EYE-foss-fam-ide
High Alert
Absorption: IV administration results in complete bioavailability.
Distribution: Minimally distributed to tissues.
Half-Life: 15 hr.
Contraindicated in:
WBC count <2000/mm3
;Platelet count <50,000/mm3
;Use Cautiously in:
High ifosfamide dose, hypoalbuminemia, renal impairment, poor performance status, or bulky abdominal-pelvic disease (↑ risk of encephalopathy)
;CV: cardiotoxicity
Derm: alopecia, impaired wound healing
EENT: blurred vision
GI: nausea, vomiting, anorexia, constipation, diarrhea, hepatotoxicity
GU: HEMORRHAGIC CYSTITIS, dysuria, RENAL FAILURE, sterility, urinary incontinence
Hemat: ANEMIA, LEUKOPENIA, THROMBOCYTOPENIA
Local: phlebitis
Neuro: confusion, sedation, dizziness, ENCEPHALOPATHY, extrapyramidal symptoms, hallucinations, psychosis, SEIZURES
Drug-drug:
Drug-Food:
Monitor urinary output frequently during therapy.
Monitor for signs and symptoms of encephalopathy (confusion, somnolence, hallucinations, blurred vision, psychotic behavior, extrapyramidal symptoms, incontinence, seizures) during and for hours to days after administration. If CNS signs/symptoms occur, treat as clinically indicated and consider methylene blue until complete resolution. Dose interruption or permanent discontinuation may be required based on individual safety and tolerability.
Lab Test Considerations:
Monitor CBC with differential prior to and periodically during therapy. Leukocyte nadir usually occurs in 2nd wk after administration. For WBC <2000/µL, platelets <50,000/µL, active infection, or signs of severe immunosuppression, delayed administration may be required. Nadir of leukopenia and thrombocytopenia occurs within 7–14 days and usually recovers within 21 days of therapy.
Monitor serum and urine phosphorus and potassium, sediment for the presence of erythrocytes, and serum creatinine prior to initiation and as indicated during therapy. Obtain urinalysis prior to each dose. If microscopic hematuria (>10 RBCs per high-power field) present, hold therapy until complete resolution; may resume with vigorous oral or parenteral hydration. Avoid administration with active urinary tract infection.
Prior to initiating therapy, correct urinary tract obstructions.
Administer with extensive hydration of ≥2 L of oral or IV fluid per day to ↓ incidence or severity of bladder toxicity.
Administer with mesna to ↓ incidence or severity of hemorrhagic cystitis.
IV Administration:
Emphasize need for adequate fluid intake throughout therapy and to void frequently to ↓ bladder irritation. Notify health care provider immediately if blood in the urine occurs.
Instruct patient to notify health care provider promptly if fever; chills; cough; hoarseness; sore throat; signs of infection; lower back or side pain; painful or difficult urination; bleeding gums; bruising; petechiae; blood in urine, stool, or emesis; or confusion occurs.
Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to avoid falls. Patient should also be cautioned not to drink alcoholic beverages or take products containing aspirin or NSAIDs, as these may cause GI hemorrhage.
Advise patient to notify health care provider immediately if confusion, sedation, hallucination, blurred vision, psychotic behavior, extrapyramidal symptoms, urinary incontinence, or seizure occur.
