DurgicalDurgical
EN
Open the app

Pharmacology · Platinum compounds

Oxaliplatin !

A platinum drug for colorectal cancer, given with fluorouracil and folinic acid. Cold can trigger tingling in the throat and hands.

Updated 2026-11-01

  • Class: Platinum compounds
  • Target: DNA (adjacent guanines)
  • ATC code: L01XA03
  • WHO Model List of Essential Medicines

The crystal shows a DNA duplex with an oxaliplatin cross-link: platinum (PT) carrying the diaminocyclohexane ring bridges two adjacent guanines.

Target in 3D: DNA (adjacent guanines). PDB structure 1IHH (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

After its oxalate group is displaced, oxaliplatin's platinum binds the N7 position of guanines and adenines and forms intrastrand and interstrand cross-links that block replication and transcription. Its diaminocyclohexane ring makes the adducts bulkier and harder to repair, and its effect does not rely on an active mismatch-repair system, one reason it works in colorectal cancer, where cisplatin does not.

  1. The oxalate leaves; platinum becomes reactive
  2. Bulky adducts link adjacent guanines
  3. Repair fails, even without mismatch repair
  4. DNA synthesis stops: colorectal tumour cells die

Pharmacokinetics

Absorption
Intravenous infusion only.
Distribution
Platinum spreads quickly into tissues and binds plasma proteins irreversibly; it also accumulates in red blood cells.
Elimination
Mainly in the urine; exposure rises in severe kidney impairment.

Indications

  • Colorectal cancer: adjuvant treatment of resected stage III colon cancer and advanced disease, with infusional fluorouracil and folinic acid. Colorectal cancer →

Adverse effects

Common

  • Acute neuropathy within hours to days, triggered by cold: tingling of hands, feet, mouth and throat
  • Cumulative sensory neuropathy that can affect writing, buttoning and walking
  • Neutropenia, nausea, diarrhoea and fatigue

Contraindications

  • History of hypersensitivity to oxaliplatin or other platinum compounds

Key interactions

QT-prolonging drugs (e.g. class Ia and III antiarrhythmics)
Additive QT prolongation; ECG and electrolytes are monitored.
Oral anticoagulants
Prolonged prothrombin time and INR, sometimes with bleeding, when given with fluorouracil and folinic acid.
Alkaline drugs or solutions (such as basic fluorouracil solutions)
Incompatible in the same line; the line is flushed with dextrose between drugs.
Other nephrotoxic drugs
Can reduce platinum clearance.

What is monitored

  • Neurological symptoms before each cycle
  • Blood counts before each cycle
  • ECG and electrolytes in people at risk of QT prolongation
  • Liver tests and respiratory symptoms

Administration and safety

  • Diluted only in dextrose (glucose) solution: never in sodium chloride or other chloride-containing solutions.
  • Not mixed or run in the same line with alkaline drugs; the line is flushed with dextrose before other medicines.
  • Never prepared or given with needles or sets that contain aluminium: aluminium makes it precipitate and lose potency.
  • Given with folinic acid in separate bags; emergency treatment for anaphylaxis is ready.
  • 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).
  • Watch for rash, flushing, wheeze or low blood pressure during each infusion: reactions can appear in any cycle.
  • Ask about tingling, numbness and trouble with fine tasks before each cycle.
  • Teaching: avoid cold drinks, ice and cold objects after each dose, and cover the skin in cold weather.
  • Ice chips are not used to prevent mouth sores with oxaliplatin, because cold worsens the neuropathy.

Pregnancy and breastfeeding

Can cause fetal harm; effective contraception is used during treatment by women and by men with female partners.

Test yourself

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

What triggers or worsens oxaliplatin's acute neuropathy?

Exposure to cold: cold drinks, ice or cold objects and cold air.

In which solution is oxaliplatin diluted, and which solutions must be avoided?

Dextrose (glucose) solution; sodium chloride and other chloride-containing solutions are avoided.

Why is oxaliplatin active in colorectal cancer while cisplatin is not?

Its bulky adducts are poorly repaired and its cytotoxicity does not depend on an active mismatch-repair system.

Add to my cards (3)

← 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 - OXALIPLATIN injection, solution, concentrate (DailyMed (U.S. National Library of Medicine), 2026); 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).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.