Ifosfamide & Mesna (Generic)
Generic Name
Ifosfamide & Mesna
Manufacturer
Various Generic Manufacturers
Country
Globally manufactured
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| ifamide mesna 1 gm injection | ৳ 1,850.00 | N/A |
Description
Overview of the medicine
Ifosfamide is an alkylating antineoplastic agent used in the treatment of various cancers. Mesna is a uroprotective agent administered concurrently to prevent ifosfamide-induced hemorrhagic cystitis.
Uses & Indications
Dosage
Adults
Dosage varies significantly based on the cancer type, patient's condition, and chemotherapy regimen. Typically, ifosfamide is given at doses ranging from 1.2 gm/m² daily for 5 days or 2.5 gm/m² daily for 3 days, up to 5 gm/m² as a single dose every 3-4 weeks. Mesna is administered concurrently to a total daily dose of 60-160% of the ifosfamide dose, usually divided into 3 doses (e.g., 20% ifosfamide dose at 0, 4, 8 hours).
Elderly
Dosage adjustments may be necessary due to age-related decline in renal or hepatic function; monitor closely.
Renal_impairment
Use with extreme caution. Significant dose reduction or discontinuation may be required depending on the degree of impairment and risk of toxicity. Mesna excretion may also be affected.
How to Take
Administer intravenously as an infusion, typically over 30 minutes to several hours, diluted in appropriate intravenous fluids (e.g., 5% Dextrose Injection, 0.9% Sodium Chloride Injection). Mesna should be administered before and after each ifosfamide dose according to the regimen.
Mechanism of Action
Ifosfamide's active metabolites cross-link DNA strands, inhibiting DNA synthesis and causing cell death. Mesna binds to and detoxifies acrolein, a urotoxic metabolite of ifosfamide, preventing bladder damage.
Pharmacokinetics
Onset
Ifosfamide: Active metabolites appear within hours. Mesna: Rapid onset of uroprotection.
Excretion
Ifosfamide: Primarily renal excretion of parent drug and metabolites. Mesna: Excreted renally as mesna and dimesna.
Half life
Ifosfamide: Dose-dependent, typically 7-15 hours. Mesna: Approximately 1-2 hours for the parent compound.
Absorption
Ifosfamide and Mesna are administered intravenously, resulting in 100% bioavailability.
Metabolism
Ifosfamide: Extensively metabolized in the liver by CYP450 enzymes (e.g., CYP3A4, CYP2B6) to active (e.g., 4-hydroxyifosfamide) and inactive metabolites (e.g., acrolein, chloroacetaldehyde). Mesna: Rapidly oxidized in the blood to the inactive disulfide, dimesna, which is reduced back to mesna in the kidney.
Side Effects
Contraindications
- Hypersensitivity to ifosfamide or mesna, or any excipients.
- Severe bone marrow depression (especially in patients with impaired immune function).
- Severe renal impairment (especially if associated with urinary outflow obstruction).
- Active urinary tract infections.
Drug Interactions
Warfarin
Potential for altered anticoagulant effects, monitor INR.
Anthracyclines
Increased risk of cardiotoxicity.
Myelosuppressive agents
Increased risk of severe myelosuppression.
CYP450 inducers (e.g., rifampicin, phenytoin)
May reduce ifosfamide efficacy by increasing metabolism to inactive forms.
Nephrotoxic drugs (e.g., aminoglycosides, cisplatin)
Increased risk of nephrotoxicity.
CYP450 inhibitors (e.g., azole antifungals, cimetidine)
May increase ifosfamide exposure and toxicity.
Storage
Store intact vials at controlled room temperature (20-25°C), protected from light. Reconstituted solution must be used immediately or stored for a limited time as per guidelines.
Overdose
Symptoms of overdose include severe myelosuppression, neurotoxicity, and nephrotoxicity. Management is supportive, including aggressive hydration, administration of mesna (for ifosfamide toxicity), hematopoietic growth factors, and symptomatic treatment. Dialysis may be considered.
Pregnancy & Lactation
Pregnancy Category D. Ifosfamide is teratogenic and genotoxic; use is contraindicated during pregnancy. It is excreted in breast milk; breastfeeding is contraindicated during treatment.
Side Effects
Contraindications
- Hypersensitivity to ifosfamide or mesna, or any excipients.
- Severe bone marrow depression (especially in patients with impaired immune function).
- Severe renal impairment (especially if associated with urinary outflow obstruction).
- Active urinary tract infections.
Drug Interactions
Warfarin
Potential for altered anticoagulant effects, monitor INR.
Anthracyclines
Increased risk of cardiotoxicity.
Myelosuppressive agents
Increased risk of severe myelosuppression.
CYP450 inducers (e.g., rifampicin, phenytoin)
May reduce ifosfamide efficacy by increasing metabolism to inactive forms.
Nephrotoxic drugs (e.g., aminoglycosides, cisplatin)
Increased risk of nephrotoxicity.
CYP450 inhibitors (e.g., azole antifungals, cimetidine)
May increase ifosfamide exposure and toxicity.
Storage
Store intact vials at controlled room temperature (20-25°C), protected from light. Reconstituted solution must be used immediately or stored for a limited time as per guidelines.
Overdose
Symptoms of overdose include severe myelosuppression, neurotoxicity, and nephrotoxicity. Management is supportive, including aggressive hydration, administration of mesna (for ifosfamide toxicity), hematopoietic growth factors, and symptomatic treatment. Dialysis may be considered.
Pregnancy & Lactation
Pregnancy Category D. Ifosfamide is teratogenic and genotoxic; use is contraindicated during pregnancy. It is excreted in breast milk; breastfeeding is contraindicated during treatment.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years, refer to specific manufacturer's label.
Availability
Available in hospitals and specialized oncology pharmacies
Approval Status
Approved for cancer chemotherapy
Patent Status
Off-patent, generic available
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established Ifosfamide's efficacy in various solid tumors and hematological malignancies. Ongoing research explores new combinations and regimens for improved outcomes and reduced toxicity.
Lab Monitoring
- Complete Blood Count (CBC) with differential (before each dose and regularly during treatment)
- Renal function tests (serum creatinine, BUN, urinalysis for hematuria and proteinuria) before each dose and regularly
- Liver function tests (ALT, AST, bilirubin) regularly
- Serum electrolytes (especially sodium) if neurotoxicity or SIADH is suspected
- Neurological assessment
Doctor Notes
- Ensure adequate hydration before, during, and after ifosfamide administration.
- Closely monitor CBC, renal function, and neurological status throughout treatment.
- Mesna dosing must be meticulous and timed correctly to prevent hemorrhagic cystitis.
Patient Guidelines
- Report any signs of bleeding (especially in urine), confusion, dizziness, or changes in vision immediately.
- Maintain excellent hydration as instructed by your doctor.
- Avoid contact with people who are sick or have infections due to lowered immunity.
- Use effective contraception during and for a period after treatment (both male and female patients).
Missed Dose Advice
Contact your oncology team immediately. A missed dose of this chemotherapy regimen can significantly impact treatment efficacy and safety. Do not self-administer or adjust dosage.
Driving Precautions
Ifosfamide can cause neurotoxicity (e.g., confusion, dizziness, seizures) which may impair the ability to drive or operate machinery. Patients should avoid such activities if these side effects occur.
Lifestyle Advice
- Maintain good oral hygiene.
- Avoid alcohol consumption during treatment.
- Follow a balanced diet and engage in light exercise if tolerated.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.