IFOSFAMIDE
| IFOSFAMIDE (i-fos'fa-mide) Classifications: antineoplastic; alkylating agent; Therapeutic: antineoplastic Prototype: Cyclophosphamide Pregnancy Category: D |
Availability
1 g, 3 g vials
Action
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.
Therapeutic Effect
It has antineoplastic and cytotoxic action on cancer cells that results in cell death.
Uses
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.
Contraindications
Patients with severe bone marrow depression or who have demonstrated previous hypersensitivity to ifosfamide; dehydration; pregnancy (category D), lactation.
Cautious Use
Impaired renal function, renal failure; hepatic disease; prior radiation or prior therapy with other cytotoxic agents.
Route & Dosage
| Antineoplastic 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) |
Administration
| Intravenous 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 0.6–20 mg/mL.??Use solution prepared with sterile water within 6 h. ADMINISTER: IV Infusion: Give slowly over 30 min.
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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, anorexia, diarrhea, metabolic acidosis, hepatic dysfunction. Hematologic: Neutropenia, thrombocytopenia. Urogenital: Hemorrhagic cystitis, nephrotoxicity. Skin: Alopecia, skin necrosis with extravasation.Interactions
Drug: hepatic enzyme inducers (barbiturates, phenytoin, chloral hydrate) may increase hepatic conversion of ifosfamide to active metabolite; corticosteroids may inhibit conversion to active metabolites.Pharmacokinetics
Distribution: Distributed into breast milk. Metabolism: In liver via CYP3A4. Elimination: 70–86% in urine. Half-Life: 7–15 h.Nursing Implications
Assessment & Drug Effects
- Lab tests: Monitor CBC with differential prior to each dose and at regular intervals; urinalysis prior to each dose for microscopic hematuria.
- 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 provider.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug