Key points
- Cisplatin is a chemotherapy drug from the platinum family that damages the DNA of cancer cells [1].
- It is used for testicular, ovarian and bladder cancer and, with radiotherapy, for head and neck, cervical, lung and bile duct cancer [1, 2, 3, 4, 5].
- It has four important side effects: kidney damage, numbness of the hands and feet, severe nausea and vomiting and low blood counts [1].
- IV fluids and anti-sickness medicines are given before the infusion, and kidney function, magnesium and blood counts are followed [1].
- It can cause ringing in the ears and hearing loss, which is sometimes permanent; report any change in your hearing [1].
- Women should avoid pregnancy for 14 months and men for 11 months after the last dose [1].
What is this drug and how does it work?
For physicians
Cisplatin is a metal compound in which a platinum atom is surrounded by two chlorine atoms and two ammonia molecules in the “cis” arrangement [1]. It belongs to the platinum-based chemotherapy drugs; carboplatin is another member of the same family [1, 6].
Its main mechanism of action is binding to DNA in the cell nucleus and forming intrastrand and interstrand cross-links. These cross-links disrupt DNA transcription and replication and set off processes that lead to cell death [1]. Platinum from the drug remains in tissues for up to 180 days after the last infusion and is mostly excreted by the kidneys; this is why kidney function matters so much in choosing and adjusting the dose [1].
Cisplatin was first approved in the United States in 1978 [1]. In randomised trials, adding concurrent cisplatin to radiotherapy improved survival in head and neck cancer and cervical cancer [2, 3].
Which cancers is it used for?
Your doctor may prescribe this drug for:
- Testicular cancer (germ cell tumours) [1, 7]
- Ovarian cancer [1, 8]
- Bladder cancer [1, 9]
- Head and neck cancer (squamous cell) [2]
- Cervical cancer [3]
- Non-small cell lung cancer [4, 11]
- Bile duct cancer [5]
Whether it suits you depends on the type and stage of your cancer and your test results. Details of each use are in the section for doctors.
For physicians
| Cancer | Setting |
|---|---|
| Testicular cancer (germ cell tumours) | Advanced disease; in combination with bleomycin and etoposide (FDA-labelled indication) [1, 7] |
| Ovarian cancer | Advanced disease; combined with paclitaxel (FDA-labelled indication) [1, 8] |
| Bladder cancer | Advanced disease (FDA-labelled indication); neoadjuvant gemcitabine–cisplatin before cystectomy [1, 9] |
| Head and neck cancer (squamous cell) | Concurrent chemoradiotherapy, including after surgery in high-risk patients [2] |
| Cervical cancer | Concurrent chemoradiotherapy in locally advanced disease [3] |
| Non-small cell lung cancer | Advanced disease; platinum-based doublets, alone or with immunotherapy [4, 11] |
| Bile duct cancer | Advanced or recurrent disease; gemcitabine–cisplatin with durvalumab [5] |
The only official FDA-labelled indications are advanced testicular, ovarian and bladder cancer; other uses are based on randomised trials and clinical guidelines [1].
| Cancer | Key evidence |
|---|---|
| Testicular cancer (germ cell tumours) | In a randomised trial of 261 men, 83% of evaluable patients became disease-free with cisplatin + bleomycin + etoposide (with or without later surgery), and this regimen caused less neuromuscular toxicity and gave better survival than a vinblastine-containing regimen [1, 7] |
| Ovarian cancer | In a GOG trial of 410 women, cisplatin + paclitaxel raised median overall survival from 24 to 38 months compared with cisplatin + cyclophosphamide [1, 8] |
| Bladder cancer | In NIAGARA, adding durvalumab to neoadjuvant gemcitabine–cisplatin raised 24-month event-free survival from 59.8% to 67.8% (HR 0.68) [1, 9]. In EV-304, in cisplatin-eligible patients, perioperative enfortumab vedotin + pembrolizumab gave better 2-year event-free survival than neoadjuvant cisplatin–gemcitabine (79.4% vs 66.2%; HR 0.53) [10] |
| Head and neck cancer (squamous cell) | In EORTC 22931, adding cisplatin 100 mg/m² (days 1, 22 and 43) to postoperative radiotherapy raised 5-year overall survival from 40% to 53% (HR 0.70) [2] |
| Cervical cancer | In a GOG trial of 526 women, weekly cisplatin 40 mg/m² with radiotherapy lowered the risk of death compared with hydroxyurea (relative risk 0.61) [3] |
| Non-small cell lung cancer | In an ECOG trial of 1207 patients, four platinum-based doublets (cisplatin with paclitaxel, gemcitabine or docetaxel, and carboplatin + paclitaxel) gave similar results [11]. In KEYNOTE-189, adding pembrolizumab to pemetrexed and cisplatin or carboplatin raised 5-year overall survival from 11.3% to 19.4% [4] |
| Bile duct cancer | In TOPAZ-1 with 685 patients, adding durvalumab to gemcitabine–cisplatin improved overall survival (HR 0.80) [5] |
How it is taken and dosing
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Treatment regimens and doses: index5 regimens
Cisplatin is given only as a slow intravenous infusion (drip) under the supervision of a specialist at a chemotherapy centre [1]. Before the infusion you receive enough IV fluid to protect your kidneys, and good hydration and urine output must be kept up for 24 hours afterwards [1]. Anti-sickness medicines are given before and after the infusion [1].
