ইঙ্গিত ও ব্যবহার
Renacarb এর জন্য নির্দেশিত:
ডোজ নির্দেশিকা
শুধুমাত্র নির্দেশিকা তথ্য
প্রদর্শিত ডোজগুলি সরকারি উৎসের সাধারণ নির্দেশিকা। ব্যক্তিগতকৃত ডোজের জন্য সর্বদা আপনার ডাক্তার বা ফার্মাসিস্টের পরামর্শ নিন।
Adults:
Needles or intravenous sets with aluminium parts that may touch Carboplatin injection must not be used to prepare or give the drug. Aluminium reacts with Carboplatin, which can form a precipitate and/or reduce its potency. Proper procedures for handling and disposing of anti-cancer drugs should be followed. Several guidelines on this topic have been published, but there is no general agreement that every procedure they recommend is necessary or appropriate. After dilution, Carboplatin should be given by the intravenous route only. For previously untreated adult patients with normal kidney function, the recommended dose of Carboplatin is 400 mg/m2 as a single I.V. dose, infused over 15 to 60 minutes. Treatment should not be repeated until four weeks after the previous Carboplatin course and/or until the neutrophil count is at least 2000 cells/mm3 and the platelet count is at least 100,000 cells/mm3. A 20-25% reduction of the initial dose (i.e. 300-320 mg/m2) is recommended for patients with risk factors such as prior myelosuppressive treatment or low performance status (ECOG-Zubrod 2-4 or Karnofsky below 80). For patients aged 65 and over, dose adjustment, either at the start or later, may be needed depending on the patient's physical condition. Determination of the hematologic nadir through weekly blood counts during the initial courses of Carboplatin treatment is recommended to guide dose adjustment in later courses.
পার্শ্বপ্রতিক্রিয়া
Incidences of adverse reactions reported here under are based on cumulative data obtained in a large group ofpatients with various pretreatment prognastic features.Haematologic toxicity: Bone marrow suppression is the dose-limited toxicity of Carboplatin Hexal Hexal. At maximum tolerated dosages of Carboplatin Hexal Hexal administered as a single agent, thrombocytopenia, with platelet counts of less than 50,000/mm 3 , occurs in 25% of the patients. The nadir usually occurs between days 14 and 21, with recovery within 35 days from the start of therapy. Neutropenia with granulocyte counts below 1,000/mm 3 occurs in 18% of patients. Leucopenia, with nadir WBC counts of less than 2000/mm 3 , occurs in 14% of the patients but its recovery from the day of nadir (day 14-28) may be slower and usually occurs within 42 days from the start of therapy. Anaemia with haemoglobin values below 11 g/dL has been is observed in 71% of the patients. Myelosuppression may be more severe and prolonged in patients with impaired kidney function, extensive prior treatment, poor performance status and age above 65. Myelosuppression is also worsened by therapy combining Carboplatin Hexal Hexal with other compounds that are toxic to the bone marrow. Myelosuppression is usually reversive and not cumulative when Carboplatin Hexal Hexal is used as a single agent and at the recommended dosages and frequencies of administration. Infectious and haemorrhagic complications have been reported in 4% and 5% of the patients given Carboplatin Hexal Hexal, respectively.Nephrotoxicity: When given in usual doses, development of abnormal renal function has been uncommon, despite the fact that Carboplatin Hexal Hexal has been administered without high-volume fluid hydration and/or forced diuresis. Elevation of serum creatinine occurs in 6% of patients, elevation of blood urea nitrogen in 14%, and of uric acid in 5% of patients. These are usually mild and are reversible in about one-half the patients. Creatinine clearance has proven. to be the most sensitive renal function measure in patients receiving Carboplatin Hexal Hexal. Twenty-seven percent of patients who have a baseline value of 60 mL/min or greater, experience a reduction in creatinine clearance during Carboplatin Hexal Hexal therapy. Decreases in serum electrolytes sodium, potassium, calcium, magnesium occur in 29%, 20%, 22%, 29% of patients respectively. Spontaneous reports of early hypotension have been reported which were generally reversed by sodium replacements or free water restriction.Gastrointestinal toxicity: Nausea without vomiting occurs in about 15% of the patients receiving Carboplatin Hexal Hexal; vomiting has been reported in 65% of the patients. One-third of those patients who vomit suffer severe emesis. Nausea and vomiting usually disappear within 24 hours after treatment and are usually responsive to (and may be prevented by) antiemetic medication. Other gastrointestinal side effects consist of pain (17%); diarrhoea (6%), and constipation (6%). Anorexia has been reported from post-marketing surveillance.Allergic reactions: Infrequent reactions to Carboplatin Hexal Hexal have been reported in less than 2% of the patients. These