Comprehensive Guide to Oxaliplatin: Uses, Dosage, Side Effects, and More
What is Oxaliplatin?
Overview of Oxaliplatin
Generic Name: Oxaliplatin
Brand Name: Eloxatin, generics
Drug Group: Platinum-based alkylating agent (antineoplastic)
Commonly Used For
- Treat colorectal cancer.
- Manage advanced gastrointestinal cancers.
- Control metastatic disease.
Key Characteristics
Form: Lyophilized powder or solution for injection (50 mg, 100 mg/vial) (detailed in Dosage section).
Mechanism: Forms inter- and intra-strand DNA adducts, inducing apoptosis in cancer cells.
Approval: FDA-approved (2002 for Eloxatin) and EMA-approved for colorectal cancer.
Indications and Uses of Oxaliplatin
Oxaliplatin is indicated for a range of neoplastic conditions, leveraging its cytotoxic effects to target rapidly dividing cells:
Colorectal Cancer (Adjuvant): Treats stage III colon cancer post-surgery in combination with 5-fluorouracil (5-FU) and leucovorin (FOLFOX regimen), reducing recurrence, per oncology guidelines.
Metastatic Colorectal Cancer: Manages metastatic colorectal cancer with FOLFOX or XELOX (capecitabine), improving survival rates, supported by clinical trials like MOSAIC.
Gastric Cancer: Used off-label in combination therapy for advanced gastric cancer, enhancing response rates, with evidence from gastrointestinal oncology studies.
Pancreatic Cancer: Investigated off-label as part of multi-drug regimens for pancreatic adenocarcinoma, improving progression-free survival, supported by pancreatic cancer research.
Esophageal Cancer: Employed off-label with chemoradiotherapy for esophageal cancer, reducing tumor burden, with data from thoracic oncology trials.
Ovarian Cancer: Explored off-label for platinum-sensitive recurrent ovarian cancer, offering an alternative to cisplatin, with gynecologic oncology evidence.
Hepatocellular Carcinoma: Used off-label in transarterial chemoembolization (TACE) for hepatocellular carcinoma, improving local control, supported by hepatology studies.
Neuroendocrine Tumors: Managed off-label for advanced neuroendocrine tumors, reducing symptoms and tumor growth, with emerging endocrine oncology data.
Head and Neck Cancer: Investigated off-label in combination with radiation for head and neck squamous cell carcinoma, enhancing locoregional control, noted in head and neck cancer research.
Dosage of Oxaliplatin
Dosage for Adults
Adjuvant Colorectal Cancer (FOLFOX4): 85 mg/m² IV on day 1 of a 14-day cycle for 12 cycles, with 5-FU and leucovorin.
Metastatic Colorectal Cancer (FOLFOX6): 85 mg/m² IV every 2 weeks, with 5-FU and leucovorin, continued until disease progression.
Off-Label Use (e.g., Gastric Cancer): 85–130 mg/m² IV every 3 weeks, adjusted for toxicity, in combination regimens.
Dosage for Children
Off-Label Use (e.g., Pediatric Solid Tumors): 85–100 mg/m² IV every 2–3 weeks, under pediatric oncologist supervision, based on BSA.
Not recommended under 6 months unless critical.
Dosage for Pregnant Women
Pregnancy Category D: Avoid unless benefits outweigh risks (e.g., life-threatening cancer). Consult an obstetrician, with fetal monitoring.
Dosage Adjustments
Renal Impairment: Reduce dose to 65 mg/m² if CrCl 30–59 mL/min; avoid if <30 mL/min.
Hepatic Impairment: No specific adjustment; monitor in severe cases (bilirubin >3 mg/dL).
Elderly: Start with 65–85 mg/m²; increase cautiously with monitoring.
Concomitant Radiation: Reduce dose by 25–50% if used with radiotherapy due to enhanced neurotoxicity.
Additional Considerations
- Administer this active ingredient via IV infusion over 2 hours by a healthcare provider.
- Premedicate with antiemetics and hydration to reduce nausea and nephrotoxicity.
How to Use Oxaliplatin
Administration:
- Reconstitute with water for injection or 5% dextrose, dilute, and infuse IV over 2 hours; avoid chloride-containing solutions.
