carboplatin

kar-boe-PLA-tin

Therapeutic Classification: antineoplastics

Pharmacologic Classification: alkylating agents

High Alert

Advanced ovarian carcinoma (in combination with other agents).
Palliative treatment of ovarian carcinoma unresponsive to other modalities.

Inhibits DNA synthesis by producing cross-linking of parent DNA strands (cell-cycle phase–nonspecific).

Therapeutic Effects:

Death of rapidly replicating cells, particularly malignant ones.

Absorption: IV administration results in complete bioavailability.

Distribution: Well distributed to tissues.

Protein Binding: Platinum is irreversibly bound to plasma proteins.

Metabolism/Excretion: Excreted mostly by the kidneys.

Half-life: Carboplatin: 2.6–5.9 hr (↑ in renal impairment); platinum: 5 days.

(effects on blood counts)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	21 days	28 days

Contraindicated in:

Hypersensitivity to carboplatin, cisplatin, or mannitol
OB: Pregnancy
Lactation: Lactation.

Use Cautiously in:

Hearing loss
Electrolyte abnormalities
Renal impairment (dose ↓ recommended if CCr <60 mL/min)
Active infection
Diminished bone marrow reserve (dose ↓ recommended)
Rep: Women of reproductive potential
Pedi: Safety and effectiveness not established in children
Geri: ↑ risk of thrombocytopenia in older adults; consider renal function in dose determination.

Derm: alopecia, rash.

EENT: ototoxicity.

F and E: hypocalcemia, hypokalemia, hypomagnesemia, hyponatremia.

GI: abdominal pain, nausea, vomiting, constipation, diarrhea, hepatitis, stomatitis.

GU: gonadal suppression, nephrotoxicity.

Hemat: ANEMIA, LEUKOPENIA, THROMBOCYTOPENIA.

Metab: hyperuricemia.

Neuro: peripheral neuropathy, weakness.

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS).

Drug-Drug:

↑ nephrotoxicity and ototoxicity with other aminoglycosides and loop diuretics.
↑ bone marrow depression with other bone marrow–depressing drugs or radiation therapy.
May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.

IV (Adults): Initial treatment: 300 mg/m² with cyclophosphamide at 4-wk intervals. Treatment of refractory tumors: 360 mg/m² as a single dose; may be repeated at 4-wk intervals, depending on response.

Renal Impairment

IV (Adults): CCr 41–59 mL/min: initial dose 250 mg/m²; CCr 16–40 mL/min: initial dose 200 mg/m².

(Generic available)

Solution for injection: 10 mg/mL;

Assess for nausea and vomiting; often occur 6–12 hr after therapy (1–4 hr for aqueous solution) and may persist for 24 hr. Prophylactic antiemetics may be used. Adjust diet as tolerated to maintain fluid and electrolyte balance and ensure adequate nutritional intake. May require discontinuation of therapy.
Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, and emesis) and avoid IM injections and rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur and may be cumulative; transfusions are frequently required. Monitor for increased fatigue, dyspnea, and orthostatic hypotension.
Monitor for signs of anaphylaxis (rash, urticaria, pruritus, facial swelling, wheezing, tachycardia, hypotension). Discontinue medication immediately and notify physician if these occur. Epinephrine and resuscitation equipment should be readily available.
Audiometry is recommended before initiation of therapy and subsequent doses. Ototoxicity manifests as tinnitus and unilateral or bilateral hearing loss in high frequencies and becomes more frequent and severe with repeated doses. Ototoxicity is more pronounced in children.

Lab Test Considerations:

Monitor CBC, differential, and clotting studies before and weekly during therapy. The nadirs of thrombocytopenia and leukopenia occur after 21 days and recover by 30 days after a dose. Nadir of granulocyte counts usually occurs after 21–28 days and recovers by day 35. Withhold subsequent doses until neutrophil count is >2000/mm³ and platelet count is >100,000/mm³.
- Monitor renal function and serum electrolytes before initiation of therapy and before each course of carboplatin.
- Monitor hepatic function before and periodically during therapy. May cause ↑ serum bilirubin, alkaline phosphatase, and AST concentrations.