reactions are similar to those observed after administration of other platinum-containing compounds, i.e. erythematous rash, fever with no other apparent cause, pruritus, urticaria, rarely bronchospasm and hypotension.Hepatic Toxicity: The incidences of abnormal liver function tests in patients with normal baseline values were reported as follows: total bilirubin, 5%; SGOT, 15%; and alkaline phosphatase, 24%; (5%, 19%, and 37%, respectively, in pretreated ovarian cancer patients). These abnormalities have generally been mild and reversible in about one-half of the cases, although the role of metastatic tumor in the liver may complicate the assessment in many patients. In a limited series of patients receiving very high dosages of Carboplatin Hexal Hexal and autologous bone marrow transplantation, severe abnormalities of liver function tests were reported.Neurotoxicity: The incidence of peripheral neuropathies after treatment with Carboplatin Hexal Hexal is 4%. In the majority of the patients neurotoxicity is limited to paresthesias and decreased deep tendon reflexes. The frequency and intensity of this side effect increase in patients previously treated with cisplatin. Paresthesias present before commencing Carboplatin Hexal Hexal therapy, particularly if related prior cisplatin treatment, may persist or worsen during treatment with Carboplatin Hexal Hexal. Central nervous symptoms have been reported in 5% of patients and often appear to be related to the use of antiemectics. The overall frequency of neurologic side effects seems to be increased in patients receiving Carboplatin Hexal Hexal in combination. This may also be related to longer cumulative exposure.
সতর্কতা ও নিষেধাজ্ঞা
Warnings & Precautions
Carboplatin Hexal Hexal should be given only under the supervision of a qualified doctor who is experienced in the use of cancer chemotherapy medicines. Therapy and its complications can be managed properly only where adequate diagnostic and treatment facilities are readily available. Peripheral blood counts and kidney and liver function tests should be monitored closely. Blood counts are recommended at the start of therapy and weekly thereafter to assess the haematologic nadir for subsequent dose adjustment. Neurologic evaluations should also be carried out on a regular basis. The drug should be stopped if abnormal bone marrow depression or abnormal kidney or liver function is seen. Myelosuppression caused by Carboplatin Hexal Hexal is closely related to its renal clearance. Patients with abnormal kidney function, or those receiving other medicines with nephrotoxic potential at the same time, are likely to experience more severe and prolonged myelotoxicity. Kidney function parameters should therefore be assessed carefully before and during therapy. Under normal circumstances, courses of Carboplatin Hexal Hexal should not be repeated more often than once a month. Thrombocytopenia, leucopenia and anaemia, which are dose dependent and dose limiting, occur after administration of Carboplatin Hexal Hexal. Frequent monitoring of peripheral blood counts is recommended throughout and after therapy with Carboplatin Hexal Hexal. Combination therapy of Carboplatin Hexal Hexal with other myelosuppressive compounds must be planned very carefully with respect to dosages and timing in order to minimise additive effects. Supportive transfusion therapy may be required in patients who suffer severe myelosuppression. Anaemia is frequent and cumulative. Transfusion support is often needed during treatment with Carboplatin Hexal Hexal, particularly in patients receiving prolonged therapy. Carboplatin Hexal Hexal can cause nausea and vomiting. Premedication with antiemetics, and prolonging the administration of Carboplatin Hexal Hexal by continuous infusion or over five consecutive days, have been reported to help reduce the incidence and intensity of these effects. Kidney function impairment may occur with Carboplatin Hexal Hexal. Although no clinical evidence of compounding nephrotoxicity has been accumulated, it is recommended not to combine Carboplatin Hexal Hexal with aminoglycosides or other nephrotoxic compounds. As with other platinum coordination compounds, allergic reactions to Carboplatin Hexal Hexal have been reported. These may occur within five minutes of administration and should be managed with appropriate supportive therapy.
নিষেধাজ্ঞা
Carboplatin should not be given to patients who already have severe kidney impairment, unless the physician and patient together judge that the likely benefits of treatment outweigh the risks. It should not be used in patients with severe bone marrow suppression. Carboplatin is also contraindicated in anyone with a history of severe allergic reactions to Carboplatin, other platinum-containing compounds, or mannitol. It must not be given to patients with bleeding tumours.