Drug information of Mesna

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

Pharmacodynamic

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

Pharmacokinetics

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)

Dosage

• 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. 

Side effects

Fever , nausea , chest pain , dry mouth , vomiting , Seizures , Blurred vision , irregular or fast heart rate , vertigo , asthenia , confusion , sweating , Thirst , swelling , blood in the urine , lightheadedness , tightness in the chest

Interactions

Acethyl cysteine , Warfarin

Alerts

• 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

B

Related drugs

Dexrazoxane , Amifostine