Oxaliplatin (Injection, Intravenous)

Oxaliplatin is usually injected into the vein and contains platinum as a key component. It works by slowing down the growth of cancerous cells or stopping it altogether. Doctors prescribe it together with other chemotherapy medications.

Overview

Oxaliplatin (Diaminocyclohexane Oxalotoplatinum) also known by its brand name Eloxatin is a type of chemotherapy drug that a cancer doctor prescribes as a therapy for different types of carcinomas. It mainly treats cancer of the colon and the rectum (or colorectal cancer) that has already metastasized and is in its advanced stages. The doctor can also give it to patients with gullet (esophageal) cancer and in advanced stages of pancreatic and ovarian cancer. They can also approve it for other uses as they deem fit.

It is classified as a platinum-based antineoplastic and belongs to the larger class of alkylating agents (specifically, a metal salt). Cancer cells have uncontrolled cell division. One of their characteristic traits is that they lack cell division inhibiting mechanisms present in normal cells. Chemotherapy or antineoplastic drugs are meant to help stop these cells from dividing further. Alkylating agents like the platinum-containing Eloxatin works by interfering with the development of DNA via a process known as alkylation in a cell. The cell, therefore, is unable to divide into two new cells, so it dies.

This drug is normally used in combination with other cancer medicines. The medications prescribed in tandem with Eloxatin depend on the type of cancer a patient ails from, and some examples include leucovorin and fluorouracil, which combine to form Folfox used as colorectal cancer therapy. Only cancer and chemotherapy medical practitioners can give this drug. The patient receives it as an infusion or IV drip in a vein in your arm or on your chest.

Condition It Treats

Oxaliplatin is used to treat:

Type Of Medicine

  • Chemotherapy cancer drug
  • Therapeutic class: Antineoplastic/Cytotoxic
  • Broad class: alkylating agents
  • Platinum-containing compounds

Side Effects

All chemotherapy drugs have undesirable effects that accompany the intended and wanted effects of the drug. They also affect the patients differently. Some side effects are more common and occur more frequently than others. There are those that have adverse effects and require immediate medical attention, and there are those which are mild. One does not necessarily have to experience all the side effects accompanying a treatment.

Side effects accompanying Eloxatin prescriptions may include those that typically occur with other chemotherapy treatments, those that arise due to IV infusion and those that are specific to the medication. The onset and duration of most of the drug's effects are predictable. It is also not very difficult to reverse them as there are various options in existence to help with management. Some go away on their own during or after the treatment.

Side effects related to IV infusion of Oxaliplatin include:

  • Hypersensitivity reactions with symptoms such as hives or a skin rash that itches, dizziness, swollen face, tongue, lips, mouth, throat and neck, shortness of breath, wheezing, feeling flushed, chest pain and tightness among other characteristics of an allergic reaction. Though rare, the doctor should urgently address the issue of hypersensitivity.
  • A laryngeal spasm may occur whereby the drug affects the areas around the mouth, the jaw, and the voice box. It results in difficulties in swallowing, an abnormal tongue sensation, and experiencing shortness of breath together with some chest pressure and congestion. It occurs typically within hours of infusion with Eloxatin or within the first few days after and is quite scary. However, it is temporary and should not last very long if handled correctly.

A patient experiencing this effect should calmly take long, deep breaths through the nose to restore normal breathing. The effect is rare (less than 5% frequency of occurrence reported), but you should alert your doctor if it happens. In future, they may administer the infusion for a more extended period (between 4 hours to 6 hours) to reduce the chances of recurrence. Note that exposure to cold may increase the incidence and worsen the symptoms so always avoid exposure to frozen foods and drinks and keep warm and cover your face (especially the nose and mouth areas) during periods of low temperature.

  • Pain at the point of injection and along the vein may also occur. Let the doctor or nurse know, and they will address the issue accordingly.

The following are some of the common side effects occurring when a patient is on Oxaliplatin. Most patients will not experience them all, some will also experience other rare effects, and there are some that are uncommon and unlikely to affect a patient.

