What it's for (Indications)
- Ifosfamide is used in various types of cancers, including bronchogenic carcinoma (lung cancer), testicular tumors, mammary carcinoma (breast cancer), ovarian cancer, and soft tissue cancers.
Dosage Information
| Type | Guideline |
|---|---|
| Standard | Ifosfamide Injection should be administered intravenously at a dose of 1.2 grams per m² per day for 5 consecutive days. Treatment is repeated every 3 weeks or after recovery from hematologic toxicity. To prevent bladder toxicity, extensive hydration consisting of at least 2 liters of oral or intravenous fluid per day is required. Mesna should be used concurrently to reduce the incidence of hemorrhagic cystitis. Administer as a slow intravenous infusion lasting a minimum of 30 minutes. Solutions may be diluted further to concentrations of 0.6 to 20 mg/mL in 5% Dextrose Injection, 0.9% Sodium Chloride Injection, or Lactated Ringer’s Injections. Studies in patients with hepatic or renal impairment have not been conducted. |
Safety & Warnings
Common Side Effects
- Common adverse reactions (≥ 10%) include alopecia, nausea/vomiting, leukopenia, anemia, CNS toxicity, hematuria, infection, and somnolence.
- Myelosuppression (decreased production of blood cells) is also a significant concern.
Serious Warnings
- Black Box Warning: WARNING: MYELOSUPPRESSION, NEUROTOXICITY, AND UROTOXICITY. Myelosuppression can be severe and lead to fatal infections. Monitor blood counts prior to and at intervals after each treatment cycle. CNS toxicities can be severe and result in encephalopathy and death. Monitor for CNS toxicity and discontinue treatment for encephalopathy. Nephrotoxicity can be severe and result in renal failure. Hemorrhagic cystitis can be severe and can be reduced with Mesna and extensive hydration.
- Myelosuppression can be severe and lead to fatal infections; monitor blood counts prior to and at intervals after each treatment cycle.
- CNS toxicities can be severe, resulting in encephalopathy and death; monitor for CNS toxicity and discontinue treatment for encephalopathy.
- Nephrotoxicity can be severe and result in renal failure.
- Hemorrhagic cystitis can be severe and should be mitigated with extensive hydration and Mesna.
- This medicine needs monitoring in patients with impaired renal function and compromised bone marrow function.
- It is not recommended with other anthracyclines.
- Pregnancy: Consult a doctor before use; use safer alternatives if possible.
- Lactation: Consult a doctor before taking this medicine.
- Alcohol: Avoid consuming alcohol when taking this medicine.
How it Works (Mechanism of Action)
Ifosfamide is a prodrug requiring metabolic activation by hepatic cytochrome P450 isoenzymes. Activation forms 4-hydroxyifosfamide, which decomposes to the cytotoxic and urotoxic compound acrolein and an alkylating isophosphoramide mustard. Its cytotoxic action primarily involves DNA crosslinks caused by alkylation at guanine N-7 positions, leading to inter- and intra-strand cross-links and subsequent cell death.