Drug information of Ifosfamide

Ifosfamide

Drug group:

Ifosfamide is a cancer medication that interferes with the growth and spread of cancer cells in the body. Ifosfamide is used with other cancer medicines to treat testicular cancer.

Mechanism of effect

Ifosfamide is a prodrug. its cytotoxic action is primarily through DNA crosslinks caused by alkylation by the isophosphoramide mustard at guanine N-7 positions. The formation of inter- and intra-strand cross-links in the DNA results in cell death.

Pharmacodynamic

Ifosfamide requires activation by microsomal liver enzymes to active metabolites in order to exert its cytotoxic effects

Pharmacokinetics

Metabolism: Primarily hepatic. Ifosfamide is extensively metabolized in humans. After administration of doses of 5 g/m2 of 14C-labeled ifosfamide, from 70% to 86% of the dosed radioactivity was recovered in the urine, with about 61% of the dose excreted as parent compound. At doses of 1.6–2.4 g/m2 only 12% to 18% of the dose was excreted in the urine as unchanged drug within 72 hours. Half life: 7-15 hours.

Drug indications

Cervical Cancer , Testicular Cancer

Dosage

Usual Adult Dose for Testicular Cancer
For third line chemotherapy of germ cell testicular cancer:
1.2 g/m2, diluted to 50 mg/mL IV over 30 minutes once a day with mesna (intravenous, oral, or continuous intravenous infusion) just before and 4 and 8 hours after each dose and aggressive (usually IV) hydration (2 to 4 L/day).
Ifosfamide is usually given for 5 days, with 5 day regimens repeated every 3 to 4 weeks, and after recovery from hematologic toxicity.

Alerts

1-Myelosuppression can be severe and lead to fatal infections. Monitor blood counts prior to and at intervals after each treatment cycle.
2-CNS toxicities can be severe and result in encephalopathy and death. Monitor for CNS toxicity and discontinue treatment for encephalopathy.
3-Nephrotoxicity can be severe and result in renal failure. Hemorrhagic cystitis can be severe and can be reduced by the prophylactic use of mesna.

Points of recommendation

1-Use with caution in patients with renal or hepatic impairment.
2-Unless clinically essential, initial or repeat doses should not be given to patients with a white blood cell count less than 1500 to 2000/mm3 and/or a platelet count less than 50,000/mm3.
3-Ifosfamide should be discontinued if neurologic symptoms of somnolence, irritability, anxiety, confusion, hallucinations, or coma are observed.

Pregnancy level

D


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