Should hydration be administered before all doses of cyclophosphamide (Cytoxan, Neosar) or just for high-dose Cytoxan? — Ann Proctor, RN, OCN, clinical nurse educator

According to National Comprehensive Cancer Network (NCCN) guidelines, patients receiving cyclophosphamide therapy should receive 2 to 3 liters per day of both oral and IV hydration on the day chemotherapy is administered. Intravenous sodium chloride 0.9% infused at a rate of 1.5 to 3 mL/kg per hour for a total of 500 mL on the day of chemotherapy is recommended. These recommendations apply to all doses of cyclophosphamide. According to the Bethesda Handbook of Clinical Oncology, vigorous intravenous hydration and Mesna therapy should be considered to further reduce the risk of hemorrhagic cystitis with high doses of Cytoxan. — Jiajoyce R. Conway, DNP, FNP-BC, NP-C