Medicine Information

Ifomes

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

Injection (Powder for solution)400 mgAntineoplastic agentATC: L01AA06

Generic Name

Ifosfamide

Manufacturer

Reputable Generic Manufacturer

Country

Varies (e.g., Bangladesh, India)

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Price Details

Current market pricing information

Variant	Unit Price	Strip Price
ifomes 400 mg injection	৳ 190.00	N/A

Description

Overview of the medicine

Ifosfamide is an alkylating antineoplastic agent used in the treatment of various cancers, including testicular cancer, sarcomas, and lymphomas. It is typically administered intravenously and often co-administered with Mesna to reduce urotoxicity.

Uses & Indications

Germ cell testicular cancer (second-line or salvage therapy)

Soft tissue sarcoma

Hodgkin's and non-Hodgkin's lymphoma (relapsed/refractory)

Ewing's sarcoma and osteosarcoma

Breast cancer (select cases)

Dosage

Adults

Highly variable depending on indication and regimen. Common doses include 1.2 g/m² daily for 5 days, given with Mesna, repeated every 3-4 weeks. Refer to specific chemotherapy protocols.

Elderly

Dosage adjustments may be necessary based on renal function, overall health status, and tolerability; initiate with caution.

Renal_impairment

Dose reduction is often required in patients with moderate to severe renal impairment (e.g., GFR < 50 mL/min). Specific guidelines should be consulted.

How to Take

Administer intravenously as an infusion over a minimum of 30 minutes, usually 2-3 hours, or longer for higher doses. Must be accompanied by Mesna administration (either as a bolus or continuous infusion) to prevent hemorrhagic cystitis. Adequate hydration is crucial.

Mechanism of Action

Ifosfamide is a prodrug that is metabolically activated in the liver to form active alkylating metabolites. These metabolites cross-link DNA strands, interfere with DNA replication and transcription, leading to cell cycle arrest and apoptosis in rapidly dividing cancer cells.

Pharmacokinetics

Onset

Rapid distribution and metabolic activation.

Excretion

Mainly renal excretion of unchanged drug and metabolites; approximately 70-80% of a dose is excreted renally within 48-72 hours.

Half life

Dose-dependent, typically 7-15 hours.

Absorption

Completely absorbed after intravenous administration.

Metabolism

Extensive hepatic metabolism via CYP450 enzymes (mainly CYP3A4) to active (4-hydroxyifosfamide, ifosfamide mustard) and inactive/toxic (acrolein, chloroacetaldehyde) metabolites.

Side Effects

Contraindications

Hypersensitivity to ifosfamide or any component of the formulation.
Severe bone marrow depression (especially in prior chemotherapy/radiotherapy).
Severe renal or hepatic impairment (relative contraindication).
Severe urinary outflow obstruction.

Drug Interactions

Neurotoxic agents

Increased risk of neurotoxicity (e.g., cisplatin, paclitaxel).

Nephrotoxic agents

Increased risk of renal toxicity (e.g., aminoglycosides, cisplatin).

Bone marrow depressants

Increased risk of myelosuppression (e.g., other cytotoxic agents, radiation therapy).

CYP3A4 inducers/inhibitors

May alter ifosfamide metabolism and exposure (e.g., phenobarbital, phenytoin, ritonavir, cimetidine, grapefruit juice - theoretical for oral, less relevant for IV).

Storage

Store unopened vials at controlled room temperature (20-25°C), protected from light. Do not freeze. Reconstituted solutions should be used promptly or stored as per manufacturer's guidelines.

Overdose

Symptoms of overdose include severe myelosuppression, neurotoxicity, nephrotoxicity, and hemorrhagic cystitis. Management is supportive, including aggressive hydration, administration of Mesna, and symptomatic treatment for complications such as infection, anemia, and neurological manifestations. Hemodialysis may be considered for severe neurotoxicity.

Pregnancy & Lactation

Ifosfamide is contraindicated in pregnancy (Category D/X) due to significant embryotoxic, teratogenic, and mutagenic risks. Women of childbearing potential should use effective contraception during treatment and for at least 6 months after. Breastfeeding is contraindicated due to potential excretion into breast milk and harm to the infant.

Frequently Asked Questions

Common questions about this medicine

Pack Sizes

1 x 400 mg vial1 x 1 g vial1 x 2 g vial

Shelf Life

Varies by manufacturer, usually 2-3 years for unopened vials. Reconstituted solution typically stable for 24 hours at room temperature or 7 days refrigerated.

Availability

Hospitals, specialized oncology centers

Approval Status

Approved (Generic)

Patent Status

Off-patent, generic available

WHO Essential Medicine

Yes

Clinical Trials

Ifosfamide has been extensively studied in clinical trials for various cancers, both as a single agent and in combination regimens. Ongoing trials explore new combinations, dose optimization, and management of side effects.

Lab Monitoring

Complete Blood Count (CBC) with differential before each dose and periodically during treatment.
Urinalysis for hematuria before each dose and daily for gross or microscopic hematuria.
Renal function tests (serum creatinine, BUN) before each dose.
Liver function tests (ALT, AST, bilirubin) periodically.
Electrolytes (e.g., sodium, potassium, chloride) especially if SIADH is suspected.
Neurological assessment.

Doctor Notes

Always administer Ifosfamide with Mesna and ensure adequate hydration.
Monitor CBC, renal function, urinalysis for hematuria, and neurological status closely.
Be vigilant for signs of neurotoxicity; if it occurs, consider discontinuing ifosfamide or switching to an alternative.
Discuss fertility preservation options with patients of childbearing potential before initiating treatment.

Patient Guidelines

Report any unusual bleeding, bruising, fever, signs of infection, or neurological changes (confusion, drowsiness) immediately to your healthcare provider.
Drink plenty of fluids as directed to help prevent bladder problems.
Use effective contraception during and for an extended period after treatment.
Avoid live vaccines during treatment.

Missed Dose Advice

Contact your healthcare team immediately if you miss a scheduled dose. Chemotherapy regimens are critical and require strict adherence to the schedule.

Driving Precautions

Ifosfamide can cause side effects like dizziness, confusion, or visual disturbances. Do not drive or operate heavy machinery if you experience these symptoms.