the drug, giving you extra fluids by vein, and asking you to drink extra fluids for a few days after the drug is given. This extra fluid helps to flush the medicine out of your system and protect your kidneys. Call your doctor if you see blood in your urine, or if you notice swelling in your feet or ankles.

This drug can damage your hearing and inner ear (balance), and occasionally cause deafness. Let your doctor know if you notice ringing in your ears, trouble hearing high-pitched sounds, or trouble with your balance. Your doctor may test your hearing before and during treatment.

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor will give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs such as the liver and kidneys. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it completely. Keep all your appointments for lab tests and doctor visits.

Cisplatin can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

This drug may lower your red blood cell count. If this occurs, it is usually a few months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Cisplatin may affect your immune system. This could make vaccinations ineffective, or even lead to serious infections if you get live virus vaccines during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

This drug can cause allergic reactions in some people while the drug is being given. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), fever or chills, hives, nausea, itching, headache, coughing, tightness in the throat, shortness of breath, trouble swallowing, or swelling of the face, tongue, or eyes. Tell your doctor or nurse right away if you notice any of these symptoms as you are being given the drug.

This drug may damage certain nerves in the body, and lead to a problem called peripheral neuropathy. This can cause numbness, weakness, pain, or sensations of burning or tingling, usually in the hands or feet. Constipation can also occur. These symptoms can sometimes worsen to include trouble walking or holding things in your hands. Let your doctor know right away if you notice any of them. If your symptoms are severe enough, this drug may need to be stopped or the dose reduced until they get better. In some people, the damage is permanent.

Because of the way this drug acts on cells in the body, it may increase your long-term risk of getting a second type of cancer, such as leukemia. This is rare, but if it does occur it would likely be years after the drug is used. If you are getting this drug, your doctor feels this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor.

Avoid pregnancy during and for at least a few months after treatment. Talk with your doctor about this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • kidney damage*
  • decreased blood levels of magnesium, potassium, and calcium
  • nausea*
  • vomiting*
  • low white blood cell count with increased risk of infection*
  • low platelet count with increased risk of bleeding*
  • low red blood cell count (anemia), which can make you tired, dizzy, or easily out of breath*
  • taste changes, including metallic taste of foods and rarely loss of taste
  • sensation of pins and needles or numbness in hands and/or feet caused by irritation of nerves, which usually goes away when treatment is stopped*
  • swelling in hands, feet, or legs*
  • fetal changes if pregnant during treatment

Less common

  • tiredness (fatigue)
  • hearing loss, which may be permanent*
  • poor balance due to inner ear damage*
  • trouble walking and weakness of legs and feet due to nerve damage*
  • loss of appetite
  • hair thinning or loss (may include face and body hair as well as scalp hair)
  • diarrhea
  • sterility (inability to have children)

Rare

  • severe allergic reaction*
  • uncontrolled muscle jerking due to changes in blood chemistry
  • seizures due to changes in blood chemistry
  • blindness or vision changes, which usually go away when treatment stopped
  • chest pain and heart attack
  • second cancer, which may happen years later*
  • death due to infection or other causes

*See "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval:

Yes – first approved before 1984 (FDA cannot verify dates of drugs approved before 1984.)

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 01/14/2010
Last Revised: 01/14/2010