Classifications: antineoplastic; alkylating agent; Therapeutic: antineoplastic
Pregnancy Category: D
1 g, 3 g vials
Ifosfamide is a chemotherapeutic agent chemically related to nitrogen mustards. The alkylated metabolites of ifosfamide
interact with DNA. It is a cell cycle nonspecific agent. Antineoplastic or cytotoxic action is primarily due to cross-linking
of strands of DNA and RNA, as well as inhibition of protein synthesis.
It has antineoplastic and cytotoxic action on cancer cells that results in cell death.
In combination with other agents in various regimens for germ cell testicular cancer, soft tissue sarcomas, Ewing's sarcoma,
and non-Hodgkin's lymphoma. Also for lung and pancreatic sarcoma.
Patients with severe bone marrow depression or who have demonstrated previous hypersensitivity to ifosfamide; dehydration;
pregnancy (category D), lactation.
Impaired renal function, renal failure; hepatic disease; prior radiation or prior therapy with other cytotoxic agents.
Route & Dosage
Adult: IV 1.2 g/m2/d for 5 consecutive d; administer over at least 30 min, repeat q3wk or after recovery from hematologic toxicity (platelets
≥100,000/mm3; WBC ≥4000/mm3)
PREPARE: IV Infusion: ??Dilute each 1 g in 20 mL of sterile water or bacteriostatic water to yield 50 mg/mL.??Shake well to dissolve.??May be further diluted with D5W, NS, or RL to achieve concentrations of 0.620 mg/mL.??Use solution prepared with sterile water within 6 h.
ADMINISTER: IV Infusion: Give slowly over 30 min.
- Note: Mesna is always given concurrently with ifosfamide; never give ifosfamide alone.
INCOMPATIBILITIES Y-site: Cefepime, methotrexate.
- Store reconstituted solution prepared with bacteriostatic solution up to a week at 30° C (86° F) or 6 wk at 5°
C (41° F).
Adverse Effects (≥1%)CNS: Somnolence, confusion, hallucinations,
coma, dizziness, seizures, cranial nerve dysfunction. GI: Nausea, vomiting,
, metabolic acidosis, hepatic
dysfunction. Hematologic: Neutropenia, thrombocytopenia. Urogenital: Hemorrhagic cystitis, nephrotoxicity. Skin: Alopecia,
skin necrosis with extravasation.
InteractionsDrug: hepatic enzyme inducers (barbiturates
, phenytoin, chloral hydrate
) may increase hepatic
conversion of ifosfamide to active metabolite
may inhibit conversion to active metabolites.
Distributed into breast milk. Metabolism:
In liver via CYP3A4. Elimination:
7086% in urine. Half-Life:
Assessment & Drug Effects
- Lab tests: Monitor CBC with differential prior to each dose and at regular intervals; urinalysis prior to each dose for
- Hold drug and notify physician if WBC count is below 2000/mm3 or platelet count is below 50,000/mm3.
- Reduce risk of hemorrhagic cystitis by hydrating with 3000 mL of fluid daily prior to therapy and for at least 72 h following
treatment to ensure ample urine output.
- Discontinue therapy if any of the following CNS symptoms occur: Somnolence, confusion, depressive psychosis, and hallucinations.
Patient & Family Education
- Void frequently to lessen contact of irritating chemical with bladder mucosa by keeping well hydrated.
- Note: Susceptibility to infection may increase. Avoid people with infection. Notify physician of any infection, fever or chills,
cough or hoarseness, lower back or side pain, painful or difficult urination.
- Check with physician immediately if there is any unusual bleeding or bruising, black tarry stools, or blood in urine or if
pinpoint red spots develop on skin.
- Discuss possible adverse effects (e.g., alopecia, nausea, and vomiting) and measures that can minimize them with health care