The dose is based on body surface area (height and weight), the type of cancer and the regimen; depending on the regimen, the drug may be given every 3 to 4 weeks or weekly alongside radiotherapy [1, 3]. Take your anti-sickness tablets exactly as planned, even if you do not feel sick; nausea and vomiting can start or continue 24 hours or more after the infusion [1].
Never skip or move a treatment appointment on your own; decisions about delaying, lowering the dose or changing the drug based on tests and side effects are made by your treating doctor.
- Hydration: pretreatment hydration is mandatory, and adequate hydration and urine output should be maintained for 24 hours after the infusion. Dilute the reconstituted solution (1 mg/mL) in 1 to 2 litres of a compatible fluid, with or without 37.5 g of mannitol, and give as a slow infusion; do not use needles or sets containing aluminium [1].
- Antiemetics: it is highly emetogenic; give effective antiemetic premedication and antiemetics after the infusion (delayed nausea up to 72 hours and beyond) [1]. ASCO guideline for adults: NK1 antagonist + 5-HT3 antagonist + dexamethasone + olanzapine [12].
- Before starting and monitoring: creatinine, BUN, creatinine clearance and electrolytes including magnesium before starting and as needed (magnesium supplements as needed); CBC before each cycle; neurological examination before, during and after treatment; consider audiometric and vestibular assessment (especially in children); monitor the infusion site (concentrations above 0.5 mg/mL cause more tissue damage) [1].
- Dose modification: the label gives no specific dose table; with reduced creatinine clearance (at baseline or during treatment), myelosuppression or neuropathy, reduce the dose or use an alternative treatment according to clinical guidelines; grade 3 to 4 neuropathy: consider permanent discontinuation. Nephrotoxicity is dose-related and cumulative and usually starts in the second week after a dose [1].
- Contraindications: severe hypersensitivity to cisplatin. Severe hypersensitivity reaction: stop immediately; cross-reactivity with other platinum drugs has been reported [1].
For physicians
Regimens and dosing
Advanced testicular cancer (FDA label)
Usually in a combination regimen (such as BEP with bleomycin and etoposide)
Usually in a combination regimen (such as BEP with bleomycin and etoposide)
Before prescribing: Shared safety points| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Cisplatin | 20 mg/m² daily | Slow IV infusion | Days 1 to 5 |
The label also recognises other doses and regimens and refers to current guidelines for the dose of each regimen [1].
Advanced ovarian cancer (FDA label)
Usually with paclitaxelCycle length: Every 3 to 4 weeks
Usually with paclitaxel
Before prescribing: Shared safety points| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Cisplatin | 75 to 100 mg/m² | Slow IV infusion | Day 1 |
Dosing as per the FDA label [1].
In the GOG trial (410 women): cisplatin 75 mg/m² with paclitaxel 135 mg/m² over 24 hours [8].
Evidence: GOG-111 (1996)
Advanced bladder cancer (FDA label)
Monotherapy or in combinationCycle length: Every 3 to 4 weeks
Monotherapy or in combination
Before prescribing: Shared safety points| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Cisplatin | 50 to 70 mg/m²; after heavy prior treatment: start at 50 mg/m² every 4 weeks | Slow IV infusion | Day 1 |
Dosing as per the FDA label [1].
Postoperative head and neck chemoradiotherapy (EORTC 22931)
High-risk stage III or IV squamous cell head and neck cancer after surgery (off-label use)
High-risk stage III or IV squamous cell head and neck cancer after surgery (off-label use)
Before prescribing: Shared safety points| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Cisplatin | 100 mg/m² | Slow IV infusion | Days 1, 22 and 43 of radiotherapy |
| Radiotherapy | 66 Gy over 6.5 weeks |
Doses from the EORTC 22931 trial [2].
Evidence: EORTC 22931 (2004)
Weekly chemoradiotherapy for cervical cancer (GOG)
Locally advanced cervical cancer (off-label use)Cycle length: Weekly
Locally advanced cervical cancer (off-label use)
Before prescribing: Shared safety points| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Cisplatin | 40 mg/m² | Slow IV infusion | Weekly with external beam radiotherapy |
Doses from the GOG trial with 526 women [3].
