Urothelial toxicity (acrolein)
The metabolite that burns the bladder
- Direct chemical injury to bladder urothelium
- Acrolein: reactive aldehyde metabolite of cyclophosphamide/ifosfamide, excreted and CONCENTRATED in urine
- Hemorrhagic cystitis
- Dose- and contact-time-dependent
- A thiol donor plus hydration prevents it
- Defenses: mesna (binds it), frequent voiding (shorten contact)
Drugs with this mechanism (1)
- Acrolein — Bladder-toxic metabolite of cyclophosphamide and ifosfamide; mesna helps prevent its hemorrhagic cystitis.
Self-check
- Which metabolite causes this bladder injury?
Acrolein. - Why does frequent voiding help protect the bladder?
Shortens contact time.
All mechanisms · Open Urothelial toxicity in the interactive console ↗