Mesnex mesna dosing, indications, interactions, adverse. Burk cd, restaino i, kaplan bs, meadows at 1990 ifosfamideinduced renal tubular dysfunction and rickets in children with wilms tumor. Ifosfamide injection is used in combination with other medicines to treat cancer of the testicles ifosfamide interferes with the growth of cancer cells, which are eventually destroyed. Renal drug handbook gfr 2050mlsmin dose as in normal renal function. Using ifosfamide may increase your risk of developing other cancers, such as leukemia. To report on the activity of highdose prolongedinfusion ifosfamide hdifx chemotherapy in a retrospective series of patients affected by myxoid liposarcoma treated at fondazione irccs istituto nazionale dei tumori in milan, italy. Abacavir abacavir lamivudine abacavir lamivudine zidovudine acarbose acebutolol acetaminophen acetazolamide acetohexamide acetohydroxamic acid acetylsalicylic acid aspirin acrivastine acyclovir adefovir adenosine albuterol inhaled albuterol oral alfentanil alfentanil allopurinol alprazolam alteplase tissuetype plasminogen activator. Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. Here we report results from the use of ifx in this population. Renal toxicity occurred in 6% of the patients treated with ifosfamide as a single agent. Consult the product instructions and your pharmacist for storage details. Cumulative dose of ifosfamide greater than 60 gm 2. This includes testicular cancer, soft tissue sarcoma, osteosarcoma, bladder cancer, small cell lung cancer, cervical cancer, and ovarian cancer.
Ifosfamide injection 1g summary of product characteristics. Ifosfamide therapy is associated with minor transient serum enzyme elevations and has been linked to cases of acute. As a single agent it has successfully produced objective remissions in a wide range of malignant conditions. Trivalent forms of arsenic are methylated in humans and mostly excreted in urine. The renal functions in pediatric cancer patients who received ifosfamide ifo treatment were evaluated and the risk factors related to ifo nephrotoxicity were determined. Like cyclophosphamide, ifosfamide causes cardiotoxicity in a dosagerelated manner dosages. Clonidine, codeine, cyclophosphamide, cyclosporine, cytarabine, dapsone.
Ifosfamide, carboplatin, and cisplatin can cause renal complications, including acute tubular dysfunction, although carboplatin is less nephrotoxic than cisplatin. Mechanism of action and pharmacokinetics indications and status adverse effects dosing administration guidelines special precautions interactions recommended clinical. Ifosfamide is a chemotherapeutic agent chemically related to the nitrogen mustards and a synthetic analog of cyclophosphamide. Younger age group, especially patients treated at less than 4 years of age. Ifosfamide is a parenterally administered alkylating agent similar to cyclophosphamide that is used in the treatment of several forms of cancer including lymphomas, sarcoma and advanced forms of solid organ cancer such as breast, testicular, ovarian, gastric and lung cancer. Nov 09, 2018 ifosfamide is a cancer medication that interferes with the growth and spread of cancer cells in the body. Eastern cooperative oncology group phase ii trial of. However, if crcl is 31 to 45 mlminute, administer 75% of the dose and with crcl under 30 mlminute reduce to 70% of the regular dose. Studies of ifosfamide for injection in patients with hepatic or renal impairment have not been conducted see use in specific populations 8. The onset of hf can be reversible, usually resolving over 3 to 4 weeks. Since the growth of normal body cells may also be affected by ifosfamide, other effects will also occur. Ixempra ixabepilone dosing1 the recommended dosage of ixempra is 40 mgm2 administered intravenously over 3 hours every 3 weeks 2doses for patients with body surface area greater than 2.
The molecular formula is c 7 h 15 cl 2 n 2 o 2 p and its molecular weight is 261. Mesna should be used for all patients receiving ifosfamide and high dose cyclophosphamide 1gm2. Ifosfamide fda prescribing information, side effects and. Aug, 2018 ifex ifosfamide for injection, usp singledose vials for constitution and administration by intravenous infusion each contain 1 gram or 3 grams of sterile ifosfamide. Body surface area is calculated using your height and weight. Renal dose adjustment guidelines for antimicrobials crrt.
Used as an antineoplastic agent in treatment of leukemia, lymphoma, and cancers of the lung, ovary, testes, and other organs. Ifosfamide, carboplatin, and cisplatin can cause renal complications, including acute tubular. A group of 23 children who had received ifosfamide at age 21162 years median 69 for various cancers were assessed for nephrotoxicity, at 128 2 months after the end of treatment, by renal function testing, laboratory values, and a grading score none, mild, moderate, severe. Follow your doctors dosing instructions very carefully.
Pdf ifosfamide may be safely used in patients with end. Purpose alkylating agents have modest activity in advanced urothelial carcinoma. Cvvhd removes solutes including drugs via diffusion. Fda label information for this drug is available at dailymed. Dosing needs to be adjusted in renal impairment as the drug undergoes renal elimination. The patient was referred to the renal service, while on hemodialysis, for consideration of the feasibility of ifosfamide chemotherapy in a patient with end stage renal disease.
