Oncology Drug Reference Sheet: Oxaliplatin

September 17, 2024

By Courtney Lamontagne, BSN, RN, OCN®

Oxaliplatin (Eloxatin®) is a platinum-based drug used since 2002 to treat colorectal cancer. It can cause serious hypersensitivity adverse reactions and has the unique side effect of reversible peripheral sensory neuropathy exacerbated by exposure to cold temperature or objects. It gets its name from its chemical structure, which has an oxalate ligand.

This ONS resource was produced for educational purposes only. Refer to the full oxaliplatin package insert (https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/021492s016lbl.pdf) for all details. 

DRUG INFORMATION
ClassificationAlkylating agent (https://www.ons.org/sites/default/files/2023-06/AlkylatingAgents_HuddleCard.pdf); platinum analog 
Mechanism of ActionInhibits 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 
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.
RouteIV
Safe HandlingOxaliplatin 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. 
RESOURCES
Patient Resources
Healthcare Professional Resources
Other ResourcesNational Cancer Institute page for oxaliplatin (https://www.cancer.gov/about-cancer/treatment/drugs/oxaliplatin)

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