Generic Name

Carboplatin

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Classification

FDA Approved Indications

• Treatment of ovarian carcinoma
• Carboplatin in combination with other agents for small cell lung cancer, head and neck cancers, endometrial carcinoma, and others

Mechanism of Action

Carboplatin forms crosslinks with DNA, inhibiting DNA synthesis and function, leading to apoptosis of cancer cells.

Dosage and Administration

Adult: Dose based on renal function, typically 360-400 mg/m² every 3-4 weeks. The dose is adjusted according to blood counts and renal function.

Pediatric: Dosing varies; typically calculated based on body surface area (BSA) and body weight.

Geriatric: Use with caution; age-related decline in renal function necessitates dose adjustment.

Renal Impairment: Reduce dose based on renal function; CrCl <60 mL/min requires dose adjustment.

Hepatic Impairment: No specific adjustment; monitor hepatic function.

Pharmacokinetics

Absorption: Administered intravenously; bioavailability is nearly 100%.

Distribution: Widely distributed; crosses the placenta, minimal concentrations in cerebrospinal fluid.

Metabolism: Metabolized to active compounds, with some biotransformation.

Excretion: Primarily excreted unchanged in urine.

Half Life: Approx. 1.5 to 3 hours.

Contraindications

• Hypersensitivity to carboplatin or other platinum compounds
• Severe myelosuppression

Precautions

• Use cautiously in patients with renal impairment, liver dysfunction, or active infection. Monitor blood counts regularly.
• Pregnancy Category D; use only if benefits outweigh risks. Lactation not recommended.

Adverse Reactions - Common

• Myelosuppression (neutropenia, thrombocytopenia, anemia) (Common)
• Nausea and vomiting (Common)
• Alopecia (Common)

Adverse Reactions - Serious

• Hypersensitivity reactions including anaphylaxis (Less common)
• Nephrotoxicity (less than cisplatin) (Less common)
• Peripheral neuropathy (Less common)
• Secondary malignancies (rare) (Rare)

Drug-Drug Interactions

• Other myelosuppressants, nephrotoxic drugs (e.g., aminoglycosides), ototoxic agents.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report signs of infection, bleeding, or allergic reactions immediately.
• Maintain hydration during treatment.
• Follow-up tests are essential for monitoring side effects.

Special Considerations

Black Box Warnings:

• Myelosuppression is severe and may be life-threatening; monitor blood counts closely.
• Hypersensitivity reactions can be severe; have emergency treatments available.

Genetic Factors: Patients with deficient glutathione-S-transferase may have increased toxicity.

Lab Test Interference: May cause falsely elevated serum creatinine levels.

Overdose Management

Signs/Symptoms: Severe myelosuppression, nausea, vomiting, neurotoxicity.

Treatment: Supportive care; expeditious use of hematopoietic growth factors, transfusions; no specific antidote.

Storage and Handling

Storage: Store in a refrigerator at 2-8°C; protect from light.

Stability: Stable for at least 24 hours when reconstituted, per manufacturer's guidelines.