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ALERT: U.S. Boxed Warning
The FDA-approved labeling includes a boxed warning. See Warnings/Precautions section for a concise summary of this information. For verbatim wording of the boxed warning, consult the product labeling or www.fda.gov.
Pronunciation
(KAR boe pla tin)
Generic Available (U.S.)
Yes
Index Terms
Brand Names: Canada
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of advanced ovarian cancer
Use: Unlabeled
Treatment of bladder cancer, breast cancer (metastatic), central nervous system tumors, cervical cancer (recurrent or metastatic), endometrial cancer, esophageal cancer, head and neck cancer, Hodgkin's lymphoma (relapsed or refractory), malignant pleural mesothelioma, melanoma (advanced or metastatic), merkel cell carcinoma, neuroendocrine tumors (adrenal gland and carcinoid tumors), non-Hodgkin's lymphomas (relapsed or refractory), nonsmall cell lung cancer, retinoblastoma, sarcomas (Ewing's sarcoma and osteosarcoma), small-cell lung cancer, testicular cancer, thymic malignancies, unknown primary adenocarcinoma, and as a conditioning regimen prior to hematopoietic stem cell transplantation
Pregnancy Risk Factor
D
Pregnancy Considerations
Embryotoxicity and teratogenicity have been observed in animal reproduction studies. May cause fetal harm if administered during pregnancy. Women of childbearing potential should avoid becoming pregnant during treatment.
Lactation
Excretion in breast milk unknown/not recommended
Breast-Feeding Considerations
Due to the potential for toxicity in nursing infants, breast-feeding is not recommended.
Contraindications
History of severe allergic reaction to carboplatin, cisplatin, other platinum-containing formulations, mannitol, or any component of the formulation; should not be used in patients with severe bone marrow depression or significant bleeding
Warnings/Precautions
Boxed warnings:
• Bone marrow suppression: See “Concerns related to adverse effects” below.
• Experienced physician: See “Other warnings/precautions” below.
• Hypersensitivity/anaphylactoid reactions: See “Concerns related to adverse effects” below.
• Vomiting: See “Concerns related to adverse effects” below.
Special handling:
• Hazardous agent: Use appropriate precautions for handling and disposal.
Concerns related to adverse effects:
• Bone marrow suppression: [U.S. Boxed Warning]: Bone marrow suppression, which may be severe, is dose related; may result in infection (due to neutropenia) or bleeding (due to thrombocytopenia); anemia may require blood transfusion. Reduce dosage in patients with bone marrow suppression; cycles should be delayed until WBC and platelet counts have recovered. Patients who have received prior myelosuppressive therapy and patients with renal dysfunction are at increased risk for bone marrow suppression. Anemia is cumulative.
• Hypersensitivity/anaphylactoid reactions: [U.S. Boxed Warning]: Anaphylactic-like reactions have been reported with carboplatin; may occur within minutes of administration. Epinephrine, corticosteroids and antihistamines have been used to treat symptoms. The risk of allergic reactions (including anaphylaxis) is increased in patients previously exposed to platinum therapy. Skin testing and desensitization protocols have been reported (Confina-Cohen, 2005; Lee, 2004; Markman, 2003).
• Liver function abnormalities: High doses (>4 times the recommended dose) have resulted in severe abnormalities of liver function tests.
• Neurotoxicity: Although peripheral neuropathy occurs infrequently, the incidence of peripheral neuropathy is increased patients >65 years of age and those who have previously received cisplatin treatment.
• Ototoxicity: Ototoxicity may occur when administered concomitantly with aminoglycosides. Clinically significant hearing loss has been reported to occur in pediatric patients when therapy was administered at higher than recommended doses in combination with other ototoxic agents (eg, aminoglycosides). In a study of children receiving carboplatin for the treatment of retinoblastoma, those <6 months of age at treatment initiation were more likely to experience ototoxicity; long-term audiology monitoring is recommended (Qaddoumi, 2012).
• Renal toxicity: Limited potential for nephrotoxicity unless administered concomitantly with aminoglycosides.
• Vision loss: Loss of vision (usually reversible within weeks of discontinuing) has been reported with higher than recommended doses.
• Vomiting: [U.S. Boxed Warning]: Vomiting may occur. May be severe in patients who have received prior emetogenic therapy.
Disease-related concerns:
• Renal impairment: Use with caution in patients with renal impairment; patients with renal dysfunction are at increased risk for bone marrow suppression.
