Ifex / Mesnex Kit

General

• Consult specialized references for procedures for proper handling and disposal of antineoplastics.1

• Adequately hydrate patient prior to and during ifosfamide therapy (e.g., 2 L of oral or IV fluid daily) to minimize urotoxicity.1 2 58 59 141

• Concomitant therapy with a uroprotective agent (e.g., mesna) recommended during ifosfamide therapy to decrease the incidence of bladder toxicity.1 2 58 59 95 141 160 (See Bladder Toxicity under Cautions.)

Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer by slow IV infusion.1

Handle cautiously (e.g., use protective gloves);1 avoid exposure during handling and preparation of IV solution.1 If skin or mucosal contact occurs, immediately wash skin with soap and water and flush mucosa with water.1

IV Administration

Reconstitute vial containing 1 or 3 g of ifosfamide powder with 20 or 60 mL, respectively, of sterile or bacteriostatic water for injection, to provide a solution containing 50 mg/mL.a

Shake well to ensure complete dissolution.a May be infused directly or further diluted prior to IV infusion.a

May be diluted with 5% dextrose injection, 0.9% sodium chloride injection, lactated Ringer’s injection, or sterile water for injection to a concentration of 0.6–20 mg/mL.a

Administer as a slow IV infusion over a period of ≥30 minutes.a

Dosage

Consult published protocols for the dosage of ifosfamide and other chemotherapeutic agents and the method and sequence of administration.b

Adults

1.2 g/m2 daily for 5 consecutive days.a Repeat course of therapy every 3 weeks (or following recovery of patient’s hematologic functions to within acceptable limits), usually for a total of 4 courses.a

• Risk of bladder toxicity, myelosuppression, and neurotoxicity.a

• Importance of informing clinicians if excessive sleepiness, confusion, or hallucinations occur.a

• Advise that alopecia is likely.1

• Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs, as well as any concomitant illnesses.1

• Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.1 Advise pregnant women of risk to the fetus.1

• Importance of informing patients of other important precautionary information. (See Cautions.)

Commonly reported side effects of ifosfamide include: central nervous system toxicity, confusion, drowsiness, and hallucination. See below for a comprehensive list of adverse effects.

Data not available

The recommended dose of ifosfamide may depend on whether other cytotoxic agents are coadministered. For adults, many experts recommend total daily doses as high as 5 g/m2 or total doses over 4 days of 8 to 18 g/m2. Reference to specific protocols is recommended.