CISPLATIN HYDRATION ORIGINATED BY: Pharmacy Clinical Specialist, Oncology APPROVAL:
Medical Director, Cancer Center/Pharmacy & Therapeutics Committee
DISTRIBUTION:
Department Policy Manual ORIGINAL DATE: LAST REVIEWED DATE: SIGNATURE: LAST REVISED DATE:
To provide standardized, evidenced based guidelines for prevention of cisplatin-induced nephrotoxicity.
1. Daily administration regimen refers to any cisplatin regimen that requires administration of a low
dose of cisplatin over multiple days (i.e. 25 mg/m2 daily on days 1-3)
2. > Weekly Administration Regimen refers to any cisplatin regimen that requires administration of
cisplatin on one or multiple days, but given at least one week apart. (i.e. 75 mg/m2 every 21 days,50 mg/m2 days 1 and 8, etc.)
All cisplatin administration cycles will fall into one of two categories: 1. daily administration regimen or 2. $ weekly administration regimen. General administration guidelines pertain to both administration categories. This policy will serve as standard practice guidelines for all patients receiving cisplatin at Hillcrest Hospital following a physicians order. Exceptions include patients enrolled in a clinical trial or other comorbidities (i.e. CHF) that warrant deviation from this policy. 1. Daily Administration Regimen
C Prehydration
B Day 1: Potassium chloride 20meq + Magnesium sulfate 2 grams in 1000ml 0.9% sodium
B Subsequent days: 500 ml 0.9% sodium chloride over 1-2 hours
C Diuretic therapy
B Mannitol: not necessary for low dose, daily therapy B Furosemide (LASIX): not necessary unless patient has signs/symptoms of fluid overload
C Urine output
B Verify that patient has urine output > 100 ml prior to administration of cisplatin
C Post-hydration(optional based on physician preference)
B If yes: 500ml fluid as post hydration over 1-2 hours
P Include IV fluids given with other chemotherapeutic agents (ex: Drug A in 500 ml of
0.9% sodium chloride over 2 hours after cisplatin administration).
B Instruct patient to drink 1-2 liters of fluid per day for 2-3 days following cisplatin
2. > Weekly Administration Regimen
C Prehydration
B Potassium chloride 20meq + Magnesium sulfate 2 grams in 1000ml 0.9% sodium chloride
C Diuretic therapy
B Mannitol: Current literature does not support the use of Mannitol to prevent Cisplatin-induced
nephrotoxicity. However, 12.5g may be given, based on physician preference.
B Furosemide (LASIX): not necessary unless patient has signs/symptoms of fluid overload
C Urine output
B Verify that patient has urine output > 200 ml prior to administration of cisplatin
C Post-hydration
B Post hydration consist of 1000 ml IV fluid.
P Include IV fluids given with other chemotherapeutic agents.
B Instruct patient to drink 1-2 liters of fluid per day for 2-3 days following cisplatin
3. General Administration Guidelines
C Electrolyte levels should be monitored and additional supplementation should be added as
C Co-administration of other nephrotoxic agents should be avoided whenever possible
B Including, but not limited to: aminoglycosides, non-steroidal anti-inflammatory drugs
(NSAIDS), iodinated contrast media, and bisphosphonates
Al-Sarraf M, Fletcher W, Oishi N, Pugh R, et.al. Cisplatin hydration with and without mannitoldiuresis in refractory disseminated malignant melanoma: a southwest oncology group study. CancerTreatment Reports 66(1):31-35, 1982.
Goodman M. Cisplatin: outpatient and office hydration regimens. Seminars in Oncology Nursing3(1):36-45, 1987.
Hodgkinson E. Neville-Webbe HL, Coleman RE. Magnesium depletion in patients receiving cisplatin-based chemotherapy. Clinical Oncology 18:710-718, 2006.
Launay-Vacher V, Rey JB, Isnard-Bagnis C, Deray G, Daouphars M. Prevention of cisplatinnephrotoxicity: state of the art recommendations from the European Society of Clinical PharmacySpecial Interest Group on Cancer Care. Cancer Chemother Pharmacol 61:903-909, 2008.
Numico G, Benasso M, Vannozzi, M, et. al. Hydration regimen and hematological toxicity of acisplatin-based chemotherapy regimen. Anticancer Research 18:1313-1318, 1998.
Ostrow S, Egorin MJ, Hahn D, et.al. High-dose cisplatin therapy using mannitol versus furosemidediuresis: comparative pharmacokinetics and toxicity. Cancer treatment reports 65(1-2):73-78, 1981.
Portilla D, Safar AM, Kundi IK, et. al. Cisplatin-induced nephrotoxicity. Uptodate version 16.1. January 31,2008. www.uptodateonline.com. Accessed on 05/30/2008.
Tiseo M, Martell O, Mancuso A, et.al. Short hydration regimen and nephrotoxicity of intermediate tohigh-dose cisplatin-based chemotherapy for outpatient treatment in lung cancer and mespthelioma. Tumori 93:138-144, 2007.
Santoso JT, Lucci JA, Coleman RL, et. al. Saline, mannitol, and furosemide hydration in acutecisplatin nephrotoxicity: a randomized trial 52:13-18, 2003.
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In an effort to promote the appropriate use of certain drugs and to help better manage the cost of expensive drugs, the ConnectiCare Pharmacy & Therapeutics Committee has developed a list of prescription drugs that require prior authorization. Prior authorization requests must be faxed to ConnectiCare’s Pharmacy Services department at 860-674-2851 or toll free 800-249-1367 by the prescribin