Concurrent drug therapy issues:
• Taxane derivatives: When administered as sequential infusions, taxane derivatives (docetaxel, paclitaxel) should be administered before the platinum derivatives (carboplatin, cisplatin) to limit myelosuppression and to enhance efficacy.
Special populations:
• Elderly: Patients >65 years of age are more likely to develop thrombocytopenia (severe) and peripheral neuropathy.
Other warnings/precautions:
• Dosing with Calvert formula: When calculating the carboplatin dose using the Calvert formula and an estimated glomerular filtration rate (GFR), the laboratory method used to measure serum creatinine may impact dosing. Compared to other methods, standardized isotope dilution mass spectrometry (IDMS) may underestimate serum creatinine values in patients with low creatinine values (eg, ≤0.7 mg/dL) and may overestimate GFR in patients with normal renal function. This may result in higher calculated carboplatin doses and increased toxicities. If using IDMS, the Food and Drug Administration (FDA) recommends that clinicians consider capping estimated GFR at a maximum of 125 mL/minute to avoid potential toxicity.
• Experienced physician: [U.S. Boxed Warning]: Should be administered under the supervision of an experienced cancer chemotherapy physician.
Adverse Reactions
Percentages reported with single-agent therapy.
>10%:
Central nervous system: Pain (23%)
Endocrine & metabolic: Hyponatremia (29% to 47%), hypomagnesemia (29% to 43%), hypocalcemia (22% to 31%), hypokalemia (20% to 28%)
Gastrointestinal: Vomiting (65% to 81%), abdominal pain (17%), nausea (without vomiting: 10% to 15%)
Hematologic: Myelosuppression (dose related and dose limiting; nadir at ~21 days with single-agent therapy), anemia (71% to 90%; grades 3/4: 21%), leukopenia (85%; grades 3/4: 15% to 26%), neutropenia (67%; grades 3/4: 16% to 21%), thrombocytopenia (62%; grades 3/4: 25% to 35%)
Hepatic: Alkaline phosphatase increased (24% to 37%), AST increased (15% to 19%)
Neuromuscular & skeletal: Weakness (11%)
Renal: Creatinine clearance decreased (27%), BUN increased (14% to 22%)
Miscellaneous: Hypersensitivity/allergic reaction (2% to 16%)
1% to 10%:
Central nervous system: Neurotoxicity (5%)
Dermatologic: Alopecia (2% to 3%)
Gastrointestinal: Constipation (6%), diarrhea (6%), stomatitis/mucositis (1%), taste dysgeusia (1%)
Hematologic: Bleeding (5%), hemorrhagic complications (5%)
Hepatic: Bilirubin increased (5%)
Neuromuscular & skeletal: Peripheral neuropathy (4% to 6%)
Ocular: Visual disturbance (1%)
Otic: Ototoxicity (1%)
Renal: Creatinine increased (6% to 10%)
Miscellaneous: Infection (5%)
<1%, postmarketing, and/or case reports (limited to important or life-threatening): Anaphylactic reaction, anorexia, bronchospasm, cardiac failure, cerebrovascular accident, dehydration, embolism, erythema, hemolytic anemia (acute), hemolytic uremic syndrome (HUS), hyper-/hypotension, injection site reactions (pain, redness, swelling), limb ischemia (acute), malaise, necrosis (associated with extravasation), neutropenic fever, pruritus, rash, secondary malignancies, urticaria, vision loss
Metabolism/Transport Effects
None known.
