Cisplatin Disease Interactions

Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

Cisplatin injection can cause ototoxicity, which is cumulative and may be severe. Consider audiometric and vestibular function monitoring. Ototoxicity can occur during or after treatment and can be unilateral or bilateral. Deafness after the initial dose of cisplatin injection has been reported. Vestibular toxicity has also been reported. Ototoxic effects can be more severe and detrimental in pediatric patients, particularly in patients less than 5 years of age. The prevalence of hearing loss in pediatric patients is estimated to be 40-60%. Additional risk factors for ototoxicity include simultaneous cranial irradiation, treatment with other ototoxic drugs and renal impairment. Consider audiometric and vestibular testing in all pediatric patients receiving cisplatin.

Myelosuppression has been reported in 25% to 30% of patients administered cisplatin. Fever and infection have been reported in patients with neutropenia. Potential fatalities due to infection (secondary to myelosuppression) have been reported. Therapy with cisplatin should be administered cautiously in patients whose bone marrow reserve may be severely depressed by prior chemotherapy or irradiation or whose marrow function is recovering from previous cytotoxic therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended. For patients who develop severe myelosuppression during treatment with cisplatin injection, consider dose modifications and manage according to clinical treatment guidelines.

Cisplatin injection can cause dose-related peripheral neuropathy that becomes more severe with repeated courses of the drug. Neurologic symptoms have been reported to occur after a single dose. Neuropathy can also have a delayed onset from 3 to 8 weeks after the last dose of cisplatin injection. Manifestations include paresthesias in a stocking-glove distribution, areflexia, and loss of proprioception and vibratory sensation. The neuropathy may progress further even after stopping treatment. Peripheral neuropathy may be irreversible in some patients. Therapy with cisplatin should be administered cautiously in patients with or predisposed to peripheral neuropathy.

Patients with baseline renal impairment may be more susceptible to cisplatin nephrotoxicity. Ensure adequate hydration before, during, and after cisplatin injection administration. Measure serum creatinine, blood urea nitrogen, creatinine clearance, and serum electrolytes prior to initiating therapy, and as clinically indicated. Consider alternative treatments or reduce the dose of cisplatin injection for patients with baseline renal impairment or who develop significant reductions in creatinine clearance during treatment with cisplatin injection according to clinical treatment guidelines

A (+) Coombs' hemolytic anemia has been reported with the use of cisplatin. Subsequent therapy may result in increased hemolysis. If need outweighs the risk, extreme caution should be exercised in administering cisplatin. Patients should be instructed to immediately report signs and symptoms suggesting anemia such as fatigue, weakness, and/or bloody urine. Therapy with cisplatin should be administered cautiously in patients with anemia and those with a history of or a predisposition to hemolytic syndromes. Close clinical monitoring of hematopoietic function for hemolysis and anemia is recommended.

Optic neuritis, papilledema, and cortical blindness have been reported in patients receiving standard recommended doses of cisplatin injection. Blurred vision and altered color perception have been reported after the use of regimens with higher doses and dose frequencies of cisplatin injection. Improvement and/or total recovery usually occurs after discontinuing cisplatin injection but can be delayed. Caution is advised in patients with visual disabilities.