Platinum-Based Chemotherapy Pregnancy: Carboplatin can cause foetal harm; it is embryotoxic and teratogenic in rats and safe use in pregnancy has not been established. It should not be used in pregnant women or women of childbearing potential who might become pregnant unless the potential benefits to the mother outweigh the possible risks to the foetus. Women of childbearing potential should use effective contraception during treatment and for at least 7 months after the last dose; men with female partners of childbearing potential should use effective contraception during treatment and for at least 4 months after the last dose. Carboplatin and its active metabolites have been identified in human milk — breast-feeding must be stopped during therapy and for 1 month after the last dose. Male and female fertility may be impacted and gonadal suppression may be irreversible; advice on fertility preservation/sperm preservation should be sought before treatment.

Carboplatin

Brand names: Paraplatin

Carboplatin is a platinum-based cytotoxic chemotherapy agent used to treat a range of cancers, including urological malignancies such as urothelial carcinoma.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 400 mg/m2 in previously untreated adults with normal renal function; alternatively dose by the Calvert formula — Dose (mg) = target AUC (mg/ml x min) x [GFR ml/min + 25]

Route: Intravenous infusion only, given as a single short-term infusion over 15 to 60 minutes

Frequency: Therapy should not be repeated until 4 weeks after the previous carboplatin course and/or until the neutrophil count is at least 2,000 cells/mm3 and the platelet count is at least 100,000 cells/mm3

CALVERT TARGET AUC TABLE (SPC §4.2): 5–7 mg/ml.min for single-agent carboplatin in previously untreated patients; 4–6 mg/ml.min for single-agent carboplatin in previously treated patients; 4–6 mg/ml.min for carboplatin plus cyclophosphamide in previously untreated patients. Note: with the Calvert formula the total dose of carboplatin is calculated in mg, NOT mg/m2. DOSE REDUCTION FOR RISK FACTORS: the initial dosage should be reduced by 20–25% in patients with risk factors such as previous myelosuppressive therapy and/or poor performance status (ECOG-Zubrod 2–4 or Karnofsky below 80). Determination of the haematologic nadir by weekly blood counts during initial courses is recommended for future dose adjustment and scheduling. All dosing recommendations apply to the initial course; subsequent doses should be adjusted according to the patient's tolerance and the acceptable level of myelosuppression. COMBINATION THERAPY: optimal use with other myelosuppressive agents requires dosage adjustment according to the regimen and schedule adopted. ELDERLY: in patients over 65 years, adjustment of the carboplatin dose to the general condition is necessary during the first and subsequent therapeutic courses. PAEDIATRIC: there is insufficient information to support a dosage recommendation in the paediatric population. PREPARATION/ADMINISTRATION: needles or intravenous sets containing aluminium parts that may come into contact with carboplatin must not be used — aluminium reacts with carboplatin causing precipitate formation and/or loss of potency. Preparation must be carried out by personnel trained in the safe handling of cytotoxics, wearing protective gloves, face mask and protective clothing. FOR CROSS-REFERENCE ONLY, US labelling (Apotex) quotes different body-surface-area figures for its own studied indications: single-agent 360 mg/m2 IV on day 1 every 4 weeks in recurrent ovarian carcinoma, and 300 mg/m2 IV on day 1 every 4 weeks for 6 cycles in combination with cyclophosphamide 600 mg/m2 — these differ from the UK SPC's 400 mg/m2 and should not be substituted for it.

Dose adjustments

Renal

In impaired renal function the dose should be reduced (refer to the Calvert formula) and haematological nadirs and renal function monitored. Patients with creatinine clearance below 60 ml/min are at increased risk of severe myelosuppression. SPC initial dose (Day 1) recommendations: baseline creatinine clearance 41–59 ml/min, 250 mg/m2 IV; 16–40 ml/min, 200 mg/m2 IV. Insufficient data exist on use in patients with creatinine clearance of 15 ml/min or less to permit a recommendation for treatment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Severe myelosuppression
Pre-existing severe renal impairment (creatinine clearance < 30 ml/min) unless, in the judgement of physician and patient, the possible benefits outweigh the risks
Bleeding tumours
Concomitant use with yellow fever vaccine
History of severe allergic reaction to carboplatin or other platinum-containing compounds

Side effects

Thrombocytopenia, neutropenia, leukopenia and anaemia (very common); bone marrow failure and febrile neutropenia (frequency not known)
Vomiting, nausea and abdominal pain (very common); diarrhoea, constipation, mucous membrane disorder (common)
Decreased creatinine renal clearance, increased blood urea, and decreased blood sodium, potassium, calcium and magnesium (very common)
Peripheral neuropathy, paraesthesia, decreased osteotendinous reflexes, sensory disturbance, dysgeusia (common)
Ototoxicity and visual disturbance including rare cases of loss of vision (common)
Hypersensitivity and anaphylactoid-type reactions (common), which may progress to Kounis syndrome (acute allergic coronary arteriospasm that can result in myocardial infarction)

Interactions

eMC §4.5 was not retrieved in this bundle — the entries below are from §4.3, §4.4 and from US labelling, and must be checked against the UK SPC §4.5
Yellow fever vaccine — concomitant use is contraindicated (§4.3)
Nephrotoxic drugs — in patients with abnormal renal function or receiving concomitant nephrotoxic therapy, myelosuppression (especially thrombocytopenia) may be more severe and prolonged (§4.4); US labelling states the renal effects of nephrotoxic compounds may be potentiated by carboplatin
Other myelosuppressive drugs — combination therapy may require modification of dosage/timing of schedules to minimise additive effects (§4.4)
Aluminium — needles or IV sets containing aluminium parts must not be used; aluminium reacts with carboplatin causing precipitate formation and loss of potency

Clinical monograph

How it works

It forms platinum-DNA adducts and cross-links that disrupt DNA replication and transcription, triggering tumour cell death.

Prescribing in practice

Dose-limiting, cumulative myelosuppression (especially thrombocytopenia) is the principal toxicity and dosing is individualised to renal function rather than a fixed amount.
Hypersensitivity reactions can occur, particularly with repeated cycles, and require monitoring during infusion.
Administer only under specialist oncology supervision with full blood count and renal function review before each cycle.

Monitoring

Monitor full blood count and renal function before each cycle and watch for hypersensitivity reactions during administration.

Counselling the patient

Seek urgent advice for fever, unusual bruising or bleeding, or signs of infection.
Report any rash, flushing or breathlessness during or after infusion.

Evidence & guidelines

Carboplatin is an established platinum chemotherapy supported by extensive trial evidence and used within NICE-recognised regimens.

Reference: EAU Bladder Cancer Guidelines 2024; Calvert et al. (1989) formula; NICE NG2; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Cisplatin · Platinum-Based Chemotherapy

Pathways