Pronounciation
- (MEZ-nah)
Trade Name(s)
- Mesnex, Uromitexan
Verify pregnancy status. Specific testing recommended before each dose of ifosfamide; see Monitor.
Total daily dose is 60% of the ifosfamide dose equally divided into 3 doses. A single dose of mesna equal to 20% of the ifosfamide dose is given at the time of the ifosfamide injection and repeated 4 hours and 8 hours later (e.g., ifosfamide 1.2 Gm/M2 would require mesna 240 mg/M2 with the ifosfamide, followed by additional doses of 240 mg/M2 in 4 hours, and again at 8 hours). The initial mesna dose each day may be mixed with the ifosfamide. Appears to be compatible.
Combination of intravenous and oral doses:
At the time of the ifosfamide injection, give a single IV dose of mesna equal to 20% of the ifosfamide dose. At 2 hours and at 6 hours after each dose of ifosfamide, administer mesna tablets PO in a dose equal to 40% of the ifosfamide dose (e.g., ifosfamide 1.2 Gm/M2 would require mesna 240 mg/M2 IV with the ifosfamide, followed by an oral mesna dose of 480 mg/M2 in 2 hours and again at 6 hours). The total daily dose of mesna (IV [20%] and PO [80%] combined) is 100% of the ifosfamide dose; see Monitor. The efficacy and safety of this ratio of IV and oral mesna have not been established as being effective for daily doses of ifosfamide higher than 2 Gm/M2.
Dose of mesna must be repeated each day ifosfamide is administered and adjusted with each increase or decrease of the ifosfamide dose so that the ratio of mesna to ifosfamide remains the same.
Each 100 mg (1 mL) must be diluted in a minimum of 4 mL D5W, D5NS, D5/1/4NS, D5/⅓NS, D5/1/2NS, NS, or LR. Desired concentration is 20 mg/mL.
Manufacturer’s studies measured the potency of ifosfamide in combination with mesna through a 5-micron filter. No significant drug loss for ifosfamide; mesna was not measured.
Store at CRT before use. Opened multidose vials may be stored at CRT and used for up to 8 days. Diluted solutions are stable for 24 hours at 25° C (77° F).
Manufacturer states, “Do not mix mesna injection with cyclophosphamide carboplatin, cisplatin, epirubicin, and nitrogen mustard. The benzyl alcohol contained in mesna injection can reduce the stability of ifosfamide. Ifosfamide and mesna may be mixed in the same bag provided the final concentration of ifosfamide does not exceed 50 mg/mL. Higher concentrations of ifosfamide may not be compatible with mesna and may reduce the stability of ifosfamide.”
Other sources suggest specific compatibilities dependent on concentration and manufacturer; consult a pharmacist.
A single dose over a minimum of 1 minute given as a single agent. Administer at rate for ifosfamide if given together. Another source recommends administering as an infusion over 15 to 30 minutes or as a continuous infusion maintained for 12 to 24 hours after completion of the ifosfamide infusion.
A detoxifying agent. Reacts chemically with urotoxic ifosfamide metabolites to detoxify them and inhibit hemorrhagic cystitis. Is distributed to total body water (plasma, extracellular fluid, and intracellular water). Rapidly metabolized in the plasma to its major metabolite mesna disulfide (dimesna). Half-life is 0.36 hours. Excreted in the urine as mesna and dimesna.
A prophylactic agent used to reduce the incidence of hemorrhagic cystitis caused by ifosfamide.
May reduce the incidence of hemorrhagic cystitis caused by cyclophosphamide.
Hypersensitivity reactions ranging from mild to anaphylaxis have been reported. May occur after the first dose or after several months of exposure.
■ Dermatologic toxicity, including drug rash with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), or toxic epidermal necrolysis (TEN), has been reported. Other skin and mucosal reactions characterized by angioedema, erythema, periorbital edema, pruritus, rash, stomatitis, and urticaria have also been reported. May occur after the first dose or after several months of exposure.
