Adult and Children Single Agent Therapy: Typical doses and schedules are: 50-100 mg/m2 as a single IV infusion every 3-4 weeks over 6-8 hours; or slow IV infusion of 15-20 mg/m2/day for 5 days, every 3-4 weeks.
Dosage should be reduced in patients with depressed bone marrow function.
Combination Therapy: Cisplatin is commonly used in combination therapy with the following cytotoxic agents: treatment of testicular cancer: vinblastine, bleomycin, actinomycin D;
treatment of ovarian cancer: cyclophosphamide, doxorubicin, hexamethylmelamine, 5- fluorouracil;
treatment of head and neck cancer: bleomycin, methotrexate.
Subsequent Treatment with Cisplatin: A repeat course of cisplatin should not be given until: the serum creatinine is below 140 micromol/L and/or the plasma urea is below 9 mmol/L and circulating blood elements are at an acceptable level (platelets at least 100,000/mm3, WBC at least 4000/mm3).
A base line audiogram should be taken and the patient monitored periodically for auditory deterioration (see Precautions).
Impaired Hepatic Function: Human studies show a high uptake of cisplatin in the liver.
Elevated aspartate aminotransferase (AST) and alkaline phosphatase with clinical signs of liver toxicity have been reported. Cisplatin should be used with caution in patients with pre-existing hepatic dysfunction.
Impaired Renal Function: Cisplatin displays high tissue uptake in the kidneys and exhibits dose related and cumulative nephrotoxicity. It is excreted mainly in the urine. The plasma elimination half-life of cisplatin is prolonged and plasma levels are markedly elevated in renal function.
Caution should be exercised in patients with pre-existing renal dysfunction. Cisplatin is contraindicated in patients with serum creatinine levels greater than 200 micromol/L. Repeat courses are not advised until serum creatinine is below 140 micromol/L and/or blood urea below 9 mmol/L.
Administration: Patients should be adequately hydrated before and for 24 hours following administration of cisplatin to ensure good urinary output and minimise nephrotoxicity.
Pretreatment Hydration: Hydration may be achieved by intravenous infusion of 2 litres of 5% glucose in ½ to ⅓ normal saline infused over a 2-4 hour period.
Administration: Cisplatin Injection may be added to 1 litre of normal saline and infused over the desired time period.
Post-treatment Hydration: It is important to maintain adequate hydration and urinary output for 24 hours following the infusion.
The product and its admixtures contain no antimicrobial agent. In order to reduce microbiological hazards it is recommended that further dilution be effected immediately prior to use and infusion commenced as soon as practicable after preparation of the admixture. Infusion should be completed within 24 hours of preparation and the residue discarded.