CARBOplatin

Appearance:

Clear, colourless solution

mixed into larger bags of fluids

Monograph Name:

carboplatin

Monograph Body:

Drug Monograph

A - Drug Name

CARBOplatin

B - Mechanism of Action and Pharmacokinetics

Carboplatin is a cisplatin derivative and shares the same mechanism of action. Highly reactive platinum complexes are formed intracellularly. These complexes inhibit DNA synthesis through covalent binding of DNA molecules to form intrastrand and interstrand DNA crosslinks. Carboplatin is considered to be cell cycle phase-nonspecific, but recent studies have shown complex and variable effects on the cell cycle.

Absorption

Intraperitoneal: 65% after a 4-hour dwell period.

Distribution

Widely distributed, highest concentration in liver, kidney and skin. Pharmacokinetics are dose proportional. No apparent accumulation with repeated daily dosing, after 4 days.

Cross blood brain barrier?

Yes; Low concentrations

PPB

87% within 24 h (platinum-containing products)

Metabolism

Carboplatin is hydrolyzed to aquated and hydroxylated compounds

Active metabolites

Platinum complexes

Inactive metabolites

No information found

Elimination

Primarily renal via glomerular filtration, clearance correlates with glomerular filtration rate.

Urine

70% as carboplatin

Half-life

total plasma platinum: 24 hours

Half-life

free plasma platinum: 6 hours

Half-life

carboplatin: 1.5 hours

Half-life

total platinum from erythrocytes: 12 days

C - Indications and Status

Health Canada Approvals:

For the treatment of ovarian cancer of epithelial origin in first-line therapy or second-line therapy after other treatments have failed.

Other Uses:

Brain and CNS tumours
Breast cancer
Neuroendocrine Tumours
Bladder cancer
Gynecological cancers: endometrial, fallopian tube, cervical, vulvar, primary peritoneal, sarcoma
Lung cancer: small cell, non-small cell
Testicular cancer
Anal cancer
Colorectal cancer
Gastroesophageal cancer
Hepatobiliary cancer
Pancreatic cancer
Prostate cancer
Head and Neck cancer
Mesothelioma
Thymoma
Thyroid cancer
Melanoma
Merkel cell cancer
Cancer of unknown primary origin
Cutaneous squamous cell cancer
Part of combination therapy for lymphomas

D - Adverse Effects

Emetogenic Potential:

Moderate + NK1 antagonist (Carboplatin AUC ≥ 5)
Moderate (Carboplatin AUC < 5)

Extravasation Potential: None

The following table contains adverse effects reported with single agent carboplatin in the product monograph. It also includes severe, life-threatening and post-marketing adverse effects from other sources.

ORGAN SITE	SIDE EFFECT* (%)	ONSET**
Auditory	Hearing impaired (15%)	E
	Tinnitus (1%)	E
Cardiovascular	Arterial thromboembolism (rare)	E
	Venous thromboembolism (rare)	E
Dermatological	Alopecia (2%)	E
Gastrointestinal	Constipation (3%)	E
	Diarrhea (6%)	E
	Nausea, vomiting (53%)	I
General	Fatigue (11%) (may be severe)	E
	Flu-like symptoms (1%)	E
Hematological	Hemolytic anemia (rare)	E
	Hemolytic uremic syndrome (rare)	E
	Myelosuppression ± infection, bleeding (59%)	E
Hepatobiliary	↑ LFTs (16%) (AST; transient)	L
	Veno-occlusive disease (rare)	E
Hypersensitivity	Hypersensitivity (<2%)	I
Injection site	Injection site reaction (<1%)	I
Metabolic / Endocrine	Abnormal electrolyte(s) (≤37%) (↓Mg 37% ↓K 16%, ↓Ca 5%, ↓Na; may be severe)	E
	Tumor lysis syndrome (rare)	E
Neoplastic	Secondary malignancy (rare)	L
Nervous System	Dysgeusia (<1%)	E
	Encephalopathy (rare)	E
	Other (5%) (CNS symptoms)	E
	Peripheral neuropathy (6%)	E
Ophthalmic	Other (1%) Visual disturbances	E
Renal	↑ BUN (16%)	E
	Creatinine increased (7%)	E
	Nephrotoxicity (25%) (may be severe)	E

* "Incidence" may refer to an absolute value or the higher value from a reported range.
"Rare" may refer to events with < 1% incidence, reported in post-marketing, phase 1 studies,
isolated data or anecdotal reports.