Explained below are effects occurring at a more than 10% frequency that will need medical attention while a patient is on Oxaliplatin and how to manage them:

  • Increased risk of infections due to low white blood cell count (neutropenia). If you have symptoms of an infection, sudden high fever or unexplained sickness, these may come about as a result of neutropenia. Ensure that you contact your doctor immediately.
  • Anemia also presents due to a reduced number of red blood cells. It decreases hemoglobin levels, and the patient may experience breathlessness and fatigue due to oxygen insufficiency. Anemic individuals should let their doctor know beforehand although it might reflect on the blood tests. One may require a transfusion if these symptoms persist.
  • The number of platelets is also reduced, and that presents a problem with blood clotting. Therefore, one may experience unusual bruising and bleeding, bleeding gums, nose bleeding, pinpoint blood spots or skin rashes, heavy menstruation, prolonged bleeding from an injury and wounds will heal slowly. Persistence of these symptoms may necessitate platelet transfusion.
  • Peripheral neuropathy and paresthesia, characterized by tingling and numbness in the extremities (hands and feet) may occur. These symptoms may be related to cold. So, avoid exposure to ice, cold air, and frozen foods/drinks. The doctor may also decide to lower the dose.
  • General fatigue and lethargy will occur and worsen towards the completion of therapy. Get enough rest and do not operate machinery.
  • Nausea and feelings of sickness are common in chemotherapy and antiemetic, and steroid drugs are usually prescribed to deal with this effect. If it persists, call your doctor.
  • Diarrhea is also very common. The doctor should prescribe medicine to deal with it, and the patient should stay hydrated.

Other commonly occurring side effects including some of those stemming from the above are:

  • Swelling, blistering and peeling of the soles of feet and palms of hands
  • Numbness and unusual sensations in the extremities and the tongue
  • Chills
  • Bloody urine and stool
  • Difficulty urinating/ painful urination
  • Decreased urination
  • Tarry, black stool
  • Pain in the chest, legs, and groin
  • Pain in the joints
  • Muscle aches and stiffness
  • Dry mouth
  • Fever
  • Constipation
  • Lightheadedness
  • Fainting
  • A sore throat
  • Coughing
  • Change in vision
  • Eye pain and sunken eyes (may also present with jaundice)
  • Increased heart rate (irregular)
  • Difference in taste
  • Headaches
  • Mouth swelling and inflammation
  • Swollen glands
  • Sores in the mouth and ulcers/ white spots on the lips
  • Paleness of the skin or jaundice
  • Difficulties breathing, swallowing, speaking, moving and performing daily tasks, e.g., writing, buttoning clothes
  • Rapid breathing
  • Increased thirst
  • Loss of appetite among others

This list does not exhaust all the side effects that may accompany the use of Oxaliplatin. It is imperative to report all side effects and the persistence of any that are already under management to your doctor. These side effects do not affect the efficiency of the drug.

Dosage

A patient normally receives Oxaliplatin at a hospital or chemotherapy unit from a cancer doctor or nurse. Before chemotherapy, the physician has to ensure that you undergo a blood test to determine whether you can safely receive the treatment. Typically, you will also receive a shot of anti-sickness medicine (antiemetics) in the vein (intravenous route) together with the cancer medicine.

Each chemotherapy treatment normally runs as a course consisting of several treatment sessions known as cycles. For therapy with Oxaliplatin, doctors employ a 14 or 21-day period whereby the patient receives the drug on the first day of the cycle with the next session being two or three weeks after.

The drug exists in powder form, and proper preparation and dilution have to take place before administration. There are 3 ways by which one can receive Eloxatin:

1. The one administering it puts a cannula (short, thin tube) into your vein and delivers Eloxatin via drip infusion

2. They may infuse it into a vein under the skin of your chest via a very fine tube. This method is known as the central line

3. Alternatively, the administrator may use a PICC line which involves fine tubing in a vein in your arm, going up into another vein in your chest

The IV infusion runs through a pump over a set amount of time (about two hours or more). The dose or amount you receive and your dosing schedule will depend on various factors. Some of the determinant parameters the doctor checks include the type of cancer the patient has, their body weight, height, general health condition and any other medical problems present at the time of prescription and the response to therapy.