■ Mesna is a thiol compound. Hypersensitivity reactions to mesna and to amifostine, another thiol compound, have been reported. It is unclear whether patients who experience an adverse reaction to a thiol compound are at increased risk for a hypersensitivity reaction to mesna. Repeated doses are required to maintain adequate levels of mesna in the kidneys and bladder to detoxify urotoxic ifosfamide metabolites.
■ Hemorrhagic cystitis caused by ifosfamide is dose dependent. Mesna is most effective when ifosfamide dose is less than 1.2 Gm/M2/24 hr and is somewhat less effective when ifosfamide dose is 2 to 4 Gm/M2/24 hr. If hematuria develops with appropriate doses of mesna, ifosfamide dose may need to be reduced or discontinued.
■ Does not inhibit any other side effects or toxicities caused by ifosfamide therapy.
■ Not effective in preventing hematuria caused by other conditions (e.g., thrombocytopenia).
Maintain adequate hydration and sufficient urinary output as required for ifosfamide treatment.
■ Before administering each dose of ifosfamide, obtain a morning specimen of urine and test for hematuria. Depending on the severity of the hematuria, dose reduction or discontinuation of ifosfamide may be required.
■ If emesis occurs within 2 hours of taking PO mesna, either repeat the PO dose or administer an IV dose.
■ Monitor for S/S of a hypersensitivity reaction (e.g., acute renal impairment, angioedema, arthralgia, cardiovascular symptoms [hypotension, tachycardia], disseminated intravascular coagulation [DIC], fever, hematologic abnormalities, hypoxia, increased liver enzymes, myalgia, nausea, respiratory distress, urticaria, vomiting).
■ Monitor for S/S of dermatologic toxicity.
Read FDA-approved patient information.
■ Verify pregnancy status of females of reproductive potential before initiating therapy. Effective contraception required during treatment with mesna in combination with ifosfamide and for at least 6 months after the last dose.
■ Advise males with female partners of reproductive potential to use effective contraception during treatment with mesna in combination with ifosfamide and for at least 3 months after the last dose.
■ Drink at least one to two liters of liquid daily.
■ Report pink or red urine immediately. Mesna does not prevent hemorrhagic cystitis in all patients and does not prevent or alleviate any of the other adverse reactions associated with ifosfamide.
■ Take mesna at prescribed times. Report emesis within 2 hours of taking PO mesna.
■ Promptly report any S/S of a hypersensitivity or dermatologic reaction.
Mesna is used in combination with ifosfamide or other cytotoxic agents. Ifosfamide can cause fetal harm when administered to a pregnant woman; see ifosfamide prescribing information for use during pregnancy and lactation. Use during pregnancy only if benefits clearly outweigh risks.
■ Avoid breast-feeding during treatment and for 1 week after the last dose of mesna or ifosfamide.
■ Multidose vial contains benzyl alcohol. Serious adverse reactions, including fatal reactions and the “gasping syndrome,” have occurred in premature neonates and low-birth-weight infants who have received benzyl alcohol. Do not use in neonates or infants.
Dosing should be cautious; however, the ratio of ifosfamide to mesna should remain the same.
No clinical drug interactions studies have been conducted. May interfere with several laboratory studies. May cause a false-positive reaction for urinary ketones. If a red-violet color develops, glacial acetic acid returns the coloring to violet.
■ May cause a false-negative test for enzymatic CPK activity.
■ May cause a false-positive test for urinary ascorbic acid.
The most common adverse reactions (greater than 10%) when mesna is given with ifosfamide are abdominal pain, alopecia, anemia, anorexia, asthenia, constipation, diarrhea, fatigue, fever, granulocytopenia, headache, leukopenia, nausea, somnolence thrombocytopenia, and vomiting. Less frequently reported reactions include anxiety, back pain, chest pain, confusion, coughing, dehydration, dizziness, dyspepsia, dyspnea, edema, flushing, hematuria, hypersensitivity reactions, hypokalemia, hypotension, injection site reactions, insomnia, pain, pallor, pneumonia, sweating, tachycardia.
Convulsions, dysgeusia, hemoptysis, hepatitis, hypertension.
Diarrhea, fever, hypersensitivity reactions (including asthma exacerbation), flushing, mild hypotension, rash, shortness of breath, and vomiting.