Cisplatin Injection

Cisplatin Injection is a platinum-based IV chemotherapy approved for three cancer types. The specific use depends on the cancer and whether cisplatin is given alone or combined with other drugs.

• Metastatic testicular tumors: Used in combination with other approved chemotherapy drugs in patients who have already undergone surgery and/or radiation therapy.
• Metastatic ovarian tumors (combination therapy): Used alongside cyclophosphamide (and other approved agents) in patients who have already had surgery and/or radiation.
• Metastatic ovarian tumors (single agent): Used alone as a secondary (second-line) treatment when standard chemotherapy has not worked and the patient has not previously received cisplatin.
• Advanced bladder cancer: Used alone for transitional cell bladder cancer that can no longer be treated with surgery or radiation therapy.

Cisplatin works by entering cancer cells and binding directly to their DNA — the genetic blueprint the cell needs to divide and survive. It forms abnormal cross-links within and between DNA strands, which physically blocks the cell from replicating its DNA or making the proteins it needs. This damage triggers the cancer cell to die.

Unlike most drugs, cisplatin is not broken down by enzymes in the body. Instead, it undergoes chemical reactions with water and other molecules, which contributes to both its cancer-fighting action and its side effects in healthy tissues.

Cisplatin Injection is given intravenously (into a vein) by slow infusion — never as a fast injection. It is given in treatment cycles that repeat every few weeks, with the exact schedule depending on the cancer type and whether it is used alone or with other drugs. Before each dose, patients receive intravenous fluids for 8–12 hours to protect the kidneys, and anti-nausea medicines are given beforehand to manage severe nausea and vomiting.

• Adequate hydration and urine output must be maintained for 24 hours after each dose.
• A new cycle cannot begin until kidney function, blood counts, and hearing have been checked and are at acceptable levels.
• Follow your prescriber's schedule exactly — do not adjust timing or frequency on your own.

Cisplatin causes a wide range of side effects; some are very common, and some require urgent attention.

Serious reactions to report immediately include signs of severe allergic reaction (swelling, wheezing, rapid heartbeat, sudden low blood pressure), signs of infection during low blood count periods, worsening nerve symptoms, significant hearing changes, and vision problems including sudden vision loss.

Cisplatin's most critical risks are kidney damage, bone marrow suppression, nerve damage, and hearing loss — all of which worsen with repeated doses. Kidney damage can be severe enough to cause acute kidney failure; close monitoring and aggressive hydration before and after every dose are essential. Bone marrow suppression can make infections life-threatening, so blood counts are checked before every cycle.

• Kidney toxicity: Cumulative and dose-related; patients with existing kidney problems are especially vulnerable and may need dose reductions or a different treatment.
• Peripheral neuropathy: Can start after just one dose, may appear weeks after the last dose, and may be irreversible. Treatment may need to stop if symptoms worsen.
• Hearing loss (ototoxicity): Cumulative and potentially permanent; especially severe in children under 5. Hearing tests are required before and throughout treatment.
• Severe allergic reactions: Can occur within minutes of infusion; emergency medications must be available during every infusion.
• Ocular toxicity: Optic nerve damage, papilledema (swelling around the optic nerve), and blindness have been reported.
• Secondary leukemia: Rare cases of acute leukemia have been reported, usually when cisplatin was combined with other chemotherapy drugs.
• Embryo-fetal harm: Cisplatin can seriously harm an unborn baby. Effective contraception is required during and for many months after treatment for both men and women.
• Injection site reactions: Cisplatin can damage surrounding tissue if it leaks outside the vein (extravasation); the infusion site must be monitored closely during every infusion.

Cisplatin can interact with several drugs, increasing the risk of serious side effects or reducing treatment effectiveness.

• Aminoglycoside antibiotics (e.g., gentamicin, tobramycin): Increase the risk of kidney damage when used alongside cisplatin.
• Other nephrotoxic drugs: Any drug that strains the kidneys can add to cisplatin's kidney toxicity risk.
• Ototoxic drugs (e.g., aminoglycosides, vancomycin): Combined use raises the risk and severity of hearing loss.
• Anticonvulsant (anti-seizure) medicines: Cisplatin can lower the blood levels of these drugs, making seizure control less reliable — monitoring and dose adjustments may be needed.
• Pyridoxine (vitamin B6) with altretamine and cisplatin: This combination was shown to shorten how long ovarian cancer responds to treatment.

Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.

• Do not use cisplatin if you already have kidney impairment, significant hearing loss, or severely low blood counts — these are contraindications.
• Do not use if you have ever had a serious allergic reaction to cisplatin or any other platinum-based drug (such as carboplatin or oxaliplatin).
• Tell your doctor if you are pregnant — cisplatin has been shown to cause fetal harm including growth restriction, premature birth, and neonatal hearing loss. Breastfeeding is not recommended during treatment.
• Both female and male patients of reproductive age must use reliable contraception during treatment and for an extended period after the last dose (as directed by their doctor).
• Cisplatin can affect fertility in both men and women; discuss this with your doctor before starting treatment if it is a concern.
• Older adults face higher risks of kidney damage, nerve damage, and severe low blood counts — dose selection and monitoring require extra care.
• Children, especially those under 5 years old, are at the highest risk for hearing loss; hearing tests must be performed before, during, and for years after treatment.
• Tell your doctor about all medications you take, including antibiotics, anti-seizure drugs, and any supplements.

An overdose of cisplatin can cause severe kidney failure, liver failure, significant hearing and vision loss, dangerous bone marrow suppression, and serious nerve damage — and can be fatal. If an overdose is suspected, the focus is on supportive care, particularly aggressive intravenous hydration to protect the kidneys. Contact the National Poison Control Center at 1-800-222-1222 or go to the emergency room immediately.

Cisplatin exerts its effects by forming tight, abnormal cross-links within and between DNA strands inside cancer cells. These cross-links block normal DNA transcription (reading the genetic code) and replication (copying DNA before cell division), ultimately triggering the cancer cell to die. The platinum component of cisplatin also binds to various proteins in the body, which contributes to its wide tissue distribution and to many of its side effects — including kidney and nerve damage.

After an IV infusion, cisplatin itself is cleared from the blood quickly, with a half-life of about 20–30 minutes. However, the platinum it releases binds tightly to blood proteins and remains in the body much longer — the protein-bound platinum has a half-life of 5 days or more, and platinum can be detected in body tissues up to 180 days after the last dose. The kidneys are the primary route of elimination; cisplatin is actively secreted by the kidney tubules, which is why kidney damage is such a significant risk. Cisplatin does not rely on liver enzymes for metabolism — instead it undergoes direct chemical reactions with water and sulfur-containing molecules in the body.

Store at 20° to 25°C (68° to 77°F). Do not refrigerate. Protect from light.