** I = immediate (onset in hours to days) E = early (days to weeks)
D = delayed (weeks to months) L = late (months to years)

The most common side effects for CARBOplatin include myelosuppression ± infection, bleeding, nausea, vomiting, abnormal electrolyte(s), nephrotoxicity, ↑ LFTs, ↑ BUN, hearing impairment and fatigue.

Myelosuppression is dose-limiting, especially thrombocytopenia. Myelosuppression may be more pronounced than with cisplatin. Patients with renal dysfunction, receiving nephrotoxic drugs, with poor performance status, the elderly or with prior exposure to cisplatin may experience more prolonged and severe myelosuppression. Anemia may be cumulative and transfusions may be required.

Nausea and vomiting usually occur within 6 to 12 hours after administration and may persist for up to 24 hours or longer. Incidence and severity of vomiting may be reduced by prophylactic antiemetics.

Nephrotoxicity is not usually dose-limiting and does not usually require hydration or forced diuresis. Nephrotoxicity is less common and severe than that associated with cisplatin. Decreases in serum electrolytes including magnesium, potassium and calcium have not been reported to be severe enough to cause clinical signs or symptoms, nor require routine supplementation.

Neurotoxicity is usually limited to paresthesia and decreased deep tendon reflexes, although visual changes and ototoxicity may occur. The incidence and severity of neurotoxicity are less with carboplatin than with cisplatin but severity increases in patients on prolonged therapy, who were previously treated with cisplatin or other nephrotoxic drugs and in elderly patients. Visual disturbances including vision loss has been reported rarely; this is usually reversible when carboplatin is discontinued.

Infusion reactions have been reported in up to 2% of patients who recently started treatment and are receiving carboplatin alone, in 10-12% when given with other agents, and in > 40% of patients who have received several lines of treatment. They vary from mild to severe and may occur within minutes after administration. Reactions are similar to other platinum agents and include rash, fever, pruritis and anaphylaxis. Risk of reaction is increased in patients with previous exposure to platinum therapy; however, exact cross sensitivity with other platinum agents is not known. With appropriate precautions (eg. desensitization and/or antihistamine/steroid prophylaxis etc.) patients with hypersensitivity to carboplatin may tolerate retreatment or switch to other platinum agents; however, recurrent reactions can still occur in some patients and may be severe.

Secondary malignancies: Acute promyelocytic leukemia (APL) and myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) have been reported years after use of combination treatment.

E - Dosing

Refer to protocol by which patient is being treated. Numerous dosing schedules exist and depend on disease, response and concomitant therapy.

Guidelines for dosing also include consideration of myelosuppression. Dosage may be reduced and/or delayed in patients with bone marrow depression due to cytotoxic/radiation therapy, in the elderly or in patients with poor performance status.

Pre-medications (prophylaxis for infusion reactions):

There is insufficient evidence that routine prophylaxis with pre-medications reduce infusion reaction (IR) rates.
Corticosteroids and H1-receptor antagonists ± H2-receptor antagonists may reduce IR rates for some patients (e.g. gynecological patients with a PFI >12 months or a history of drug allergy who are receiving carboplatin starting from the 7th cycle) but no optimal pre-medication regimen has been established.

Adults:

Carboplatin dosing by BSA does not take into account renal function, which may result in overdosing (i.e. in patients with poor renal function) or underdosing (i.e. in patients with above average renal function). Alternative methods that consider the area under the curve (AUC) and the direct relationship between glomerular filtration and carboplatin clearance are more commonly used to calculate carboplatin dose.

Calvert Formula:

Dose (mg) = Target AUC (mg/mL per min) x [CrCl† (mL/min) + 25]

(See "References - Appendix" section)

†Note: Serum creatinine measured by Isotope Diluted Mass Spectrometry (IDMS) is a standardized and more accurate measure of creatinine compared to older laboratory methods, which overestimated serum creatinine values when values were low. However, the IDMS method generally produces lower serum creatinine levels in patients with normal renal function, which could result in an overestimation of the calculated creatinine clearance (CrCl) and the estimated GFR, in these patients, compared to previous methods. A Calvert formula-calculated carboplatin dose, based on estimated GFR using IDMS serum creatinine, could be higher than desired and result in increased toxicity.

