ifosfamide


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ifosfamide

 [i-fos´fah-mīd]
an alkylating agent, one of the nitrogen mustards, which binds to protein and DNA and inhibits DNA synthesis. Used as an antineoplastic agent in treatment of leukemia, lymphoma, and cancers of the lung, ovary, testes, and other organs.

ifosfamide

Ifex, Mitoxana (UK)

Pharmacologic class: Alkylating agent, nitrogen mustard

Therapeutic class: Antineoplastic

Pregnancy risk category D

FDA Box Warning

• Give under supervision of physician experienced in using cancer chemotherapy, in facility with adequate diagnostic and treatment resources. Adverse urotoxic effects (especially hemorrhagic cystitis) and CNS toxicities (such as confusion and coma) have occurred; these effects may warrant drug discontinuation.

• Severe myelosuppression may occur.

Action

Alkylates DNA, interfering with replication and synthesis of susceptible cells and ultimately causing cell death

Availability

Injection: 1 g or 3 g in single-dose vials

Indications and dosages

Germ-cell testicular cancer

Adults: 1.2 g/m2/day by I.V. infusion over 30 minutes for 5 days. May repeat q 3 weeks or after recovery from hematologic toxicity.

Off-label uses

• Acute leukemia

• Breast, lung, ovarian, and pancreatic cancer

• Malignant lymphomas

• Sarcomas

Contraindications

• Hypersensitivity to drug

• Severe bone marrow depression

• Pregnancy or breastfeeding

Precautions

Use cautiously in:

• impaired renal or hepatic function, mild to moderate bone marrow depression.

Administration

• Follow facility policy for handling antineoplastic agents.

• Know that drug is usually given with other antineoplastics and hemorrhagic cystitis agent.

• To reconstitute, add sterile water or bacteriostatic water to vial, and shake gently.

• Mix 20 ml of diluent with 1-g vial or 60 ml of diluent with 3-g vial, to yield a concentration of 50 mg/ml. For smaller concentrations, dilute solution further with normal saline solution, dextrose 5% in water, lactated Ringer's solution, or sterile water.

• Administer I.V. slowly over at least 30 minutes.

Adverse reactions

CNS: drowsiness, confusion, ataxia, hallucinations, depressive psychosis, dizziness, disorientation, cranial nerve dysfunction, coma, seizures

CV: phlebitis

GI: nausea, vomiting, diarrhea, anorexia, stomatitis

GU: hematuria, bladder fibrosis, gonadal suppression, nephrotoxicity, hemorrhagic cystitis

Hematologic: anemia, leukopenia, thrombocytopenia, bone marrow depression

Metabolic: metabolic acidosis

Skin: alopecia

Other: infection, secondary neoplasms

Interactions

Drug-diagnostic tests. Hepatic enzymes, uric acid: increased levels

Platelets, white blood cells: decreased counts

Patient monitoring

• Monitor hematopoietic function tests (such as CBC with white cell differential) before therapy and weekly during therapy.

• Assess fluid intake and output. Ensure fluid intake of at least 2 L daily to prevent bladder toxicity.

Monitor urine output for hematuria and hemorrhagic cystitis. Administer mesna (protective drug), as indicated and prescribed.

Patient teaching

Tell patient to immediately report jaundice, unusual bleeding or bruising, bloody urine, pain on urination, fever, chills, sore throat, cough, difficulty breathing, unusual lumps or masses, mouth sores, or pain in flank, stomach, or joints.

• Instruct patient to maintain adequate hydration and nutrition. Advise him to drink 10 to 12 glasses of fluid each day.

• Inform patient that drug may cause hair loss.

• Advise both male and female patients to use reliable contraception during and immediately after therapy, because drug may cause severe birth defects.

• Urge patient to keep regular follow-up appointments for blood tests and monitoring of drug effects.

• As appropriate, review other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

i·fos·fa·mide

(ī-fos'fă-mīd),
A prodrug antineoplastic alkylating agent.

ifosfamide

Oncology An alkylating antineoplastic agent approved under an IND protocol as a 3rd-line therapy for germ-cell testicular malignancy; it is also used for cervical CA, soft tissue sarcomas Side effects Myelosuppression, encephalopathy, confusion, coma, hemorrhagic cystitis Treatment Hemorrhagic cystitis may respond to mesna, encephalopathy may respond to methylene blue

i·fos·fa·mide

(ī-fos'fă-mīd)
A prodrug antineoplastic alkylating agent.

ifosfamide

An ALKYLATING AGENT used as an anticancer drug. A brand name is Mitoxana.
References in periodicals archive ?
A phase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: A Gynecologic Oncology Group Study.
Addition of ifosfamide and etoposide to standard chemotherapy for ewing's sarcoma and primitive neuroectodermal tumor of bone.
reported on a phase II trial combining gemcitabine with ifosfamide and cisplatin (GIP) in the initial salvage treatment of 37 patients with GCT and the favorable criteria used in the MSKCC TIP study [17].
All patients treated with the alternating VIA/VIP schedule started with 2 cycles of VIA (vincristine 1.2 mg/[m.sup.2] on days 1, 8, and 15; ifosfamide 3000 mg/[m.sup.2] on days 1-3; and doxorubicin 20 mg/[m.sup.2] on days 1-3 in a three-weekly schedule).
[19] In a Phase I dose escalation study of eltrombopag in patients with advanced soft tissue sarcoma receiving doxorubicin and ifosfamide disclosed that the platelet counts increased in all patients receiving eltrombopag on day 1 of cycle 2 compared to day 1 of cycle 1 in patients not receiving eltrombopag.
Pharmacokinetics, metabolism and clinical effect of ifosfamide in breast cancer patients.
Researchers presented the results of a phase 2 trial of paclitaxel (T) plus ifosfamide (I) followed by high-dose carboplatin (C) plus etoposide (E) with stem-cell support (TICE) among 101 patients with relapsed advanced germ cell tumours (GCTs-71 with testicular tumours).
The effigies Morphine, Nicotine, and Ifosfamide (all works 2016) seemed to indicate both earthly and otherworldly purpose.
Campos et al., "Tumor necrosis factor-alpha and interleukin-1beta mediate the production of nitric oxide involved in the pathogenesis of ifosfamide induced hemorrhagic cystitis in mice," The Journal of Urology, vol.
A 12-year-old male affected by an osteosarcoma of femur, diagnosed in August 2012, after several neoadjuvant cycles of chemotherapy with adriamycin, cisplatin, ifosfamide, and methotrexate, underwent a surgical removal of femur in December 2012.
The patient was given vincristine, doxorubicin, and cyclophosphamide followed by ifosfamide and etoposide plus radiation to the left cerebellopontine angle.