Carboplatin !

A gentler cousin of cisplatin: the same DNA cross-links with far less kidney damage and vomiting, but more bone-marrow suppression.

Updated 2026-11-01

Class: Platinum compounds
Target: DNA (N7 of guanine)
ATC code: L01XA02
WHO Model List of Essential Medicines

DNA (N7 of guanine)Carboplatin

The figure shows the cisplatin adduct. Carboplatin leaves the same diammine-platinum on DNA after losing its cyclobutane-dicarboxylate group, so the lesion is equivalent.

Target in 3D: DNA (N7 of guanine). PDB structure 1AIO (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Carboplatin carries a cyclobutane-dicarboxylate leaving group that is displaced more slowly than cisplatin's chlorides. Once activated it forms the same platinum–DNA cross-links as cisplatin and causes equivalent lesions. The slower activation makes it less toxic to the kidney, ear and nerves, while bone-marrow suppression becomes the main toxicity.

Slow loss of the dicarboxylate leaving group
Platinum binds guanine N7 like cisplatin
DNA cross-links block replication
Dividing cells die; marrow takes the main hit

Pharmacokinetics

Absorption: Intravenous only.
Elimination: Mainly by the kidneys, so exposure follows kidney function; the dose is calculated from the glomerular filtration rate (Calvert formula).

Indications

Advanced ovarian carcinoma, first line in combination and for recurrence. Ovarian cancer →

Adverse effects

Common

Myelosuppression: thrombocytopenia, neutropenia and cumulative anaemia
Nausea and vomiting (milder than cisplatin)
Low magnesium and other electrolytes
Peripheral neuropathy, uncommon

Contraindications

History of severe allergic reactions to cisplatin, other platinum compounds or mannitol
Severe bone-marrow depression or significant bleeding

Key interactions

Aminoglycosides: More kidney and hearing toxicity.
Other nephrotoxic drugs: Carboplatin may add to their kidney effects.
Other myelosuppressive therapy: Additive marrow suppression; dose and timing are adjusted.

What is monitored

Blood counts frequently, until recovery
Kidney function (to calculate the dose) and electrolytes
Allergic reactions during every infusion

Administration and safety

Look-alike risk with cisplatin: the name is read in full and the dose is checked against kidney function.
Never prepared or given with needles or sets that contain aluminium: aluminium makes it precipitate and lose potency.
Emergency drugs for anaphylaxis are at hand during every infusion.
Hazardous drug: prepared and given following hazardous-drug handling procedures (impervious gloves, no skin contact) and disposed of as cytotoxic waste.

Nursing care

Independent double check of drug, patient, route and cycle before giving it (high-alert medicine).
Blood count before each cycle; fever with neutropenia is treated as an emergency.
Watch for flushing, rash, wheeze or low blood pressure during the infusion; stop and call for help if they appear.
Bleeding precautions when platelets are low (soft toothbrush, no injections in the muscle).
Teaching: report fever, chills, sore throat, bleeding or bruising at once.

Pregnancy and breastfeeding

May cause fetal harm (embryotoxic and teratogenic in animals); pregnancy is avoided during treatment.

Test yourself

Think of the answer, then tap the question to see it.

Compared with cisplatin, what is carboplatin's main dose-limiting toxicity?

Myelosuppression, especially thrombocytopenia; kidney damage and vomiting are milder.

Which patient value is used to calculate a carboplatin dose?

Kidney function (glomerular filtration rate), using the Calvert formula and a target AUC.

Minutes into a carboplatin infusion a patient develops flushing, wheeze and low blood pressure. What is the likely cause?

A platinum hypersensitivity (anaphylactic-like) reaction; the infusion is stopped and it is treated with epinephrine, corticosteroids and antihistamines.

Add to my cards (3)

Ovarian cancer

← Back to the class: Platinum compounds

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: DailyMed - CARBOPLATIN injection, solution (DailyMed (U.S. National Library of Medicine), 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 70 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).

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Representative model, for educational purposes only.