Adult Dosing

Ifosfamide-induced hemorrhagic cystitis

• Start ifosfamide IV 1.2 g/m² with IV 240 mg/m² mesna dose, then give mesna 480 mg/m² PO at 2 hrs and 6 hrs

• Total qd dose = 100% total qd ifosfamide dose
• Repeat the oral dose or administer IV bolus dose if the patient vomits within 2 hrs of administration

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Prophylactic treatment in reducing the incidence of ifosfamide-induced hemorrhagic cystitis

• Hypersensitivity to any of the ingredients of the product
• Hypersensitivity to thiol compounds
• Neonates or infants (benzyl alcohol-containing INJ forms)

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

See Supplemental Patient Information

• Allergic reactions such as mild hypersensitivity to systemic anaphylactic reactions have been reported with mesna. Higher incidence of allergic reactions may occur in patients with autoimmune disorders receiving cyclophosphamide and mesna together
• Mesna does not prevent or alleviate any other adverse reactions associated with ifosfamide therapy other than reducing the incidence of ifosfamide-induced hemorrhagic cystitis
• Some cases of hematuria have been reported in patients receiving mesna; evaluate a morning specimen of urine for the presence of hematuria everyday before ifosfamide therapy. Consider reductions or discontinuation of ifosfamide therapy, depending on the severity of the hematuria, if hematuria develops on giving Mesnex with ifosfamide
• Risk of hematuria can be reduced by administering mesna with each dose of ifosfamide as prescribed; mesna does not reduce the risk of hematuria due to other pathological conditions such as thrombocytopenia
• Avoid using multidose vial in neonates or infants and should be used cautiously in older pediatric patients because of the benzyl alcohol content
• Patients treated with mesna may show a false positive test for urinary ketones

Cautions: Use cautiously in

• Pediatric patients
• Autoimmune disorders

Supplemental Patient Information

• Advise patients to drink at least 4 cups of liquid a day during therapy
• Instruct patients to promptly report their physicians on noticing that their urine has turned a pink or red color
• Advise patients to have their urine checked in the laboratory each day after getting mesna
• Instruct patients to take tablets at the exact times prescribed. If they miss a dose, advise them to take it as and when they remember and contact their physicians. Caution them not to double their dose to compensate for the missed dose
• Advise patients to contact their physicians if they vomit within 2 hours of taking oral mesna

Pregnancy Category:B

Breastfeeding: Safety unknown. As per manufacturer's data, because of the potential for adverse reactions in breastfed infants, a decision should be made whether to discontinue nursing or discontinue the drug, analyzing the importance of the drug to the mother.

• CV: Chest pain, hypotension, edema, peripheral edema, tachycardia
• CNS: Headache, dizziness, somnolence, insomnia
• NEURO: Hyperaesthesia, asthenia
• PSYCHIATRY: Anxiety, confusion
• GI: Nausea, vomiting, diarrhea, anorexia, constipation, abdominal pain, dyspepsia
• GU: Hematuria
• HEMA: Leukopenia, granulocytopenia , thrombocytopenia, anemia
• METABOLIC: Hypokalemia, dehydration
• DERM: Alopecia, increased sweating, flushing, pallor, rash
• EENT: Pharyngitis, conjunctivitis
• RESP: Coughing, dyspnea, pneumonia
• MUSC: Back pain, arthralgia
• HYPERSENSITIVITY: Anaphylaxis, allergic reaction
• MISC: Fever, fatigue, pain, influenza-like symptoms, face edema, rigors

• Antidote: rapidly oxidized to its major metabolite, dimesna, which is reduced to the free thiol compound, mesna that reacts with the urotoxic ifosfamide metabolites leading to detoxification
• Metabolized by kidney; CYP450: Unknown
• Excreted in urine (18-26%)
• Half-life: 1.2-8.3 hrs

US Trade Name(s)

• Mesnex

US Availability

Mesnex

• TABS: 400 mg

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Hematology/Oncology

Cytoprotective Agents

Detoxifying Agents

Drug Name: Mesnex 400 MG Oral Tablet

Ingredient(s): Mesna

Imprint: M4

Color(s): White

Shape: Oval

Size (mm): 16.00

Score: 2

Inactive Ingredient(s): lactose / cellulose, microcrystalline / dibasic calcium phosphate dihydrate / starch, corn / povidone / magnesium stearate / hydroxypropyl cellulose / polyethylene glycol / titanium dioxide

Drug Label Author:
Baxter Healthcare Corporation

DEA Schedule:
Non-Scheduled