| DRUG INFORMATION |
| Classification | Alkylating agent (https://www.ons.org/sites/default/files/2023-06/AlkylatingAgents_HuddleCard.pdf); platinum analog |
| Mechanism of Action | Inhibits DNA replication and transcription and is cell-cycle nonspecific |
| Indications | - Treatment of advanced colorectal cancer
- Adjuvant treatment of stage III colon cancer in patients who have undergone complete tumor resection
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| ADMINISTRATION |
| Dosing, Frequency, and Administration | - Infuse 85 mg/m2 over 120 minutes every two weeks.
- Prolonging the infusion rate to six hours may lessen the severity of acute toxicities such as infusion-related reactions.
- Refer to the prescribing information for dose modifications.
- For adjuvant treatment, patients receive up to 12 cycles or until they experience unacceptable toxicity.
- For advanced colorectal cancer, patients receive treatment until they experience disease progression or unacceptable toxicity.
|
| Route | IV |
| Safe Handling | Oxaliplatin is a potentially hazardous drug per the National Institute for Occupational Safety and Health (https://www.usp.org/compounding/general-chapter-hazardous-drugs-handling-healthcare#:~:text=The%20National%20Institute%20for%20Occupational,low%20doses%2C%20genotoxicity%2C%20or%20structure) definition. Follow safe-handling precautions. (https://www.ons.org/books/safe-handling-hazardous-drugs-third-edition) |
| ADVERSE REACTIONS |
- Peripheral neuropathy may be acute or delayed and is usually reversible. Symptoms may be precipitated or exacerbated by cold temperature or objects and usually occur within hours to 2 days after administration and resolve within 14 days. It frequently recurs with subsequent dosing.
- Grade 3 or 4 neutropenia may occur and increases risk for neutropenic sepsis and septic shock.
- Other adverse reactions include increased transaminases and alkaline phosphate, stomatitis, nausea, vomiting, diarrhea, and fatigue.
- Oxaliplatin is an irritant and can cause damage to tissue.
|
| WARNINGS |
- Black Box Warnings
- Risk for serious and fatal hypersensitivity reactions, including anaphylaxis, within minutes of administration during any cycle
- Contraindicated in patients with a history of hypersensitivity to oxaliplatin or other platinum-based drugs
- Other Warnings
- Embryo-fetal toxicity
- Hemorrhage
- Hepatoxicity
- Peripheral sensory neuropathy
- Posterior reversible encephalopathy syndrome (PRES)
- Prolonged QT interval
- Pulmonary toxicity
- Rhabdomyolysis
- Severe myelosuppression
|
| NURSING CONSIDERATIONS |
| Pretreatment | - Conduct complete blood count, comprehensive metabolic panel, and liver function tests.
- Confirm negative pregnancy status in patients of reproductive potential.
- Premedicate with an antiemetic (e.g., 5-HT3 antagonist with or without dexamethasone).
- Assess for baseline neuropathy and side effects from previous treatments, if applicable.
- Obtain a baseline echocardiogram in patients with congestive heart failure, bradyarrhythmias, and electrolyte abnormalities.
|
| Administration | - Monitor IV site for redness, swelling, and pain
- Monitor closely for infusion reaction and ensure that epinephrine, corticosteroids, and antihistamines are readily available.
- Oxaliplatin is incompatible with normal saline and must be flushed with 5% dextrose in water.
|
| Post-Treatment | - Perform follow-up assessment for toxicities.
- Prescribe antiemetics.
- Identify any potential drug interactions with patient’s prescribed medications (e.g., drugs that prolong the QT interval, nephrotoxic drugs, anticoagulants).
|
| PATIENT EDUCATION |
- Seek immediate medical attention for signs of a reaction, including a delayed reaction, such as shortness of breath, chest tightness, wheezing, dizziness, and angioedema.
- Avoid cold drinks, ice, and exposure to cold temperatures or objects.
- This medication can cause low blood cell counts; contact your healthcare provider if you experience fever, bleeding, or symptoms of infection.
- Contact your healthcare provider for persistent vomiting, diarrhea, or signs of dehydration; headache, vision changes, confusion, or seizures; new-onset cough; muscle pain or weakness; and red-brown urine.
- Patients of reproductive potential should use effective contraception during treatment and for 9 months after the final dose for females and 6 months for males. Do not breastfeed/chestfeed during treatment and for 3 months after your final dose.
- Inform your healthcare provider of any medications you are taking.
- Monitor for signs and symptoms of PRES, including headache, altered mental status, seizures, and abnormal vision, and call your healthcare provider if you develop any of those symptoms.
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| RESOURCES |
| Patient Resources | |
| Healthcare Professional Resources | |
| Other Resources | National Cancer Institute page for oxaliplatin (https://www.cancer.gov/about-cancer/treatment/drugs/oxaliplatin) |
