Taj Pharma's FDA-Approved Generic Version, Cisplatin Injection
Taj Pharma's FDA-Approved Generic Version, Cisplatin Injection
Taj Pharma's FDA-Approved Generic Version, Cisplatin Injection
Injection BP
hours after the end of a three- hour infusion, 90% of the plasma Note: Needles or intravenous sets containing aluminum parts REACTIOS section). Elderly patients may be more
platinum is protein bound. The complexes between albumin that may come in contact with cisplatin should not be used for susceptible to nephrotoxicity (see PRECAUTIONS: Geriatric
1mg/1ml and the platinum from cisplatin do not dissociate to significant
extent and are slowly eliminated with a minimum half- life of
preparation or administration. Aluminium reacts with cisplatin,
causing precipitate formation and a loss of potency.
Use.)
There are reports of severe neuropathies in patients in whom
five days or more. Metastatic Testicular Tumors – The usual CISPLATIN regimens are employed using higher doses of cisplatin or
Following cisplatin doses of 20 to 120 mg/m², the (Cisplatin Injection) dose for the treatment of testicular cancer greater dose frequencies than those recommended. These
concentrations of platinum are highest in liver, prostate, and in combination with other approved chemotherapeutic agents neuropathies may be irreversible and are seen as
2
Rx only kidney, somewhat lower in bladder, muscle, testicle, is 20mg/m IV daily for 5 days per cycle. paresthesias in a stocking glove distribution, areflexia, and
pancreas, and spleen and lowest in bowel, adrenal, heart, Metastatic Ovarian Tumors – The usual CISPLATIN loss of proprioception and vibratory sensation. Elderly patients
COMPOSITION lung, cerebrum, and cerebellum. Platinum is present in tissues (Cisplatin Injection) dose for the treatment of metastatic may be more susceptible to peripheral neuropathy (see
CISPLATIN 10 for as long as 180 days after the last administration. With the ovarian tumors in combination with cyclophosphamide is 75 to PRECAUTIONS: Geriatric Use).
Cisplatin Injection BP 10 mg/10 mL exception of intracerebral tumors, platinum concentrations in 100 mg/m² IV per cycle once every four weeks (DAY 1). Loss of motor function has also been reported.
Each mL contains
Cisplatin 1 mg tumors are generally somewhat lower than the concentrations The dose of cyclophosphamide when used in combination Anaphylactic- like reactions to cisplatin have been reported.
Excipients q.s in the organ where the tumor is located. Different metastatic with CISPLATIN (Cisplatin Injection) is 600 mg/m² IV once These reactions have occurred within minutes of
CISPLATIN 50 sites in the same patient may have different platinum every four weeks (DAY 1). administration to patients with prior exposure to cisplatin, and
Cisplatin Injection BP 50 mg/ 50 mL concentrations. Hepatic metastases have the highest For directions for the administration of cyclophasphamide, have been alleviated by administration of epinephrine,
Each ml contains platinum concentrations, but these are similar to the platinum refer to the cyclophasphamide package insert. corticosteroids, and antihistamines.
Cisplatin BP 1 mg concentrations in normal liver. Maximum red blood cell In combination therapy, cisplatin and cyclophasphamide are Since ototoxicity of cisplatin is cumulative, audiometric testing
Excipients q.s concentrations of platinum are reached within 90 to 150 administered sequentially. should be performed prior to initiating therapy and prior to
2
minutes after a 100 mg/m dose of cisplatin and decline in As a single agent, cisplatin should be administered at a dose of each subsequent dose of drug (see ADVERSE REACTIONS
DESCRIPTION biphasic manner with a terminal half- life of 36 to 47 days. 100 mg/m² IV per cycle once every four weeks. section).