To avoid toxicity, FDA recommends capping the carboplatin dose for a desired AUC. The maximum dose is based on a capped GFR estimate at 125 mL/min for patients with normal renal function:

Maximum Carboplatin Dose (mg) = target AUC (mg/mL per min) x (125 mL/min + 25)

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

(See FDA communication on carboplatin dosing)

Dosage with Toxicity:

Modify according to protocol by which patient is being treated.

Below are suggested dose modifications.

Toxicity / Counts (x 10⁹/L)	Dose Modification
ANC < 1.5 but ≥ 0.5 and/or Platelets < 100 but ≥ 25	Hold^#; may consider dose ↓ at restart
Febrile Neutropenia OR ANC < 0.5 for ≥ 5-7 days OR Platelets < 25	Hold^# Restart by ↓ 25%
Grade 3 related organ / non-hematologic	Hold^# Restart by ↓ 25%
Grade 4 related organ / non- hematologic	Discontinue

^#_{Do not retreat unless platelets ≥ 100 x 10⁹/L, ANC ≥ 1.5 x 10⁹/L and toxicities have recovered to ≤ grade 2.}

Management of Infusion-related reactions:

Also refer to the CCO guideline for detailed description of Management of Cancer Medication-Related Infusion Reactions.

There is insufficient evidence that routine prophylaxis with extended infusion reduces IR rates.

Grade

Management

Re-challenge

1 or 2

Stop or slow the infusion rate.
Manage the symptoms.

Restart:

After symptom resolution, restart with pre-medications ± reduced infusion rate.

There is evidence that re-challenging with cisplatin after carboplatin reaction can be a viable option.
However: exact cross reactivity between platinum agents is not known, but can be as high as 25%.
Consider pre-medications* and infusing at a reduced infusion rate prior to re-challenge
May consider adding oral montelukast ± oral acetylsalicylic acid

3 or 4

Stop treatment.
Aggressively manage symptoms.

Re-challenge is discouraged, especially if vital signs have been affected.
Consider desensitization if therapy is necessary.

* Up to 50% of patients can experience recurrent reactions during re-challenge despite using pre-medications (e.g. corticosteroid and H1/H2-receptor antagonist

Dosage with Hepatic Impairment:

No dose adjustment required.

Dosage with Renal Impairment:

Creatinine Clearance (ml/min)

Carboplatin

(% previous dose)

20 - 50

Use Calvert formula

< 20

Discontinue

Dosage in the elderly:

Caution should be exercised and dose reduction considered as elderly patients may have reduced renal function, more severe myelosuppression and neuropathy.

Children:

Safety and efficacy have not been systematically studied.

F - Administration Guidelines

Mix in 100mL to 250mL bag (5% Dextrose or Normal Saline); infuse IV over 15 to 60 minutes.
There is insufficient evidence that routine prophylaxis with extended infusion reduces IR rates.
Incompatible with sets, needles or syringes containing aluminum – leads to precipitation and loss of potency.
Protect from light.

Also refer to the CCO guideline for detailed description of Management of Cancer Medication-Related Infusion Reactions.

G - Special Precautions

Contraindications:

Patients who have a severe allergic reaction to this drug or other platinum-containing compounds
Patients with pre-existing severe renal impairment
Patients with severe myelosuppression or bleeding tumours

Other Warnings/Precautions:

Patients with abnormal renal function or who are receiving concomitant nephrotoxic drugs
Patients who have received extensive prior treatment, have poor performance status and those over 65 years of age
Avoid live vaccines. Reduced immunogenicity may occur with the use of inactivated vaccines.

Other Drug Properties:

Carcinogenicity: Yes

Pregnancy and Lactation:

Embryotoxicity: Yes
Teratogenicity: Yes

Carboplatin is not recommended for use in pregnancy. Adequate contraception should be used by both sexes during treatment, and for at least 6 months after the last dose (general recommendation).
Excretion into breast milk: Probable
Breastfeeding is not recommended.
Fertility effects: Unknown

H - Interactions

AGENT	EFFECT	MECHANISM	MANAGEMENT
Aminoglycosides	Exacerbates nephro- and ototoxicity	Additive	Monitor
Phenytoin	↓ serum phenytoin level	possibly ↓ absorption or increased metabolism of phenytoin	Monitor serum phenytoin level; ↑ dose of phenytoin if necessary
Other nephrotoxic drugs	↑ incidence of renal dysfunction	Additive	Monitor closely
Warfarin	Risk of ↑ INR or bleeding	Unknown	Monitor INR and adjust warfarin dose accordingly

I - Recommended Clinical Monitoring

Treating physicians may decide to monitor more or less frequently for individual patients but should always consider recommendations from the product monograph.

