Carboplatin

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Generic Name: Carboplatin Brand Name(s): Generics only. No brands available. Avability: Rx Pregnancy Category: D

Uses

What is Carboplatin used for?

Carboplatin is used to treat various types of cancer. It is a chemotherapy drug that contains platinum. It is used alone or in combination with other medications to slow or stop cancer cell growth.

How should I take Carboplatin?

Carboplatin is usually given by infusion into a vein (intravenously-IV) over at least 15 minutes by a healthcare professional.

The dosage is based on your medical condition, body size, and response to therapy. In general, courses of carboplatin treatment should not be given more often than once every 4 weeks. Consult your doctor or pharmacist for more details.

How do I store Carboplatin?

Unopened vials of Carboplatin Injection are stable to the date indicated on the package when stored at 25°C (77°F); excursions permitted from 15°– 30°C (59°– 86°F). Protect from light.

Carboplatin Injection multidose vials maintain microbial, chemical, and physical stability for up to 14 days at 25°C following multiple needle entries.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. Solutions for infusion should be discarded 8 hours after preparation.

There may be different brands of Carboplatin that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Carboplatin down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Carboplatin?

Before using carboplatin, tell your doctor or pharmacist if you are allergic to it, or to cisplatin; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: decreased bone marrow function/blood cell disorders (e.g., anemia, leukopenia, thrombocytopenia).

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney problems, mineral imbalance (low blood levels of sodium, potassium, magnesium, calcium).

Do not have immunizations/vaccinations without the consent of your doctor, and avoid contact with people who have recently received oral polio vaccine.

Use caution with sharp objects like safety razors or nail cutters and avoid activities such as contact sports to lower the chance of getting cut, bruised or injured.

Wash your hands well to prevent the spread of infections.

The elderly may be more sensitive to the side effects of this drug, especially to bleeding problems and numbness/tingling of the hands/feet.

Children may be at greater risk for hearing loss when carboplatin is used at higher-than-recommended doses in combination with other medications that may affect hearing.

This medication can affect sperm production in men. Therefore, men should use a reliable form of birth control during treatment and for some time afterwards. Consult your doctor for more details.

This medication is not recommended for use during pregnancy. It may cause harm to an unborn baby. Women of childbearing age should use reliable form(s) of birth control during treatment and for some time afterwards. Consult your doctor for more details.

It is not known whether this drug passes into breast milk. Because of the potential risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Carboplatin during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Carboplatin. Carboplatin is pregnancy risk category D according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Carboplatin?

Stomach pain, body aches/pain, diarrhea, constipation, weakness, nausea, and vomiting may occur. Nausea and vomiting can be severe in some patients but usually go away within 24 hours of treatment. Drug therapy may be needed to prevent or relieve nausea and vomiting. Not eating before your treatment may help relieve vomiting. Changes in diet such as eating several small meals or limiting activity may help lessen some of these effects. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Temporary hair loss may occur. Normal hair growth should return after treatment has ended.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: numbness or tingling in the hands/feet, mouth sores, yellowing eyes/skin, dark urine, unusual tiredness, signs of kidney problems (such as change in the amount of urine), pain/swelling/redness at the injection site, hearing problems (e.g., ringing in the ears, hearing loss), easy bruising/bleeding, blood in the urine, black/bloody stools, fast/irregular heartbeat.

Rarely, temporary vision loss may occur with high doses of carboplatin. Normal vision usually returns within several weeks after the end of treatment. Consult your doctor or pharmacist for more details and report this side effect right away if it occurs.

This medication can lower your body’s ability to fight an infection. Notify your doctor promptly if you develop any signs of an infection such as fever, chills or persistent sore throat.

A very serious allergic reaction to this drug is unlikely, but get medical help right away if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Carboplatin?

Some products that may interact with this drug include: aminoglycoside antibiotics (e.g., gentamicin, neomycin), amphotericin B, certain anti-seizure medications (hydantoins such as phenytoin), certain “water pills” (loop diuretics such as furosemide, bumetanide), nalidixic acid.

Carboplatin may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Carboplatin?

Carboplatin may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Carboplatin?

Carboplatin may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Carboplatin.

What is the dose of Carboplatin for an adult?

Usual Adult Dose for Ovarian Cancer

Single agent therapy for use in the treatment of recurrent ovarian cancer:

360 mg/m2 by intravenous injection on day 1 every 4 weeks (alternatively, the carboplatin dose may be calculated by the Calvert formula below). In general, however, single intermittent courses of carboplatin should not be repeated until the neutrophil count is at least 2000 and the platelet count is at least 100,000.

Combination therapy (with cyclophosphamide) for use in the treatment of advanced ovarian cancer (an effective combination for previously untreated patients):

  • carboplatin 300 mg/m2 by intravenous injection on day 1 every four weeks for six cycles (alternatively, the carboplatin dose may be calculated by the Calvert formula below).
  • cyclophosphamide 600 mg/m2 by intravenous injection. on day 1 every 4 weeks for six cycles.