Drug Interactions
Aminoglycosides: May enhance the ototoxic effect of CARBOplatin. Especially with higher doses of carboplatin. Risk C: Monitor therapy
BCG: Immunosuppressants may diminish the therapeutic effect of BCG. Risk X: Avoid combination
Bexarotene: CARBOplatin may increase the serum concentration of Bexarotene. Risk C: Monitor therapy
Bexarotene (Systemic): CARBOplatin may increase the serum concentration of Bexarotene (Systemic). Risk C: Monitor therapy
CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for agranulocytosis may be increased. Risk X: Avoid combination
Coccidioidin Skin Test: Immunosuppressants may diminish the diagnostic effect of Coccidioidin Skin Test. Risk C: Monitor therapy
Denosumab: May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. Risk C: Monitor therapy
Echinacea: May diminish the therapeutic effect of Immunosuppressants. Risk D: Consider therapy modification
Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Risk D: Consider therapy modification
Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Risk X: Avoid combination
Pimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Risk X: Avoid combination
Roflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Risk D: Consider therapy modification
Sipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Risk C: Monitor therapy
SORAfenib: May enhance the adverse/toxic effect of CARBOplatin. Management: Concurrent sorafenib with carboplatin and paclitaxel in patients with squamous cell lung cancer is contraindicated. Use in other settings is not specifically contraindicated but should be approached with added caution. Risk X: Avoid combination
Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Risk X: Avoid combination
Taxane Derivatives: Platinum Derivatives may enhance the myelosuppressive effect of Taxane Derivatives. Administer Taxane derivative before Platinum derivative when given as sequential infusions to limit toxicity. Risk D: Consider therapy modification
Topotecan: Platinum Derivatives may enhance the adverse/toxic effect of Topotecan. Risk D: Consider therapy modification
Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Risk C: Monitor therapy
Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Risk C: Monitor therapy
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Vaccinial infections may develop. Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Risk X: Avoid combination
Ethanol/Nutrition/Herb Interactions
Herb/Nutraceutical: Avoid black cohosh, dong quai in estrogen-dependent tumors.
Storage
Store intact vials at room temperature at 20°C to 25°C (68°F to 77°F). Protect from light. Further dilution to a concentration as low as 0.5 mg/mL is stable at room temperature (25°C) for 8 hours in NS or D5W. Stability has also been demonstrated for dilutions in D5W in PVC bags at room temperature for 9 days (Benaji, 1994); however, the manufacturer recommends use within 8 hours due to lack of preservative.
Reconstitution
Powder for reconstitution: Reconstitute powder with SWFI, D5W, or NS to yield a final concentration of 10 mg/mL). According to the manufacturer's labeling, reconstituted solution can be further diluted to concentrations as low as 0.5 mg/mL in NS or D5W; however, most clinicians generally dilute dose in 100 mL to 250 mL of NS or D5W.
Solution for injection: Manufacturer's labeling states solution can be further diluted to concentrations as low as 0.5 mg/mL in NS or D5W; however, most clinicians generally dilute dose in either 100 mL or 250 mL of NS or D5W.
Concentrations used for desensitization vary based on protocol.
Use appropriate precautions for handling and disposal. Needles or I.V. administration sets that contain aluminum should not be used in the preparation or administration of carboplatin; aluminum can react with carboplatin resulting in precipitate formation and loss of potency.
Compatibility
Stable in D51/4NS, D51/2NS, D5NS, D5W, NS.
Y-site administration: Compatible: Allopurinol, amifostine, anidulafungin, aztreonam, caspofungin, cefepime, cladribine, doripenem, doxorubicin liposomal, etoposide phosphate, filgrastim, fludarabine, gemcitabine, granisetron, linezolid, melphalan, micafungin, ondansetron, oxaliplatin, paclitaxel, palonosetron, pemetrexed, piperacillin/tazobactam, propofol, sargramostim, teniposide, thiotepa, topotecan, vinorelbine. Incompatible: Amphotericin B cholesteryl sulfate complex.
Mechanism of Action
Carboplatin is a platinum compound alkylating agent which covalently binds to DNA; interferes with the function of DNA by producing interstrand DNA cross-links
Pharmacodynamics/Kinetics
Distribution: Vd: 16 L (based on a dose of 300-500 mg/m2); into liver, kidney, skin, and tumor tissue
Protein binding: Carboplatin: 0%; Platinum (from carboplatin): Irreversibly binds to plasma proteins
Metabolism: Minimally hepatic to aquated and hydroxylated compounds
Half-life elimination: Clcr >60 mL/minute: Carboplatin: 2.6-5.9 hours (based on a dose of 300-500 mg/m2); Platinum (from carboplatin): ≥5 days
Excretion: Urine (~70% as carboplatin within 24 hours; 3% to 5% as platinum within 1-4 days)
Dosage
Details concerning dosing in combination regimens should also be consulted. Note: Doses for adults are commonly calculated by the target AUC using the Calvert formula, where Total dose (mg) = Target AUC x (GFR + 25). If estimating glomerular filtration rate (GFR) instead of a measured GFR, the Food and Drug Administration (FDA) recommends that clinicians consider capping estimated GFR at a maximum of 125 mL/minute to avoid potential toxicity.