- Administer in a controlled setting with antiemetics, hydration, and neurotoxicity monitoring.
Timing: Use as part of a scheduled chemotherapy cycle, typically every 2–3 weeks.
Monitoring: Watch for cold sensitivity, numbness, or signs of infection (e.g., fever).
Additional Tips:
- Store at 15–30°C (59–86°F); protect from light.
- Handle with gloves; dispose of waste per hazardous drug protocols.
- Report severe neuropathic pain, vision changes, or signs of allergic reaction immediately.
Contraindications for Oxaliplatin
Hypersensitivity: Patients with a known allergy to Oxaliplatin or other platinum compounds.
Severe Renal Impairment: Contraindicated if CrCl <30 mL/min.
Myelosuppression: Avoid in severe cases due to infection risk.
Pregnancy: Contraindicated unless life-saving.
Side Effects of Oxaliplatin
Common Side Effects
- Peripheral Neuropathy (70–85%, acute with cold, chronic with cumulative dose)
- Nausea (60–75%, managed with antiemetics)
- Fatigue (50–70%, decreases with rest)
- Diarrhea (40–60%, transient)
- Vomiting (35–50%, reduced with hydration)
These effects may subside with dose adjustment or cycle breaks.
Serious Side Effects
Seek immediate medical attention for:
- Neurological: Severe neuropathy, seizures, or vision loss.
- Hematologic: Neutropenia, thrombocytopenia, or anemia.
- Hepatic: Sinusoidal obstruction syndrome or jaundice.
- Pulmonary: Interstitial pneumonitis or pulmonary fibrosis.
- Allergic: Rash, angioedema, or anaphylaxis.
Additional Notes
- Regular monitoring for neurological function, blood counts, and liver health is advised.
- Report any unusual symptoms (e.g., persistent numbness, fever) immediately to a healthcare provider.
Warnings & Precautions for Oxaliplatin
General Warnings
Peripheral Neuropathy: Risk of acute and chronic sensory neuropathy, especially with cold exposure; monitor neurological status.
Myelosuppression: Risk of neutropenia, thrombocytopenia, and anemia; monitor blood counts weekly.
Hepatotoxicity: Risk of sinusoidal obstruction syndrome; check liver function regularly.
Allergic Reactions: Risk of anaphylaxis during infusion; have resuscitation equipment ready.
Pulmonary Toxicity: Rare interstitial lung disease; monitor respiratory symptoms.
Additional Warnings
Ototoxicity: Rare hearing loss or tinnitus; assess auditory function.
Cardiotoxicity: Rare QT prolongation or arrhythmias; monitor ECG.
Gastrointestinal Perforation: Rare with prolonged use; watch for abdominal pain.
Renal Impairment: Monitor in moderate cases; adjust if worsening.
Hypersensitivity Reactions: Severe reactions possible; discontinue if severe.
Use in Specific Populations
- Pregnancy: Category D; avoid unless critical; use contraception.
- Breastfeeding: Avoid due to potential toxicity; monitor infant.
- Elderly: Higher risk of neuropathy; start with lower doses.
- Children: Limited to 6 months+ off-label; supervise closely.
- Renal/Hepatic Impairment: Adjust dose; avoid in severe cases.
Additional Precautions
- Inform your doctor about kidney disease, neuropathy, or prior platinum therapy before starting this medication.
- Avoid cold drinks or environments during and after infusion to minimize neuropathy.
Overdose and Management of Oxaliplatin
Overdose Symptoms
- Nausea, vomiting, or severe neuropathy.
- Severe cases: Bone marrow failure, renal failure, or seizures.
- Fever, fatigue, or paresthesia as early signs.
- Cardiorespiratory arrest with extremely high doses.
Immediate Actions
Contact the Medical Team: Seek immediate medical help.
Supportive Care: Administer IV fluids, blood transfusions, and anticonvulsants if needed.
Specific Treatment: No antidote; manage symptoms and monitor organ function.
Monitor: Check blood counts, kidney function, and neurological status for 7–14 days.
Additional Notes
- Overdose risk is high; store securely.
- Report persistent symptoms (e.g., severe weakness, vision loss) promptly.