CISPLATIN (Cisplatin Injection) is a clear colorless sterile Over ac dose rang of 40 to 140 mg cisplatin/m² given a bolus Advanced bladder Cancer – CISPLATIN (Cisplatin Injection) Cisplatin can cause fetal harm when administered to a
injection or as infusions varying in length from 1 hour to 24 should be administered as a single agent at a dose of 50 to 70 pregnant woman. Cisplatin is mutagenic in bacteria and
aqueous solution, available in 10 and 50 mL multiple does hours, from 10% to about 40% of the administered platinum is mg/m² IV per cycle once every 3 to 4 weeks depending on the produces chromosome aberrations in animal cells in tissue
excreted in the urine in 24 hours. Over five days following extent of prior exposure to radiation therapy and/or prior culture. In mice, cisplatin is teratogenic and embryotoxic. If this
vials, each mL containing 1 mg cisplatin 9 mg sodium chloride administration of 40 to 100 mg/m² doses given as rapid, 2 to 3 chemotherapy. For heavily pretreated patients an initial dose drug is used during pregnancy or if the patient becomes
in water for injection. Hcl and/or sodium hydroxide added to hour, or 6 to 8 hour infusions, a mean of 35% to 51% of the of 50 mg/m² per cycle repeated every four weeks is pregnant while taking this drug, the patient should be apprised
dosed platinum is excreted in the urine. Similar mean urinary recommended. of the potential hazard to the fetus.
adjust pH. recoveries of platinum of about 14% to 30% of the dose are All Patients- Pretreatment hydration with 1 to 2 liters of fluid Patients should be advised to avoid becoming pregnant.
Cisplatin (cis-diamminedichloroplatinum) is a heavy metal found following five daily administrations of 20, 30, or 40 infused for 8 to 12 hours prior to a cisplatin does is The carcinogenic effect of cisplatin was studied in BD IX rats.
complex containing central atom of platinum surrounded by mg/m²/day. Only a small percentage of the administered recommended. The drug is then diluted in 2 liters of 5% Cisplatin was administered i.p to 50 BD IX rats for 3 weeks, 3 x
two chloride atoms molecules in the cis position. It is a white platinum is excreted beyond 24 hours post-infusion and most dextrose in 1/2 or 1/3 normal saline containing 37.5 g of 1 mg/kg body weight per week. Four hundred and fifty-five
powder with the molecular formula PtCl2H8N2, and a molecular of the platinum excreted in the urine in 24 hours is excreted mannitol, and infused over a 6- to 8- hour period . If diluted days after the first application, 33 animals died, 13 of them
weight of 300.05. It is soluble in water or saline at 1 mg/mL, within the first few hours. Platinum –containing species solution is not to be used within 6 hours, protect solution from related to malignancies: 12 leukemias and 1 renal
and in dimethyl formamide at 24 mg/mL. It has a melting point excreted in the urine are the same as those found following the light. Do not dilute cisplatin in just 5% Dextrose injection. fibrosarcoma.
of 207°C. incubation of cisplatin with urine healthy subjects, except that Adequate hydration and urinary output must be maintained The development of acute leukemia coincident with the use of
the proportions are different. during the following 24 hours. cisplatin has rarely been reported in humans. In these reports,
A repeat course of cisplatin should not be given until the serum cisplatin was generally given in combination with other
INDICATIONS creatinine is below 1.5 mg/100mL, and/or the BUN is below 25 leukemogenic agents.
mg/ 100mL. A repeat course should not be given until
CISPLATIN (Cisplatin Injection) is indicated as therapy to be circulating blood elements are at an acceptable level (platelets PRECAUTIONS
employed as follows: □ 100,000 / mm³, WBC ≥ 4,000 /mm³). Subsequent doses of Peripheral blood counts should be monitored weekly. Liver
Metastatic Testicular Tumors- In established combination cisplatin should not be given until an audiometric analysis function should be monitored periodically. Neurologic
CLINICAL PHARMACLOGY therapy with other approved chemotherapeutic agents in indicates that auditory acuity is within normal limits. examination should also be performed regularly (see
Plasma concentrations of parent compound, cisplatin, decay patients with metastatic testicular tumors who have already As with other potentially toxic compounds, caution should be ADVERSE REACTIONS section).
monoexponentially with a half-life of about 20 to 30 minutes received appropriate surgical and/or radiotherapeutic exercised in handling the aqueous solution. Skin reactions
following bolus administration of 50 or 100 mg/m² doses. procedures. associated with accidental exposure to cisplatin may occur. Carcinogenesis, Mutagenesis, Impairment of Fertility –
Monoexponential decay and plasma half- lives of about 0.5 Metastatic Ovarian Tumors-In established combination The use of gloves is recommended. If cisplatin contacts the see WARNINGS section.
hour are also seen following two hour or seven hour infusions therapy with other approved chemotherapeutic agents in skin or mucosa, immediately and thoroughly wash the skin
of 100 mg/m². After the latter, total –body clearances and patients with metastatic ovarian tumors who have already with soap and water and flush the mucosa with water. Pregnancy: Teratogenic Effects, Pregnancy Category D- see
volumes of distribution at steady- state for cis –platin are about received appropriate surgical and/or radiotherapeutic The aqueous solution should be used intravenously only and WARNINGS section.