Intermittent courses of carboplatin in combination with cyclophosphamide should not be repeated until the neutrophil count is at least 2000 and the platelet count is at least 100,000.

Calvert formula: Another approach for determining the initial dose of carboplatin is the use of the following mathematical formula, which is based on a patient’s preexisting renal function or renal function and desired platelet nadir. (Renal excretion is the major route of elimination for carboplatin.) The use of this dosing formula, as compared to empirical dose calculation based on body surface area, allows compensation for patient variations in pretreatment renal function that might otherwise result in either underdosing (in patients with above average renal function) or overdosing (in patients with impaired renal function).

A simple formula for calculating dosage, based upon a patient’s glomerular filtration rate (GFR in mL/min) and carboplatin target area under the concentration versus time curve (AUC in mg/mL/min), has been proposed by Calvert.

Calvert formula for carboplatin dosing: Total Dose (mg)=(target AUC) × (GFR + 25)

Note: With the Calvert formula, the total dose of carboplatin is calculated in mg, not mg/m2 .

The target AUC of 4-6 mg/mL/min using single agent carboplatin appears to provide the most appropriate dose range in previously treated patients.

In order to avoid potential toxicity due to overdosing, if a patient’s GFR is estimated based on serum creatinine measured by the standardized Isotope Dilution Mass Spectrometry (IDMS) method rather than using an actual GFR measurement, a capping of the dose of carboplatin for the desired exposure (AUC) has been recommended.

Maximum carboplatin dose (mg) = target AUC (mg x min/mL) x (150 mL/min)

The maximum dose is based on a GFR estimate that is capped at 125 mL/min for patients with normal renal function. No higher estimated GFR values should be used.

For example:

  • For a target AUC = 6, the maximum dose is 6 x 150 = 900 mg
  • For a target AUC = 5, the maximum dose is 5 x 150 = 750 mg
  • For a target AUC = 4, the maximum dose is 4 x 150 = 600 mg

Usual Adult Dose for Cervical Cancer

(In combination with other chemotherapeutic agents as a part of the BIC regimen)

200 mg/m2 IV on day 1

The cycle is repeated every 21 days.

Renal Dose Adjustments

Patients with Impaired Kidney Function:

Patients with creatinine clearance values below 60 mL/min are at increased risk of severe bone marrow suppression. In renally-impaired patients who received single agent carboplatin therapy, the incidence of severe leukopenia, neutropenia, or thrombocytopenia has been about 25% when the dosage modifications in the table below have been used.

If a patient has a baseline creatinine clearance of 41-59 mL/min, then the recommended dose for this patient on day 1 is 250 mg/m 2.

If a patient has a baseline creatinine clearance of 16-40 mL/min, then the recommended dose for this patient on day 1 is 200 mg/m 2.

The data available for patients with severely impaired kidney function (creatinine clearance below 15 mL/min) are too limited to permit a recommendation for treatment.

These dosing recommendations apply to the initial course of treatment. Subsequent dosages should be adjusted according to the patient’s tolerance based on the degree of bone marrow suppression.

Dose Adjustments

Pretreatment platelet count and performance status are important prognostic factors for severity of myelosuppression in previously treated patients. The suggested dose adjustments for single agent or combination therapy shown in the table below are modified from controlled trials in previously treated and untreated patients with ovarian carcinoma. Blood counts were done weekly, and the recommendations are based on the lowest posttreatment platelet or neutrophil value.

Platelets Neutrophils Adjusted Dose (from prior course)

> 100,000 > 2000 125%

50-100,000 500-2000 No Adjustment

< 50,000 < 500 75%

*Percentages apply to carboplatin as a single agent or to both carboplatin and cyclophosphamide in combination. In the controlled studies, dosages were also adjusted at a lower level (50% to 60%) for severe myelosuppression. Escalations above 125% were not recommended for these studies.

Dialysis

Carboplatin is contraindicated in patients with severe renal impairment (CrCl less than 20 mL/min).

Other Comments

Carboplatin is usually administered by an infusion lasting 15 minutes or longer. No pre- or posttreatment hydration or forced diuresis is required.

What is the dose of Carboplatin for a child?

Usual Pediatric Dose for Malignant Disease (Not approved by FDA)

Pediatric Calvert Formula:

Total dose (mg) = [Target AUC (mg/mL/min)] x [GFR (mL/min) + (0.36 x body weight in kg)]

Note: With the Calvert formula, the total dose of carboplatin is calculated in mg, not mg/m2 .

The target AUC varies with the number of agents in the regimen and if the patient has been treated previously or not.

Solid Tumor:

300-600 mg/m2 once every 4 weeks.

Brain Tumor:

175 mg/m2 once weekly for 4 weeks with a 2 week recovery between courses. The dose should then be adjusted based on platelet and neutrophil count values.

Bone Marrow Transplant Preparative Regimen:

500 mg/m2/day for 3 days.

How is Carboplatin available?

Carboplatin is available in the following dosage forms and strengths:

  • Intravenous solution,
  • Intravenous powder for injection.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Carboplatin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: August 16, 2018 | Last Modified: August 16, 2018

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