Recommended Clinical Monitoring

Monitor Type	Monitor Frequency
Renal function tests, including electrolytes	Baseline and before each cycle
CBC	Baseline and before each cycle
Clinical toxicity assessment for neurotoxicity, ototoxicity, hypersensitivity, bleeding, infection, nausea and vomiting	At each visit

Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

Suggested Clinical Monitoring

Monitor Type	Monitor Frequency
Liver function tests	Baseline and as clinically indicated
INR	Baseline and as clinically indicated

K - References

Product Monograph: Carboplatin Injection BP. Pfizer Canada., December 31, 2018

Lexicomp drug monograph: Carboplatin. Access January 18, 2019.

Product Monograph: Carboplatin Injection. Novopharm Limited., November 16, 2004

Drug Monograph: Carboplatin. BC Cancer Agency Cancer Drug Manual. Revised January 1, 2014.

Calvert AH. Dose optimisation of carboplatin in adults. Anticancer Res 1994; 14(6A): 2273-8.

U.S. Food and Drug Administration, Center for Drug Evaluation and research. Carboplatin dosing. 10 October 2010

Markman M, Kennedy A, Webster K, et al. Clinical features of hypersensitivity reactions to carboplatin. J Clin Oncol 1999; 17: 1141-5.

McEvoy GK, editor. AHFS Drug Information 2011. Bethesda: American Society of Health-System Pharmacists, p. 963-71.

Micromedex 2.0. Truven Health Analytics Inc, 2014.

Product Monograph: Carboplatin Injection. Hospira Healthcare Corp., July 17, 2014.

Sliesoraitis S, Chikhale PJ. Carboplatin hypersensitivity. Int J Gynecol Cancer 2005; 15: 13-8.

van der Vijgh WJ. Clinical pharmacokinetics of carboplatin. Clin Pharmacokinet 1991;21(4)242-61.

Appendix:

Calvert Formula:

Dose (mg) = Target AUC (mg/mL per min) x {CrCl (mL/min)+ 25}

Refer to regimen for target AUC.

(see Creatinine Clearance Calculation)

_{Calvert AH, Newell DR, Gumbrell LA, et al. Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol 1989; 7: 1748-56.}

L - Disclaimer

Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.

The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

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Info Sheet Name:

carboplatin (patient)

Info Sheet Introduction:

For treating ovarian and other cancers.

Info Sheet Date: Tuesday, July 14, 2020 Info Sheet body:

Medication Information Sheet

CARBOplatin (KAR-boe-pla-tin)

This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Generic brand(s) available

Appearance:

Clear, colourless solution

mixed into larger bags of fluids

What is this medication for?

For treating ovarian and other cancers.

What should I do before I have this medication?

Tell your health care team if you have or had significant medical condition(s), such as:
- kidney problems
- hearing problems
- any allergies, especially to other similar drugs such as cisplatin or oxaliplatin

Remember to:

Tell your health care team about all of the other medications you are taking.
Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team

How will this medication affect sex, pregnancy and breastfeeding?

Talk to your health care team about:

How this treatment may affect your sexual health.
How this treatment may affect your ability to have a baby, if this applies to you.

This treatment may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.

If there is any chance of pregnancy happening, you and your partner together must:
- Use 2 effective forms of birth control at the same time until 6 months after your last treatment dose (general recommendation). Talk to your health care team about which birth control options are best for you.
Do not use hormonal birth control (such as birth control pills), unless your health care team told you that they are safe. Talk to your health care team about the safest birth control for you.
Do not breastfeed while on this treatment.

How is this medication given?

This drug is given through an IV (injected into a vein) . Talk to your health care team about your treatment schedule.

You may be given this treatment along with other medications to help prevent side effects or prevent a reaction.
If you missed your treatment appointment, talk to your health care team about what to do.

