Assessment

• Monitor blood pressure before and every 5 min during infusion. Discontinue antihypertensives 24 hr prior to treatment. If significant hypotension requiring interruption of therapy occurs, place patient in Trendelenburg position and administer an infusion of 0.9% NaCl using a separate IV line. If blood pressure returns to normal in 5 min and patient is asymptomatic, infusion may be resumed so that full dose may be given

• Assess fluid status before administration. Correct dehydration before instituting therapy. Nausea and vomiting are frequent and may be severe. Administer prophylactic antiemetics including dexamethasone 20 mg IV and a serotonin-antagonist antiemetic (ondansetron, dolasetron, granisetron, palonosetron) before and during infusion. Monitor fluid status closely

• Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify physician or other health care professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction

• Assess patient for dry mouth and mouth sores periodically during therapy

• Monitor serum calcium concentrations before and periodically during therapy. May cause hypocalcemia. Calcium supplements may be necessary

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