Oxaliplatin – Uses, Dosage, Side Effects, Interaction

Mechanism of Action

Oxaliplatin undergoes nonenzymatic conversion to active derivatives via displacement of the labile oxalate ligand. Several transient reactive species are formed, including Monaco and diaquo DACH platinum, which covalently bind with macromolecules. After activation, oxaliplatin binds preferentially to the guanine and cytosine moieties of DNA, leading to cross-linking of DNA, thus inhibiting DNA synthesis and transcription. Cytotoxicity is cell-cycle nonspecific.

Oxaliplatin selectively inhibits the synthesis of deoxyribonucleic acid (DNA). The guanine and cytosine content correlates with the degree of Oxaliplatin-induced cross-linking. At high concentrations of the drug, cellular RNA and protein synthesis are also suppressed.


The compound features a square planar platinum(II) center. In contrast to other drugs of the platinum-based antineoplastic class of drugs cisplatin and carboplatin, oxaliplatin features the bidentate ligand trans-1,2-diaminocyclohexane in place of the two monodentate ammine ligands. It also features a bidentate oxalate group. The three-dimensional structure of the molecule has been elucidated by X-ray crystallography, although the presence of pseudosymmetry in the crystal structure has caused confusion in its interpretation.

According to in vivo studies, oxaliplatin fights carcinoma of the colon through non-targeted cytotoxic effects. Like other platinum compounds, its cytotoxicity is thought to result from the inhibition of DNA synthesis in cells. In particular, oxaliplatin forms both inter- and intra-strand cross-links in DNA,[rx] which prevent DNA replication and transcription, causing cell death.


  • Used in combination with infusional 5-FU/LV, is indicated for the treatment of advanced carcinoma of the colon or rectum and for adjuvant treatment of stage III colon cancer patients who have undergone complete resection of the primary tumor.
  • Used in combination with infusional 5-FU/LV, is indicated for the treatment of advanced carcinoma of the colon or rectum and for adjuvant treatment of stage III colon cancer patients who have undergone complete resection of the primary tumor.
  • Oxaliplatin is approved to be used with fluorouracil and leucovorin calcium to treat: Colorectal cancer that is advanced Stage III colon cancer. It is used after surgery to remove cancer.
  • Advanced Colorectal Cancer
  • Stage III Colon Cancer


  • low amount of magnesium in the blood
  • low amount of potassium in the blood
  • anemia
  • decreased blood platelets
  • low levels of a type of white blood cell called neutrophils
  • a painful condition that affects the nerves in the legs and arms called peripheral neuropathy
  • abnormal EKG with QT changes from birth
  • a type of inflammation of the lung called interstitial pneumonitis
  • a condition where there is formation of fibrous tissue in the lung called pulmonary fibrosis
  • abnormal liver function tests
  • pregnancy
  • a patient who is producing milk and breastfeeding
  • muscle pain or tenderness with increase creatine kinase
  • a type of brain disorder called posterior reversible encephalopathy syndrome
  • chronic kidney disease stage 4 (severe)
  • chronic kidney disease stage 5 (failure)


Strengths: 5 mg/mL; 50 mg; 100 mg

Colorectal Cancer

  • 85 mg/m2 via IV infusion over 120 minutes every 2 weeks; administer in combination with infusional 5-fluorouracil and leucovorin.

Duration of Therapy

  • Adjuvant Treatment of Stage III Colon Cancer: Total of 6 months (12 cycles)
  • Treatment of Advanced Colorectal Cancer: Until disease progression or unacceptable toxicity
  • Premedication with antiemetics, including 5-HT3 blockers with or without dexamethasone, is recommended.
  • Consult the manufacturer product information for 5-fluorouracil and leucovorin dosing recommendations.
  • Uses In combination with infusional 5-fluorouracil and leucovorin:
    Adjuvant treatment of Stage III colon cancer in patients who have undergone complete resection of the primary tumor.
  • Treatment of advanced colorectal cancer.

Renal Dose Adjustments

  • Mild to Moderate Renal Impairment (CrCl 30 to 80 mL/min): No adjustment recommended.
  • Severe Renal Impairment (CrCl less than 30 mL/min): Reduce dose to 65 mg/m2.

Dose Adjustments

ACUTE TOXICITIES: Consider prolonging the infusion time for this drug from 2 hours to 6 hours.


  • Adjuvant Treatment of Stage III Colon Cancer: 75 mg/m2
  • Treatment of Advanced Colorectal Cancer: 65 mg/m2

GRADE 4 NEUTROPENIA, FEBRILE NEUTROPENIA, OR GRADE 3/4 THROMBOCYTOPENIA: Reduce the dose and delay the next dose until neutrophils 1.5 x 10(9)/L or greater and platelets 75 x 10(9)/L or greater.

  • Adjuvant Treatment of Stage III Colon Cancer: 75 mg/m2
  • Treatment of Advanced Colorectal Cancer: 65 mg/m2

GRADE 2: Consider reducing the dose.

