1.82
m²
136
mg
136
mg
1
days
1
2,000
mL
1.82
m²
136
mg
136
mg
1
days
1
2,000
mL
The Cisplatin Dosing Calculator determines body surface area-based cisplatin doses with integrated renal function assessment and hydration guidance. Cisplatin (cis-diamminedichloroplatinum II) is a first-generation platinum chemotherapy agent that remains one of the most effective and widely used anticancer drugs, essential in the curative treatment of testicular cancer, head and neck cancer, bladder cancer, cervical cancer, ovarian cancer, and non-small cell lung cancer, among others.
Discovered serendipitously by Barnett Rosenberg in 1965 and approved by the FDA in 1978, cisplatin revolutionized cancer treatment by establishing that metastatic solid tumors could be cured with chemotherapy. The cure rate for metastatic testicular cancer increased from less than 10% to over 80% with cisplatin-based regimens, one of the greatest achievements in medical oncology.
Cisplatin is dosed based on body surface area (BSA), calculated using the Mosteller formula: BSA (m²) = sqrt[(height in cm × weight in kg) / 3600]. Common doses range from 20 mg/m² (daily × 5 for testicular cancer BEP regimen) to 100 mg/m² (single dose for head and neck cancer) per cycle. The specific dose and schedule depend on the treatment protocol, cancer type, and combination regimen being used.
Nephrotoxicity is the primary dose-limiting and most clinically significant toxicity of cisplatin. It causes direct tubular damage, particularly affecting the proximal and distal tubules and collecting ducts. Adequate pre- and post-hydration is mandatory: minimum 1-2 liters of normal saline over 2-4 hours before cisplatin, with ongoing hydration for 24 hours post-infusion. Mannitol-induced diuresis may be used for high doses (≥60 mg/m²). GFR should be ≥60 mL/min before each cycle; doses must be reduced or held for renal impairment.
Other significant toxicities include severe nausea and vomiting (cisplatin is the most emetogenic chemotherapy agent, requiring triple antiemetic prophylaxis with NK1 antagonist + 5-HT3 antagonist + dexamethasone ± olanzapine), ototoxicity (dose-cumulative, irreversible high-frequency hearing loss), peripheral neuropathy (dose-cumulative), myelosuppression, and electrolyte wasting (magnesium, potassium, sodium).
Cumulative dose monitoring is important for irreversible toxicities. Ototoxicity becomes significant at cumulative doses >300-400 mg/m², and peripheral neuropathy typically emerges at >300 mg/m² cumulative dose. Audiometry should be performed at baseline and before each cycle for high-risk regimens, and dose modification or substitution with carboplatin should be considered when toxicity thresholds are approached.
This calculator provides BSA calculation, per-administration and per-cycle dosing, renal function assessment, and minimum hydration volume guidance to support safe cisplatin prescribing in oncology practice.
Important: Cisplatin must only be prescribed by qualified oncologists with appropriate supportive care infrastructure for hydration, antiemetic prophylaxis, and toxicity monitoring.
BSA is calculated using the Mosteller formula: sqrt[(height × weight) / 3600]. Dose per administration = BSA × protocol dose (mg/m²). For 5-day schedules, the total cycle dose is divided equally across 5 days. Renal check: GFR ≥60 = proceed, 45-59 = caution/dose reduce, <45 = hold/contraindicated. Pre-hydration: ≥2000 mL for doses ≥60 mg/m², ≥1000 mL for lower doses.
Dose per Administration: Amount given per infusion day. Cycle Total: Total cisplatin per cycle (same as single-day dose for single-dose regimens; sum over 5 days for daily×5). Renal Check: 1 = GFR adequate (≥60), 2 = borderline (45-59, consider dose reduction), 3 = hold cisplatin (GFR <45). Hydration: Minimum pre-hydration volume; post-hydration and ongoing monitoring of urine output also required.
Inputs
Results
Cisplatin 191 mg day 1 with ≥2 L pre-hydration. GFR adequate. Triple antiemetic prophylaxis required.
Inputs
Results
Cisplatin 40 mg/day × 5 days = 200 mg/cycle. Daily hydration required for each infusion day.
Unlike carboplatin, cisplatin undergoes extensive biotransformation and tissue binding in addition to renal excretion. Its clearance does not correlate as linearly with GFR as carboplatin. BSA-based dosing, while imperfect, has been the standard since clinical trials established efficacy at specific mg/m² doses. AUC-guided cisplatin dosing has been studied but has not been widely adopted.
Generally, GFR ≥60 mL/min is required for full-dose cisplatin. For GFR 45-59, dose reduction by 25-50% may be considered depending on the protocol. GFR <45 is generally a contraindication to cisplatin; carboplatin substitution should be considered. Renal function should be assessed before each cycle and hydration optimized.
Cisplatin concentrates in renal tubular cells, causing direct tubular necrosis. Adequate hydration maintains renal blood flow and dilutes cisplatin in tubular fluid, reducing tubular exposure. Without hydration, cisplatin causes nephrotoxicity in >30% of patients. With adequate hydration and monitoring, the incidence drops to <5-10% for moderate doses.
Cisplatin is classified as 'highly emetogenic' (>90% risk). NCCN guidelines recommend quadruple therapy: NK1 antagonist (aprepitant/fosaprepitant) + 5-HT3 antagonist (ondansetron/granisetron) + dexamethasone + olanzapine. This prevents acute (day 1) and delayed (days 2-5) nausea/vomiting. Without prophylaxis, virtually all patients experience significant emesis.
Cisplatin causes irreversible, bilateral, high-frequency sensorineural hearing loss through direct damage to outer hair cells in the cochlea. Incidence increases with cumulative dose (>300 mg/m²), concurrent aminoglycosides or loop diuretics, and in children. Baseline and serial audiometry is recommended. Hearing aids may be needed for functional hearing loss.
Cisplatin damages renal tubules, impairing reabsorption of magnesium, potassium, sodium, and calcium. Hypomagnesemia occurs in up to 90% of patients and can be severe and prolonged. Supplementation (IV magnesium sulfate during hydration, oral magnesium maintenance) and monitoring of electrolytes before each cycle are essential.
Not always. While both are platinum agents, they are not therapeutically equivalent for all cancers. Cisplatin is preferred when data show superior efficacy (e.g., head and neck, bladder cancer, testicular cancer curative regimens). Carboplatin may be substituted when cisplatin toxicity is limiting or in palliative settings. Tumor board discussion guides these decisions.
There is no absolute maximum, but cumulative toxicity considerations guide treatment decisions. Ototoxicity risk increases significantly >300-400 mg/m² cumulative. Peripheral neuropathy typically limits treatment at 300-500 mg/m² cumulative. Nephrotoxicity can occur at any dose if hydration is inadequate. Cumulative dose tracking is essential for long-term care.
Monitor serum creatinine, BUN, and electrolytes (Mg, K, Na, Ca) before each cycle. GFR/CrCl should be calculated before each dose. 24-hour urine creatinine clearance is the gold standard. Signs of nephrotoxicity: rising creatinine, persistent electrolyte wasting, proteinuria. Ensure urine output ≥100-200 mL/hour during and for 6-8 hours after infusion.
Cisplatin is FDA Category D — known teratogen. It should be avoided during pregnancy, especially in the first trimester. If cancer treatment cannot be delayed, cisplatin has been used in the second/third trimester with careful fetal monitoring, though platinum agents cross the placenta. Fertility counseling before treatment is recommended for all patients of reproductive age.
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