High Alert:Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double-check single, daily, and course-of-therapy dose limits; have second practitioner independently double-check original order, calculations, and infusion pump settings.
- High Alert:Do not confuse carboplatin with cisplatin.
- High Alert:Carboplatin should be administered in a monitored setting under the supervision of a physician experienced in cancer chemotherapy.

IV Administration:

Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard equipment in specially designated containers.
- Do not use aluminum needles or equipment during preparation or administration; aluminum reacts with the drug.
Intermittent Infusion: Concentration: 0.5 mg/mL. Stable for 8 hr at room temperature.
Rate: Infuse over 15–60 min.
Y-Site Compatibility:
- acyclovir
- alemtuzumab
- allopurinol
- amifostine
- amikacin
- aminocaproic acid
- aminophylline
- amiodarone
- amphotericin B lipid complex
- amphotericin B liposomal
- ampicillin
- ampicillin/sulbactam
- anidulafungin
- argatroban
- atracurium
- azithromycin
- aztreonam
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- caspofungin
- cefazolin
- cefepime
- cefotaxime
- cefotetan
- cefoxitin
- ceftazidime
- ceftriaxone
- cefuroxime
- ciprofloxacin
- cisatracurium
- cisplatin
- cladribine
- clindamycin
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- daptomycin
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- foscarnet
- fosphenytoin
- furosemide
- ganciclovir
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- haloperidol
- heparin
- hetastarch
- hydrocortisone
- hydromorphone
- idarubicin
- ifosfamide
- imipenem/cilastatin
- insulin, regular
- isoproterenol
- ketorolac
- labetalol
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methotrexate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- micafungin
- midazolam
- milrinone
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- nafcillin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- paclitaxel
- palonosetron
- pamidronate
- pantoprazole
- pemetrexed
- pentamidine
- pentobarbital
- phenobarbital
- phenylephrine
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- potassium phosphate
- prochlorperazine
- promethazine
- propofol
- propranolol
- remifentanil
- rituximab
- rocuronium
- sargramostim
- sodium acetate
- sodium bicarbonate
- sodium phosphate
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- trastuzumab
- trimethoprim/sulfamethoxazole
- vancomycin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B deoxycholate
- chlorpromazine
- diazepam
- leucovorin calcium
- phenytoin
- procainamide
- thiopental

Instruct patient to notify health care professional promptly if fever; chills; sore throat; signs of infection; lower back or side pain; difficult or painful urination; bleeding gums; bruising; pinpoint red spots on skin; blood in stools, urine, or emesis; increased fatigue, dyspnea, or orthostatic hypotension occurs.
Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to avoid falls. Caution patients not to drink alcoholic beverages or take medication containing aspirin or NSAIDs because they may precipitate gastric bleeding.
Instruct patient to promptly report any numbness or tingling in extremities or face, decreased coordination, difficulty with hearing or ringing in the ears, unusual swelling, or weight gain to health care professional.
Instruct patient not to receive any vaccinations without advice of health care professional and to avoid contact with persons who have received oral polio vaccine within the past several mo.
Advise patient of the need for contraception (if patient is not infertile as a result of surgical or radiation therapy).
Instruct patient to inspect oral mucosa for erythema and ulceration. If ulceration occurs, advise patient to notify health care professional, rinse mouth with water after eating, and use sponge brush. Mouth pain may require treatment with opioids.
Discuss with patient the possibility of hair loss. Explore methods of coping.
Emphasize the need for periodic lab tests to monitor for side effects.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise patient of the need for contraception during therapy.

Decrease in size or spread of ovarian carcinoma.

Paraplatin

NDC Code^*

0703- Teva Parenteral Medicines, Inc.
0703-4239- Carboplatin 0703-4239-81- 1 VIAL, MULTI-DOSE in 1 CARTON (0703-4239-81) > 60 mL in 1 VIAL, MULTI-DOSE

0703- Teva Parenteral Medicines, Inc.
0703-4239- Carboplatin 0703-4239-01- 1 VIAL, MULTI-DOSE in 1 CARTON (0703-4239-01) > 60 mL in 1 VIAL, MULTI-DOSE

0703- Teva Parenteral Medicines, Inc.
0703-4244- Carboplatin 0703-4244-81- 1 VIAL, MULTI-DOSE in 1 CARTON (0703-4244-81) > 5 mL in 1 VIAL, MULTI-DOSE

