A patient diagnosed with multiple myeloma has been prescribed cyclophosphamide (Cytoxan). What instruction should the nurse give?

A key consideration in the management of patients receiving cyclophosphamide, particularly those with multiple myeloma, is the importance of hydration. Cyclophosphamide is an alkylating agent that can lead to the formation of toxic metabolites, which may cause bladder irritation and potentially result in hemorrhagic cystitis. To mitigate this side effect, it is essential for patients to maintain adequate hydration.

By increasing daily water intake, patients can help dilute the metabolites in the urine and flush them out of the bladder more effectively, thereby reducing the risk of urinary tract complications. This approach not only aims to protect the bladder but also enhances the overall excretion of the drug, which can help in minimizing toxicity.

In contrast, limiting or avoiding fluids can lead to more concentrated urine, increasing the risk of irritation and complications associated with cyclophosphamide therapy. Additionally, taking the medication on an empty stomach is not a standard recommendation, as this may not be necessary and can increase gastrointestinal side effects for some patients.