Pharmacologic class: Detoxifying agent
Therapeutic class: Hemorrhagic cystitis inhibitor
Pregnancy risk category B
Reacts in kidney with urotoxic ifosfamide metabolites (acrolein and 4-hydroxy-ifosfamide), resulting in their detoxification. Also binds to double bonds of acrolein and to other urotoxic metabolites.
Injection: 100 mg/ml in 10-ml vials
Tablets (coated): 400 mg
Indications and dosages
➣ To prevent hemorrhagic cystitis in patients receiving ifosfamide
Adults: Combination I.V. and P.O. regimen-Single I.V. bolus dose of mesna at 20% of ifosfamide dosage, given at same time as ifosfamide, followed by two doses of mesna tablets P.O. at 40% of ifosfamide dosage given 2 and 6 hours after ifosfamide dose. I.V. regimen-I.V. bolus of mesna at 20% of ifosfamide dosage given at same time as ifosfamide, repeated 4 and 8 hours after each ifosfamide dose.
• Hypersensitivity to drug or other thiol compounds
Use cautiously in:
• autoimmune disorders
• pregnant or breastfeeding patients.
• Dilute with dextrose 5% in water, dextrose 5% in normal saline solution, dextrose 5% in 0.2% sodium chloride solution, dextrose 5% in 0.33% sodium chloride solution, dextrose 5% in 0.45% sodium chloride solution, normal saline solution, or lactated Ringer's solution for injection.
• Give I.V. bolus over at least 1 minute with ifosfamide dose and at prescribed intervals after ifosfamide doses.
☞ Don't use multidose vial (contains benzyl alcohol) in neonates or infants. In older children, use with caution.
• If patient vomits within 2 hours of oral mesna dose, repeat oral dose or switch to I.V. route.
CNS: fatigue, malaise, irritability, headache, dizziness, drowsiness, hyperesthesia, rigors
CV: hypertension, hypotension, ST-segment elevation, tachycardia
EENT: conjunctivitis, pharyngitis, rhinitis
GI: nausea, vomiting, diarrhea, constipation, anorexia, flatulence
Musculoskeletal: back pain, joint pain, myalgia
Respiratory: coughing, tachypnea, bronchospasm
Skin: flushing, rash
Other: arm or leg pain, injection site reactions, fever, flulike symptoms, allergic reactions
Drug-diagnostic tests. Hepatic enzymes: increased levels
Urinary erythrocytes: false-positive or false-negative results
Urine tests using Ames Multistix: false-positive for ketonuria
• Monitor nutritional and hydration status.
• Monitor vital signs and ECG. Watch closely for blood pressure changes and tachycardia.
• Assess body temperature. Stay alert for fever, flulike symptoms, and EENT infections.
• Monitor respiratory status carefully. Watch closely for cough, bronchospasm, and tachypnea.
• Inform patient that drug may cause significant adverse effects. Reassure him that he will be monitored closely.
• Encourage patient to request analgesics or other pain-relief measures for headache, back or joint pain, hyperesthesia, or muscle ache.
☞ Advise patient to immediately report breathing difficulties and allergic symptoms.
• Inform patient about drug's adverse CNS effects. Explain safety measures used to prevent injury.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.
Pharmacologic: ifosfamide detoxifying agents
Time/action profile (detoxifying action)
|PO, IV||rapid||unknown||4 hr|
Adverse Reactions/Side Effects
Central nervous system
- unpleasant taste
- injection site reactions
- flu-like symptoms
Drug-Drug interactionNone significant.
Availability (generic available)
- Monitor for development of hemorrhagic cystitis in patients receiving ifosfamide.
- Lab Test Considerations: Causes a false-positive result when testing urinary ketones.
Potential Nursing DiagnosesDeficient knowledge, related to medication regimen (Patient/Family Teaching)
- Initial IV bolus is to be given at time of ifosfamide administration.
- Oral: If second and third doses are given orally, administer 2 and 6 hr after IV dose.
- If PO mesna is vomited within 2 hr of administration, repeat dose or use IV mesna.
- pH: 7.5–8.5.
- Intermittent Infusion: 2nd IV dose is given 4 hr later, 3rd dose is given 8 hr after initial dose. This schedule must be repeated with each subsequent dose of ifosfamide. Diluent: Dilute 2-, 4-, and 10-mL ampules, containing a concentration of 100 mg/mL in 8 mL, 16 mL, or 50 mL, respectively, of D5W, 0.9% NaCl, D5/0.9% NaCl, D5/0.2% NaCl, D5/0.33% NaCl, or LR.Concentration: 20 mg/mL. Refrigerate to store. Use within 6 hr. Discard unused solution.
- Rate: Administer over 15–30 min or as a continuous infusion.
- Syringe Compatibility: ifosfamide
- Y-Site Compatibility: allopurinol, amifostine, aztreonam, cefepime, docetaxel, doxorubicin liposome, etoposide phosphate, filgrastim, fludarabine, gemcitabine, granisetron, linezolid, melphalan, methotrexate, ondansetron, oxaliplatin, paclitaxel, pemetrexed, piperacillin/tazobactam, sargramostim, sodium bicarbonate, teniposide, thiotepa, vinorelbine
- Y-Site Incompatibility: amphotericin B cholesteryl complex, lansoprazole
- Additive Compatibility: ifosfamide
- Additive Incompatibility: carboplatin, cisplatin
- Inform patient that unpleasant taste may occur during administration.
- Advise patient to notify health care professional if nausea, vomiting, or diarrhea persists or is severe.
- Prevention of hemorrhagic cystitis associated with ifosfamide therapy.
mesnaAn agent that may act as an antioxidant, protecting the urogenital tract from toxic effects of ifosfamide and cyclophosphamide by binding them with its sulfhydryl-moieties, thereby reducing the incidence of haemorrhagic cystitis and haematuria.
Rash, itching, diarrheoa, nausea, vomiting.