0703- Teva Parenteral Medicines, Inc.
0703-4244- Carboplatin 0703-4244-01- 1 VIAL, MULTI-DOSE in 1 CARTON (0703-4244-01) > 5 mL in 1 VIAL, MULTI-DOSE

0703- Teva Parenteral Medicines, Inc.
0703-4246- Carboplatin 0703-4246-81- 1 VIAL, MULTI-DOSE in 1 CARTON (0703-4246-81) > 15 mL in 1 VIAL, MULTI-DOSE

0703- Teva Parenteral Medicines, Inc.
0703-4246- Carboplatin 0703-4246-01- 1 VIAL, MULTI-DOSE in 1 CARTON (0703-4246-01) > 15 mL in 1 VIAL, MULTI-DOSE

0703- Teva Parenteral Medicines, Inc.
0703-4248- Carboplatin 0703-4248-81- 1 VIAL, MULTI-DOSE in 1 CARTON (0703-4248-81) > 45 mL in 1 VIAL, MULTI-DOSE

0703- Teva Parenteral Medicines, Inc.
0703-4248- Carboplatin 0703-4248-91- 1 VIAL, MULTI-DOSE in 1 CARTON (0703-4248-91) > 45 mL in 1 VIAL, MULTI-DOSE

0703- Teva Parenteral Medicines, Inc.
0703-4248- Carboplatin 0703-4248-01- 1 VIAL, MULTI-DOSE in 1 CARTON (0703-4248-01) > 45 mL in 1 VIAL, MULTI-DOSE

16729- Accord Healthcare, Inc.
16729-295- Carboplatin 16729-295-12- 1 VIAL, MULTI-DOSE in 1 CARTON (16729-295-12) > 60 mL in 1 VIAL, MULTI-DOSE

16729- Accord Healthcare, Inc.
16729-295- Carboplatin 16729-295-31- 1 VIAL, MULTI-DOSE in 1 CARTON (16729-295-31) > 5 mL in 1 VIAL, MULTI-DOSE

16729- Accord Healthcare, Inc.
16729-295- Carboplatin 16729-295-33- 1 VIAL, MULTI-DOSE in 1 CARTON (16729-295-33) > 15 mL in 1 VIAL, MULTI-DOSE

16729- Accord Healthcare, Inc.
16729-295- Carboplatin 16729-295-34- 1 VIAL, MULTI-DOSE in 1 CARTON (16729-295-34) > 45 mL in 1 VIAL, MULTI-DOSE

25021- Sagent Pharmaceuticals
25021-202- Carboplatin 25021-202-45- 1 VIAL in 1 CARTON (25021-202-45) > 45 mL in 1 VIAL

25021- Sagent Pharmaceuticals
25021-202- Carboplatin 25021-202-51- 1 VIAL in 1 CARTON (25021-202-51) > 60 mL in 1 VIAL

47335- Sun Pharmaceutical Industries, Inc.
47335-284- carboplatin 47335-284-40- 1 VIAL, MULTI-DOSE in 1 CARTON (47335-284-40) > 60 mL in 1 VIAL, MULTI-DOSE

50742- Ingenus Pharmaceuticals, LLC
50742-445- Carboplatin 50742-445-05- 1 VIAL, MULTI-DOSE in 1 CARTON (50742-445-05) > 5 mL in 1 VIAL, MULTI-DOSE

50742- Ingenus Pharmaceuticals, LLC
50742-446- Carboplatin 50742-446-15- 1 VIAL, MULTI-DOSE in 1 CARTON (50742-446-15) > 15 mL in 1 VIAL, MULTI-DOSE

50742- Ingenus Pharmaceuticals, LLC
50742-447- Carboplatin 50742-447-45- 1 VIAL, MULTI-DOSE in 1 CARTON (50742-447-45) > 45 mL in 1 VIAL, MULTI-DOSE

50742- Ingenus Pharmaceuticals, LLC
50742-448- Carboplatin 50742-448-60- 1 VIAL, MULTI-DOSE in 1 CARTON (50742-448-60) > 60 mL in 1 VIAL, MULTI-DOSE

55150- AuroMedics Pharma LLC
55150-333- CARBOPLATIN 55150-333-01- 1 VIAL, MULTI-DOSE in 1 CARTON (55150-333-01) > 5 mL in 1 VIAL, MULTI-DOSE