Children: I.V.:
Glioma (unlabeled use): 175 mg/m2 weekly for 4 weeks every 6 weeks, with a 2-week recovery period between courses (in combination with vincristine) (Packer, 1997)
Neuroblastoma, localized and unresectable (unlabeled use): Children ≥10 kg: 200 mg/m2/day days 1, 2, and 3 every 21 days for 2 cycles (in combination with etoposide for 2 cycles then followed by cyclophosphamide, doxorubicin and vincristine) (Rubie, 1998) or Children <1 year: 6.6 mg/kg/day days 1, 2, and 3 (in combination with etoposide for 2 cycles, then followed by cyclophosphamide, doxorubicin, and vincristine) (Rubie, 2001)
Sarcomas: Ewing's sarcoma, osteosarcoma (unlabeled uses): 400 mg/m2/day for 2 days every 21 days (in combination with ifosfamide and etoposide) (van Winkle, 2005)
Adults: I.V.:
Ovarian cancer, advanced: 360 mg/m2 every 4 weeks (as a single agent) or 300 mg/m2 every 4 weeks (in combination with cyclophosphamide) or Target AUC 4-6 (single agent; in previously-treated patients)
Unlabeled dosing: Target AUC 5-7.5 every 3 weeks (in combination with paclitaxel) (Ozols, 2003; Parmar, 2003) or Target AUC 5 every 3 weeks (in combination with docetaxel) (Vasey, 2004)
Bladder cancer (unlabeled use): Target AUC 5 every 3 weeks (in combination with gemcitabine and paclitaxel) (Hainsworth, 2005) or Target AUC 5 every 3 weeks (in combination with gemcitabine) (Bamias, 2006) or Target AUC 6 every 3 weeks (in combination with paclitaxel) (Vaughn, 2002)
Breast cancer, metastatic (unlabeled use): Target AUC 6 every 3 weeks (in combination with trastuzumab and paclitaxel) (Robert, 2006) or Target AUC 6 every 3 weeks (in combination with trastuzumab and docetaxel) (Pegram, 2004)
Cervical cancer, recurrent or metastatic (unlabeled use): Target AUC 5 every 3 weeks (in combination with paclitaxel) (Pectasides, 2009) or Target AUC 5-6 every 4 weeks (in combination with paclitaxel) (Tinker, 2005) or 400 mg/m2 every 28 days (as a single agent) (Weiss, 1990)
Endometrial cancer (unlabeled use): Target AUC 5 every 3 weeks (in combination with paclitaxel) (Pectasides, 2008) or Target AUC 2 on days 1, 8, and 15 every 28 days (in combination with paclitaxel) (Secord, 2007)
Esophageal cancer (unlabeled use): Target AUC 2 on days 1, 8, 15, 22, and 29 for 1 cycle (in combination with paclitaxel) (van Meerten, 2006) or Target AUC 5 every 3 weeks (in combination with paclitaxel) (El-Rayes, 2004)
Head and neck cancer (unlabeled use): Target AUC 5 every 3 weeks (in combination with cetuximab) (Chan, 2005) or Target AUC 5 every 3 weeks (in combination with cetuximab and fluorouracil) (Vermorken, 2008) or 300 mg/m2 every 4 weeks (in combination with fluorouracil) (Forastiere, 1992) or Target AUC 6 every 3 weeks (in combination with paclitaxel) (Clark, 2001)
Hodgkin's lymphoma, relapsed or refractory (unlabeled use): Target AUC 5 (maximum dose 800 mg) for 2 cycles (in combination with ifosfamide and etoposide) (Moskowitz, 2001)
Malignant pleural mesothelioma (unlabeled use): Target AUC 5 every 3 weeks (in combination with pemetrexed) (Castagneto, 2008; Ceresoli, 2006)
Melanoma, advanced or metastatic (unlabeled use): Target AUC 2 on days 1, 8, and 15 every 4 weeks (in combination with paclitaxel) (Rao, 2006)
Non-Hodgkin's lymphomas, relapsed or refractory (unlabeled use): Target AUC 5 (maximum dose 800 mg) per cycle for 3 cycles (in combination with rituximab, ifosfamide and etoposide) (Kewalramani, 2004)
