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In the event of an overdosage, the described side effects are more intense. As a rule, bone marrow toxicity predominates. An overdose is potentially lethal and leads to the following symptoms, among other: Liver failure, deafness, ocular toxicity (including retinal detachment), incontrollable vomiting or retching and/or neuritis. A direct influence on the respirator center with life-threatening impaired ventilation and acid-base imbalances is possible with an overdose (≥ 200 mg/m2 BSA) due to the crossing of the blood-brain barrier.
Therapeutic measures for overdose: There is not known specific antidote against Cisplatin. The immediate, emergency measures to be taken in the event of severe intolerance reactions consist of withdrawing the therapy immediately, symptomatic treatment and shock therapy if required.
The following individual counter measures are recommended: Renal function impairment: The frequency and severity of renal function impairments can be substantially reduced through adequate hydration before and after the administration (see Dosage & Administration). Modulators, such as Sodium thiosulphate can be applied to reduce the nephrotoxic effect of Cisplatin.
Hyperuricaemia: Elevated serum uric acid levels can be lowered by administering Allopurinol.
Plasma electrolyte losses: Clinically relevant electrolyte losses (mostly sodium, magnesium and calcium) can be compensated by appropriate electrolyte replacement therapy.
Anaphylactic reactions: Symptomatic treatment, e.g. with sympathomimetics, corticoids and antihistamines.
Dialysis: Over 90% of the Cisplatin administered is bound to plasma proteins 2 hours after the administration. Due to the rapid protein binding, Cisplatin is dialyzable only in the first 2 hours after the administration. Approximately 8% of the administered dose can be removed from the plasma via dialysis immediately after administration.
