Ifosfamide

What is Ifosfamide?

• Ifosfamide (Ifex) is an alkylating drug used with other drugs to treat testicular germ cell tumors.
• It is used in combination with mesna for prophylaxis of hemorrhagic cystitis.

Ifosfamide

Ifosfamide-3D-balls

What are the uses of this medicine?

Ifosfamide (Ifex) used with other drugs to treat:

• Testicular germ cell tumors that are malignant. It is used in patients who have already been treated with two other types of chemotherapy.
• It is used in combination with mesna for prophylaxis of hemorrhagic cystitis.

How does this medicine work?

Ifosfamide mechanism

Ifosfamide (eye fos' fa mide) is an analogue of cyclophosphamide and thus a nitrogen mustard-like alkylating agent that is used in the therapy of several forms of leukemia, lymphoma and solid organ cancer. Like cyclophosphamide, ifosfamide requires activation in the liver to form its active intermediaries which act by modifying and cross linking purine bases in DNA, thus inhibiting DNA, RNA and protein synthesis and leading to programmed cell death (apoptosis) in rapidly dividing cells.

Who Should Not Use this medicine ?

This medicine cannot be used in patients with:

• Known hypersensitivity to administration of ifosfamide.
• Urinary outflow obstruction.

What drug interactions can this medicine cause?

Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: aprepitant (Emend)

• certain antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral)
• certain seizure medications such as carbamazepine (Tegretrol), phenobarbital (Luminal), and phenytoin (Dilantin)
• medications for allergies or hay fever
• medications for nausea
• opioid (narcotic) medications for pain
• rifampin (Rifadin, Rimactane)
• sedatives
• sleeping pills
• sorafenib (Nexavar)
• busulfan (Busulfex)

Is this medicine FDA approved?

• Ifosfamide was approved for use in the United States in 1988 and its major indication is for germ cell testicular cancer, but it is also used in combination with other agents in the treatment of breast, lung, bladder, cervical, and ovarian cancer, Hodgkin's and non-Hodgkin’s lymphoma, and soft tissue and osteogenic sarcomas.
• Ifosfamide is given intravenously and is available in liquid formulations (1 and 3 gram vials), generically and under the trade name Ifex.

How should this medicine be used?

Recommended dosage:

• Ifosfamide for Injection should be administered as a slow intravenous infusion lasting a minimum of 30 minutes 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, Ifosfamide for Injection should be given with extensive hydration consisting of at least 2 liters of oral or intravenous fluid per day.
• Mesna should be used to reduce the incidence of hemorrhagic cystitis.

Administration:

• Ifosfamide comes as powder to be mixed with liquid to be injected over at least 30 minutes intravenously (into a vein) by a doctor or nurse in a medical facility.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Single dose vials: 1 gram, 3 grams

This medicine is available in fallowing brand namesː

• Ifex

What side effects can this medication cause?

The most common side effects of this medicine include:

• alopecia
• nausea/vomiting
• leukopenia
• anemia
• CNS toxicity
• hematuria
• infection

What special precautions should I follow?

• Treatment with ifosfamide may cause myelosuppression and significant suppression of immune responses, which can lead to severe infections. Monitor blood counts prior to and at intervals after treatment.
• Severe and fatal neurotoxicity can occur. Carefully monitor the patient for CNS toxicity and other neurotoxic effects. Discontinue therapy should encephalopathy develop.
• Severe nephrotoxicity with renal failure and death can occur. Monitor for nephrotoxicity with serum and urine chemistries. Mesna should be used to reduce hemorrhagic cystitis.
• Arrhythmias, other ECG changes, and cardiomyopathy can occur and result in death. Use with caution in patients with cardiac risk factors and in patients with preexisting cardiac disease. The risk of cardiotoxicity is dose dependent.
• Interstitial pneumonitis, pulmonary fibrosis, and other forms of pulmonary toxicity with fatal outcomes can occur. Monitor for signs and symptoms of pulmonary toxicity and treat as clinically indicated.
• Treatment with ifosfamide involves the risk of secondary tumors and their precursors as late sequelae. The secondary malignancy may develop several years after chemotherapy has been discontinued.
• Ifosfamide for Injection can cause fetal harm when administered to a pregnant woman. Women should not become pregnant and men should not father a child during therapy.
• Anaphylactic/anaphylactoid reactions have been reported.
• Ifosfamide may interfere with normal wound healing.
• Ifosfamide is excreted in breast milk. Women must not breastfeed during treatment with ifosfamide.
• Ifosfamide interferes with oogenesis and spermatogenesis. Amenorrhea, azoospermia, and sterility in both sexes have been reported.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• CNS toxicity, nephrotoxicity, myelosuppression, and mucositision

Management of overdosage:

• No specific antidote for Ifosfamide for Injection is known.
• Management of overdosage would include general supportive measures.
• Ifosfamide as well as ifosfamide metabolites are dialyzable.
• Cystitis prophylaxis with mesna may be helpful in preventing or limiting urotoxic effects with overdose.

Can this medicine be used in pregnancy?

• Ifosfamide for Injection can cause fetal harm when administered to a pregnant woman.
• Pregnancy Category D.

Can this medicine be used in children?

• Safety and effectiveness have not been established in pediatric patients.

What are the active and inactive ingredients in this medicine?

Active ingredient:

• IFOSFAMIDE

Inactive ingredients:

• BENZYL ALCOHOL

Who manufactures and distributes this medicine?

Packager: Fresenius Kabi USA, LLC

Ifex: Manufactured by:

• Baxter Healthcare Corporation
• Deerfield, IL USA
• Made in Germany

What should I know about storage and disposal of this medication?

• The container closure is not made with natural rubber latex.
• Store at controlled room temperature 20°C to 25°C (68°F to 77°F).
• Protect from temperatures above 30°C (86°F).
• Exercise caution when handling Ifosfamide for Injection.

• Dailymed label info on Ifosfamide
• FDA Ifosfamide

Ifosfamide Resources
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• Dailymed label info on Ifosfamide
• FDA Ifosfamide

Ifosfamide Resources
Latest articles Most recent articles Ongoing trials	Wikipedia