Nonsmall cell lung cancer (unlabeled use): Target AUC 6 every 3 weeks (in combination with paclitaxel) (Schiller, 2002; Strauss, 2008) or Target AUC 6 every 3 weeks (in combination with bevacizumab and paclitaxel) (Sandler, 2006) or Target AUC 5 every 3 weeks (in combination with pemetrexed) (Gronberg, 2009) or in combination with radiation therapy and paclitaxel (Belani, 2005):
Target AUC 6 every 3 weeks for 2 cycles or
Target AUC 6 every 3 weeks for 2 cycles; then target AUC 2 weekly for 7 weeks or
Target AUC 2 every week for 7 weeks; then target AUC 6 every 3 weeks for 2 cycles
Sarcomas: Ewing's sarcoma, osteosarcoma (unlabeled uses): 400 mg/m2/day for 2 days every 21 days (in combination with ifosfamide and etoposide) (van Winkle, 2005)
Small cell lung cancer (unlabeled use): Target AUC 6 every 3 weeks (in combination with etoposide) (Skarlos, 2001) or Target AUC 5 every 3 weeks (in combination with irinotecan) (Hermes, 2008) or Target AUC 5 every 28 days (in combination with irinotecan) (Schmittel, 2006)
Testicular cancer (unlabeled use): Target AUC 7 as a one-time dose (Oliver, 2011) or 700 mg/m2/day for 3 days beginning 5 days prior to peripheral stem cell infusion (in combination with etoposide) for 2 cycles (Einhorn, 2007)
Thymic malignancies (unlabeled use): Target AUC 5 every 3 weeks (in combination with paclitaxel) (Lemma, 2008)
Unknown primary adenocarcinoma (unlabeled use): Target AUC 6 every 3 weeks (in combination with paclitaxel) (Briasoulis, 2000) or Target AUC 6 every 3 weeks (in combination with docetaxel) (Greco, 2000) or Target AUC 6 every 3 weeks (in combination with paclitaxel and etoposide) (Hainsworth, 2006) or Target AUC 5 every 3 weeks (in combination with paclitaxel and gemcitabine) (Greco, 2002)
Elderly: The Calvert formula should be used to calculate dosing for elderly patients.
Dosage adjustment for toxicity: Platelets <50,000 cells/mm3 or ANC <500 cells/mm3: Administer 75% of dose
Dosing adjustment in renal impairment: Note: Dose determination with Calvert formula uses GFR and, therefore, inherently adjusts for renal dysfunction.
The manufacturer's labeling recommends the following dosage adjustment guidelines for single-agent therapy: Adults:
Baseline Clcr 41-59 mL/minute: Initiate at 250 mg/m2 and adjust subsequent doses based on bone marrow toxicity
Baseline Clcr 16-40 mL/minute: Initiate at 200 mg/m2 and adjust subsequent doses based on bone marrow toxicity
Baseline Clcr ≤15 mL/minute: No guidelines are available.
The following dosage adjustments have been used by some clinicians:
Aronoff, 2007:
Children:
GFR <50 mL/minute: Use Calvert formula incorporating patient's GFR
Hemodialysis, peritoneal dialysis, continuous renal replacement therapy (CRRT): Use Calvert formula incorporating patient's GFR
Adults (Note: For dosing based on mg/m2):
GFR >50 mL/minute: No dosage adjustment necessary
GFR 10-50 mL/minute: Administer 50% of the dose
GFR <10 mL/minute: Administer 25% of the dose
Hemodialysis: Administer 50% of dose
Continuous ambulatory peritoneal dialysis (CAPD): Administer 25% of dose
Continuous renal replacement therapy (CRRT): 200 mg/m2
Janus, 2010: Hemodialysis: Carboplatin dose (mg) = Target AUC x 25; administer on a nondialysis day, hemodialysis should occur between 12-24 hours after carboplatin dose
Dosing adjustment in hepatic impairment: No dosage adjustment provided in manufacturer's labeling; however, carboplatin undergoes minimal hepatic metabolism therefore dosage adjustment may not be needed.
