Discontinue therapy if patient experiences any haematologic or non-haematologic Grade 3 or 4 toxicity after 2 dose reductions or immediately if Grade 3 or 4 neurotoxicity is observed. Withhold treatment if patients develop non-haematologic toxicities ≥ Grade 3 until resolution to less than or equal to pre-therapy values. Not recommended to use in patients w/ CrCl <45 mL/min. Not to be given to patients until ANC returns to ≥1,500 cells/mm
3 & platelet count returns to ≥100,000 cells/mm
3. Serious renal events, including acute renal failure. May suppress bone marrow function. Myelosuppression. Skin reactions in patients not pre-treated w/ corticosteroid. Patients w/ dehydration, pre-existing HTN or diabetes. Monitor patients for myelosuppression during therapy; CBC including differential white cell & platelet count before each dose. Instruct patients to take folic acid & vit B
12 as prophylaxis. Give adequate anti-emetic & appropriate hydration prior to &/or after receiving treatment. Reduce dose for subsequent cycles based on nadir ANC, platelet count & max non-haematologic toxicity. Not recommended to use concomitantly w/ attenuated vaccines. Serious CV events including MI & cerebrovascular events in patients w/ pre-existing CV risk factors when concomitantly used w/ another cytotoxic agent. Severe dehydration w/ cisplatin. Cases of radiation pneumonitis in patients treated w/ radiation either prior, during or subsequent to therapy; radiation recall in patients who received RT wk or yr previously. Concomitant use w/ other radiosensitising agents. May affect ability to drive & use machines. Avoid NSAIDs eg, ibuprofen & aspirin (>1.3 g daily) in patients w/ mild to moderate renal insufficiency (CrCl 45-79 mL/min) 2 days before, on the day of, & 2 days following administration. Interrupt NSAIDs in patients w/ mild to moderate renal insufficiency eligible for therapy at least 5 days prior to, on the day, & at least 2 days following administration. Sexually mature males should not father a child during treatment & up to 6 mth thereafter. Women of childbearing potential must use effective contraception during treatment. Pregnancy. Discontinue breastfeeding during therapy. Not recommended for use in childn & adolescent <18 yr.
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