oxaliplatin

High Alert

Adjuvant treatment of stage III colon cancer in patients who have undergone complete resection of the primary tumor (in combination with 5-fluorouracil and leucovorin).
Advanced colorectal cancer (in combination with 5-fluorouracil and leucovorin)

Unlabeled Use:

Ovarian cancer that has progressed despite treatment with other agents.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Hypersensitivity to other platinum compounds;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Renal impairment;
HF, bradycardia, concurrent use of QT interval prolonging medications, hypokalemia, and hypomagnesemia;
Rep: Women of reproductive potential and men with female partners of reproductive potential;
Pedi: Safety and effectiveness not established in children;
Geri: ↑risk of adverse reactions in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

Adverse reactions are noted for the combination of oxaliplatin, 5-fluorouracil, and leucovorin.

CV: chest pain, edema, QT interval prolongation, thromboembolism, TORSADES DE POINTES

EENT: visual abnormalities

F and E: dehydration, hypokalemia

GI: diarrhea, nausea, vomiting, abdominal pain, anorexia, gastroesophageal reflux, stomatitis

Hemat: anemia, neutropenia, thrombocytopenia, leukopenia

Local: injection site reactions

MS: rhabdomyolysis, back pain

Neuro: fatigue, neurotoxicity, POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES)

Resp: cough, dyspnea, INTERSTITIAL LUNG DISEASE (ILD), PULMONARY FIBROSIS

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), fever

Interactions ⬆ ⬇

Drug-drug:

Nephrotoxic agents may ↑ risk of nephrotoxicity.
QT interval prolonging medications, including Class Ia antiarrhythmics and Class III antiarrhythmics, may ↑ risk of torsades de pointes.

Availability ⬆ ⬇

(Generic available)

Lyophilized powder for injection: 50 mg/vial; 100 mg/vial
Solution for injection: 5 mg/mL

Route/Dosage ⬆ ⬇

IV (Adults ): Day 1: 85 mg/m² with leucovorin 200 mg/m² at the same time over 2 hr, followed by 5-fluorouracil 400 mg/m² bolus over 2–4 min, then 5-fluorouracil 600 mg/m² as a 22-hr infusion. Day 2: Leucovorin 200 mg/m² over 2 hr, followed by 5-fluorouracil 400 mg/m² bolus over 2–4 min, then 5-fluorouracil 600 mg/m² as a 22-hr infusion. Cycle is repeated every 2 wk. Dosage ↓/alteration may be required for neurotoxicity or other serious adverse effects.

Renal Impairment

IV (Adults ): CCr <30 mL/min:↓ dose on Day 1 to 65 mg/m².

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Inhibits DNA replication and transcription by incorporating platinum into normal cross-linking (cell-cycle nonspecific).

Therapeutic effects:

Death of rapidly replicating cells, particularly malignant ones.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: alkylating agents

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Extensive tissue distribution.

Protein Binding: >90% (platinum).

Metabolism/Excretion: Undergoes rapid and extensive nonenzymatic biotransformation; excreted mostly by the kidneys.

Half-Life: 391 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IV	unknown	unknown	unknown

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Inform patient of potential for peripheral neuropathy and potentiation by exposure to cold or cold objects. Advise patient to avoid cold drinks, use of ice in drinks or as ice packs, and to cover exposed skin prior to exposure to cold temperatures or cold objects. Caution patients to cover themselves with a blanket during infusion, avoid breathing deeply when exposed to cold air, wear warm clothing, cover mouth and nose with a scarf or pull-down ski cap to warm the air that goes to their lungs, avoid taking things from the freezer or refrigerator without wearing gloves, drink fluids warm or at room temperature, always drink through a straw, avoid using ice chips for nausea, avoid running air conditioning at high levels in house or car, wash hands with warm water. Notify health care provider of response since last treatment before next infusion.
Instruct patient to notify health care provider immediately if signs of allergic reactions occur.
Instruct patient to notify health care provider immediately if signs of PRES, low blood cell counts (fever, persistent diarrhea, infection), persistent vomiting, signs of dehydration, cough or breathing difficulty, thirst, dry mouth, dizziness, ↓ urination, or signs of infection (fever, temperature of ≥100.5° F, cough that brings up mucus, chills or shivering, burning or pain on urination, pain on swallowing, sore throat, redness or swelling at IV site) occur.
Rep: May cause fetal harm. Advise women of reproductive potential to use effective contraception during therapy and for ≥9 mo after final dose and to avoid breastfeeding during and for 3 mo after final dose. Advise men with female partners of reproductive potential to use effective contraception for 6 mo after final dose. May impair female and male fertility.

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Indications ⬇