Drug Interactions with Oxaliplatin
This active ingredient may interact with:
- Nephrotoxic Drugs: Enhances renal damage (e.g., aminoglycosides); monitor.
- Anticoagulants: Alters bleeding risk; monitor INR.
- Live Vaccines: Reduces immune response; avoid.
- Neurotoxic Agents: Potentiates neuropathy (e.g., taxanes); adjust dose.
- Radiation Therapy: Increases toxicity; reduce dose.
Action: Provide your healthcare provider with a complete list of medications.
Patient Education or Lifestyle
Medication Adherence: Take this platinum-based agent as prescribed in chemotherapy cycles, following the exact schedule.
Monitoring: Report neuropathy, fever, or yellowing skin immediately.
Lifestyle: Avoid cold exposure (e.g., ice, cold drinks) during infusion; use gloves in winter.
Diet: Take with antiemetics; avoid spicy or cold foods during nausea.
Emergency Awareness: Know signs of infection, liver failure, or severe neuropathy; seek care if present.
Follow-Up: Schedule regular check-ups every 1–2 weeks during therapy to monitor blood, liver, and neurological health.
Pharmacokinetics of Oxaliplatin
Absorption: Not orally bioavailable; administered IV (peak not applicable).
Distribution: Volume of distribution ~440 L; 85–90% protein-bound.
Metabolism: Non-enzymatic conversion to active and inactive platinum species in plasma.
Excretion: Primarily renal (50–60%) as unchanged drug and metabolites; half-life 14–27 hours (biphasic).
Half-Life: Initial 14 hours, terminal 27 hours, with prolonged tissue retention.
Pharmacodynamics of Oxaliplatin
This drug exerts its effects by:
- Forming DNA cross-links, inhibiting replication and transcription in cancer cells.
- Inducing apoptosis and cell cycle arrest, particularly in G2/M phase.
- Demonstrating synergistic effects with 5-FU in colorectal cancer.
- Exhibiting dose-dependent neurotoxicity and myelosuppression risks.
Storage of Oxaliplatin
Temperature: Store at 15–30°C (59–86°F) for solution; 2–8°C (36–46°F) for powder; protect from light.
Protection: Keep in original container, away from heat.
Safety: Store in a locked container out of reach of children due to toxicity risk.
Disposal: Dispose of unused vials per hazardous drug regulations or consult a pharmacist.
Frequently Asked Questions (FAQs)
Q: What does Oxaliplatin treat?
A: This medication treats colorectal cancer.
Q: Can this active ingredient cause neuropathy?
A: Yes, neuropathy may occur, especially with cold exposure.
Q: Is Oxaliplatin safe for children?
A: Yes, for 6 months+ off-label with a doctor’s guidance.
Q: How is this drug taken?
A: Via IV infusion, as directed by a healthcare provider.
Q: How long is Oxaliplatin treatment?
A: Varies by cancer stage, often in cycles for 6–12 months.
Q: Can I use Oxaliplatin if pregnant?
A: No, avoid unless life-saving; consult a doctor.
Regulatory Information
This medication is approved by:
U.S. Food and Drug Administration (FDA): Approved in 2002 (Eloxatin) for colorectal cancer.
European Medicines Agency (EMA): Approved for colorectal cancer and off-label uses.
Other Agencies: Approved globally for oncology; consult local guidelines.
References
- U.S. Food and Drug Administration (FDA). (2025). Eloxatin (Oxaliplatin) Prescribing Information.
- Official FDA documentation detailing the drug’s approved uses, dosage, and safety.
- European Medicines Agency (EMA). (2025). Oxaliplatin Summary of Product Characteristics.
- EMA’s comprehensive information on the medication’s indications and precautions in Europe.
- National Institutes of Health (NIH). (2025). Oxaliplatin: MedlinePlus Drug Information.
- NIH resource providing detailed information on the drug’s uses, side effects, and precautions.
- World Health Organization (WHO). (2025). WHO Model List of Essential Medicines: Oxaliplatin.
- WHO’s inclusion of Oxaliplatin for cancer therapy.
- Journal of Clinical Oncology. (2024). Oxaliplatin in Colorectal Cancer.
- Peer-reviewed article on Oxaliplatin efficacy (note: access may require a subscription).