15 to 16 L/h/m²and 11 to 12 L/m². Due to its unique chemical procedures. An established combination consists of cisplatin should be administered by IV infusion over a 6- to 8- hour
structure, the chlorine atoms of cisplatin are more subject to and cyclophosphamide. Cisplatin, as a single agent, is period. The cisplatin remaining in the vial following initial entry Nursing Mothers- Cisplatin has been reported to be found in
chemical displacement reactions by nucleophiles, such as indicated as secondary therapy in patients with metastatic is stable for 28 days protected from light or for 7 days under human milk; patients receiving cisplatin should not breast
water or sulfhydryl groups, than to enzyme catalyzed ovarian tumors refractory to standard chemotherapy who fluorescent room light. feed.
metabolism. At physiological pH in the presence of 0.1M NaCl, have not previously received cisplatin therapy. Procedures for proper handling and disposal of anticancer Pediatric Use – Safety and effectiveness in pediatric patients
the predominant molecular species are cisplatin and Advanced Bladder Cancer – Cisplatin is indicated as a single drugs should be considered .Several guidelines on this have not been established.
monohydroxymonochloro cis –diammine platinum (II) in agent for patients with transitional cell bladder cancer which is subject have been published.1-7 there is no general agreement Geriatric Use –Insufficient data are available from clinical trials
nearly equal concentrations. The latter, combined with the no longer amenable to local treatments such surgery and/ or that all of the procedures recommended in the guidelines are of cisplatin in the treatment of metastatic testicular tumors or
possible direct displacement of the chlorine atoms by radiotherapy necessary or appropriate. advanced bladder cancer to determine whether elderly
patients respond differently than younger patients. In four frequency and with the same timing as leukopenia and dose of cisplatin, although this is rare. Cisplatin therapy should after the overdosage, appears to have little effect on removing
clinical trials of combination chemotherapy for advanced thrombocytopenia. Fever and infections have also been be discontinued when the symptoms are first observed. The platinum from the body because of cisplatin’s rapid and high
ovarian carcinoma, 1484 patients received cisplatin either in reported in patients with neutropenia. Elderly patients may be neuropathy, however, may progress further even after degree of protein binding. Management of overdosage should
combination with cyclophosphamide or paclitaxel. Of these, more susceptible to myelosuppression (see PRECAUTIONS: stopping treatment. Preliminary evidence suggests peripheral include general supportive measures to sustain the patient
426 (29%) were older than 65 years. In these trials, age was Geriatric Use). neuropathy may be irreversible in some patients. Elderly through any period of toxicity that may occur.
not found to be a prognostic factor for survival. However, in a In addition to anemia secondary to myelosuppression, a patients may be more susceptible to peripheral neuropathy
later secondary analysis for one these trials, elderly patients Coombs’ positive hemolytic anemia has been reported. In the (see PRECAUTIONS: Geriatric Use). STORAGE
were found to have shorter survival compared with younger presence of cisplatin hemolytic anemia, a further course of Lhermitte’s sign, dorsal column myelopathy, and autonomic Store at 15° to 25°C (59° to 77°F). Do not refrigerate. Protect
patients. In all four trials, elderly patients experienced more treatment may be accompanied by increased hemolysis and neuropathy have also been reported. from light.
severe neutropenia than younger patients. Higher incidences this risk should be weighed by the treating physician. Loss of taste and seizures has also been reported.
of severe thrombocytopenia and leucopenia were also seen in The development of acute leukemia coincident with the use of Muscle cramps, defined as localized, painful, involuntary SHELF LIFE
elderly compared with younger patients, although not in all cisplatin has rarely been reported in humans. In these reports, skeletal muscle contractions of sudden onset and short 24 Months
cisplatin-containing treatment arms. In the two trials where cisplatin was generally given in combination with other duration, have been reported and were usually associated in
nonhematologic toxicity was evaluated according to age, leukemogenic agents. patients receiving a relatively high cumulative dose of cisplatin HOW SUPPLIED
elderly patients had a numerically higher incidence of and with a relatively advanced symptomatic stage of
peripheral neuropathy than younger patients. Other reported Gastrointestinal—Marked nausea and vomiting occur in peripheral neuropathy. CISPLATIN 10
clinical experience suggests that elderly patients may be more almost all patients treated with cisplatin, and are occasionally Ocular toxicity - Optic neuritis, papilledema, and cerebral Cisplatin Injection BP 10mg/10mL
susceptible to myelosuppression, infectious complications, so severe that the drug must be discontinued. Nausea and blindness have been reported infrequently in patients Each Sterile Single dose vial, packed in a individually carton.
and nephrotoxicity than younger patients. vomiting usually begin within 1 to 4 hours after treatment and receiving standard recommended doses of cisplatin.
