Drug reference

Carboplatin

Platinum-based alkylating agent · Antineoplastic

Also known as Paraplatin, CBDCA

START

Calvert formula: dose (mg) = AUC × (GFR + 25); ovarian first-line AUC 5–6 IV q3–4 weeks

TYPICAL MAX

AUC-defined; cap GFR at 125 mL/min in the formula — no fixed mg ceiling

STOP IF

Severe hypersensitivity/anaphylaxis, persistent grade 4 myelosuppression, or rising creatinine

WATCH

CBC with platelets each cycle · electrolytes (Mg/K) · hypersensitivity from cycle 6 · renal function

CDSCO approvedSchedule HATC L01XA02

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 30min · IV infusion (immediate exposure)
PEAK: 1h · End of infusion Cmax
t½: 1.5h · free platinum t½
DURATION: 3w · 3-week cycle interval

EXCRETION

~65% renal unchanged within 24 h

route + CYP

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

Avoid — fetotoxic/teratogenic; effective contraception required during and after therapy

FDA category + note

Top interactionssee all 12 →

Live VaccinesContraindicatedDatabaseKimi deep-research + Cla
TorsemideSevereTextbookG&G 14e · p566
AdalimumabSevereDatabaseDDInter
Aminoglycosides (e.g., Amikacin, Gentamicin)SevereDatabase

Available in India

64 branded formulations. Look up specific brands in the Drugs workspace.

Mechanism

Carboplatin forms reactive platinum complexes that bind and crosslink DNA (predominantly intrastrand N7-guanine adducts), inhibiting DNA replication and transcription and triggering apoptosis. It is cell-cycle non-specific. Compared with cisplatin it is less reactive, producing fewer DNA adducts per unit dose, which underlies its lower nephro-, oto- and neurotoxicity but greater myelosuppression.

Indications

Epithelial ovarian carcinoma (first-line and recurrent)Non-small cell and small cell lung cancerCarcinoma of unknown primaryEndometrial, cervical, breast and bladder cancer (regimen-dependent)Germ cell tumours

Dosing

Adult: Dose by Calvert formula: dose (mg) = target AUC × (GFR + 25). Ovarian first-line target AUC 5–6 IV every 3–4 weeks; AUC 4–6 in combination regimens.
Pediatric: Body-surface or GFR-based per protocol (e.g. AUC-based or 300–560 mg/m² per cycle); specialist oncology only.
Renal adjustment: Dose is intrinsically renal-function-adjusted via the Calvert formula (uses measured/estimated GFR). Cap GFR at 125 mL/min in the formula to avoid overdosing.
Hepatic adjustment: No specific adjustment; minimal hepatic metabolism.
Geriatric: Use measured renal function in the Calvert formula; no separate age adjustment.
Max dose: Calvert-formula AUC-defined (no fixed mg ceiling); GFR capped at 125 mL/min in the equation

Pharmacokinetics

Onset

Nadir of counts ~day 14–21

Peak effect

End of infusion (Cmax immediate, IV)

Duration

Cycle-based (every 3–4 weeks)

Half-life

Free platinum ~1.1–2 h; total platinum elimination prolonged (days)

Bioavailability

100% (IV)

Protein binding

Free drug minimal initially; platinum becomes irreversibly protein-bound over time

Metabolism

Aquation (non-enzymatic) to active species; minimal hepatic metabolism

Excretion

~60–70% renal (glomerular filtration), largely as unchanged drug within 24 h

Contraindications

Severe hypersensitivity to carboplatin, cisplatin or other platinum compounds
Severe pre-existing myelosuppression
Significant bleeding
Severe renal impairment (relative — requires AUC dose reduction)

Side effects

Common

Myelosuppression (thrombocytopenia, neutropenia, anaemia)Nausea and vomitingFatigueAlopecia (regimen-dependent)Electrolyte disturbance (Mg, K, Ca, Na)

Serious

Severe/dose-limiting thrombocytopenia and neutropenia
Anaphylaxis/hypersensitivity (risk rises after ≥6 cycles)
Secondary acute leukaemia (cumulative)
Peripheral neuropathy and ototoxicity (less than cisplatin)
Tumour lysis syndrome

Pregnancy & lactation

Pregnancy

Avoid — fetotoxic/teratogenic; effective contraception required during and after therapy

Lactation

Discontinue breastfeeding during treatment (cytotoxic, excreted in milk)

Drug interactions

Live Vaccines

Contraindicated

Database

Immunosuppression — risk of disseminated vaccine infection

Do not give live vaccines during or shortly after therapy

Source: Kimi deep-research + Cla

Torsemide

Severe

Textbook

Increased risk of ototoxicity (e.g., tinnitus, hearing impairment, deafness, vertigo).

Not explicitly stated, but implies careful monitoring or avoidance if possible.

Source: G&G 14e · p566

Adalimumab

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Aminoglycosides (e.g., Amikacin, Gentamicin)

Severe

Database

Increased risk and severity of nephrotoxicity (acute kidney injury) and ototoxicity (hearing loss, tinnitus, vestibular dysfunction).

Avoid concomitant use if possible. If co-administration is necessary, monitor renal function (serum creatinine, GFR) and audiometry closely. Adjust carboplatin dose based on renal function. Consider therapeutic drug monitoring for aminoglycosides.

Baricitinib

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Aminoglycosides

Severe

Database

Additive nephrotoxicity and ototoxicity

Avoid concurrent use; if unavoidable monitor renal function and audiometry

Source: Kimi deep-research + Cla

Certolizumab

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Cidofovir

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Cisplatin

Severe

Database

Significantly increased risk and severity of nephrotoxicity, ototoxicity, and myelosuppression. This combination is generally not used due to cumulative toxicity.

This combination is rarely used due to severe overlapping toxicities. If considered in very specific protocols, extreme caution, intensive monitoring of renal function, audiometry, and CBCs are required. Dose reductions are likely necessary.

Source: DDInter

Cladribine

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Clozapine

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Deferiprone