Metastatic Testicular Tumors: Cisplatin is used as part of combination chemotherapy with other approved anticancer medicines for patients with Testicular Cancer that has spread (metastasized). It is typically given after appropriate surgery and/or radiotherapy.

Metastatic Ovarian Tumors: Cisplatin is also used in combination chemotherapy for patients with metastatic Ovarian Cancer who have already undergone surgery or radiotherapy. A commonly used combination includes Cisplatin and the chemotherapy drug Cyclophosphamide.
In some cases, Cisplatin may be used alone as a secondary treatment in patients whose ovarian cancer does not respond to standard chemotherapy and who have not previously received Cisplatin therapy.

Advanced Bladder Cancer: Cisplatin may be used as a single-agent treatment for patients with advanced Bladder Cancer, particularly when the disease can no longer be treated effectively with surgery or radiotherapy.

Non-Small Cell Lung Cancer: Cisplatin is used in combination with other chemotherapy drugs for the treatment of Non-Small Cell Lung Cancer in patients who are not suitable candidates for curative surgery or radiation therapy.

Cisplatin is a platinum-based chemotherapy drug, and only its cis-isomer form is biologically active. It works mainly by forming cross-links within and between DNA strands, which alters the structure of DNA and prevents the replication of cancer cells. By interfering with DNA structure, Cisplatin blocks DNA synthesis and slows the growth of tumor cells. To a lesser extent, it also inhibits the production of proteins and RNA within the cell. The drug does not act on a specific phase of the cell cycle.

Cisplatin injection is administered by slow intravenous infusion. It should not be given by rapid intravenous injection.
Needles or intravenous sets containing aluminum parts that may come in contact with Cisplatin Injection should not be used for preparation or administration. Aluminum reacts with Cisplatin Injection, causing precipitate formation and a loss of potency.

Metastatic Testicular Tumors: The usual Cisplatin Injection dose for the treatment of testicular cancer in combination with other approved chemotherapeutic agents is 20 mg/m² IV daily for 5 days per cycle.

Metastatic Ovarian Tumors: The usual Cisplatin Injection dose for the treatment of metastatic ovarian tumors in combination with cyclophosphamide is 75 to 100 mg/m² IV per cycle once every 4 weeks (DAY 1). The dose of cyclophosphamide when used in combination with cisplatin is 600 mg/m² IV once every four weeks (DAY 1). In combination therapy, Cisplatin Injection and cyclophosphamide are administered sequentially. As a single agent, Cisplatin Injection should be administered at a dose of 100 mg/m² IV per cycle once every four weeks.

Advanced Bladder Cancer: Cisplatin Injection should be administered as a single agent at a dose of 50 to 70 mg/m² IV per cycle once every 3 to 4 weeks depending on the extent of prior exposure to radiation therapy and/or prior chemotherapy. For heavily pretreated patients an initial dose of 50 mg/m² per cycle repeated every 4 weeks is recommended.

Non Small Cell Lung Carcinoma: Cisplatin Injection (75 mg/m²) should be administered in combination with Paclitaxel (135 mg/m²) in every three weeks. Or, as directed by the registered physicians.

Cisplatin is frequently used with other anticancer drugs that have similar cytotoxic effects. When used together, the risk of combined toxicity may increase. Important drug interactions include:

Nephrotoxic drugs: Concurrent use of aminoglycoside antibiotics or other kidney-toxic drugs such as Amphotericin B may increase the risk of kidney damage caused by Cisplatin.

Ototoxic drugs: Medicines that affect hearing, such as aminoglycoside antibiotics or loop diuretics, may increase the risk of hearing loss when used with Cisplatin.

Renally excreted drugs: Cisplatin may reduce kidney elimination of drugs like Bleomycin and Methotrexate, potentially increasing their toxicity.

Anticonvulsants: Cisplatin may reduce blood levels of Phenytoin, possibly due to decreased absorption or increased metabolism. Monitoring of phenytoin levels may be required.