Since the drug mainly treats colorectal cancer in adults, standard dosage instructions exist for that treatment. Adjustments for other conditions are done accordingly. The following dosage information is applicable to 5mg/ml, 50mg/ml and 100mg/ml strengths for:

  • Adults with colorectal cancer:

Patients typically receive an IV infusion of 85mg/m2 for 2 hours (120 minutes). Subsequent treatment happens every two weeks for a total of 6 months, which makes 12 cycles. The doctor will administer Leucovorin and 5-fluorouracil concurrently with Oxaliplatin. This prescription is suitable for stage 3 colon cancer patients after they have had the entire primary tumor surgically removed. It is also appropriate for advanced colorectal cancer. Therapy with Eloxatin will continue until the doctor determines to stop due to either excessive amounts of toxicity or according to the disease progression. Administration may begin with premedication on anti-sickness drugs such as 5-HT3 blockers to reduce the incidence of nausea.

Different doses exist for other cancers treatable by this therapy. Dose adjustment is also recommended for patients suffering other conditions. For instance, individuals with severe renal impairment should have their dose reduced from 85mg/m2 to 6mng/m2.

Always ensure you receive all scheduled treatments for the maximum effectiveness of the drug. If you miss a cycle or a dose, let your physician know, and they will advise accordingly.

Possible drug overdose may occur. It normally presents with symptoms such as the patient getting into a coma, coughing or hoarse voice, disorientation, lack of coordination, agitation, diarrhea, lethargy and severe weakness. Others include paralysis, profuse vomiting, seizing and tremors, involuntary and rapid eye movements, irregular heart rhythm, respiratory failure and pain on the side or lower back. If a patient has these symptoms and you suspect an overdose, especially when they have passed out or have trouble breathing, call 911 and get emergency medical help immediately. You can also call the poison center helpline at 1-800-222-1222 straightaway and carefully give all the necessary details. There is no known specific antidote for Eloxatin.

Major Drug Interactions

Some medicines, when used concurrently, will interact. The interaction results in various pharmacological effects on the body. Some may be positive, with no effects while other drugs affect those they interact with negatively. Sometimes, new adverse effects may arise. That is why drugs are checked against one another. There are also those that are contraindicated. Always inform the doctor of any drug that you are on. These are some of the medications checked against Eloxatin that may interact causing various effects:

  • Bacitracin
  • Palifermin
  • Cidofovir
  • Tofacitinib
  • Adriamycin (doxorubicin)
  • Aloxi (palonosetron)
  • Capecitabine
  • Dichlorphenamide
  • Elvitegravir/cobicistat/emtricitabine/tenofovir df
  • Hydroxyurea
  • Decadron (dexamethasone)
  • Fentanyl Transdermal System (fentanyl)
  • Fluorouracil
  • Avastin (bevacizumab)
  • Benadryl (diphenhydramine)
  • Bevacizumab
  • Bortezomib
  • Bupropion
  • Polymyxin b
  • Sipuleucel-t
  • Vandetanib
  • Zidovudine
  • Caffeine
  • Citalopram
  • Clotrimazole
  • Gemzar (gemcitabine)
  • Fingolimod
  • Cholera vaccine
  • Ifosfamide
  • Amphotericin b deoxycholate
  • Bendamustine
  • Lobeglitazone
  • Macimorelin
  • Busulfan
  • Dacarbazine
  • Irinotecan
  • Cetuximab
  • Compazine (prochlorperazine)
  • Leucovorin
  • Neupogen (filgrastim)
  • Norco (acetaminophen / hydrocodone)
  • Taxol (paclitaxel)
  • Trastuzumab
  • Vemurafenib
  • Zucapsaicin
  • Morphine Sulfate ER (morphine)
  • Neulasta (pegfilgrastim)
  • Neupogen (filgrastim)
  • Norco (acetaminophen / hydrocodone)
  • Taxol (paclitaxel)
  • Taxotere (docetaxel)
  • Neupogen (filgrastim)
  • Tipiracil
  • Norco (acetaminophen / hydrocodone
  • Tylenol (acetaminophen)
  • Vitamin B12 (cyanocobalamin)
  • Vitamin C (ascorbic acid)
  • Vitamin D3 (cholecalciferol)
  • Xeloda (capecitabine)
  • Zofran (ondansetron)
  • Dosulepin
  • Eltrombopag
  • Fluvoxamine
  • Lanatoside C
  • Lidocaine
  • Rucaparib
  • Simeprevir
  • Gitoformate
  • Isoniazid
  • Midostaurin
  • Ticlopidine
  • Mexiletine
  • Peramivir
  • Streptomycin

