Drug information of Mesna


Drug group:

Coenzyme M (commonly known by it's salt form, Mesna) is a synthetic sulfhydryl (thiol) compound and is used for prophylaxis of Ifosfamide and cyclophosphamide induced hemorrhagic cystitis.

Mechanism of effect

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

Mesna disulfide (dimesna): Inert metabolite


Mesna binds to and inactivates acrolein there by preventing or reducing bladder problems


Bioavailability : 45-79 %

Protein Bound : 69-75% (mesna plus dimesna)

Metabolism : Kidney

Metabolites : Mesna disulfide

Excretion : Urine (18-32% as mesna; 33% as dimesna)

Distribution : Does not penetrate tissue

Half-life : 0.36 hr (Mesna); 1.17 hr (dimesna)

Peak plasma time : 4 hr (mesna); 3 hr (dimesna)

Peak plasma concentration: 3.3 mcg/mL (PO; mesna); 7.3 mcg/mL (PO; dimesna)


  • Prevention of Ifosfamide Induced Hemorrhagic Cystitis

240 mg/m² (if receiving 1.2 g/m² ifosfamide dose) IVP 15 minutes before & 4 & 8 hours after ifosfamide admin OR 

240 mg/m² (if receiving 1.2 g/m² ifosfamide dose) IVP 15 minutes before & 480 mg/m² of mesna tablets PO 2 & 6 hours after ifosfamide admin

Adjust dose accordingly if ifosfamide dose changes

  • Prevention of Cyclophosphamide Induced Hemorrhagic Cystitis (Off-label)

20% of cyclophosphamide dose when injected, 4 and 8 hours after each dose


Mesna injection is given as intravenous bolus injections in a dosage equal to 20% of the ifosfamide dosage (w/w) at the time of ifosfamide administration.  Mesna tablets are given orally in a dosage equal to 40% of the ifosfamide dose 2 and 6 hours after each dose of ifosfamide.  The total daily dose of Mesna is 100% of the ifosfamide dose. 


Acethyl cysteine , Warfarin


  • The Mesna injection multiple dose vials may be stored and used for up to 8 days after initial puncture.

    Store diluted solutions at 25°C (77°F).  Use diluted solutions within 24 hours.

    Do not mix Mesna injection with epirubicin, cyclophosphamide, cisplatin, carboplatin, and nitrogen mustard.
  • Dilute the volume of Mesna injection for the dose in any of the following fluids to obtain a final concentration of 20 mg/mL:
  • 5% Dextrose Injection, USP
  • 5% Dextrose and 0.2% Sodium Chloride Injection, USP
  • 5% Dextrose and 0.33% Sodium Chloride Injection, USP
  • 5% Dextrose and 0.45% Sodium Chloride Injection, USP
  • 9% Sodium Chloride Injection, USP
  • Lactated Ringer’s Injection, USP 
  • Does NOT prevent nephrotoxicity, myelosuppression, or neurotoxicity
  • Contains benzyl alcohol as preservative ( associated w/ potentially fatal "Gasping Syndrome" in preemies)
  • Will not prevent hemorrhagic cystitis in all patients; examine morning urine specimen for hematuria prior to ifosfamide or cyclophosphamide treatment
  • Does not prevent or improve other toxicities associated with ifosfamide or cyclophosphamide
  • Mesna does not prevent thrombocytopenia-related hematuria
  • Benzyl alcohol, a preservative in Mesna injection, has been associated with serious adverse reactions and death (including gasping syndrome) in neonates, premature, and low-birth weight infants. 

Points of recommendation

If patient vomits within 2 hr after PO dose, repeat dose or give IV

Pregnancy level


Related drugs

Dexrazoxane , Amifostine

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