Hospital Pharmacy - May 2017 - 353

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research-article2017

HPXXXX10.1177/0018578717715356Hospital PharmacyCorbin and Bossaer

Article

Mannitol Prescribing Practices
With Cisplatin Before and After an
Educational Newsletter Intervention

Hospital Pharmacy
2017, Vol. 52(5) 353-356
© The Author(s) 2017
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https://doi.org/10.1177/0018578717715356
DOI: 10.1177/0018578717715356
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Morgan Corbin1 and John B. Bossaer2

Abstract
Background: Mannitol has been used in the past for the prevention of cisplatin-induced nephrotoxicity. Studies on its efficacy
have conflicting results. An educational newsletter was designed for local oncologists on the conflicting data of mannitol use
in preventing cisplatin-induced nephrotoxicity. Purpose: The purpose of this study was to determine whether a pharmacistcreated newsletter intervention led to changes in the mannitol prescribing practices of local oncologists. Methods: A newsletter
describing the paucity of evidence to support mannitol use to prevent cisplatin-induced nephrotoxicity was distributed via e-mail
to local oncologists in October 2010. Mannitol prescribing rates were retrospectively evaluated before and after newsletter
distribution. The Mann-Whitney U test was used to compare nonparametric continuous data. The chi-square test was used for
nominal data. Descriptive statistics were performed for baseline demographics, and odds ratios were calculated for possible risk
factors for acute kidney injury (AKI). The primary endpoint was a change in mean mannitol dose before and after the newsletter
intervention. The secondary endpoint was the difference in the rate of AKI before and after the intervention. Data were
collected for 67 patients with various malignancies. Results: There was a difference in the average mannitol dose before and
after newsletter intervention (P = .02). The rates of AKI before and after newsletter were similar. Conclusion: A pharmacistled newsletter intervention was associated with significantly decreased rates of mannitol usage after intervention.
Keywords
cisplatin, mannitol, prescriber education, prescribing habits
Cisplatin was the first platinum agent discovered to have
oncological activities, and it is used in the treatment of many
malignancies including testicular, head and neck, lung, gynecologic, and other cancers. Cisplatin causes significant toxicities such as nausea, vomiting, ototoxicity, electrolyte
abnormalities, and nephrotoxicity. Nephrotoxicity was cisplatin's major dose-limiting adverse effect until pretreatment
and posttreatment hydration became a standard preventive
measure.1 Despite this, nephrotoxicity may still occur, leading to dose delays and treatment cessation. Cisplatin's package insert states that 28% to 36% of patients treated with a
single dose of cisplatin (50 mg/m2) can experience nephrotoxicity, which is manifested as elevations in blood urea
nitrogen and serum creatinine (SCr).2 In addition to hydration, forced diuresis with mannitol has been used to minimize cisplatin-induced nephrotoxicity.
Mannitol is an osmotic diuretic that is indicated for the
promotion of diuresis; it is a logical choice for reduction of
cisplatin-induced nephrotoxicity as it is nontoxic and could
reduce the half-life of cisplatin in the kidney.3 However,
studies have not demonstrated a clearly consistent
benefit of mannitol use in preventing cisplatin-induced

nephrotoxicity.4-6 Readers are referred to a thorough review
of this topic for more in-depth information, which concluded, "There are no compelling data that the addition of
mannitol is more nephroprotective than the use of hydration alone."7 In reflection of this, an educational newsletter
was prepared and e-mailed to oncologists on the lack of
data to support mannitol's use for preventing cisplatininduced nephrotoxicity with the hope of decreasing mannitol prescribing. The objective of this study was to
determine whether a pharmacist-created newsletter intervention led to changes in the mannitol prescribing practices
of local oncologists.

1

University Health, Shreveport, LA, USA
East Tennessee State University, Johnson City, TN, USA

2

Supplemental material is available in the online version of the article.
Corresponding Author:
John B. Bossaer, Associate Professor of Pharmacy Practice, Bill Gatton
College of Pharmacy, East Tennessee State University, Box 70657,
Johnson City, TN 37614, USA.
Email: bossaer@etsu.edu


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Table of Contents for the Digital Edition of Hospital Pharmacy - May 2017

Editorial, For Sale: FDA Priority Review Vouchers
Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Pharmacists’ Knowledge of the Cost of Laboratory Testing
Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 317
Hospital Pharmacy - May 2017 - 318
Hospital Pharmacy - May 2017 - 319
Hospital Pharmacy - May 2017 - 320
Hospital Pharmacy - May 2017 - 321
Hospital Pharmacy - May 2017 - 322
Hospital Pharmacy - May 2017 - 323
Hospital Pharmacy - May 2017 - Editorial, For Sale: FDA Priority Review Vouchers
Hospital Pharmacy - May 2017 - 325
Hospital Pharmacy - May 2017 - Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Hospital Pharmacy - May 2017 - Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
Hospital Pharmacy - May 2017 - 328
Hospital Pharmacy - May 2017 - 329
Hospital Pharmacy - May 2017 - ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Hospital Pharmacy - May 2017 - 331
Hospital Pharmacy - May 2017 - 332
Hospital Pharmacy - May 2017 - 333
Hospital Pharmacy - May 2017 - Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Hospital Pharmacy - May 2017 - 335
Hospital Pharmacy - May 2017 - 336
Hospital Pharmacy - May 2017 - 337
Hospital Pharmacy - May 2017 - 338
Hospital Pharmacy - May 2017 - 339
Hospital Pharmacy - May 2017 - 340
Hospital Pharmacy - May 2017 - Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Hospital Pharmacy - May 2017 - 342
Hospital Pharmacy - May 2017 - 343
Hospital Pharmacy - May 2017 - 344
Hospital Pharmacy - May 2017 - 345
Hospital Pharmacy - May 2017 - 346
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Hospital Pharmacy - May 2017 - Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Hospital Pharmacy - May 2017 - 349
Hospital Pharmacy - May 2017 - 350
Hospital Pharmacy - May 2017 - 351
Hospital Pharmacy - May 2017 - 352
Hospital Pharmacy - May 2017 - Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Hospital Pharmacy - May 2017 - 354
Hospital Pharmacy - May 2017 - 355
Hospital Pharmacy - May 2017 - 356
Hospital Pharmacy - May 2017 - Pharmacists’ Knowledge of the Cost of Laboratory Testing
Hospital Pharmacy - May 2017 - 358
Hospital Pharmacy - May 2017 - 359
Hospital Pharmacy - May 2017 - 360
Hospital Pharmacy - May 2017 - Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Hospital Pharmacy - May 2017 - 362
Hospital Pharmacy - May 2017 - 363
Hospital Pharmacy - May 2017 - 364
Hospital Pharmacy - May 2017 - 365
Hospital Pharmacy - May 2017 - 366
Hospital Pharmacy - May 2017 - Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Hospital Pharmacy - May 2017 - 368
Hospital Pharmacy - May 2017 - 369
Hospital Pharmacy - May 2017 - 370
Hospital Pharmacy - May 2017 - 371
Hospital Pharmacy - May 2017 - 372
Hospital Pharmacy - May 2017 - 373
Hospital Pharmacy - May 2017 - Formulary Drug Reviews
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Hospital Pharmacy - May 2017 - 376
Hospital Pharmacy - May 2017 - 377
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Hospital Pharmacy - May 2017 - 380
Hospital Pharmacy - May 2017 - 381
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