[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Platinum compounds](https://durgical.com/en/pharmacology/classes/platinum-compounds/) › Oxaliplatin

[Pharmacology](https://durgical.com/en/pharmacology/) · [Platinum compounds](https://durgical.com/en/pharmacology/classes/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](https://durgical.com/en/pharmacology/classes/platinum-compounds/)
- Target: DNA (adjacent guanines)
- ATC code: L01XA03
- WHO Model List of Essential Medicines

## ⚠ High-alert medication

An error with this medicine can cause serious harm: double checks and protocols are used.

◆**DNA (adjacent guanines)**Oxaliplatin

ⓘ 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](https://www.rcsb.org/structure/1IHH) · Drag to rotate · pinch to zoom

## 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.

- The oxalate leaves; platinum becomes reactive
- Bulky adducts link adjacent guanines
- Repair fails, even without mismatch repair
- 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 →](https://durgical.com/en/conditions/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

### Serious (rare, important)

- Hypersensitivity reactions including fatal anaphylaxis, in any cycle (boxed warning)
- Pharyngolaryngeal dysaesthesia: a feeling of being unable to breathe or swallow without true airway obstruction
- Severe neutropenia and sepsis
- Pulmonary fibrosis, liver injury, QT prolongation and torsade de pointes, rhabdomyolysis and posterior reversible encephalopathy

## 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.

## Memory aid

OXaliplatin hates the cold: «no ice, no ice cream, no icy hands». And it hates chloride: mix it in dextrose only.

## 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)](https://durgical.app/estudiar/?add=/en/pharmacology/oxaliplatin/)

## Related drugs

- [Cisplatin](https://durgical.com/en/pharmacology/cisplatin/)
- [Carboplatin](https://durgical.com/en/pharmacology/carboplatin/)
- [Irinotecan](https://durgical.com/en/pharmacology/irinotecan/)
- [Calcium folinate](https://durgical.com/en/pharmacology/calcium-folinate/)

## Related conditions

- [Colorectal cancer](https://durgical.com/en/conditions/colorectal-cancer/)

[← Back to the class: Platinum compounds](https://durgical.com/en/pharmacology/classes/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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e51a62ba-d163-4c57-835c-8c86cf097e40) (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](https://atcddd.fhi.no/atc_ddd_index/?code=L01XA03) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/oxaliplatin/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/oxaliplatin/