Carboplatin Teva concentrate for solution for infusion 450mg N1
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Active ingredients
Carboplatin
Composition
1 bottle contains: Active substance: carboplatin 450 mg. Auxiliary substances: mannitol.
Pharmacological effect
Carboplatin is an inorganic complex compound containing a heavy metal - platinum. It is assumed that the main mechanism of action of this drug is due to binding to DNA, resulting in the formation of predominantly intra-helical crosslinks that change the structure of DNA and suppress its synthesis. This effect appears regardless of the phase of the cell cycle. Hydration of carboplatin, which results in the formation of the active form (s) of the drug, is slower than the hydration of cisplatin.
Pharmacokinetics
After a single injection of carboplatin in the form of intravenous infusion for 1 hour, the concentration in plasma of total platinum and free (ultrafiltrable) platinum decreases in accordance with a two-phase model of first-order kinetics. The initial T1 / 2 of free platinum is about 1-2 hours, and the terminal T1 / 2 is 3-6 hours; total platinum is characterized by a similar initial T1 / 2, but its terminal T1 / 2 is longer (about 24 hours). With repeated dose injections for four consecutive days, accumulation of platinum in plasma was not observed. 24 hours after the dose is administered, more than 85% of platinum in the plasma is in a state bound to proteins. Karboplatin is excreted mainly by the kidneys, and about 30% of the administered dose is excreted unchanged. In patients with a CC of 60 ml / min or more, approximately 65% and 70% of the administered dose are eliminated, respectively, 12 and 24 hours after the administration. Since carboplatin is eliminated almost entirely by glomerular filtration, only a very small concentration of carboplatin is present in the renal tubules, which may explain the small nephrotoxic potential of the drug compared with cisplatin.
Indications
Treatment of the following solid tumors: - ovarian cancer; - germ cell tumors of men and women; - lung cancer; - cervical cancer; - head and neck tumors; - osteogenic sarcomas; - medulloblastoma.
Contraindications
- severe renal dysfunction; - severe myelosuppression; - heavy bleeding; - pregnancy and lactation period; - hypersensitivity to carboplatin or other platinum-containing compounds.
Use during pregnancy and lactation
Contraindications: pregnancy and lactation.
Dosage and administration
Carboplatin can be used both as a monotherapy, and in combination with other anticancer drugs. The drug is injected / in the following dose regimens: - 300-400 mg / m2 IV drip for 15-60 minutes or as a 24-hour infusion - 100 mg / m2 IV drip for 15-60 minutes daily for 5 days. Carboplatin administration is repeated at intervals of at least 4 weeks with platelet counts of at least 100,000 cells / mm3 of blood and neutrophils at least 1,500 cells / mm3 of blood. Fluid injection before or after using carboplatin and forced diuresis required. Depending on the state of the bone marrow or kidney function, a therapeutic dose of carboplatin and can be corrected as follows: - for patients who have symptoms of moderate or severe hematologic toxicity (ie, the number of platelets and neutrophilic leukocytes is less than 50,000 and 500 / mm3, respectively), the possibility of reducing the dose should be considered - both in cases of monotherapy, and in combined treatment regimens - by 25%; In the presence of risk factors, such as, for example, previous courses of myelosuppressive therapy and / or age over 65 years, a dose reduction of 20-25% is recommended; Careful use of carboplatin is also recommended if the patient has previously been treated with nephrotoxic drugs such as cisplatin. Before use, the solution of carboplatin must be visually monitored for the presence of mechanical inclusions and discoloration. Carboplatin should be diluted in physiological solution or 5% glucose solution to achieve a concentration of 1-0.5 mg / ml immediately before use - an infusion should be made no more than 24 hours after preparation of the solution.
