Cisplatin

Drug Levels and Effects:




Summary of Use during Lactation:


Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. Excretion of platinum into milk occurs, but results from 3 cases are inconsistent. The exact form and toxicity of platinum excreted into breastmilk are also not known. The nursing infant would receive any platinum compounds orally rather than intravenously and oral absorption of oral platinum compounds by infants is not known.


Drug Levels:


Maternal Levels.

Platinum was not detected (<100 mcg/L) in the milk of one patient at any time after an IV infusion of 100 mg/sq m (130 mg) of cisplatin.[1]

In another patient, trough milk platinum was 900 mcg/L at 19.5 hr after her second daily dose of cisplatin 20 mg/sq m infused intravenously over 4 hours. The simultaneous plasma platinum level was 0.8 mg/L.[2] Note: the original report stated a cisplatin dose of30mg/sq m, but this was later corrected to 20 mg/sq m in a published erratum.

A patient was given cisplatin 60 mg/sq m (100 mg) infused intravenously over 3 hours. Samples from two cycles of therapy found average peak milk platinum concentrations of about 125 mcg/L occurred at30minutes after the dose and about 112 mcg/L at 18 hours after the dose. Milk platinum levels were about 10% of simultaneous plasma levels at all time points over the 18-hour sampling periods of two cycles.[3]

Three patients with cervical cancer received cisplatin 20 mg/sq. m during pregnancy as part of their treatment. All women had a cesarean section and hysterectomy between 31 and 35 weeks of gestation, followed by another course of chemotherapy. Breastmilk samples "in the first days of lactation" were obtained and analyzed, although the time since the last cisplatin dose and the time since surgery were not specified. Cisplatin concentrations in breastmilk samples were 0.2, 1.4, and 5.5 mg/L, which were 0.9%, 2.3% and 9% of concentrations in maternal blood at the time of surgery.[4]

Infant Levels.

Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:


Relevant published information was not found as of the revision date.


Possible Effects on Lactation:


Relevant published information was not found as of the revision date.


Alternate Drugs to Consider:


Dependent on the condition being treated.


References:


1. Egan PC, Costanza ME, Dodion P et al. Doxorubicin and cisplatin excretion into human milk. Cancer Treat Rep. 1985;69:1387-9. PMID:4075315
2. de Vries EGE, van der Zee AGJ, Uges DRA, Sleijfer DT. Excretion of platinum into breast milk. Lancet. 1989 ;1 (8636):497. Letter. Erratum in Lancet 1989 Apr 8;1(8641):798. PMID:2563865
3. Ben-Baruch G, Menczer J, Goshen R et al. Cisplatin excretion in human milk. J Natl Cancer Inst. 1992;84:451-2. Letter. PMID:1538424
4. Lanowska M, Kohler C, Oppelt P et al. Addressing concerns about cisplatin application during pregnancy. J Perinat Med. 2011;39:279-85. PMID:21391877



Substance Identification:




Substance Name:

Cisplatin

CAS Registry Number:

15663-27-1

Drug Class:


  • Antineoplastic Agents


  • Administrative Information:




    LactMed Record Number:


    70


    Last Revision Date:


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