Ifosfamide

Indications & Dose:

Bronchogenic carcinoma, testicular tuours of all histological types. Soft tissue sarcomas, leoiomyosarcoma, mammary carcinoma, ovarian carcinoma, endometrial carcinoma, hypernephroid carcinoma of the kidney, pancrease, malignant lymphoma

•  BY INJECTION

IV for refractory testicular cancer 1.2 g/m2/day over 30 min to 4 hr for 5 days, or 2 g/m2/day for 3 consecutive days. The recommended concurrent IV mesna dose is 20% of the ifosfamide dose, given 15 min before ifosfamide and again at 4 and 8 hr. It can be directly and mixed with ifosfamide. The latter two mesna doses can be given orally at twice the dose (ie, each at 40% of the ifosfamide dose) if patient compliance and a lack of emesis can be assured.

Alternatively, IV by continuous infusion 5-8 g/ m2 over 24 hr with mesna added at the same concentration as ifosfamide. However, more severe nephrotoxicity can occur with this this regimen.

Special Populations. Pediatric Dosage. IV for sarcomas (Ewing’s and osteosarcoma) 1.2 g/m2/ day over 30 min for 5 days, each with 3 IV mesna doses, as above.

Geriatric Dosage. Same as adult dosage but adjust for age-related reduction in renal function. 

Other Conditons. Dosage reduction is indicated in patients with reduced renal function, although specific guidelines are not available.

Contraindications:

Severe pre-existing myelosuppression. 

Side Effects:

Cautions:

Precautions:

Because of more severe nephrotoxicity and CNS toxicities, patients with reduced renal function, and particularly nephrectomized renal cell cancer patients, are poor candidates for this agent. Withhold repeat therapy until there is resolution of microscopic hematuria (<10 RBCs per high-power field). An adequate state of hydration is critical to reducing urotoxicity. 

Interaction:

Use with cisplatin can increase nephrotoxicity and potassium and magnesium loss, especially in children. Nephrotoxicity is also enhanced when ifosfamide is combined with other nephrotoxic drugs

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Nausea and vomiting, Alopecia, hematuria, Renal tubular toxicity, Leukopenia, allergic reactions, diarrhea, peripheral neuropathy, and stomatitis. 

Patient And Carer Advice: