Administering Mannitol With Hydration and Premeds

I have worked in 2 different infusion clinics, and both administer medications differently. At my current clinic, hydration and mannitol are administered before premedications on a cisplatin regimen. At my previous clinic, however, premeds and hydration were administered before mannitol, which was immediately before cisplatin. Does it make a difference?

—Name withheld on request

Cisplatin premedications such as antiemetics should be administered 30 to 60 minutes prior to the chemotherapy drug to allow time for the drug to reach its target site prior to chemotherapy administration.

Mannitol is an osmotic diuretic that increases urine output. It may be used before cisplatin to reduce the nephrotoxic effects of cisplatin. Not all institutions use mannitol for this purpose, and may use other methods such as administering prehydration and posthydration with saline and electrolytes. The diuretic effects of mannitol begin approximately 15 to 30 minutes after an infusion, and can last for 2 to 8 hours.

Given the duration of action of mannitol, as long as the premedications are administered sufficiently early, administration sequence relative to mannitol does not seem likely to impact clinical outcomes.