Cisplatin
Adequate hydration must be established prior to administration of cisplatin.
- Why Is Hydration Necessary?
- Maintaining A High Urine Flow Rate
- Manufacturers' Suggestions
- In Practice...
Why Is Hydration Necessary?
Hydration is necessary to ameliorate the renal damage caused by cisplatin and an adequate urine output must be established prior to administration.
Maintaining A High Urine Flow Rate
In some protocols a high urine flow rate is maintained by giving either mannitol or frusemide, although frusemide can itself cause renal damage. Hydration should be continued after the end of the cisplatin infusion.
Use Of Mannitol
During the last 30 minutes of the pretreatment hydration or after the hydration, administer by side arm drip 37.5g of Mannitol
(ie 375ml of Mannitol 10% injection).
In Practice...
In practice, a number of differing hydration schedules have been used. Most current UK produced protocols for adult patients are a lot more conservative regarding the amount of pre and post hydration required for low to moderate doses of cisplatin (<60mg/m2).
Manufacturer's Suggestions
The manufacturer's "Summary of Product Characteristics" suggests the following:
Pretreatment Hydration:
Pretreatment hydration is required to induce diuresis during (and after) cisplatin administration. This hydration is achieved by giving 2 litres of either of the following over a 2 hour period:
- 0.9% Sodium Chloride
- Dextrose 4% in one-fifth Normal Saline (0.18%)
Preparation Of Cisplatin Infusion:
Cisplatin Injection Solution 1mg/ml may be diluted in 2 litres of 0.9% Sodium Chloride Injection.
Do not refrigerate solution.
Treatment:
Following prehydration, administer the cisplatin infusion over 1 to 2 hours.
It has been proposed that a longer infusion time of 6 to 8 hours may decrease the gastrointestinal and renal toxicities.
The container should be covered to exclude light.
Discard remaining contents after use.
Posttreatment Hydration:
Continue IV hydration with the aim of administering another 2 litres of Sodium Chloride 0.9% Injection, or Dextrose 4% in Sodium Chloride 0.18% Injection, over a period of 6 to 12 hours.