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.

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

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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