  • Adjuvant Treatment of Stage III Colon Cancer: 75 mg/m2
  • Treatment of Advanced Colorectal Cancer: 65 mg/m2

GRADE 3: Consider treatment discontinuation (for both indications).

Administration Advice

  • Dilute this drug before administration; consult the manufacturer’s product information for dilution instructions.
  • Consult the manufacturer’s product information for infusion instructions.
  • Do not use needles or IV administration sets containing aluminum parts since aluminum has been reported to cause the degradation of platinum compounds.
  • Immediately discontinue drug administration and initiate usual local symptomatic treatment in the event of extravasation.
  • Prior to administration, visually inspect for particulate matter and discoloration and discard if present.
  • Prior to subsequent therapy cycles, evaluate patients for clinical toxicities and recommended laboratory tests.
  • The administration of this drug does not require prehydration.

Storage Requirements

  • After dilution, the shelf life of this drug is 6 hours at room temperature (20 to 25 degrees Celsius/68 to 77 degrees Fahrenheit) or up to 24 hours under refrigeration (2 to 8 degrees Celsius/36 to 46 degrees Fahrenheit).
  • Retain this drug in its original package until the time of use. Do not freeze and protect from light; however, the final diluted drug does not need protection from light.

Reconstitution/Preparation Techniques

  • Exercise care and use gloves when handling this drug. If a solution of this drug contacts the skin or mucous membranes, wash the skin immediately with soap and water and flush the mucous membranes thoroughly with water.

IV Compatibility

  • Do not mix or administer this drug simultaneously through the same infusion line with alkaline medications or media (e.g., basic solutions of 5-fluorouracil, folinic acid preparations containing trometamol, trometamol salts of other active substances) as alkaline products will adversely affect the stability of this drug.
  • Reconstitution/final dilution of this drug should not be performed with saline or other solutions containing chloride ions (including sodium, calcium, or potassium chloride).
  • Consult the manufacturer product information for additional IV compatibilities and incompatibilities.


  • Overdosage: No known antidote.


  • Monitor a full blood count with white cell differential, hemoglobin, platelet count, and blood chemistries (including ALT, AST, bilirubin, and creatinine) prior to treatment initiation and before each subsequent treatment cycle.
  • Monitor neurological toxicity; perform a neurological examination before each administration and periodically thereafter.

Patient Advice

  • Avoid potentially dangerous activities such as driving and operating machinery until you know how this drug affects you.

Side Effects

The Most Common

  • Numbness, burning, or tingling in the fingers, toes, hands, feet, mouth, or throat
  • Neurotoxicity leads to chemotherapy-induced peripheral neuropathy, a progressive, enduring, and often irreversible tingling numbness, intense pain, and hypersensitivity to cold, beginning in the hands and feet and sometimes involving the arms and legs, often with deficits in proprioception. This chronic neuropathy may also be preceded by a transient acute neuropathy occurring at the time of infusion and associated with the excitation of voltage-gated Na+ channels.
  • Fatigue
  • Nausea, vomiting, or diarrhea
  • Neutropenia (low number of a type of white blood cells)
  • Ototoxicity (hearing loss)
  • Extravasation if oxaliplatin leaks from the infusion vein may cause severe damage to the connective tissues.
  • Hypokalemia (low blood potassium), which is more common in women than men
  • Persistent hiccups
  • pain in the hands or feet
  • increased sensitivity, especially to cold
  • decreased sense of touch
  • nausea
  • vomiting
  • diarrhea
  • constipation
  • gas
  • stomach pain
  • heartburn
  • sores in the mouth
  • loss of appetite
  • change in the ability to taste food
  • weight gain or loss
  • hiccups
  • dry mouth
  • muscle, back, or joint pain
  • tiredness
  • anxiety
  • depression
  • difficulty falling asleep or staying asleep
  • hair loss
  • dry skin
  • redness or peeling of the skin on the hands and feet
  • sweating
  • flushing

More Common

  • stumbling or loss of balance when walking
  • difficulty with everyday activities such as writing or fastening buttons
  • difficulty speaking
  • strange feeling in the tongue
  • tightening of the jaw
  • chest pain or pressure
  • cough
  • shortness of breath
  • sore throat, fever, chills, and other signs of infection
  • pain, redness, or swelling in the place where oxaliplatin was injected
  • pain when urinating
  • decreased urination
  • unusual bruising or bleeding
  • nosebleed
  • blood in urine
  • vomit that is bloody or looks like coffee grounds
  • bright red blood in stool
  • black and tarry stools
  • pale skin
  • weakness
  • problems with vision
  • swelling of the arms, hands, feet, ankles, or lower legs


