• Monitor vital signs frequently during administration. Report significant changes.
• Monitor intake and output and specific gravity frequently during therapy. To reduce risk of nephrotoxicity, maintain urinary output of at least 100 mL/hr for 4 hr before initiating and for at least 24 hr after administration.
• Encourage patient to drink 2000–3000 mL/day of water to promote excretion of uric acid. Allopurinol and alkalinization of urine may be used to help prevent uric acid nephropathy.
• Assess patency of IV site frequently during therapy. Cisplatin may cause severe irritation and necrosis of tissue if extravasation occurs. If a large amount of highly concentrated cisplatin solution extravasates, mix 4 mL of 10% sodium thiosulfate with 6 mL of sterile water or 1.6 mL of 25% sodium thiosulfate with 8.4 mL of sterile water and inject 1–4 mL (1 mL for each mL extravasated) through existing line or cannula. Inject SUBQ if needle has been removed. Sodium thiosulfate inactivates cisplatin.
• Severe and protracted nausea and vomiting usually occur 1–4 hr after a dose; vomiting may last for 24 hr. Administer parenteral antiemetic agents 30–45 min before therapy and routinely around the clock for the next 24 hr. Monitor amount of emesis and notify health care professional if emesis exceeds guidelines to prevent dehydration. Nausea and anorexia may persist for up to 1 wk.
• Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, stools, urine, and emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for increased fatigue, dyspnea, and orthostatic hypotension.
• Monitor for signs of anaphylaxis (facial edema, wheezing, dizziness, fainting, tachycardia, hypotension). Discontinue medication immediately and report symptoms. Epinephrine and resuscitation equipment should be readily available.
• Medication may cause ototoxicity and neurotoxicity. Assess patient frequently for dizziness, tinnitus, hearing loss, loss of coordination, loss of taste, or numbness and tingling of extremities; may be irreversible. Notify health care professional promptly if these occur. Audiometry should be performed before initiation of therapy and before subsequent doses. Hearing loss is more frequent with children and usually occurs first with high frequencies and may be unilateral or bilateral.
• Monitor for inadvertent cisplatin overdose. Doses >100 m g/m²/cycle once every 3–4 wk are rarely used. Differentiate daily doses from total dose/cycle. Symptoms of high cumulative doses include muscle cramps (localized, painful involuntary skeletal muscle contractions of sudden onset and short duration) and are usually associated with advanced stages of peripheral neuropathy.
• Monitor for signs of RPLS (headache, seizure, lethargy, confusion, blindness). Hypertension may or may not be present. May occur within 16 hr to 1 yr of initiation of therapy. Treat hypertension if present and discontinue cisplatin therapy. Symptoms usually resolve within days.

Lab Test Considerations:

• Monitor CBC with differential and platelet count before and routinely throughout therapy. The nadir of leukopenia, thrombocytopenia, and anemia occurs within 18–23 days and recovery 39 days after a dose. Withhold further doses until WBC is >4000/mm³ and platelet count is >100,000/mm³.
  • Monitor BUN, serum creatinine, and CCr before initiation of therapy and before each course of cisplatin to detect nephrotoxicity. May cause ↑ BUN and creatinine and ↓ calcium, magnesium, phosphate, sodium, and potassium levels that usually occur 2nd wk after a dose. Do not administer additional doses until BUN is <25 mg/dL and serum creatinine is <1.5 mg/dL. May cause ↑ uric acid level, which usually peaks 3–5 days after a dose.
  • May cause transiently ↑ serum bilirubin and AST concentrations.
  • May cause positive Coombs’ test result.