What else do I need to know while on this medication?

What should I do if I feel unwell, have pain, a headache or a fever?
- Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol) or ibuprofen (Advil)).
  - Fever can be a sign of infection that may need treatment right away.
  - If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.
How to check for fever:

Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).
- You have a fever if your temperature taken in your mouth (oral temperature) is:
  - 38.3°C (100.9°F) or higher at any time
    
    OR
  - 38.0°C (100.4°F) or higher for at least one hour.
If you do have a fever:
- Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
- Ask your health care team for the Fever pamphlet for more information.
If you do not have a fever but have mild symptoms such as headache or mild pain:
- Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.
- Talk to your health care team before you start taking Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.
- Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.
Will this medication interact with other medications or natural health products?
- This medication can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.
- Tell your health care team about all of your:
  - prescription and over-the-counter (non-prescription) medications and all other drugs, such as marijuana (medical or recreational)
  - natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements
- Check with your health care team before starting or stopping any of them.

If you take seizure medications (such as phenytoin), your health care team may monitor your blood levels closely and may change your dose.
If you are taking a blood thinner (such as warfarin), your health care team may need extra blood tests and may change your dose.

What to DO while on this medication:

DO drink plenty of fluids (unless you have been told otherwise) to prevent kidney problems. Drink at least 6 to 8 cups (2 Litres) of water or other liquids per day on your treatment day and for 1 -2 days afterwards, unless your healthcare team has told you to drink more or less.

DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.

DO talk to your health care team about your risk of getting other cancers and heart problems after this treatment.

What NOT to DO on this medication:

DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.

What are the side effects of this medication?

The following table lists side effects that you may have when getting carboplatin. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Refer to this table if you experience any side effects while on CARBOplatin.

Very Common Side Effects (50 or more out of 100 people)
Side effects and what to do	When to contact health care team
Low neutrophils (white blood cells) in the blood (neutropenia) (May be severe) When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information. What to look for? If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever. Do not take medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen). Do not eat or drink anything hot or cold right before taking your temperature. You have a fever if your temperature taken in your mouth (oral temperature) is: 38.3°C (100.9°F) or higher at any time OR 38.0°C (100.4°F) or higher for at least one hour. What to do? If your health care team has told you that you have low neutrophils: Wash your hands often to prevent infection. Check with your health care team before getting any vaccines, surgeries, medical procedures or visiting your dentist. Keep a digital thermometer at home so you can easily check for a fever. If you have a fever: If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.	If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away.
Low platelets in the blood (May be severe) When your platelets are low, you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information. What to look for? Watch for signs of bleeding: bleeding from your gums unusual or heavy nosebleeds bruising easily or more than normal black coloured stools (poo) or blood in your stools (poo) coughing up red or brown coloured mucus dizziness, constant headache or changes in your vision heavy vaginal bleeding red or pink coloured urine (pee) What to do? If your health care team has told you that you have low platelets: Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication. Check with your healthcare team before you go to the dentist. Take care of your mouth and use a soft toothbrush. Try to prevent cuts and bruises. Ask your health care team what activities are safe for you. Your treatment may have to be delayed if you have low platelets. Your health care team may recommend a blood transfusion. If you have signs of bleeding: If you have a small bleed, clean the area with soap and water or a saline (saltwater) rinse. Apply pressure for at least 10 minutes. If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away.	Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop or is severe (very heavy), you MUST get emergency help right away.
Nausea and vomiting What to look for? Nausea is feeling like you need to throw up. You may also feel light-headed. You may feel nausea within hours to days after your treatment. What to do? To help prevent nausea: It is easier to prevent nausea than to treat it once it happens. Take your anti-nausea medication(s) as prescribed, even if you do not feel like throwing up. Drink clear liquids and have small meals. Get fresh air and rest. Do not eat spicy, fried foods or foods with a strong smell. Limit caffeine (like coffee, tea) and avoid alcohol. If you have nausea or vomiting: Take your rescue (as-needed) anti-nausea medication(s) as prescribed. Ask your health care team for the Nausea & Vomiting pamphlet for more information. Talk to your health care team if: nausea lasts more than 48 hours vomiting lasts more than 24 hours or if it is severe	Talk to your health care team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if severe