Evidence: GOG (1999)
Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.
Side effects
The most common side effects:
- Nausea and vomiting: almost everyone gets them without anti-sickness medicine; they can last up to a week. Take your anti-sickness medicines exactly as planned [1].
- Kidney damage and low magnesium and other blood salts; this is why IV fluids and blood tests are needed before and after the infusion, and you should drink plenty of water [1].
- Numbness and tingling of the hands and feet, which can start even weeks after treatment ends [1].
- Ringing in the ears and hearing loss [1].
- Low blood counts, hair loss, poor appetite, diarrhoea, mouth sores and changes in taste [1].
For physicians
Common adverse reactions
According to the FDA label, the most common adverse reactions to cisplatin are nephrotoxicity, peripheral neuropathy, nausea and vomiting, myelosuppression and ototoxicity [1]. The current label does not give exact percentages for most adverse reactions; the figures and features it does give are in the table below:
| Adverse reaction | Description and frequency |
|---|---|
| Nausea and vomiting | Occur in almost all patients without antiemetics; usually start 1 to 4 hours after the infusion, are most severe 48 to 72 hours after it and may last up to 1 week [1] |
| Low blood counts | Myelosuppression in 25 to 30% of patients; fever and infection have been reported in neutropenic patients [1] |
| Kidney damage and electrolyte loss | Dose-related, cumulative damage that usually starts in the second week after the infusion; hypomagnesaemia that often needs supplementation, and low calcium, sodium, potassium and phosphate [1] |
| Peripheral neuropathy | “Stocking-and-glove” tingling and numbness, loss of reflexes and vibration sense; may start 3 to 8 weeks after the last dose or progress after the drug is stopped [1] |
| Ototoxicity | Tinnitus and high-frequency hearing loss (4000 to 8000 Hz); in children hearing loss is estimated at 40 to 60% [1] |
| Other adverse reactions | Alopecia, anorexia, diarrhoea, stomatitis, hiccups, asthenia and malaise, muscle cramps and loss of taste [1] |
Serious side effects
These are less common but serious; tell your team early if you notice any sign of them:
- Kidney failure: passing less urine or swelling [1].
- Infection because of low white blood cells: a temperature of 38 °C or chills [1].
- An allergic reaction during the infusion: swelling of the face, wheezing or dizziness [1].
- Severe hearing loss or loss of balance, and blurred vision [1].
- Burning or pain at the infusion site (the drug leaking out), blood clots and harm to an unborn baby [1].
For physicians
Boxed warning: the FDA label boxes four risks: severe nephrotoxicity including acute renal failure (dose-related and cumulative); dose-related peripheral neuropathy that worsens with repeated cycles; severe nausea and vomiting; and severe myelosuppression, which has led to deaths from infection [1].
Other warnings and precautions in the label [1]:
- Severe hypersensitivity and anaphylaxis: facial swelling, wheezing, tachycardia and hypotension, sometimes within minutes of starting the infusion in patients previously given cisplatin. Cross-reactivity with other platinum drugs has been reported.
- Ototoxicity: cumulative and sometimes severe, unilateral or bilateral; deafness after the first dose and vestibular toxicity (loss of balance) have also been reported. Concurrent cranial radiotherapy, other ototoxic drugs and renal impairment increase the risk.
- Ocular toxicity: optic neuritis, papilloedema and cortical blindness; blurred vision and altered colour perception with higher doses. Recovery usually follows stopping the drug but may be delayed.
- Secondary leukaemia: acute leukaemia after treatment, usually in people who have also received other leukaemogenic drugs.
- Embryo-fetal toxicity (see “Interactions, pregnancy and precautions”).
- Extravasation: at concentrations above 0.5 mg/mL, cellulitis, fibrosis and tissue necrosis may occur.
Venous and arterial thromboembolism, myocardial infarction, stroke, haemolytic uraemic syndrome, pneumonitis, seizures and posterior reversible encephalopathy syndrome have also been recorded in trials and after marketing [1].
When should I call my doctor?
Contact your treatment team or go to the emergency department straight away if you have [1]:
- A temperature of 38 °C or higher, chills or any sign of infection
- Unusual bleeding or bruising
- Persistent or severe vomiting that stops you drinking fluids, or a clear drop in the amount of urine you pass
- Shortness of breath, wheezing, facial swelling, palpitations or feeling faint during or after the infusion
- Hearing loss, ringing in the ears, or dizziness and loss of balance
- New tingling, numbness or weakness in the hands and feet
- Blurred vision or a change in how you see colours
- Pain, swelling or redness at the infusion site
- Chest pain, swelling of one leg or sudden weakness of one side of the body
Interactions, pregnancy and precautions
- Other medicines: taking drugs that harm the kidneys or hearing at the same time increases the risk of cisplatin side effects; give your doctor and pharmacist a full list of your medicines and supplements [1].
