administered over a 30-60 min period followed by IV hydration for 12 hr with 
2.4 L/m 2 . 
9.2.1 Sedation and antinausea drugs: Ondansetron 0.15 mg/kg IV every 8 
hours beginning one hour prior to CTX. 
9.2.2 Diuresis and hydration: The urine flow during and for 12 hours after 
CTX administration is to be kept at a minimum of 2.5cc/kg/hr. If the 
urine output decreases below these numbers, furosemide 10-20 mg/m 2 
IV may be given. IV fluids at 2.4 L/m 2 /12 hr post CTX will be 
routinely employed. A Foley catheter may be placed in young children 
if difficulty is measuring urine output occurs. 
9.2.3 Toxicity of cytoxan (CTX) 
a. Nausea and vomiting controlled with routine antiemetics. 
b. Fluid retention: CTX has an anti-diuretic effect usually 
counteracted by furosemide administration. Careful physical 
examination should be made and daily weights and electrolytes 
determined to detect fluid overload early. 
c. Cardiomyopathy: At doses greater than 200 mg/kg, CTX can 
cause fatal cardiac necrosis with heart failure. Patients are 
monitored by daily EKG's to detect decrease in voltage. Non- 
specific ST changes are not unusual but a decrease in voltage 
is significant and ominous. CTX is contra-indicated in patients 
with existing cardiac disease. The EKG must be checked 
before each dose of cytoxan, patients developing significant 
reduction in cardiac voltage will have all subsequent doses 
discontinued. 
d. Diarrhea: Treated symptomatically. 
e. Hemorrhagic cystitis: Hematuria is not uncommon at this dose 
level, but is usually not symptomatic or severe. Adequate urine 
flow is essential to avoid cystitis. All patients will be treated 
with MESNA coincident with each dose of CTX (see below). 
Pyridium will given for symptomatic relief. 
f. Alopecia: Usually reversible. 
Recombinant DNA Research, Volume 17 
