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