- Pregnancy: cisplatin can harm an unborn baby. Pregnancy status is checked before treatment. Women who could become pregnant should use effective contraception during treatment and for 14 months after the last dose, and men whose partner could become pregnant during treatment and for 11 months after the last dose [1].
- Breastfeeding: small amounts of cisplatin pass into breast milk; do not breastfeed during treatment [1].
- Fertility: this drug may cause ovarian failure, early menopause or impaired sperm production, which is sometimes permanent [1]; talk to your doctor about fertility preservation before starting treatment.
- Tests: kidney tests, electrolytes, magnesium and blood counts are done before every cycle, and electrolyte supplements (such as magnesium) may be prescribed [1].
- Hearing: regular hearing tests (audiometry) may be done during treatment; report any change in your hearing early [1].
- Older adults: they may be more sensitive to kidney damage, bone marrow suppression, infection and neuropathy, and the dose is chosen with extra care [1].
Frequently asked questions
Why are so many IV fluids given before cisplatin?
Cisplatin leaves the body mainly through the kidneys and can damage them. Good hydration before, during and after the infusion, and keeping up urine output for 24 hours, are an essential part of treatment to protect the kidneys [1].
How long does the nausea after cisplatin last?
Nausea and vomiting usually start 1 to 4 hours after the infusion and can last up to 72 hours and sometimes up to a week; the “delayed” type happens even in people who had no nausea on the first day [1]. This is why guidelines recommend a combination of several anti-sickness medicines; take them as planned [12].
Will my hearing come back?
Hearing damage from cisplatin is cumulative and may be permanent [1]. If you notice ringing in your ears or hearing loss, report it early so your doctor can decide about continuing or changing treatment before the damage gets worse.
How is cisplatin different from carboplatin?
Both belong to the platinum family and work in a similar way. According to the carboplatin label, carboplatin causes significantly less nausea and fewer, milder nerve side effects than cisplatin and is usually given without large amounts of IV fluids, but low blood counts (especially platelets) are its dose-limiting side effect [6]. The choice between them depends on the type of cancer, the aim of treatment and your kidney function and hearing.
Will cisplatin make my hair fall out?
The cisplatin label lists hair loss as a side effect of this drug [1]; how much depends on the combination regimen and the other drugs given with it.
Scientific evidence
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Key studies
14 itemsPostoperative Irradiation with or without Concomitant Chemotherapy for Locally Advanced Head and Neck Cancer
Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial
Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group
Pembrolizumab or placebo with chemoradiotherapy followed by pembrolizumab or placebo for newly diagnosed, high-risk, locally advanced cervical cancer (ENGOT-cx11/GOG-3047/KEYNOTE-A18): overall survival results from a randomised, double-blind, placebo-controlled, phase 3 trial
Nivolumab plus Gemcitabine-Cisplatin in Advanced Urothelial Carcinoma
Pembrolizumab Plus Pemetrexed and Platinum in Nonsquamous Non–Small-Cell Lung Cancer: 5-Year Outcomes From the Phase 3 KEYNOTE-189 Study
Enfortumab Vedotin and Pembrolizumab in Cisplatin-Eligible Bladder Cancer
Toripalimab Plus Chemotherapy for Recurrent or Metastatic Nasopharyngeal Carcinoma: The JUPITER-02 Randomized Clinical Trial
Perioperative Durvalumab with Neoadjuvant Chemotherapy in Operable Bladder Cancer
Durvalumab plus Gemcitabine and Cisplatin in Advanced Biliary Tract Cancer
Gemcitabine and Cisplatin Induction Chemotherapy in Nasopharyngeal Carcinoma
Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study
Improved survival with bevacizumab in advanced cervical cancer
Neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab compared with neoadjuvant chemotherapy alone in patients with early-stage non-small-cell lung cancer (KEYNOTE-671): a randomised, double-blind, placebo-controlled, phase 3 trial
Clinical guidelines
3 itemsNCCN Guidelines® Insights: Head and Neck Cancers, Version 2.2025
Cervical Cancer, Version 2.2026, NCCN Clinical Practice Guidelines In Oncology
ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023
Related cancer types
Treatment regimens (physicians)
References
12 referencesShow all references, 10 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 10Enfortumab Vedotin and Pembrolizumab in Cisplatin-Eligible Bladder Cancer
- 11
- 12Antiemetics: ASCO Guideline Update
This page is based on reputable scientific sources and was last updated on 27 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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