55150- AuroMedics Pharma LLC
55150-334- CARBOPLATIN 55150-334-01- 1 VIAL, MULTI-DOSE in 1 CARTON (55150-334-01) > 15 mL in 1 VIAL, MULTI-DOSE

55150- AuroMedics Pharma LLC
55150-335- CARBOPLATIN 55150-335-01- 1 VIAL, MULTI-DOSE in 1 CARTON (55150-335-01) > 45 mL in 1 VIAL, MULTI-DOSE

61703- Hospira, Inc.
61703-339- Carboplatin 61703-339-18- 1 VIAL, MULTI-DOSE in 1 CARTON (61703-339-18) > 5 mL in 1 VIAL, MULTI-DOSE

61703- Hospira, Inc.
61703-339- Carboplatin 61703-339-22- 1 VIAL, MULTI-DOSE in 1 CARTON (61703-339-22) > 15 mL in 1 VIAL, MULTI-DOSE

61703- Hospira, Inc.
61703-339- Carboplatin 61703-339-50- 1 VIAL, MULTI-DOSE in 1 CARTON (61703-339-50) > 45 mL in 1 VIAL, MULTI-DOSE

61703- Hospira, Inc.
61703-339- Carboplatin 61703-339-56- 1 VIAL, MULTI-DOSE in 1 CARTON (61703-339-56) > 60 mL in 1 VIAL, MULTI-DOSE

63323- Fresenius Kabi USA, LLC
63323-172- Carboplatin 63323-172-60- 1 VIAL in 1 BOX (63323-172-60) > 60 mL in 1 VIAL

68083- Gland Pharma Limited
68083-190- CARBOPLATIN 68083-190-01- 1 VIAL, MULTI-DOSE in 1 CARTON (68083-190-01) > 5 mL in 1 VIAL, MULTI-DOSE

68083- Gland Pharma Limited
68083-191- CARBOPLATIN 68083-191-01- 1 VIAL, MULTI-DOSE in 1 CARTON (68083-191-01) > 15 mL in 1 VIAL, MULTI-DOSE

68083- Gland Pharma Limited
68083-192- CARBOPLATIN 68083-192-01- 1 VIAL, MULTI-DOSE in 1 CARTON (68083-192-01) > 45 mL in 1 VIAL, MULTI-DOSE

68083- Gland Pharma Limited
68083-193- CARBOPLATIN 68083-193-01- 1 VIAL, MULTI-DOSE in 1 CARTON (68083-193-01) > 60 mL in 1 VIAL, MULTI-DOSE

69097- Cipla USA Inc.
69097-239- CARBOPLATIN 69097-239-35- 1 VIAL, MULTI-DOSE in 1 CARTON (69097-239-35) > 5 mL in 1 VIAL, MULTI-DOSE

69097- Cipla USA Inc.
69097-241- CARBOPLATIN 69097-241-38- 1 VIAL, MULTI-DOSE in 1 CARTON (69097-241-38) > 15 mL in 1 VIAL, MULTI-DOSE

69097- Cipla USA Inc.
69097-242- CARBOPLATIN 69097-242-41- 1 VIAL, MULTI-DOSE in 1 CARTON (69097-242-41) > 45 mL in 1 VIAL, MULTI-DOSE

69097- Cipla USA Inc.
69097-243- CARBOPLATIN 69097-243-43- 1 VIAL, MULTI-DOSE in 1 CARTON (69097-243-43) > 60 mL in 1 VIAL, MULTI-DOSE

71288- Meitheal Pharmaceuticals Inc.
71288-100- Carboplatin 71288-100-05- 1 VIAL in 1 CARTON (71288-100-05) > 5 mL in 1 VIAL

71288- Meitheal Pharmaceuticals Inc.
71288-100- Carboplatin 71288-100-15- 1 VIAL in 1 CARTON (71288-100-15) > 15 mL in 1 VIAL

71288- Meitheal Pharmaceuticals Inc.
71288-100- Carboplatin 71288-100-45- 1 VIAL in 1 CARTON (71288-100-45) > 45 mL in 1 VIAL

71288- Meitheal Pharmaceuticals Inc.
71288-100- Carboplatin 71288-100-51- 1 VIAL in 1 CARTON (71288-100-51) > 60 mL in 1 VIAL

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