Common Side Effects (25 to 49 out of 100 people)
Side effects and what to do	When to contact health care team
Too much or too little salt in your body What to look for? Muscle spasms, cramping, weakness, twitching, or convulsions. Irregular heartbeat, confusion or blood pressure changes. What to do? Get emergency medical help right away for severe symptoms.	Get emergency medical help right away for severe symptoms
Kidney problems (May be severe) Your health care team may check for proteins in your urine (pee) and your kidney function regularly with a blood test.You may have blood in your urine. What to look for? Swelling in your hands, ankles, feet or other areas of your body. Weight gain that is not normal for you. Pain in your lower back. Muscle twitches and cramps or itchiness that won't go away. Nausea (feeling like you need to throw up) and vomiting. Changes in urination (peeing) such as less urine than usual. What to do? If you have any of these signs, talk to your health care team or go to your closest emergency department. To prevent kidney infections: Drink at least 6 to 8 cups (2 litres) of water or other liquids per day unless your health care team has told you to drink more or less. When you feel the need to pee, go as soon as possible. Do not wait or hold in the pee.	Get emergency medical help right away

Less Common Side Effects (10 to 24 out of 100 people)
Side effects and what to do	When to contact health care team
Liver problems (Temporary) Your health care team may check your liver function with a blood test. The liver changes do not usually cause any symptoms. What to look for? Rarely, you may develop yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. This may be severe. What to do? If you have any symptoms of liver problems, get emergency medical help right away.	Get emergency medical help right away
Change in your hearing What to look for? Not being able to hear as well as before. New noise or ringing sounds in your ears. Changes in hearing usually go away over time. In some rare cases they may be permanent. What to do? Tell your health care team if you have any of these symptoms. Your health care team may need to change your medication.	Talk to your health care team as soon as possible
Fatigue What to look for? Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep. What to do? Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days. Check with your health care team before starting any new exercise. Pace yourself, do not rush. Put off less important activities. Rest when you need to. Ask family or friends to help you with things like housework, shopping, and child or pet care. Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your health care team has told you to drink more or less). Avoid driving or using machinery if you are feeling tired. Ask your health care team for the Fatigue pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe

Other rare, but serious side effects are possible.
If you experience ANY of the following, speak to your cancer health care provider or get emergency medical help right away:

Pain, hardening or swelling of a vein in your arm or leg
Shortness of breath, coughing up blood or pain in your chest or belly
Sudden loss of vision, speech, or the use of your limb(s)
Flushing, itchiness, rash, swollen lips, face or tongue or chest and throat tighness
Yellowing of your skin and/or eyes, red-brown pee or bruising easily
Tender (hurts to touch) right side of the belly or rapid weight gain
Tingling or numbness in your fingers or toes, having trouble doing up buttons, writing, picking up small objects, or pain / having trouble moving
Severe headache, fatigue or general weakness, loss of balance, confusion or vision changes

Who do I contact if I have questions or need help?

My cancer health care provider is: ______________________________________________

During the day I should contact:________________________________________________

Evenings, weekends and holidays:______________________________________________

Other Notes:

____________________________________________________________________________

For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

Info Sheet (English):

carboplatin patient.pdf Info Sheet (French):

carboplatin pour le patient.pdf Monograph:

carboplatin.pdf Phonetic Spelling:

KAR-boe-pla-tin

Cancer Type: Breast Central Nervous System Endocrine Thymoma Thyroid Gastrointestinal Anus Colorectal Esophagus Gastric / Stomach Hepatobiliary / Liver / Bile Duct Neuroendocrine (GI) Pancreas Genitourinary Bladder / Urothelial Prostate Testis Gynecologic Cervix Endometrial Ovary Uterine Sarcoma Vulva Head and Neck Hematologic Lymphoma - Hodgkin Lymphoma - Non-Hodgkin's High Grade Lymphoma - Non-Hodgkin's Intermediate Grade Lung Mesothelioma (Pleural) Non-Small Cell Small Cell Sarcoma Osteogenic / Bone Uterine Skin Melanoma Merkel Cell Squamous Cell Unknown Primary Type of Content: Drug Monograph Status: Null Info Sheet Status: Null Global Date: Friday, November 8, 2019 Universal Date: 2020-07-14 00:00:00 AddThis: Title URL: CARBOplatin Drug Display Status: Active