• Monitor vital signs periodically during administration.
• Monitor for bone marrow depression. Assess for bleeding (bleeding gums; bruising; petechiae; guaiac 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 ↑ fatigue, dyspnea, and orthostatic hypotension.
• Monitor intake and output, appetite, and nutritional intake. Nausea and vomiting usually occur within 1–2 hr. Vomiting may stop within 3–4 hr; nausea may persist for 2–3 days. Antiemetics may be administered prophylactically. Adjust diet as tolerated to help maintain fluid and electrolyte balance and nutritional status.
• Assess respiratory status and chest x-ray examination prior to and periodically during therapy. Cough, bronchospasm, hemoptysis, or dyspnea usually occurs after several doses and may be indicative of pulmonary toxicity, which may be life-threatening.
• Monitor for potentially fatal hemolytic uremic syndrome in patients receiving long-term therapy. Symptoms include microangiopathic hemolytic anemia, thrombocytopenia, renal failure, and hypertension.
• Pyelocalyceal: Monitor for signs and symptoms of ureteric obstruction (flank pain, fever, changes in renal function). May require transient or long-term ureteral stents or alternative procedures. Hold or permanently discontinue Jelmyto based on the severity of ureteric obstruction.

Lab Test Considerations:

• Verify negative pregnancy test before starting therapy.Monitor CBC with differential, platelet count, and observation for fragmented RBCs on peripheral blood smears prior to and periodically during and for several mo following therapy.
  • The nadirs of leukopenia and thrombocytopenia occur in 4–8 wk. Notify health care professional if leukocyte count <4000/mm³ or if platelet count <150,000/mm³ or is progressively declining. Recovery from leukopenia and thrombocytopenia occurs within 10 wk after cessation of therapy. Myelosuppression is cumulative and may be irreversible. Repeat courses of therapy are held until leukocyte count >4000/mm³ and platelet count >100,000/mm³.
  • Monitor liver function (AST, ALT, LDH, bilirubin) and renal function (BUN, serum creatinine) prior to and periodically throughout therapy to detect hepatotoxicity and nephrotoxicity. Notify health care professional if serum creatinine >1.7 mg/dL.