Medicine Information

Holoxan

Name: Holoxan
Brand: Holoxan
Rating: 4.5 (117 reviews)

Injection2 gmAntineoplastic agent, Alkylating agentATC: L01AA06

Generic Name

Ifosfamide

Manufacturer

Baxter Healthcare (original brand), various generics

Country

Germany (original), various

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Price Details

Current market pricing information

Variant	Unit Price	Strip Price
holoxan 2 gm injection	৳ 3,485.95	N/A

Description

Overview of the medicine

Ifosfamide (Holoxan) is an alkylating cytotoxic agent used in the treatment of various cancers, including testicular cancer, sarcomas, lymphomas, and certain lung and breast cancers. It is typically administered intravenously with Mesna to prevent bladder toxicity.

Uses & Indications

Germ cell testicular cancer (refractory/relapsed)

Sarcomas (e.g., soft tissue sarcoma, osteosarcoma)

Lymphomas (e.g., Hodgkin's and non-Hodgkin's lymphoma)

Small cell lung cancer

Breast cancer

Bladder cancer

Dosage

Adults

Highly individualized based on disease, patient condition, and other chemotherapy agents. Common regimens include 1.2 g/m² intravenously daily for 5 consecutive days, or 2.5 g/m² daily for 3 days, or 5 g/m² as a single dose, every 3-4 weeks. Always administered with Mesna.

Elderly

Dose adjustment may be necessary in elderly patients, particularly considering renal function and overall health status. Close monitoring is essential.

Renal_impairment

Dose reduction (e.g., 50% for CrCl < 20 mL/min) or extended dosing intervals are required. Avoid in severe renal impairment (CrCl < 10 mL/min) if possible.

How to Take

Administered as an intravenous (IV) infusion, typically diluted in Dextrose 5% or Sodium Chloride 0.9% and infused over 30 minutes to 2 hours. Always co-administered with Mesna to prevent hemorrhagic cystitis. Adequate hydration is crucial.

Mechanism of Action

Ifosfamide, a nitrogen mustard alkylating agent, requires metabolic activation in the liver to form active metabolites (ifosfamide mustard and 4-hydroxyifosfamide). These metabolites then cross-link DNA strands, inhibiting DNA synthesis and function, leading to programmed cell death (apoptosis). It is cell-cycle phase non-specific.

Pharmacokinetics

Onset

Rapid (IV administration).

Excretion

Primarily renal excretion, with 50-75% of the administered dose excreted in urine within 48-72 hours as metabolites and unchanged drug. Renal elimination is dose-dependent.

Half life

Dose-dependent; initial half-life approximately 7-15 hours, terminal half-life longer at higher doses.

Absorption

Administered intravenously, resulting in 100% systemic bioavailability.

Metabolism

Hepatic metabolism via cytochrome P450 enzymes (primarily CYP3A4, CYP2B6) to active (ifosfamide mustard, 4-hydroxyifosfamide) and inactive (chloroacetaldehyde) metabolites. This process is saturable at higher doses.

Side Effects

Contraindications

Severe bone marrow depression (especially with severe leukopenia and/or thrombocytopenia)
Severe renal impairment
Known hypersensitivity to ifosfamide
Severe urinary outflow obstruction
Acute infections

Drug Interactions

Live vaccines

Avoid due to immunosuppression and risk of severe infection.

Other myelosuppressive agents

Increased risk and severity of bone marrow depression.

CYP450 inducers (e.g., phenobarbital, rifampin)

May increase ifosfamide activation and toxicity.

CNS depressants (e.g., opioids, benzodiazepines)

Potentiated neurotoxicity risk.

Nephrotoxic drugs (e.g., cisplatin, aminoglycosides)

Increased risk of renal toxicity.

CYP450 inhibitors (e.g., azole antifungals, cimetidine)

May decrease ifosfamide activation, potentially reducing efficacy or altering toxicity.

Storage

Store intact vials at controlled room temperature (20-25°C), excursions permitted to 15-30°C. Protect from light. Do not freeze. Reconstituted solutions should be used within a specified period and often require refrigeration.

Overdose

Symptoms of overdose include severe myelosuppression, neurotoxicity, nephrotoxicity, and hemorrhagic cystitis. There is no specific antidote. Management involves supportive care, including blood product transfusions, antiemetics, aggressive hydration, and continuous Mesna administration to mitigate bladder toxicity.

Pregnancy & Lactation

Pregnancy: Ifosfamide is a Pregnancy Category D drug (positive evidence of human fetal risk). It can cause fetal harm when administered to a pregnant woman. Effective contraception must be used during and for a period after treatment. Lactation: It is unknown whether ifosfamide is excreted in human milk. Due to the potential for serious adverse reactions in breastfed infants, breastfeeding is contraindicated during ifosfamide therapy.

Frequently Asked Questions

Common questions about this medicine

Pack Sizes

1 x 2 gm vial

Shelf Life

Typically 2-3 years from the date of manufacture when stored unopened. Once reconstituted, solution stability varies (e.g., 7 days refrigerated).

Availability

Hospitals, Oncology clinics

Approval Status

FDA approved (1987)

Patent Status

Generic available

WHO Essential Medicine

Yes

Clinical Trials

Ifosfamide has been extensively studied in clinical trials for various solid tumors and hematological malignancies, both as a single agent and in combination regimens. Research continues to explore its efficacy in new indications and optimized dosing strategies.

Lab Monitoring

Complete Blood Count (CBC) with differential (before each dose and regularly during treatment)
Renal function tests (serum creatinine, BUN, creatinine clearance)
Urinalysis (for hematuria) before each dose
Liver function tests (ALT, AST, bilirubin, alkaline phosphatase)
Electrolytes (sodium, potassium, chloride, bicarbonate)
Neurological status assessment

Doctor Notes

Critical to administer with Mesna and ensure adequate hydration to prevent hemorrhagic cystitis.
Closely monitor for signs of neurotoxicity (encephalopathy) and initiate methylene blue if needed.
Regularly monitor complete blood counts, renal function (creatinine, BUN, urinalysis for hematuria), and electrolytes.
Ifosfamide is a vesicant; administer carefully to avoid extravasation.
Discuss fertility preservation options with patients of reproductive age.

Patient Guidelines

Report any signs of infection (fever, chills), unusual bleeding or bruising, severe nausea/vomiting, or changes in mental status immediately to your healthcare team.
Maintain excellent hydration by drinking plenty of fluids as instructed by your doctor.
Avoid consuming grapefruit or grapefruit juice during treatment.
Use reliable contraception during treatment and for a specified period afterward, as advised by your doctor.
Avoid live vaccines due to immunosuppression.

Missed Dose Advice

Holoxan is administered in a controlled clinical setting by healthcare professionals. If a scheduled dose is missed, the oncology team will adjust the treatment plan accordingly. Patients should immediately inform their healthcare provider if they believe a dose has been missed or if there are any concerns about their treatment schedule.

Driving Precautions

Holoxan can cause central nervous system side effects such as confusion, drowsiness, dizziness, or visual disturbances. Patients should be advised to avoid driving or operating machinery if they experience these symptoms.

Lifestyle Advice

Practice good hand hygiene and avoid contact with sick individuals to minimize infection risk.
Discuss any dietary changes or supplements with your oncologist.
Avoid alcohol consumption during treatment.
Report any significant changes in bowel habits or urination patterns.