Renal function: Cisplatin produces cumulative nephrotoxicity. Renal function and serum electrolyte (magnesium, sodium, potassium and calcium) should be evaluated prior to initiating cisplatin treatment and prior to each subsequent course of therapy. To maintain urine output ?and reduce renal toxicity it is recommended that cisplatin be administered as an intravenous infusion ovar 6 to 8 hours. Moreover, per-treatment intravenous hydration with 1-2 litres of fiuid over 8-12 hours followed by adequate hydration for the next 24 hours is recommended. Repeat courses of cisplatin should not be given unless the level of serum creatinine is below 1.5 mg/100 ml, or the BUN is below 25 mg/100 ml. Special care has to be taken when cisplatin-treated patients Bone marrow function: Peripheral blood counts should be monitored frequently in patients receiving Cisplatin. Although the hematologic toxicity is usually moderate and reversible, severe thrombocytopenia and leukopenia may occur. In patients who develop thrombocytopenia special precautions are recommended: care in performing invasive procedures; search for signs of bleeding or bruising; test of urine, stools and emesis for occult blood; avoiding aspirin and other NSAIDs. Patients who develop leukopenia should be observed carefully for signs of infection and might require antibiotic support and blood product transfusions. Hearing function: Cisplatin may produce cumulative ototoxicity, which is more likely to occur with high-dose regimens. Audiometry should be performed prior to initiating therapy, and repeated audiograms should be performed when auditory symptoms occur or clinical hearing changes become apparent. Clinically important deterioration of auditive function may require dosage modifications or discontinuation of therapy. CNS functions: Cisplatin is known to induce neurotoxicity; therefore, neurologic examination is warranted in patients receiving a Cisplatin-containing treatment. Since neurotoxicity may result in irreversible damage, it is recommended to discontinue therapy with Cisplatin when neurologic toxic signs or symptoms become apparent. In addition, patients receiving Cisplatin should be observed for possible anaphylactoid reactions, and appropriate equipment and medication should be readily available to treat such reactions. Nausea and Vomiting: Marked nausea and vomiting occur in almost all patients treated with Cisplatin and are occasionally so severe that dosage reduction or discontinuance of treatment is necessary. Cisplatin should be administered only by physicians experienced in the use of chemotherapeutic agents. Carcinogenicity: Secondary malignancies are potential delayed effects of many antineoplastic agents, although it is not clear whether the effect is related to their mutagenic or immunosuppressive action. The effect of dose and duration of therapy is also unknown, although risk seems to increase with long-term use. Although information is limited, available data seems to indicate that the carcinogenic risk is greatest with the alkylating agents. Dental: The bone marrow depressant effects of Cisplatin may result in an increased incidence of microbial infection,delayed healing, and gingival bleeding. Dental work, wherever possible, should be completed prior to initiation of therapy or deferred until blood counts have returned to normal.
