Carboplatin Pharmachemie Warnings

General: Carboplatin should only be administered under the supervision of a physician experienced in the use of cancer chemotherapeutic agents. Adequate diagnostic and treatment facilities must be readily available to ensure appropriate management of therapy, and treatment of possible complications.
Anaphylaxis: As with other platinum co-ordination compounds, allergic reactions, including anaphylactic-like reactions to carboplatin, have been reported. These may occur within minutes of administration and should be managed with appropriate supportive therapy. Epinephrine, corticosteroids, and antihistamines have been employed to alleviate symptoms.
Myelosuppression: Bone marrow suppression (leukopenia, neutropenia and thrombocytopenia) is dose-dependent and may be severe, and is also the dose-limiting toxicity. Peripheral blood counts (including platelets, white blood cells, neutrophils, and hemoglobin) should be frequently monitored during carboplatin treatment and, when appropriate, until recovery is achieved. In general, single intermittent courses of carboplatin should not be repeated until leukocyte, neutrophil and platelet counts have recovered.
Myelosuppression, as a result of carboplatin treatment, is closely related to the renal clearance of the drug. Therefore, in patients who have abnormal renal function or who are receiving concomitant therapy with nephrotoxic drugs, myelosuppression especially thrombocytopenia, may be more severe and prolonged. Renal function parameters should therefore be assessed prior to, during, and after therapy.
Anemia has been observed during treatment with carboplatin; since it is cumulative, transfusions may be needed particularly in patients receiving prolonged therapy.
The occurrence, severity and protraction of toxicity is likely to be greater in patients who have received extensive prior treatment for their disease, have poor performance status, and who are more than 65 years of age.
Effect on Reproduction and Fertility: Gonadal suppression, resulting in amenorrhea or azoospermia, may occur in patients receiving antineoplastic therapy, especially alkylating agents. In general, these effects appear to be related to dose and length of therapy and may be irreversible. Prediction of the degree of testicular or ovarian function impairment is complicated by the common use of combinations of several antineoplastics, which makes it difficult to assess the effects of individual agents.
Mutagenicity: Carboplatin has been shown to be mutagenic both in vitro and in vivo.
Carcinogenicity: The carcinogenic potential of carboplatin has not been studied, but compounds with similar mechanisms of action and mutagenicity profiles have been reported to be carcinogenic.
Teratogenicity: Carboplatin has been shown to be embryotoxic and teratogenic in rats receiving the drug during organogenesis.
Use in Pregnancy & Lactation: See USE IN PREGNANCY & LACTATION section for further information.
Use in the Elderly: Incidence of peripheral neurotoxicity is increased and myelotoxicity may be more severe in patients over 65 years of age. In addition, elderly patients are more likely to have age-related renal function impairment, which may require dosage reduction and careful monitoring of blood counts in patients receiving carboplatin.