Ifosfamide (an alkylating agent):
- Testicular cancer (FDA-approved)
- Off-label:
- Sarcomas (soft tissue, osteosarcoma)
- Lymphomas
- Lung, bladder, cervical, and ovarian cancers
Dose: 1.2–2.4 g/m²/day for 3 to 5 consecutive days per cycle,Repeat every 3–4 weeks,Dose depends on indication, renal function, and concurrent chemo
Mesna (Uroprotectant):
- Always co-administered with ifosfamide or cyclophosphamide to prevent hemorrhagic cystitis
Dose: Total mesna dose = 60%–100% of ifosfamide dose,Common IV regimen:20% before ifosfamide, then 20% at 4 and 8 hours after,May be given orally after IV dose to complete coverage
Ifosfamide:
- Injection: 1 g, 2 g, 3 g vials
Mesna:
- Injection: 100 mg/mL, 1 g/10 mL vials
- Tablets: 400 mg, 600 mg (varies by region)
Ifosfamide:
- IV infusion, typically over 30–120 minutes
- Must be given with mesna
- Ensure adequate hydration and urine output to reduce bladder toxicity
Mesna:
- IV or oral; timing is critical to match ifosfamide exposure
- Begin before or with ifosfamide and repeat at regular intervals
- Monitor urine output & color (to detect hematuria)
Ifosfamide:
- Class: Alkylating agent (nitrogen mustard derivative)
- MOA: DNA crosslinking → inhibits replication → cell death
- Prodrug, activated in the liver (CYP450 enzymes)
- Active metabolites: IFA mustard (cytotoxic) & acrolein (urotoxic)
Mesna:
- Class: Thiol compound
- MOA: Binds to acrolein in urine → detoxifies → prevents urothelial damage
- No anticancer activity on its own
Ifosfamide:
- Nausea, vomiting
- Hair loss
- Bone marrow suppression
- Fatigue
Mesna:
- Generally well-tolerated
- Nausea, vomiting
- Rash
- Rare: Allergic reactions, hypotension
Ifosfamide:
- Known hypersensitivity
- Severe bone marrow suppression
- Severe renal or hepatic impairment (caution)
Mesna:
- Hypersensitivity to mesna or similar compounds
Ifosfamide:
- CYP450 inducers/inhibitors may affect metabolism
- Increased neurotoxicity with aprepitant, benzodiazepines, or other CNS depressants
- Nephrotoxicity may be worsened by aminoglycosides, cisplatin
Mesna:
- No significant interactions (used only to protect bladder)
Drug Status
Availability | |
Pregnancy | |
Breastfeeding | |
Schedule |
BRAND NAME | STRENGTH | FORMULATION | PACK SIZE | MANUFACTURER | DISTRIBUTOR |
---|---|---|---|---|---|
Fosfa with Mesna | 1g | Injection | 1’s | M/S Getwell Pharma | Nairobi Enterprises |
Ifomid-M | 1g | Injection | 1’s | United Biotech | Salama Pharma |
Ifomid-M | 2g | Injection | 1’s | United Biotech | Salama Pharma |