Ifosfamide is embryotoxic to rabbits receiving 88 mgm2day doses from the 6th through the. Ifosfamide is an antineoplastic agent useful in the treatment of a wide range of cancers including sarcomas, gynecologic cancers, lymphoma and testicular cancers. Ixempra ixabepilone dosing and administration guide. Adult drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in. If you miss a dose, contact your doctor to establish a new dosing schedule. When a patient is initiated on crrt, antimicrobial therapy often requires adjustment to ensure adequate drug concentrations are achieved. Acute tubular necrosis, acute renal failure, and chronic renal failure secondary to ifosfamide therapy have been reported, and fatal outcome from nephrotoxicity has been documented. The antitumoral properties of ifosfamide take effect in a number of sarcomas, lymphomas and other tumors, and it is also effective in patients pretreated with. Mar 28, 2019 detailed ifosfamide dosage information for adults. However, if crcl is 31 to 45 mlminute, administer 75% of the dose and with crcl under.
Embryolethal effects were observed in rats following the administration of 54 mgm 2 doses of ifosfamide from the 6th through the 15th day of gestation and embryotoxic effects were apparent after dams received 18 mgm 2 doses over the same dosing period. Cco is the ontario governments principal advisor on the cancer and renal systems, and access to care for key health services. Ifosfamide can also cause hypophosphatemic rickets. Ifosfamide may lower your bodys resistance and there is a chance you might get the infection the immunization is meant to prevent. Highdose ifosfamide chemotherapy in a series of patients. Dec 22, 2017 mesna should be used to reduce the incidence of hemorrhagic cystitis. Ifosfamide for injection should be administered as a slow intravenous infusion lasting a minimum of 30 minutes. The proximal tubulopathy results in phosphaturia, glycosuria, aminoaciduria, hypophosphataemia, hypokalaemia and a hyperchloraemic. Ifex ifosfamide dosing, indications, interactions, adverse. Chemotherapy and kidney injury american society of. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Risk factors for ifosfamide nephrotoxicity include. Store intact vials at room temp or under refrigeration.
The metabolism of ifosfamide is via cyp450 3a4 and 2b6 and produces active ifosfamide mustard, the toxic metabolite acrolein and chloroacetaldehyde caa. Case 1 was a 48yearold male who four years earlier had been diagnosed with high grade synovial sarcoma of the knee, metastatic to lungs. The acute tubular dysfunction can be manifested by increased excretion of potassium, phosphorus, and magnesium. Ifosfamide, a structural isomer of cyclophosphamide, was introduced into clinical studies in 1972. Ifosfamide neurotoxicity and potential treatment with. In addition, other persons living in your house should not take oral polio vaccine since there is a chance they could pass the polio virus on to you.
Ifex ifosfamide side effects, images, uses, dosage. Chloracetaldehyde, a metabolite implicated in cns toxicity, has been shown to accumulate in patients with renal insufficiency 9, 11 and in an anephric. Medlineplus information on ifosfamide a lay language summary of important information about this drug that may include the following. Ifosfamide belongs to the group of medicines called alkylating agents. Mesnex mesna oralinjection uses, side effects, dosage. Additionally, caa is believed to induce proximal tubular dysfunction which results in fanconis syndrome. Aminoaciduria in the prediction of ifosfamideinduced. Ifosfamide can cause birth defects if a woman is exposed to it during pregnancy. It is administered by injection into a vein common side effects include hair loss, vomiting, blood in the urine. Oct 18, 2019 embryolethal effects were observed in rats following the administration of 54 mgm 2 doses of ifosfamide from the 6th through the 15th day of gestation and embryotoxic effects were apparent after dams received 18 mgm 2 doses over the same dosing period. Dailymed ifosfamide injection, powder, lyophilized, for. Oct 24, 2016 ifosfamide is a cytotoxic drug for the treatment of malignant disease. Ifosfamide is also frequently used in combination with other cytotoxic drugs, radiotherapy and surgery.
Dosage adjustment for cytotoxics in renal impairment. Renal excretion of some of the nontoxic metabolites of ifosfamide, 2 and 3dechloroethyl ifosfamide, has been shown to account for between 4% of the administered ifosfamide dose. Uclh dosage adjustment for cytotoxics in renal impairment version 3 updated january2009 page 3 of 24 drug pharmacokinetics available information recommendation arsenic trioxide arsenic is stored mainly in liver, kidney, heart, lung, hair and nails. Recommended ifosfamide dosing guidelines like many chemotherapy medicines, the ifosfamide dose your healthcare provider recommends will be based on your body surface area. Ifosfamide is 32chloroethyl22chloroethylaminotetrahydro2h1,3,2oxazaphosphorine 2oxide.
