April 2013 Prescribing in General Practice INTRODUCTION This guidance was put together by the Clinical and Prescribing subcommittee to meet the increasing demand from individuals and organisations for information relating to prescribing in general practice. Doctors have specific clinical rights and responsibilities in relation to prescribing, and as most general practitioners wo
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ORIGINATED BY: Pharmacy Clinical Specialist, Oncology
Medical Director, Cancer Center/Pharmacy & Therapeutics Committee DISTRIBUTION:
Department Policy Manual ORIGINAL DATE:
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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
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
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.
Partnership Planning Day notes This was the second partnership day organised by the Operation Fortress (OF) team with the aim of furthering the knowledge of and feedback on the partnership’s work with drug dealing violent offenders. Assistant Chief Constable, Laura Nicholson, highlighted the strategic aims of Operation Fortress as a different type of intervention to deal with the s