Cisplatin

What is cisplatin?

Cisplatin is a chemotherapy drug used to treat various forms of cancer and solid tumors in animals.

Cisplatin is prescribed off-label for use in dogs, horses, and birds, and reptiles. Cisplatin should NOT be used in cats as it may cause fatal side effects. There are no veterinary brands of cisplatin, but several generic human brands. 

Many drugs are commonly prescribed for off-label use in veterinary medicine. “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions very carefully, as their directions may be significantly different from those on the label. 

How do I give my pet cisplatin?

• Cisplatin comes as a solution that will be administered by injection at the veterinary hospital or office.
• Cisplatin is usually injected intravenously (into the vein) but may sometimes be injected directly into a body cavity (e.g., the abdomen) or directly into a tumor.
• This drug is highly likely to cause nausea and vomiting, so it is recommended that your pet be treated with an anti-nausea drug prior to administration.
• Avoid contact with the administration site. 

This medication takes several days for beneficial effects to occur. Full effects may not be evident for several weeks. However, side effects (e.g., upset stomach or sleepiness) may occur immediately. Clinical signs will gradually improve over time.

Cisplatin is considered a hazardous drug and can cause serious adverse effects in people or animals that are exposed to it. Although you will not handle the drug directly, this drug can be found in your pet’s saliva, urine, feces, and blood for a few days after the treatment. Observe the following cautions when interacting with your pet after treatment:

• If you are pregnant or nursing, do not contact your pet, or handle any waste or items used to clean the waste.
• Wear gloves when disposing of dog droppings or cleaning up urine spills or vomit, to avoid contact with skin. Do not reuse gloves.
• Seal the waste in a plastic bag, along with all gloves and items used to clean it (e.g., paper towels), then place it into an additional plastic bag (double bag) before putting in the regular trash.
• Be careful not to accidentally rub your eyes during or after handling the pet’s waste.
• Do not let treated animals lick human skin. If skin exposure occurs, wash the area thoroughly with soap and water. Contact your physician if you have any concerns.

What if I miss giving my pet the medication?

If you miss a scheduled treatment of cisplatin, contact your veterinary office to arrange for an appointment as soon as possible. It is important to maintain a regular dosing schedule. Your veterinarian will instruct you on how to proceed after a missed dose.

Are there any potential side effects from cisplatin?

Cisplatin may cause the following side effects:

• Vomiting (common; If the vomiting is severe and not controlled, contact your veterinarian)
• Loss of fur in dogs (especially in dogs with continuously growing hair coats such as poodles, terriers, Afghan hounds, or Old English sheepdogs)
• Damage to the inner ear and hearing loss
• Damage the liver or kidneys

Serious adverse reactions associated with this drug may occur without warning and could, in rare cases, lead to death. If any of the following signs develop, contact your veterinarian immediately:

• Weakness, fever, bruising, or bleeding (signs of bone marrow suppression, which can occur about 14 days after cisplatin is given)
• Abnormal bleeding or bruising
• Abnormal urination
• Depression
• Infection
• Shortness of breath
• Vomiting, loss of appetite 

Drug sensitivities can develop over time with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of treatment. This moderate-acting medication should stop working within several days, although effects may be longer in pets with liver or kidney disease. 

Are there any risk factors for this medication?

DO NOT USE this medication in:

• Cats (it can cause fatal lung toxicity and other fatal side effects)
• Pets that have experienced an allergic reaction to cisplatin or other drugs like it (e.g., carboplatin)
• Pets with kidney problems
• Pets with bone marrow suppression (when the body cannot fight infections)

USE WITH CAUTION in pets who: 

• Have heart failure
• Have an existing infection

Are there any drug interactions I should be aware of?

Certain medications may interact with cisplatin and so it is important to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your dog is taking before starting any new treatment.

Avoid any drugs that also contribute to damage to the kidneys or inner ear after repeated doses, such as:

• Aminoglycoside antibiotics
• Carboplatin
• Furosemide
• Polymyxin B, systemic
• Tigilanol tiglate

Several medications should be used with caution when given with cisplatin, including:

• Amiodarone
• Doxorubicin
• Immune globulin, intravenous (IVIG)
• Iodixanol
• Iohexol
• Leflunomide
• NSAIDs (e.g., tolfenamic acid)
• Prochlorperazine
• Promethazine
• Verdinexor

Is any monitoring needed with this medication?

• Several blood values must be checked before starting therapy with cisplatin, and before each subsequent treatment. 
• A neurological examination should be performed by your veterinarian regularly.
• At home, monitor for any side effects such as those noted above. If any side effects occur, discontinue use of the medication and contact your veterinarian. 
• Your veterinarian will let you know when they want to reassess your pet to ensure the medication is working and not causing side effects.

How do I store cisplatin?

Cisplatin will be given at your veterinarian’s office. You will not need to store this medication. 

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.