Uses

Ifosfamide is an alkylating antineoplastic agent indicated, in combination with other chemotherapy agents, for third-line treatment of germ cell testicular cancer. It must be co-administered with mesna to prevent hemorrhagic cystitis.

Do not use if

Contraindicated in known hypersensitivity to ifosfamide, urinary outflow obstruction, and severely compromised bone marrow function.

Side effects

Common adverse reactions include alopecia, nausea and vomiting, myelosuppression (leukopenia, anemia), hemorrhagic cystitis, CNS toxicity (encephalopathy, confusion), and nephrotoxicity.

Warnings

Severe myelosuppression can lead to fatal infections; monitor blood counts before and after each cycle. CNS toxicities including encephalopathy and death have occurred; discontinue if severe CNS effects develop. Always co-administer mesna for urothelial protection.

How it works

Ifosfamide is a prodrug requiring hepatic CYP450-mediated activation. Its active metabolites cross-link DNA strands, disrupting replication and transcription in rapidly dividing cells. The urotoxic metabolite acrolein is responsible for hemorrhagic cystitis, necessitating mesna co-administration.

Storage

Store at controlled room temperature 20–25°C (68–77°F). The reconstituted solution is stable for up to 24 hours under refrigeration.