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Cisplatin

Platinum compound Antineoplastic


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Cisplatin was the first member of a class of anti-cancer drugs which now also includes carboplatin and oxaliplatin. It was first discovered in 1845 and known as Peyrones salt and first approved clinically as an anti-cancer drug by FDA in 1978.

Used to treat solid tumours located at the ENT, Lungs, Oesophagus and Genitourinary regions. sometimes used for brain tumours in children.

Indications
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Monotherapy : single dose 50-120mg/m BSA for 3-4 weeks or 15-20mg/m/day for 5 days up to 3-4 weeks
Combination therapy : cisplatin dose must be reduced to ~20mg/m once weekly for 3-4 weeks

Cisplatin Dose
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Nephrotoxicity Myelosuppression Ototoxicity (hearing impairment ) Neurotoxicity (peripheral pain and loss of taste) Potent emetogenic effect, Electrolyte imbalance Sterility in men (usually irreversible)

Side effects
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Repeated doses delayed until

- serum creatinine 1.5 mg/dl - urea < 25 mg/dl - WBC >4.0 /l - platelets > 100/l

Adequate hydration necessary. Forced diuresis required in case of decreased urine secretion using Mannitol 10% or a diuretic.

PRECAUTIONS
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Cisplatin mg/m

Hydration

Electrolyte addition
KCl 20 mEq MgSO4 1 g Mannitol 30 g KCl 20 mEq MgSO4 1 g Mannitol 30 g

> 80
60-80 40-60 < 40

4 litres/4hrs 3 litres/3hrs 2 litres/2hrs 500ml/30min

KCl 10 mEq MgSO4 0.5 g


none

Hydration regimen
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Phenytoin ... decreased epilepsy control Frusomide, hydralazine, diazoxide &propranolol increased nephrotoxicity Dose adjustment of Allopurinol & colchicine doses needed due to hyperuricemia of Cisplatin Antihistamines mask ototoxicity of cisplatin Cephalosporins Abs e.g. Cephalexin & Aminoglycosides Abs e.g. Gentamycin increased nephrotoxicity Live attenuated vaccines are contraindicated

Drug Interactions
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Drink large quantities of liquids for 24hrs after dose administration Tell your doctor if you notice any - ringing in the ears - pins and needles in fingers or toes

Counselling
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CV247 is a drug first invented 25 years ago by Dr. Carter, a british vet.

It was originally used to treat dogs.


Since December 2009 CV247 is under extensive trials on humans to be used in combination with Cisplatin allowing Cisplatin doses to be reduced by about 80%.

Under Research
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Thank you
Marwa

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