Dosage: Combination Regimens
Bladder cancer:
Gemcitabine-Carboplatin (Bladder Cancer)
Paclitaxel-Carboplatin (Bladder Cancer)
Paclitaxel-Carboplatin-Gemcitabine
Breast cancer:
Docetaxel-Trastuzumab-Carboplatin
Trastuzumab-Paclitaxel-Carboplatin
Cervical cancer: Carboplatin-Paclitaxel (Cervical Cancer)
Esophageal cancer: Paclitaxel-Carboplatin (Esophageal Cancer)
Head and neck cancer:
Carboplatin-Cetuximab (Head and Neck Cancer)
Cetuximab-Carboplatin-Fluorouracil (Head and Neck Cancer)
Fluorouracil-Carboplatin (Head and Neck Cancer)
Lung cancer (nonsmall cell):
Carbo-Tax (NSCLC)
CaT (NSCLC)
EC (NSCLC)
Gemcitabine-Carboplatin (NSCLC)
Paclitaxel-Carboplatin-Bevacizumab
PC (NSCLC)
Lung cancer (small cell):
Carboplatin-Irinotecan (Small Cell Lung Cancer)
EC (Small Cell Lung Cancer)
Lymphoma, Hodgkin: ICE (Hodgkin)
Lymphoma, non-Hodgkin's:
ICE (Lymphoma, non-Hodgkin's)
RICE
Malignant pleural mesothelioma: Carboplatin-Pemetrexed (Mesothelioma)
Neuroblastoma: CE-CAdO (Neuroblastoma)
Osteosarcoma: ICE (Sarcoma)
Ovarian cancer:
Carboplatin-Paclitaxel (Ovarian Cancer)
Docetaxel-Carboplatin (Ovarian Cancer)
Etoposide-Carboplatin (Ovarian Cancer)
Gemcitabine-Carboplatin (Ovarian Cancer)
Prostate cancer:
Estramustine + Docetaxel + Carboplatin
Paclitaxel + Estramustine + Carboplatin
Retinoblastoma:
Carboplatin-Etoposide (Retinoblastoma)
Carboplatin-Etoposide-Vincristine (Retinoblastoma)
Carboplatin-Vincristine (Retinoblastoma)
Rhabdomyosarcoma: CEV
Sarcoma, soft tissue: ICE (Sarcoma)
Unknown primary, adenocarcinoma:
Carboplatin-Paclitaxel (Unknown Primary)
Docetaxel-Carboplatin (Unknown Primary)
Paclitaxel-Carboplatin-Etoposide (Unknown Primary)
Paclitaxel-Carboplatin-Gemcitabine (Unknown Primary)
Administration: I.V.
Usually infused over 15-60 minutes, although some protocols may require infusions up to 24 hours. When administered as sequential infusions, taxane derivatives (docetaxel, paclitaxel) should be administered before platinum derivatives to limit myelosuppression and to enhance efficacy.
Needles or I.V. administration sets that contain aluminum should not be used in the preparation or administration of carboplatin; aluminum can react with carboplatin resulting in precipitate formation and loss of potency.
Monitoring Parameters
CBC (with differential and platelet count), serum electrolytes, serum creatinine and BUN, creatinine clearance, liver function tests; audiology evaluations (children <6 months of age)
Patient Education
This medicine can only be administered intravenously. Report immediately any redness, burning, pain, or swelling at infusion site. It is important that you maintain adequate nutrition and hydration, unless instructed to restrict fluid intake. You will be susceptible to infection. May cause nausea, vomiting, mouth sores, or loss of hair (reversible). Report chest pain or palpitations; sore throat, fever, chills, unusual fatigue; unusual bruising/bleeding; respiratory difficulty; numbness, pain, or tingling in extremities; muscle cramps or twitching; or change in hearing acuity.
Geriatric Considerations
Peripheral neuropathy and severe thrombocytopenia are more frequent in patients >65 years of age.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Stomatitis, mucositis, and taste dysgeusia.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
None reported
Mental Health: Effects on Psychiatric Treatment
May cause myelosuppression; use caution with clozapine and carbamazepine
Nursing: Physical Assessment/Monitoring
Assess patient allergy history prior to therapy and note specific use cautions (eg, bone marrow suppression and renal function). Assess other drugs patient may be taking for potential interactions (especially products that may be ototoxic or nephrotoxic and need for sequencing with taxane derivatives). Assess hematology, electrolytes, and renal and hepatic function tests prior to treatment and on a regular basis during therapy. Monitor for nausea and vomiting (pretreatment with antiemetic may be required), ototoxicity (audiometry may be advisable), bone marrow depression, anemia, bleeding, and peripheral neuropathy.
Oncology: Emetic Potential
Moderate (30% to 90%)
Oncology: Vesicant
May be an irritant
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Injection, powder for reconstitution: 50 mg [DSC], 150 mg [DSC], 450 mg [DSC]
Injection, solution: 10 mg/mL (5 mL [DSC], 15 mL [DSC], 45 mL [DSC], 60 mL [DSC])
Injection, solution [preservative free]: 10 mg/mL (5 mL, 15 mL, 45 mL, 60 mL)
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