Warnings

Various precautionary and self-care measures accompany the prescription and use of Eloxatin. Always let your doctor know if there is any other medication or treatment you are on. Alert them of any allergies especially if you have ever experienced such a reaction to the drug or any other platinum compounds. Vaccinations while on Oxaliplatin without a doctor's approval are highly advised against during and immediately after treatment (for a minimum of 6 months). Avoid taking aspirin or aspirin-based products without the permission of your physician as well.

Let the doctor know whether you are pregnant before you start treatment because it might harm the baby especially for those in pregnancy category D. If you are not, do not conceive. Use appropriate contraceptive methods to avoid pregnancy. Although studies are yet to reveal whether it is excreted in milk, it is advisable to avoid breastfeeding while on the drug. Depending on the risk present, the doctor will decide on which to discontinue (the drug or breastfeeding). It may also affect an individual's fertility (both men and women). The geriatric population (older patients over the age of 65) may experience side effects with higher severity than others.

The administration should only be by a qualified chemotherapy physician or under the supervision of one at a hospital or cancer treatment center. There are some precautions to follow during administration as well but mostly apply to the medical practitioner. These include:

  • Ensuring that they dilute the drug before administration according to the manufacturer's instructions
  • Examining the drug in the vial before reconstitution to check if it is expired, inspecting it after preparation for any discoloration, particles, or other inconsistencies before administering it.
  • They should avoid using aluminum-containing needles or IV sets because it may degrade the platinum in Oxaliplatin.
  • They should also ensure that they stay within IV and dose compatibility recommendations as instructed by the manufacturer, for instance, it is incompatible with alkaline media and should not be combined with alkaline medication.
  • The bag with Oxaliplatin should be separate from that containing leucovorin.
  • Evaluate the patient to determine the safety of treatment by checking that they have all the required lab and blood tests and assessing their clinical toxicities. They should also monitor these conditions after the treatment and before starting another treatment cycle.

The patients should also be careful to take care of themselves while undergoing this treatment. The following are some important tips to follow:

  • Do not operate heavy machinery or drive
  • Avoid exposure to cold: breathing cold air, contact with cold items, consuming cold foods and always keep warm
  • Stay hydrated, eat healthily, get enough rest and keep your bowels moving
  • Hygiene is crucial due to high risk of infection
  • Alert the doctor of any side effects and follow the instructions

Storage

The manufacturer recommends retention of the drug in its original package until it is required for use. One should store it at controlled room temperature, 68-77 degrees Fahrenheit (20-25 degrees Celsius). Do not freeze but keep in a cool, dry place. It should be out of the reach of children. Also, ensure that you protect it from direct light and heat.

Upon reconstitution, the solution can last for about 24 hours. On final dilution of reconstituted solution, Oxaliplatin can only stay for a maximum of 6 hours at room temperature (20-25 degrees Celsius) but may extend its shelf life to 24 hours when refrigerated at 36 to 48 degrees Fahrenheit (or 2-8 degrees Celsius). The final reconstituted form of the drug does not need protection from direct light.

Summary

Chemotherapy is extremely valuable in the fight against the currently prevalent problem of cancer. Therapy by drugs such as Oxaliplatin is useful in the management of various types of carcinomas and other conditions as the doctor prescribes. Therefore, it is a very beneficial drug. However, for maximum efficiency, both the doctor and the patients should follow instructions, take note of the warnings and recommended precautionary measures. Patients should undergo pretreatment tests, let the doctor know about any allergies and medications they are taking or health conditions they have to avoid risks. They should take good care of themselves during treatment. With constant consultation with the healthcare specialist and being careful to work together, the patient should receive the proper results and appropriate management for their condition.

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