Dosage and Administration:

• Adult Dosage (General):

• • Carboplatin is administered by intravenous infusion.
  • The dosage is typically calculated based on the calculated Glomerular Filtration Rate (GFR) using the Calvert formula:
    • Dose (mg) = Target AUC (area under the curve) × (GFR + 25)
      (Where AUC is generally 4–6, depending on the condition being treated).
  • For ovarian cancer:
    • AUC 4–6 mg/mL·min, administered every 3–4 weeks.
  • For other cancers:
    • The dose can vary depending on the tumor type and the chemotherapy regimen being used.

• Pediatric Dosage:

• • Pediatric dosing is generally based on the same principles but adjusted for age, weight, and renal function.
  • Pediatric dosing is often individualized based on the specific cancer being treated.

• Administration:

• • Carboplatin is administered by intravenous infusion over 15 to 60 minutes.
  • It must not be injected intramuscularly or subcutaneously.
  • Use appropriate dilution for infusion.

Renal Impairment:

• Moderate to Severe Renal Dysfunction (CrCl < 60 mL/min):
  • Dose adjustments are necessary, and the use of Carboplatin should be done with caution.
• Mild Renal Dysfunction (CrCl > 60 mL/min):
  • No dose adjustments typically needed, but close monitoring is required.

Side Effects:

Common and serious adverse effects include:

• Hematologic Toxicity:

• • Myelosuppression, including thrombocytopenia, anemia, and leukopenia.
  • Platelet count and white blood cell counts should be monitored.

• Renal Toxicity:

• • Though less nephrotoxic than cisplatin, carboplatin can still cause renal dysfunction, particularly in patients with pre-existing kidney disease.

• Nausea and Vomiting:

• • Common but can be controlled with antiemetics.

• Hypersensitivity Reactions:

• • Rare but include anaphylactic reactions. Monitor for signs of allergic reactions during the infusion.

• Neurotoxicity:

• • Carboplatin is generally less neurotoxic compared to cisplatin but can still cause peripheral neuropathy.

• Ototoxicity:

• • Less common than cisplatin but can cause hearing loss in some patients.

Contraindications:

• Known hypersensitivity to carboplatin or other platinum-containing compounds.
• Pre-existing severe renal impairment (CrCl < 30 mL/min), unless careful monitoring and dose adjustment are performed.
• Severe myelosuppression from any cause (e.g., bone marrow failure or previous chemotherapy).

Warnings and Precautions:

• Bone Marrow Suppression:

• • Carboplatin can cause severe myelosuppression, including thrombocytopenia and neutropenia. Monitor blood counts regularly.

• Allergic Reactions:

• • There is a risk of hypersensitivity reactions, which can be severe or even life-threatening. Pre-medication with antihistamines and steroids may be necessary in some cases.

• Renal Function Monitoring:

• • Regular monitoring of kidney function (serum creatinine, GFR) is essential due to potential nephrotoxicity.

• Pregnancy Category D:

• • Carboplatin may cause fetal harm when administered during pregnancy. It is contraindicated in pregnant women unless the benefit outweighs the risk.

• Fertility:

• • Carboplatin may impair fertility and cause reproductive toxicity. Both male and female patients should be counseled on potential effects on fertility.

Drug Interactions:

• Other nephrotoxic drugs:

• • Increased risk of renal toxicity when combined with other nephrotoxic agents like aminoglycosides, cisplatin, or NSAIDs.

• Anticoagulants:

• • Monitor for signs of bleeding, especially if carboplatin is combined with anticoagulants.

Monitoring:

• Complete Blood Count (CBC):

• • Regular monitoring to assess for myelosuppression (particularly thrombocytopenia and neutropenia).

• Renal Function Tests:

• • Monitor serum creatinine and GFR regularly.

• Electrolytes:

• • Ensure normal electrolyte levels, particularly potassium and magnesium, as disturbances can occur.

Overdose:

• Symptoms of overdose include severe myelosuppression, renal failure, and potentially life-threatening allergic reactions. Immediate supportive care and monitoring are required. Hematopoietic growth factors and blood transfusions may be necessary.

Storage:

• Store carboplatin at room temperature (20°C to 25°C, 68°F to 77°F).
• Protect from light.
• Once diluted, it should be used immediately or stored under controlled conditions as per manufacturer guidelines.

Summary:

Carboplatin is a potent chemotherapy agent with broad antitumor activity, particularly in ovarian and lung cancers. While it shares a similar mechanism of action with cisplatin, it has a more favorable toxicity profile, particularly regarding nephrotoxicity. Close monitoring of hematologic and renal parameters is crucial during treatment.