Oxaliplatin

Intravenous
Metastatic colorectal cancer

Intravenous
Adjuvant therapy in stage III colon cancer

CrCl (mL/min)	Dosage
<30	Contraindicated.

Dilute the required dose w/ 250-500 mL of dextrose 5% in water, to provide a soln containing 0.2-0.7 mg/mL.

Incompatible w/ Cl-containing solutions. Alkaline agents or soln (e.g. 5-FU, trometamol) negatively affect the stability. Needles and IV admin sets containing Al can cause degradation of platinum compd.

Hypersensitivity to oxaliplatin and other platinum agents. Myelosuppression, peripheral sensory neuropathy w/ functional impairment, congenital long QT prolongation. Severe renal impairment (CrCl <30 mL/min). Lactation. Concomitant use w/ live vaccines.

Patient w/ history of or risk for QT prolongation, electrolyte disturbances. Pregnancy.

Significant: QT prolongation, ventricular arrhythmias, hypersensitivity reactions (e.g. burning sensations, pruritus, erythema, rashes/urticaria, flushing, diaphoresis, diarrhoea, shortness of breath, chest pain, syncope, disorientation; rarely, bronchospasm, hypotension); hepatotoxicity (e.g. peliosis, nodular regenerative hyperplasia or sinusoidal alterations, perisinusoidal fibrosis, veno-occlusive lesions; rarely, hepatitis, hepatic failure, hepatic vascular disorder); peripheral sensory neuropathy; reversible posterior leukoencephalopathy syndrome; neurological toxicity (e.g. acute laryngopharyngeal dysaesthesia); pulmonary symptoms (e.g. non-productive cough, dyspnoea, crackles, radiological pulmonary infiltrates); extravasation; GI toxicity (e.g. nausea, vomiting, severe diarrhoea/emesis, ulcer); haematological toxicity (e.g. neutropenia, thrombocytopenia).
Nervous: Meningism, motor neuritis, depression, insomnia, fatigue, asthenia, rigors, dizziness, headache.
CV: DVT, haemorrhage, peripheral oedema, flushing, thromboembolism, HTN.
GI: Abdominal pain, constipation, anorexia, stomatitis, dyspepsia, flatulence, GERD, GI/rectal haemorrhage, dysgeusia, anorexia, mucositis, dysphagia.
Resp: Coughing, epistaxis, hiccups, pulmonary embolism, rhinitis, URTI.
Hepatic: Increased blood bilirubin, ALT/AST and alkaline phosphatase levels.
Genitourinary: Dysuria, abnormal micturition frequency, haematuria, increased creatinine.
Endocrine: Hyperglycaemia, wt gain/loss, increased blood lactate dehydrogenase.
Haematologic: Anaemia, leukopenia, lymphopenia.
Musculoskeletal: Arthralgia, back pain.
Ophthalmologic: Conjunctivitis, visual disturbance, abnormal lacrimation.
Dermatologic: Skin/nail disorder, alopecia, palmar-plantar erythrodysesthesia, exfoliation, hyperhidrosis.
Immunologic: Infection.
Others: Fever, hypocalcaemia, hypokalaemia, hypernatraemia, dehydration, inj site reactions (e.g. pain, redness, swelling and thrombosis).
Potentially Fatal: Anaphylaxis; bone marrow suppression (e.g. sepsis, neutropenic sepsis, septic shock); torsade de pointes; pulmonary fibrosis, interstitial lung disease; intestinal ischaemia, duodenal ulcer haemorrhage and perforation; haemolytic uraemic syndrome, disseminated intravascular coagulation; rhabdomyolysis.

IV/Parenteral: D

This drug may cause dizziness, nausea, vomiting, vision abnormalities and other neurological symptoms that affect gait and balance, if affected, do not drive or operate machinery.

Monitor CBC w/ differential, ALT/AST, bilirubin, creatinine, electrolyte, K, Mg levels. Monitor neurological status, QT interval, hypersensitivity, resp effects and toxicity.

Symptoms: Hypersensitivity reaction, myelosuppression, anaemia, neurotoxicity, grade 4 thrombocytopenia, sensory neuropathy (e.g. paraesthesia, dysaesthesia, laryngospasm and facial muscle spasms), GI disorders (e.g. nausea, vomiting, stomatitis, flatulence, enlarged abdomen, grade 4 intestinal obstruction), grade 4 dehydration, dyspnoea, wheezing, chest pain, resp failure, severe bradycardia. Management: Supportive treatment.

May enhance adverse effect of live vaccines.
Potentially Fatal: May diminish the therapeutic effect of vaccines. Increased risk of torsade de pointes w/ QT interval prolonging drugs.

Description:
Mechanism of Action: Oxaliplatin is a platinum-containing antineoplastic drug which forms several transient reactive complexes including monoaquo and diaquo diaminocyclohexane platinum. These complexes covalently bind to DNA base sequences to form inter and intra-strand cross-links thereby inhibiting replication, transcription and cell division leading to cell death.
Pharmacokinetics:
Distribution: Volume of distribution: 440 L. Plasma protein binding: >90%, mainly to albumin and γ globulin.
Metabolism: Undergoes rapid and extensive nonenzymatic metabolism into inactive and active metabolites.
Excretion: Mainly via urine (approx 54%); faeces (approx 2%). Terminal elimination half-life: 391 hr.

Source: National Center for Biotechnology Information. PubChem Database. Eloxatin (TN), CID=9887054, https://pubchem.ncbi.nlm.nih.gov/compound/Eloxatin-_TN (accessed on Jan. 22, 2020)

Store between 20-25°C. Do not freeze. Protect from light. Reconstituted soln: Store between 2-8°C for up to 24 hr.
This is a cytotoxic drug. Follow applicable procedures for receiving, handling, admin, and disposal. Any unused portions should be disposed of in accordance w/ local requirements.

Hóa trị gây độc tế bào

L01XA03 - oxaliplatin ; Belongs to the class of platinum-containing antineoplastic agents. Used in the treatment of cancer.

Anon. Oxaliplatin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 31/08/2017.

Buckingham R (ed). Oxaliplatin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 31/08/2017.

Joint Formulary Committee. Oxaliplatin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 31/08/2017.

McEvoy GK, Snow EK, Miller J et al (eds). Oxaliplatin. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 31/08/2017.

Oxaliplatin Injection (Sun Pharmaceutical Industries, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 31/08/2017.