Use of ifosfamide is associated with an increased incidence of acute leukaemia. Dose reduction is to 80% of the dose if creatinine clearance crcl is 46 to 60 mlminute. This book is distributed under the terms of the creative commons. Nephrotoxicity of ifosfamide in children springerlink. Ifex ifosfamide for injection, usp singledose vials for constitution and administration by intravenous infusion each contain 1 gram or 3 grams of sterile ifosfamide. Risk factors for ifosfamide nephrotoxicity in children. Apr 25, 2008 ifosfamide is an antineoplastic agent useful in the treatment of a wide range of cancers including sarcomas, gynecologic cancers, lymphoma and testicular cancers. Ifosfamide definition of ifosfamide by medical dictionary. Cco is the ontario governments principal advisor on the cancer and renal. Cyclophosphamide, cycloserine, cyclosporine, cyproheptadine, cytarabine, dapsone, daptomycin, daunorubicin, delavirdine, desferoxamine, desipramine.
Oral mesna is taken by mouth, usually 2 and 6 hours after you receive ifosfamide. Acute heart failure, often occurring within 1 to 10 days of treatment, has been reported with induction therapy at doses greater than 12. Cidofovir, ciprofloxacin, cisatracurium, cisplatin, cladribine, clarithromycin. Dosing needs to be adjusted in renal impairment as the drug undergoes renal. Ifosfamide may be safely used in patients with end stage. One episode of renal tubular acidosis which progressed into chronic renal. The fda approved regimen is ifosfamide along with mesna at a dose of. Ifosfamide is an alkylating substance and has to be activated by hepatic metabolism similar to cyclophosphamide l oehrer 1992. Consider dosage reduction in patients with renal impairment. Purpose to evaluate the optimal dose of carboplatin as well as the efficacy and tolerability of sequential, doseintense chemotherapy with paclitaxel and ifosfamide followed by carboplatin and etoposide tice plus peripheralblood stemcell pbsc support in patients with germ cell tumors gct who are likely to experience treatment failure with conventionaldose salvage treatment. Ifosfamide ifo, sold under the brand name ifex among others, is a chemotherapy medication used to treat a number of types of cancer. A catalogue record for this book is available from the british library. Dosing and sideeffects of ifosfamide plus mesna springerlink.
Clinical signs, such as elevation in bun or serum creatinine or decrease in creatinine clearance, were usually transient. Adjust dose accordingly if ifosfamide dose changes. Renal dose adjustment guidelines for antimicrobials. Ifosfamide may be safely used in patients with end stage renal disease on hemodialysis article pdf available in sarcoma 200957714x. Find patient medical information for ifosfamidemesna intravenous on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Fluid retention alkylating drugs can cause fluid retention with oedema and dilutional hyponatraemia in younger children. Ifosfamide may be safely used in patients with end stage renal. Ifosfamide is also being studied in the treatment of other types of cancer.
Analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. Ifosfamide is an alkylating agent that is used widely for the treatment of malignancies, including those seen in children. We treated three patients with end stage renal disease on hemodialysis with escalating doses of ifosfamide. In clinical practice and in most ongoing studies in adult and pediatric tumours, daily shorttime infusions of ifosfamide ifo on 25 consecutive days with cycle doses between 6 gm 2 and 12 gm 2 are used at present. Aug, 2018 using ifosfamide may increase your risk of developing other cancers, such as leukemia.
Ifosfamide is used with other cancer medicines to treat testicular cancer. Ifosfamide is a cancer medication that interferes with the growth and spread of cancer cells in the body. Disorders of renal function, glomerular and tubular following ifosfamide administration are very common. Although the precise incidence of severe kidney dysfunction after ifosfamide expo. Ifosfamide use by either parent may cause birth defects. In patients with renal impairment, particularly in those with severe renal impairment, decreased renal excretion may result in increased plasma levels of ifosfamide and its metabolites. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may 2020.
It is used in patients who have already been treated with two other types of chemotherapy ifosfamide is also being studied in the treatment of other types of cancer. Ipilimumab is a novel immunotherapy agent that has shown. Ifosfamide is 32chloroethyl22chloroethylaminotetrahydro2h1,3,2. Guidelines for the administration of mesna with ifosfamide. Ifosfamide is approved to be used with other drugs to treat. Doses based on body surface area are expressed as milligrams mg or grams g per meter squared m 2. Ifosfamide is an alkylating antineoplastic prodrug used to treat many solid tumors. Mesna is given either in a series of 3 injections spaced 4 hours apart, or as a single injection followed by 2 oral doses spaced 2 and 6 hours later. Ifosfamide side effects, dosage, interactions drugs. Ifosfamide ifx is an agent as yet unstudied in advanced urothelial carcinoma. Mesna should be used to reduce the incidence of hemorrhagic cystitis.
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