  • chills or shivering
  • burning or pain on urination
  • pain on swallowing
  • redness or swelling at the intravenous site
  • sore throat
  • persistent diarrhea
  • cough that brings up mucus
  •  Leukemia, a form of blood cancer, has been reported in patients after taking oxaliplatin in combination with certain other medicines.
  • Lung problems. Oxaliplatin can cause lung problems that may lead to death. Tell your doctor right away if you get any of the following symptoms as these may be indicators of serious lung disease: shortness of breath, cough, wheezing
  • Liver problems (hepatotoxicity). Your doctor will do blood tests to check your liver when you start receiving oxaliplatin, and before each treatment course as needed.
  • Heart problems. Oxaliplatin can cause heart problems that have led to death. Your doctor may do blood and heart tests during treatment with oxaliplatin if you have certain heart problems. If you faint (lose consciousness) or have an irregular heartbeat or chest pain during treatment with oxaliplatin, get medical help right away as this may be a sign of a serious heart condition.
  • Muscle problems. Oxaliplatin can cause muscle damage (rhabdomyolysis) which can lead to death. Tell your doctor right away if you have muscle pain and swelling, along with weakness, fever, or red-brown urine.
  • Harm to an unborn baby.
  • Bleeding problems (hemorrhage). Oxaliplatin when used with fluorouracil and leucovorin can cause bleeding problems (hemorrhage) that can lead to death. Your risk of bleeding may increase if you are also taking a blood thinner medicine. Tell your healthcare provider if you have any signs or symptoms of bleeding, including:
    • blood in your stools or black stools (looks like tar)
    • pink or brown urine
    • unexpected bleeding, or bleeding that is severe or you cannot control
    • vomit blood or vomit that looks like coffee grounds
    • cough up blood or blood clots
    • increased bruising
    • dizziness
    • weakness
    • confusion
    • changes in speech
    • headache that lasts a long time

Drug Interaction

Pregnancy and Lactation

US FDA pregnancy category D


If you are pregnant or plan to become pregnant. Oxaliplatin may harm your unborn baby. Tell your doctor right away if you become pregnant or think you may be pregnant during treatment with oxaliplatin.

You are able to become pregnant, your doctor may do a pregnancy test before you start treatment with oxaliplatin and for 9 months after the final dose. Talk to your doctor about forms of birth control that may be right for you.


If you are breastfeeding or plan to breastfeed. It is not known if oxaliplatin passes into your breast milk. Do not breastfeed during treatment with oxaliplatin and for 3 months after the final dose.

Females who are able to become pregnant should avoid becoming pregnant and should use effective birth control during treatment with oxaliplatin and for 9 months after the final dose. Talk to your doctor about forms of birth control that may be right for you.

Males with female partners who are pregnant or able to become pregnant should use effective birth control during treatment with oxaliplatin and for 6 months after the final dose. Oxaliplatin may cause fertility problems in males and females. Talk to your doctor if this is a concern for you.

What special precautions should I follow?

Before using oxaliplatin,

  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention oral anticoagulants (‘blood thinners) such as warfarin (Coumadin). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have or have ever had kidney disease.
  • tell your doctor if you are pregnant or plan to become pregnant. Oxaliplatin may harm the fetus. You should use birth control to prevent pregnancy during your treatment with oxaliplatin. Talk to your doctor about the types of birth control that will work for you.If you become pregnant while taking oxaliplatin, call your doctor. Do not breastfeed during your treatment with oxaliplatin.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are using oxaliplatin.
  • you should know that oxaliplatin may decrease your ability to fight infection. Stay away from people who are sick during your treatment with oxaliplatin.
  • you should know that exposure to cold air or objects may make some of the side effects of oxaliplatin worse. You should not eat or drink anything colder than room temperature, touch any cold objects, go near air conditioners or freezers, wash your hands in cold water, or go outside in cold weather unless absolutely necessary for five days after you receive each dose of oxaliplatin. If you must go outside in cold weather, wear a hat, gloves, and a scarf, and cover your mouth and nose.

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  2. https://go.drugbank.com/drugs/DB00526
  3. https://en.wikipedia.org/wiki/Oxaliplatin
  4. https://www.drugs.com/oxaliplatin.html
  5. https://medlineplus.gov/druginfo/meds/a607035.html
  6. https://pubchem.ncbi.nlm.nih.gov/compound/Oxaliplatin
  7. https://pubchem.ncbi.nlm.nih.gov/compound/Oxaliplatine
  8. https://www.webmd.com/drugs/2/drug-64025/oxaliplatin-intravenous/details/list-contraindications
  9. https://www.ncbi.nlm.nih.gov/books/
  10. CompTox Chemicals Dashboard Chemical Lists
    Data: CC-BY 4.0; Code (hosted by ECI, LCSB): Artistic-2.0
    NORMAN Suspect List Exchange Classification
  12. PubChem
    The Thieme Chemistry contribution within PubChem is provided under a CC-BY-NC-ND 4.0 license, unless otherwise stated.