Ifosfamide
IFEX
What it isAlkylating prodrug related to cyclophosphamide; sarcoma, testicular and cervical cancer.
Why this oneIt has activity in sarcoma where cyclophosphamide does not.
What limits it⚑ Chloroacetaldehyde encephalopathy may require methylene blue. Hemorrhagic cystitis requires mesna and hydration.
FDA-approved for
- testicular cancer (1988)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Antineoplastic (individualize per regimen) | Adults | 1.2 g/m²/day IV ×5 consecutive days | 1.2 g/m²/day ×5 days, repeat q3wk |
Renal Closely monitor and consider dosage modifications (renally excreted; dialyzable)
Hepatic Closely monitor for adverse reactions
Repeat every 3 weeks or after recovery from hematologic toxicity
Instructions
- Administer mesna to reduce hemorrhagic cystitis
- Extensive hydration ≥2 L oral/IV fluid per day
- Slow IV infusion over at least 30 minutes
- Individualize dose/schedule; repeat every 3 weeks or after hematologic recovery
Contraindications
- Urinary outflow obstruction
Cautions
- Myelosuppression
- Encephalopathy/CNS toxicity
- Nephrotoxicity and urotoxicity
- Cardiotoxicity
- Pulmonary toxicity
- Secondary malignancies
- Veno-occlusive liver disease
- Embryo-fetal toxicity
- Infertility
- Anaphylactic/anaphylactoid reactions
Adverse reactions
- Alopecia
- Nausea/vomiting
- Hematuria
- Leukopenia
- Anemia
- CNS toxicity
- Infection
Pregnancy Can cause fetal harm; fetal growth retardation and neonatal anemia reported
Lactation Excreted in breast milk; do not breastfeed during and for 1 week after last dose
⚠ BOXED WARNINGS
- Hemorrhagic cystitis
- Neurotoxicity
- Myelosuppression
Classes and tags
Clinical profile
Active metabolites
Mechanism of action: Ifosfamide ballicule
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