Side effects
On the part of the hematopoietic system: the main toxic factor limiting the dose of carboplatin is the suppression of the function of bone marrow hematopoiesis. Myelosuppression is dose-dependent. The lowest level of platelets and leukocytes / granulocytes, as a rule, is achieved in 2-3 weeks after the start of taking the drug, while thrombocytopenia is more common. Adequate recovery to a level that allows the next dose of carboplatin to be taken usually takes at least 4 weeks.A sufficiently large number of patients may also show symptoms of anemia (hemoglobin level less than 11 g / dl), the intensity of which depends on the total dose of the drug. It may be necessary to conduct transfusion therapy, especially in patients undergoing long-term treatment (for example, more than 6 cycles of taking the drug). There is also a chance of clinical complications, such as fever, infectious diseases, sepsis / septic shock and bleeding. On the gastrointestinal side: for 6-12 hours after taking the drug, there is a likelihood of nausea and / or vomiting (mild to moderate), continuing to 24 hours or more. The risk of emetic effects can be reduced by pre-treatment with antiemetic agents, continuous intravenous infusion of carboplatin for 24 hours, or fractional dosing for 5 consecutive days. Other types of adverse effects on the gastrointestinal tract, such as inflammation of the mucous membrane of the mouth, diarrhea, constipation and abdominal pain were also observed in some cases. From the CNS and peripheral nervous system: there is a likelihood of peripheral neuropathies, mainly in the form of paresthesia and a decrease in deep tendon reflexes, which is more likely in patients older than 65 years with prolonged or previous treatment with cisplatin. It is also possible the appearance of symptoms of dysfunction of the CNS. Prolonged drug therapy can lead to cumulative neurotoxicity. On the part of the hearing organs: ototoxicity manifests itself in the form of tinnitus and hearing impairment. On the part of the organs of vision: there is a possibility of temporary deterioration or complete loss of vision (possible loss of ability to distinguish colors and see light), and also other disorders of the visual function. Improvement and / or full recovery of vision, as a rule, occurs within a few weeks after stopping the drug. In patients with impaired renal function, treated with high doses of carboplatin, cortical blindness was observed. On the kidney side: a slight and temporary increase in serum creatinine and urea concentrations may be observed. Acute renal damage was rarely observed. The risk of nephrotoxicity in patients receiving carboplatin (decreased creatinine clearance) increases with increasing doses of carboplatin, as well as in patients who have previously been treated with cisplatin. On the side of the liver: there may be a slight and, as a rule, a temporary increase in concentrations of ACT, bilirubin and alkaline phosphatase in serum.In patients treated with high doses of carboplatin with autologous bone marrow transplantation, significant impairment of liver function was observed. On the electrolyte balance: hypokalemia, hypocalcemia, hyponatremia and / or hypomagnesemia are possible. arterial hypotension and anaphylactic reactions. These reactions can occur within a few minutes after the introduction of carboplatin. In rare cases, exfoliative dermatitis may also occur. Other Side effects: alopecia, asthenia, flu-like symptoms, hemolytic-uremic syndrome, myalgia / arthralgia, heart failure, cerebrovascular disorders and allergic reactions directly at the injection site.
Overdose
Special antidotes used in case of overdose of carboplatin does not exist. In case of overdose, more pronounced adverse reactions listed above should be expected. Symptomatic treatment. In the first 3 hours after administration of the drug, hemodialysis may be used.
Interaction with other drugs
The use of carboplatin in combination with other myelosuppressive drugs or radiation therapy may increase the risk of hematologic toxicity. The use of carboplatin in combination with aminoglycosides, as well as with other nephrotoxic drugs increases the risk of nephrotoxic and / or ototoxic effects.
special instructions
The introduction of carboplatin should be carried out under the supervision of a physician with experience in the use of cytotoxic drugs. Continuous monitoring of possible toxic effects in carboplatin treatment is mandatory, especially when using high doses of the drug. Needles, syringes, catheters and infusion systems should not be used for the preparation and administration of the drug. Aluminum may react with carboplatin, leading to sedimentation or loss of drug activity. Patients should regularly (for example, once a week) calculate the uniform elements of peripheral blood and monitor kidney function (the most sensitive indicator is CC). Neurological examinations are recommended periodically. especially in patients previously treated with cisplatin and in patients over 65 years of age. Carboplatin may cause cumulative ototoxic effects.Audiographic studies should be carried out before and during treatment or in the event of symptoms of hearing impairment. In the case of a clinically significant impaired hearing function, a corresponding change in the dose of the drug or cessation of treatment may be required. Women and men during treatment with carboplatin and for 3 months after should use reliable methods of contraception. In case of contact with the eyes, wash them immediately with a large number water or sodium chloride solution. In case of contact with the skin, immediately rinse the place of contact with the drug with a large amount of water. In the case of inhalation of the drug or getting it into the mouth, you should immediately consult a doctor.