OXALIPLATIN

OXALIPLATIN
(ox-a-li-pla'tin)
Eloxatin
Classifications: antineoplastic; alkylating agent;
Therapeutic: antineoplastic
Prototype: Cyclophosphamide
Pregnancy Category: D

Availability

5 mg/mL injection

Action

Oxaliplatin forms inter- and intra-strand DNA cross-links. These cross-links inhibit DNA replication and transcription. The cytotoxicity of oxaliplatin is cell-cycle nonspecific.

Therapeutic Effect

Antitumor activity of oxaliplatin in combination with 5-fluorouracil (5-FU) has antiproliferative activity against colon carcinoma that is greater than either compound alone.

Uses

Metastatic cancer of colon and rectum.

Unlabeled Uses

Non-small cell lung cancer, non-Hodgkin's lymphoma, ovarian cancer.

Contraindications

History of known allergy to oxaliplatin or other platinum compounds; myelosuppression; pregnancy (category D); lactation. Safety and effectiveness in children are not established.

Cautious Use

Renal impairment, because clearance of ultrafilterable platinum is decreased in mild, moderate, and severe renal impairment; older adults; hepatic impairment.

Route & Dosage

Metastatic Colon or Rectal Cancer
Adult: IV 85 mg/m² infused over 120 min once every 2 wk

Renal Impairment
Cl_cr <19 mL/min: omit dose or change therapy

Administration

Intravenous

Premedication with an antiemetic is recommended.

PREPARE: IV Infusion: NEVER reconstitute with NS or any solution containing chloride. Reconstitute the 50 mg vial or the 100 mg vial by adding 10 mL or 20 mL, respectively, of sterile water for injection or D5W. MUST further dilute in 250–500 mL of D5W for infusion.

ADMINISTER: IV Infusion: Do NOT use needles or infusion sets containing aluminum parts. Flush infusion line with D5W before and after administration of any other concomitant medication. Give over 120 min with frequent monitoring of the IV insertion site. Discontinue at the first sign of extravasation and restart IV in a different site.

INCOMPATIBILITIES Solution/additive: chloride-containing solutions, alkaline solutions, including sodium bicarbonate, 5-fluorouracil (5-FU). Y-site: alkaline solutions, including sodium bicarbonate, 5-fluorouracil (5-FU).

Store reconstituted solution up to 24 h under refrigeration at 2°–8° C (36°–46° F). After final dilution, the IV solution may be stored for 6 h at room temperature [20°–25° C (68°–77° F)] or up to 24 h under refrigeration.

Adverse Effects (≥1%)

Body as a Whole: Fever, edema, pain, allergic reaction, arthralgia, rigors. CNS: Fatigue, neuropathy, headache, dizziness, insomnia. CV: Chest pain. GI: Diarrhea, nausea, vomiting, anorexia, stomatitis, constipation, abdominal pain, reflux, dyspepsia, taste perversion, mucositis, flatulence. Hematologic: Anemia, leukopenia, thrombocytopenia, neutropenia, thromboembolism. Metabolic: Hypokalemia, dehydration. Respiratory: Dyspnea, cough, rhinitis, pharyngitis, epistaxis, hiccup. Skin: Flushing, rash, alopecia, injection site reaction. Urogenital: Dysuria.

Interactions

Drug: aminoglycosides, amphotericin B, vancomycin, and other nephrotoxic drugs may increase risk of renal failure.

Pharmacokinetics

Distribution: >90% protein bound. Metabolism: Rapid and extensive non-enzymatic biotransformation. Elimination: Primarily in urine. Half-Life: 391 h.

Nursing Implications

Assessment & Drug Effects

Monitor for S&S of hypersensitivity (e.g., rash, urticaria, erythema, pruritis; rarely, bronchospasm and hypotension). Discontinue drug and notify physician if any of these occur.
Monitor insertion site. Extravasation may cause local pain and inflammation that may be severe and lead to complications, including necrosis.
Monitor for S&S of coagulation disorders including GI bleeding, hematuria, and epistaxis.
Monitor for S&S of peripheral neuropathy (e.g., paresthesia, dysesthesia, hypoesthesia in the hands, feet, perioral area, or throat, jaw spasm, abnormal tongue sensation, dysarthria, eye pain, and chest pressure). Symptoms may be precipitated or exacerbated by exposure to cold temperature or cold objects.
Lab tests: Before each administration cycle, monitor WBC count with differential, hemoglobin, platelet count, and blood chemistries (including ALT, AST, bilirubin, and creatinine). Monitor baseline and periodic renal functions.
Do not apply ice to oral mucous membranes (e.g., mucositis prophylaxis) during the infusion of oxaliplatin as cold temperature can exacerbate acute neurological symptoms.

Patient & Family Education

Use effective methods of contraception while receiving this drug.
Avoid cold drinks, use of ice, and cover exposed skin prior to exposure to cold temperature or cold objects.
Do not drive or engage in potentially hazardous activities until response to drug is known.
Report any of the following to a health care provider: difficulty writing, buttoning, swallowing, walking; numbness, tingling or other unusual sensations in extremities; non-productive cough or shortness of breath; fever, particularly if associated with persistent diarrhea or other evidence of infection.
Report promptly S&S of a bleeding disorder such as black tarry stool, coke-colored or frankly bloody urine, bleeding from the nose or mucous membranes.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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