Cisplatin is known to be substantially excreted by the kidney last up 24 hours. Various degrees of vomiting, nausea and/or Improvement and / or total recovery usually occurs after CISPLATIN 50
and is contraindicated in patients with pre existing renal anorexia may persist for up to 1 week after treatment. discontinuing cisplatin. Steroids with or without mannitol have Cisplatin Injection BP 50mg/50mL
impairment. Because elderly patients are more likely to have Delayed nausea and vomiting (begins or persists 24 hours or been used; however, efficacy has not been established. Each Sterile Multi Dose vial, packed in a individually carton.
decreased renal function, care should taken in dose selection, more after chemotherapy) has occurred in patients attaining Blurred vision and altered color perception have been
and renal function should monitored. complete emetic control on the day of cisplatin therapy. reported after the use of regimens with higher doses of Manufactured in India by:
Diarrhea has also been reported. cisplatin or greater dose frequencies than those TAJ PHARMACEUTICALS LTD.
ADVERSE REACTIONS recommended in the package insert. The altered color Mumbai, India
Other Toxicities perception manifests as a loss of color discrimination, at SURVEY NO.188/1 TO 189/1,190/1 TO 4,
Nephrotoxicity - Dose related and cumulative renal Vascular toxicities coincident with the use of cisplatin in particularly in the blue-yellow axis. The only finding on ATHIYAWAD, DABHEL, DAMAN- 396210 (INDIA)
insufficiency is the major dose-limiting toxicity of cis-platin. combination with other antineoplastic agents have been funduscopic exam is irregular retinal pigmentation of the
Renal toxicity has been noted in 28% to 36% of patients reported rarely. The events are clinically heterogeneous and macular area. This leaflet was last revised in May 2019.
treated with a single dose of 50 mg/m2. It is first noted during may include myocardial infarction, cerebrovascular accident, Anaphylactic-like Reactions – Anaphylactic – like reactions
the second week after a dose and is manifested by elevations thrombotic microangiopathy (HUS), or cerebral atreritis. have been occasionally reported in patients previously For the use only of a Registered Medical Practitioner or
in BUN and creatinine, serum uric acid and /or a decrease in Various mechanisms have been proposed for these vascular exposed to cisplatin. The reactions consist of facial edema, a Hospital or a Laboratory
creatinine clearance. Renal toxicity becomes more prolonged complications. There are also reports of Reynaud’s wheezing, tachycardia, and hypotension within a few minutes
and severe with repeated courses of the drug .Renal function phenomenon occurring in patients treated with the of drug administration. Reactions may be controlled by
must return to normal before another dose of cisplatin can be combination of bleomycin, vinblastine with or without cisplatin. intravenous epinephrine with corticosteroids and/or
given. Elderly patients may be more susceptible to
nephrotoxicity (see PRECAUTIONS: Geriatric Use).
It has been suggested that hypomagnesemia developing
coincident with the use of cisplatin may be an added, although
antihistamines as indicated. Patients receiving cisplatin
should be observed carefully for possible anaphylactic-like
Cisplatin
Injection BP
Impairment of renal function has been associated with renal not essential, factor associated with this event. However, it is reactions and supportive equipment and medication should be
tubular damage. The administration of cis-platin using a 6- to currently unknown if the cause of Reynaud’s phenomenon in available to treat such a complication.
8- hour infusion with intravenous hydration, and manntiol has
been used to reduce nephrotoxicity. However, renal toxicity
these cases is the disease , underlying vascular compromise,
bleomycin, vin-blastin, hypomagnesemia, or a combination of
Hepatotoxicity – Transient elevations of liver enzymes,
especially SGOT, as well as bilirubin, have been reported to be 1mg/1ml
still can occur after utilization of these procedures. any of these factors. associated with cisplatin administration at the recommended
doses.
