Mesna

What is Mesna?

• Mesna (Mesnex) is a cytoprotective agent used to prevent hemorrhagic cystitis (bleeding in the bladder) caused by the anticancer drug ifosfamide.

Mesna

What are the uses of this medicine?

• Mesna (Mesnex) is a prescription medicine used to reduce the risk of inflammation and bleeding of the bladder (hemorrhagic cystitis) in people who receive ifosfamide (a medicine used to treat cancer).

Limitation of Use:

• Mesnex is not for use to reduce the risk of blood in the urine (hematuria) due to other medical conditions.

How does this medicine work?

• Mesna reacts chemically with the urotoxic ifosfamide metabolites, acrolein and 4-hydroxy-ifosfamide, resulting in their detoxification.
• The first step in the detoxification process is the binding of mesna to 4-hydroxy-ifosfamide forming a non-urotoxic 4-sulfoethylthioifosfamide.
• Mesna also binds to the double bonds of acrolein and to other urotoxic metabolites and inhibits their effects on the bladder.

Who Should Not Use this medicine ?

This medicine cannot be used in patients who:

• are allergic to mesna or any of the ingredients in Mesnex.

What drug interactions can this medicine cause?

• Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.

Is this medicine FDA approved?

• Mesna was approved for medical use in the United States in 1988.

How should this medicine be used?

Recommended dosage:

• Mesnex may be given on a fractionated dosing schedule of three bolus intravenous injections or a single bolus injection followed by two oral administrations of Mesnex tablets as below:

Intravenous Dosing Schedule:

	0 Hours	4 Hours	8 Hours
Ifosfamide	1.2 g/m2	-	-
Mesnex injection	240 mg/m2	240 mg/m2	240 mg/m2

Intravenous and Oral Dosing Schedule:

	0 Hours	2 Hours	6 Hours
Ifosfamide	1.2 g/m2	-	-
Mesnex injection	240 mg/m2	-	-
Mesnex tablets	-	480 mg/m2	480 mg/m2

Administration:

• Mesnex is given on the same day that you receive ifosfamide.
• Mesnex can be given by an intravenous (IV) infusion into a vein or tablets taken by mouth.

You will receive Mesnex in one of two ways:

• Mesnex intravenous (IV) infusion into a vein at the time you receive ifosfamide and 4 and 8 hours after you receive ifosfamide, OR
• Mesnex intravenous (IV) infusion into a vein at the time you receive ifosfamide and Mesnex tablets taken by mouth 2 and 6 hours after you receive ifosfamide.
• Take Mesnex tablets at the exact times and the exact dose your healthcare provider tells you to take it.
• During treatment with Mesnex intravenous (IV) infusion or Mesnex tablets, you should drink 4 to 8 cups of liquid (1 to 2 liters) each day.

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

This medicine is available in fallowing doasage form:

• As Injection: 1g (100 mg/mL) Multidose vials
• Tablets: 400 mg with functional score

This medicine is available in fallowing brand namesː

• Mesnex

What side effects can this medication cause?

The most common side effects of this medicine include:

• nausea
• vomiting
• constipation
• decreased white blood cell count
• tiredness
• fever
• decreased appetite
• decreased platelet count
• decreased red blood cell count
• diarrhea
• weakness
• stomach (abdomen) pain
• headache
• hair loss
• sleepiness

Mesnex may cause serious side effects, including:

• serious allergic reactions and skin reactions

What special precautions should I follow?

• Mesnex may cause systemic hypersensitivity reactions, including anaphylaxis. Anaphylactic reactions have been reported. Less severe hypersensitivity reactions may also occur. Monitor patients. If a reaction occurs, discontinue Mesnex and provide supportive care.
• Skin rash with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis have occurred. Skin rash, urticaria, and angioedema have also been seen. Monitor patients. If a reaction occurs, discontinue Mesnex and provide supportive care.
• Serious and fatal adverse reactions can occur in premature neonates and low-birth weight infants treated with benzyl alcohol-preserved drugs, including Mesnex injection. Avoid use in premature neonates and low-birth weight infants.
• False positive tests for urinary ketones and interference with enzymatic CPK activity tests have been seen.
• Mesnex is a thiol compound, i.e., a sulfhydryl (SH) group-containing organic compound. Hypersensitivity reactions to mesna and to amifostine, another thiol compound, have been reported.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• nausea
• vomiting
• diarrhea
• fever
• hypotension
• shortness of breath
• asthma exacerbation
• rash
• flushing

Management of overdosage:

• There is no known antidote for Mesnex.
• In the event of an overdose, appropriate supportive treatment should be initiated.

Can this medicine be used in pregnancy?

• Mesnex is used in combination with ifosfamide or other cytotoxic agents.
• Ifosfamide can cause fetal harm when administered to a pregnant woman.

Can this medicine be used in children?

• Mesnex injection contains the preservative benzyl alcohol which has been associated with serious adverse reactions and death when administered intravenously to premature neonates and low birth weight infants.
• Avoid use of Mesnex injection in premature neonates and low-birth weight infants.

What are the active and inactive ingredients in this medicine?

Active ingredient: mesna

Inactive ingredients:

• Mesnex injection: edetate disodium, sodium hydroxide, and benzyl alcohol as a preservative.
• Mesnex tablets: calcium phosphate, cornstarch, hydroxypropylmethylcellulose, lactose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, povidone, simethicone, and titanium dioxide.

Who manufactures and distributes this medicine?

Manufactured by:

• Baxter Healthcare Corporation, Deerfield, IL USA
• Made in Germany
• Baxter and Mesnex are registered trademarks of Baxter International Inc.

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

• Store Mesnex tablets at room temperature between 68°F to 77°F (20°C to 25°C).

• Dailymed label info on Mesna
• FDA Mesna

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