Ifex M Injection
Ifosfamide + Mesna
Biochem Pharmaceuticals Industries Limited.
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Indications
Ifex M Injection is used for:
Germ Cell Testicular Cancer
Adult Dose
Germ Cell Testicular Cancer
Indicated in combination with other antineoplastic agents for third-line germ cell testicular cancer
1.2 g/m²/day IV infusion over 30 minutes on days 1-5 q3-4wk or after recovering from hematologic toxicity (>100,000 cells/mm³ plateletes or >4,000 cells/mm³ WBC)
Use concomitant mesna (240 mg/m² IV at 0, 4, 8 hr) to prevent hemorrhagic cystitis
Hepatic Impairment
Dose adjustments not described in package insert; some clinicians have used the following guidelines
Bilirubin >3 mg/dL: 25% of regular dose
Child Dose
Renal Dose
Renal Impairment
Dose adjustments not described in package insert; some clinicians have used the following guidelines
CrCl >60 mL/min: 100% of regular dose
CrCl 30-60 mL/min: 75% of regular dose
CrCl 10-30 mL/min: 50% of regular dose
CrCl <10 mL/min: Not recommended
Administration
Maintain oral or IV hydration >2 L fluid/day
IV Preparation
Reconstitute w/ D5W, NS, dextrose/saline or LR to a final concentration of 20 mg/mL
IV Administration
IVP: bolus 15 min before ifosfamide
Intermittent infusion over 15-30 min
Continuous Infusion: may be added to ifosfamide/cyclophosphamide in infusion bag
Additive compatibility w/ cyclophosphamide shown only in D5W & LR
Contra Indications
Hypersensitivity, Severe myelosuppression
Precautions
Avoid pregnancy
May interfere with wound healing
Use caution in renal impairment
Heart Failure risk
Lactation: excreted in breast milk, do not nurse
Pregnancy-Lactation
Interactions
Causes enhanced toxicity with allopurinol, cisplatin. Ifosfamide enhances the anticoagulant effect of warfarin. CYP2A6 inducers (e.g. amobarbital, pentobarbital, phenobarbital, rifampin and secobarbital) may reduce serum levels of ifosfamide while the inhibitors (e.g. isoniazid, methoxsalen and miconazole) may increase its serum levels. CYP3A4 inducers (e.g. aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins) may reduce serum levels of ifosfamide while the inhibitors (e.g. azole antifungals, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid) may increase its serum levels.
Adverse Effects
Side effects of Ifosfamide + Mesna :
>10%
Alopecia (83%)
Nausea (58%)
Vomiting (58%)
Leukopenia (50%)
Hematuria (46%)
Metabolic acidosis (31%)
Thrombocytopenia (20%)
CNS toxicity (12%)
Neurotoxicity (10-20%)
1-10%
Infection (8%)
Nephrotoxicity (6%)
Mechanism of Action
Synthetic analog of cyclophosphamide; cross-links DNA strands; inhibits DNA synthesis and protein synthesis
Oxidized to dimesna in the blood, and is in turn reduced back to mesna in the kidney; synthetic sulfhydryl (thiol) compound binds & detoxifies ifosfamide metabolite acrolein in bladder/kidney
Note
Ifex M Injection manufactured by Biochem Pharmaceuticals Industries Limited.. Its generic name is Ifosfamide + Mesna. Ifex M is availble in Nepal.
Farmaco Nepal drug index information on Ifex M Injection is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.