Ototoxicity- Ototoxicity has been observed in up to 31% of Serum Electrolyte Disturbances – Hypomagnesemia, Other Events – Other toxicities reported to occur infrequently
patients treated with a single dose of cispatin 50 mg/m2, and is hypocalcaemia, hyponatremia, hypokalemia, and are cardiac abnormalities, hiccups, elevated serum amylase,
manifested by tinnitus and/or hearing loss in the high hypophosphatemia have been reported to occur in patients and rash. Alopecia, malaise, and asthenia have been reported
frequency range (4,000 to 8,000Hz). Decreased ability to hear treated with cisplatin and probably related to renal tubular as part of postmarketing surveillance.
normal conversational tones may occur occasionally. damage. Tetany has occasionally been reported in those Local soft tissue toxicity has rarely been reported following
Deafness after the initial dose of cisplatin has been reported patients with hypocalcaemia and hyomagnesemia. Generally, extravasation of cisplatin. Severity of the local tissue toxicity
rarely. Ototoxic effects may be more severe in children normal serum electrolyte levels are restored by administering appears to be related to the concentration of the cisplatin
receiving cisplatin. Hearing loss can be unilateral or bilateral supplemental electrolytes and discontinuing cisplatin. solution. Infusion of solutions with a cisplatin concentration
and tends to become more frequent and severe with repeated Inappropriate ant diuretic hormone syndrome has also been greater than 0.5 mg/mL may result in tissue cellulitis, fibrosis,
doses. Ototoxicity may be enhanced with prior or reported. and necrosis.
simultaneous cranial irradiation. It is unclear whether cisplatin
induced ototoxicity is reversible. Ototoxic effects may be Hyperuricemia – Hyperuricemia has been reported to occur DRUG INTERACTIONS
related to the peak plasma concentration of cisplatin. Careful at approximately the same frequency as the increases in BUN Plasma levels of anticonvulsant agents may become
monitoring of audiometry should be performed prior to and serum creatinine. subtherapeutic during cisplatin therapy. In a randomized trial
initiation of therapy and prior to subsequent doses of cisplatin. It is more pronounced after doses greater than 50mg/m2, and in advanced ovarian cancer, response duration was adversely
Vestibular toxicity has also been reported. peak levels of uric acid generally occur between 3 to 5 days affected when pyridoxine was used in combination with
Ototoxicity may become more severe in patients being treated after the dose. Allopurinol therapy for hyperuricemia altretamine (hexamethylmelamine) and cisplatin.
with other drugs with nephrotoxic potential. effectively reduces uric acid levels. Overdose
Caution should be exercised to prevent inadvertent
Hematologic- Myelosuppression occurs in 25% to 30% of Neurotoxicity – Neurotoxicity, usually characterized by overdosage with cisplatin. Acute overdosage with this drug
patients treated with cisplatin. The nadirs in circulating peripheral neuropathies, has been reported. The may result in kidney failure, liver failure, deafness, ocular
platelets and leukocytes occur between days 18 to 23 (range neuropathies usually occur after prolonged therapy (4 to 7 toxicity (including detachment of the retina), significant
7.5 to 45) with most patients recovering by day 39 (range 13 to months); however, neurologic symptoms have been reported myelosuppression, intractable nausea and vomiting and / or
62). Leucopenia and thrombocytopenia are more pronounced to occur after a single dose. Although symptoms and sign of neuritis. In addition, death can occur following overdosage.
at higher doses (>50mg/m2).Anemia (decrease of 2 g cis-platin neuropathy usually develop during treatment No proven antidotes have been established for cisplatin
hemoglobin/100mL) occurs at approximately the same symptoms of neuropathy may begin 3 to 8 weeks after the last overdosage. Hemodialysis, even when initiated four hours PACKAGE LEAFLET: INFORMATION FOR THE USER Cisplatin 1mg/ml Concentrate for Solution for Infusion Cisplatin The name of your medicine is ‘Cisplatin 1 mg/ml Concentrate for Solution for
Infusion’ but in the rest of the leaflet it will be called “Cisplatin Injection”.
Read all of this leaflet carefully before you start using this medicine because it contains important ... What you need to know before you use Cisplatin Injection. 3.
Cisplatin Injection is indicated for the palliative treatment of metastatic non-seminomatous ... some cases and the adult dosage should be used with caution.
Read all of this leaflet carefully before you start taking this medicine because it .... Cisplatin is only given by injection into a vein (an intravenous infusion).
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