Delivery order in IV/IP chemotherapy administration

Oncology nurses are taught to always administer platinums before taxanes for IV chemotherapy regimens. Does this still hold true when the taxane is ordered IV, and the platinum is ordered IP? Also, when IV mannitol is ordered, can that be run concurrent with the IP platinum? —Cathy Ollom RN, BSN, OCN

When cisplatin is administered before paclitaxel, the beneficial effects of paclitaxel may be decreased. Administering cisplatin before paclitaxel may also change how the patient’s body processes paclitaxel, which can result in an increase in its toxic effects. This rule is primarily applicable to IV administration of both drugs. But IP administration changes the dynamics as IP drug delivery is delayed and sustained, so order of administration does not make much difference. Concurrent use of paclitaxel and mannitol is compatible. —Donald R. Fleming, MD