Antigout medicines: Cisplatin can increase blood uric acid levels. Patients taking drugs such as Allopurinol, Colchicine, Probenecid, or Sulfinpyrazone may require dose adjustments.

Cisplatin is contraindicated in patients with existing renal impairment and in those with known hypersensitivity to cisplatin or other platinum-containing compounds. It should also not be used in patients with myelosuppression or in those with impaired hearing.

Severe nausea and vomiting may begin within 1–4 hours after treatment and can last for several days. Cisplatin may also cause electrolyte disturbances such as low magnesium, calcium, or potassium levels due to kidney tubular dysfunction. Symptoms may include muscle cramps, tremors, spasms, or tetany.

Cisplatin is classified as Pregnancy Category D, meaning there is evidence of risk to the fetus. Cisplatin has been detected in human breast milk, so breastfeeding during treatment is generally not recommended.

Renal function: Cisplatin is associated with cumulative nephrotoxicity. Renal function and serum electrolytes (magnesium, sodium, potassium, and calcium) should be assessed before starting therapy and prior to each subsequent treatment cycle. Maintaining a urine output greater than 2 L/day is recommended, which may be achieved by administering cisplatin via intravenous infusion over 6–8 hours. Pre-treatment intravenous hydration with 1–2 litres of fluid over 8–12 hours, followed by adequate hydration for the next 24 hours, is advised. Repeated treatment cycles should not be given unless serum creatinine is below 1.5 mg/100 mL and blood urea nitrogen (BUN) is below 25 mg/100 mL. Close monitoring is required in patients receiving cisplatin therapy.

Bone marrow function: Peripheral blood counts should be monitored regularly in patients receiving cisplatin. Although haematologic toxicity is generally moderate and reversible, severe thrombocytopenia and leukopenia may occur. Patients developing thrombocytopenia require special precautions, including careful handling during invasive procedures, monitoring for bleeding signs (such as in urine, stool, or vomitus), and avoiding aspirin and other NSAIDs. Patients with leukopenia should be monitored for signs of infection and may require antibiotic therapy and blood product transfusions.

Hearing function: Cisplatin may cause cumulative ototoxicity, particularly with high-dose regimens. Audiometric evaluation should be performed before initiating therapy and repeated if symptoms or clinical evidence of hearing impairment develop. Significant deterioration in hearing may necessitate dose adjustment or discontinuation of therapy.

CNS functions: Cisplatin may induce neurotoxicity; therefore, neurological assessment is recommended during treatment. If neurological toxicity occurs or becomes apparent, discontinuation of therapy should be considered due to the possibility of irreversible damage. Patients should also be monitored for anaphylactoid reactions, and appropriate emergency equipment and medications should be readily available.

Nausea and Vomiting: Severe nausea and vomiting are common in nearly all patients treated with cisplatin and may require dose reduction or discontinuation of therapy. Administration should be supervised by physicians experienced in chemotherapy.

Carcinogenicity: Secondary malignancies have been reported as delayed effects of many antineoplastic agents, including cisplatin. It is unclear whether this is related to mutagenic or immunosuppressive effects. The risk appears to increase with prolonged exposure, although available data are limited.

Dental: The myelosuppressive effects of cisplatin may increase the risk of infections, delayed wound healing, and gingival bleeding. Dental procedures should ideally be completed prior to initiating therapy or postponed until blood counts return to normal.

Acute overdose of this medication may lead to renal failure, hepatic failure, hearing loss, ocular toxicity (including retinal detachment), marked myelosuppression, persistent nausea and vomiting, and/or neuritis. Fatal outcomes may occur following overdose. There is no specific antidote established for cisplatin overdose. Hemodialysis, even when initiated several hours after overdose, appears to have limited effectiveness in removing platinum due to its rapid and extensive protein binding. Management should focus on supportive care to maintain the patient during periods of toxicity.

Cytotoxic Chemotherapy

Store the vial in its original carton at 25°C, protect it from light, do not refrigerate, and keep it out of the reach of children.