Nephrotoxicity - is cumulative in nature and is the main toxic factor limiting the dose of cisplatin. Renal lesions, which are accompanied by damage to the renal tubules, may first be detected in the second week after the dose is administered and may result in an increase in the level of creatinine, urea, uric acid in the blood serum and / or a decrease in creatinine clearance. Renal insufficiency, as a rule, is insignificant or moderately pronounced and is reversible at usual doses of cisplatinum.
Violations from the electrolyte balance. Cisplatinum can also cause serious electrolyte imbalance, which is mainly manifested by hypomagnesemia, hypocalcemia and hypokalemia. Hypomagnesemia and / or hypocalcemia can be manifested clinically by increased muscle sensitivity or seizures, tremor, carpopedic spasm (cramps in hands and feet) and / or tetany. Possible hyponatremia, due to the syndrome of inadequate production of antidiuretic hormone.
From the gastrointestinal tract. Nausea and vomiting, which usually begin within the first hour of therapy and last for 24 hours or more, occur in 65% of patients. These side effects are only partially eliminated with the use of standard antiemetic drugs. The severity of these symptoms can be reduced by dividing the total dose calculated for the therapy cycle into smaller doses that are administered once a day for five days.
Of the other frequently observed adverse events from the gastrointestinal tract, abdominal pain, diarrhea and constipation are noted.
On the part of the hematopoiesis system. On the background of cisplatin therapy, myelosuppression often develops,but in most cases it is expressed slightly or moderately, and when applied to conventional doses is reversible. The lowest levels of leukocytes and platelets, as a rule, are detected after about 2 weeks; their baseline in most patients is restored within 4 weeks. Anemia can also occur.
From the side of the hearing system. One-sided or bilateral tinnitus, with or without loss of hearing, is noted in about 10% of patients who received cisplatin, usually this side effect is reversible. It is established that the damage to the hearing organ is dose-dependent and cumulative, and this side effect is more often observed in patients of very young or senile age.
From the side of the central nervous system and peripheral nervous system. Peripheral neuropathies occur infrequently. They are usually sensory in nature (for example, paresthesia of the upper and lower extremities), but also motor disorders (decreased reflexes and weakness in the lower limbs) may occur. Also, vegetative neuropathy, convulsions, slurred speech, loss of taste and memory loss can be noted.
Hypersensitivity. Sometimes there are allergic reactions, manifested in the form of redness and swelling of the face, wheezing in the lungs, tachycardia and arterial hypotension. These reactions can occur within a few minutes after the onset of cisplatin administration. In rare cases, there may be hives and spottypapular skin rashes.
From the side of the vision system. In rare cases, neuritis of the optic nerve, edema of the optic nerve disk, cortical blindness are noted. These side effects are usually reversible and disappear after drug withdrawal.
Toxic effect on the liver. Occasionally, minor and transient increases in the level ACT and ALT in serum.
Other manifestations of toxic effects. Disorders from the cardiovascular system (coronary heart disease, congestive heart failure, arrhythmias, orthostatic hypotension, thrombotic microangiopathy, etc.), hyperuricemia, minor alopecia, myalgia, fever and plaque gum line.
If the product gets under the skin, phlebitis, cellulite and necrosis of the skin can develop. Cases of spermatogenesis and azoospermia are noted.