Carboplatin is a platinum-containing compound that exerts its antineoplastic effects by cross-linking DNA. It binds to DNA, forming adducts that result in the inhibition of DNA replication and transcription. This leads to cell death, particularly in rapidly dividing tumor cells. Carboplatin is a less nephrotoxic alternative to cisplatin but retains similar antitumor activity.

1. 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.

2. 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 need ed, but close monitoring is required.

3 . 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.

4. 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).

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.