Mesnex, Uromitexan (CA) (UK)

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.

Dosage adjustment

• Children


• 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.

Adverse reactions

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

Hematologic: hematuria

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

Patient monitoring

• 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.

Patient teaching

• 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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


(mes-na) ,


(trade name),


(trade name)


Therapeutic: antidotes
Pharmacologic: ifosfamide detoxifying agents
Pregnancy Category: B


Prevention of ifosfamide-induced hemorrhagic cystitis (see Ifosfamide monograph).May also prevent hemorrhagic cystitis from cyclophosphamide.


Binds to the toxic metabolites of ifosfamide in the kidneys.

Therapeutic effects

Prevents hemorrhagic cystitis from ifosfamide.


Absorption: IV administration results in complete bioavailability; 45–79% absorbed after oral administration. Following IV with PO dosing ↑ systemic exposure.
Distribution: Unknown.
Metabolism and Excretion: Rapidly converted to mesna disulfide, then back to mesna in the kidneys, where it binds to toxic metabolites of ifosfamide (18–26% excreted as free mesna in urine after IV and PO dosing).
Half-life: Mesna—0.36 hr (IV); 1.2—8.3 hr (IV followed by PO); mesna disulfide—1.17 hr.

Time/action profile (detoxifying action)

PO, IVrapidunknown4 hr


Contraindicated in: Hypersensitivity to mesna or other thiol (rubber) compounds.
Use Cautiously in: Obstetric / Lactation: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • drowsiness
  • headache


  • anorexia
  • diarrhea
  • nausea
  • unpleasant taste
  • vomiting


  • flushing


  • injection site reactions


  • flu-like symptoms


Drug-Drug interaction

None significant.


Intravenous (Adults) Give a dose of mesna equal to 20% of the ifosfamide dose at the same time as ifosfamide and 4 and 8 hr after.
Oral Intravenous (Adults) Give a dose of IV mesna equal to 20% of the ifosfamide dose at the same time as ifosfamide; then give PO mesna equal to 40% of the ifosfamide dose 2 and 6 hr after ifosfamide (total mesna dose is 100% of ifosfamide dose).

Availability (generic available)

Tablets: 400 mg
Injection: 100 mg/mL
In combination with: In a kit with ifosfamide.

Nursing implications

Nursing assessment

  • Monitor for development of hemorrhagic cystitis in patients receiving ifosfamide.
  • Lab Test Considerations: Causes a false-positive result when testing urinary ketones.

Potential Nursing Diagnoses

Deficient 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.
  • Intravenous Administration
  • 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

Patient/Family Teaching

  • 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.

Evaluation/Desired Outcomes

  • Prevention of hemorrhagic cystitis associated with ifosfamide therapy.
Drug Guide, © 2015 Farlex and Partners


An 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. 

Adverse effects
Rash, itching, diarrheoa, nausea, vomiting.
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.


A brand name for MESNA.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
Mentioned in ?
References in periodicals archive ?
Another study reported that these patients could undergo hematuria with increased chemotherapy toxicity because of DNA-repair defects despite the administration of the lower cyclophosphamide doses and the administration of the protective agent Mesna (Uromitexan; Eczacibasi-Baxter Medical, Istanbul, Turkey) (6).