mesna

Therapeutic Classification: antidotes

Pharmacologic Classification: ifosfamide detoxifying agents

REMS

Prevention of ifosfamide-induced hemorrhagic cystitis.

Unlabeled Use:

Prevention of cyclophosphamide-induced hemorrhagic cystitis.

Binds to the toxic metabolites of ifosfamide in the kidneys.

Therapeutic effects:

Prevents hemorrhagic cystitis from ifosfamide.

Absorption: IV administration results in complete bioavailability; 45–79% absorbed after oral administration. Following IV with PO dosing ↑ systemic exposure.

Distribution: Minimally distributed to tissues.

Metabolism/Excretion: Rapidly converted to mesna disulfide, then back to mesna in the kidneys, where it binds to toxic metabolites of ifosfamide (18–26% excreted as free mesna in urine after IV and PO dosing).

Half-Life: Mesna: 0.36 hr (IV); 1.2–8.3 hr (IV followed by PO); Mesna disulfide: 1.17 hr.

(detoxifying action)

ROUTE	ONSET	PEAK	DURATION
PO, IV	rapid	unknown	4 hr

Contraindicated in:

Hypersensitivity to mesna or other thiol (rubber) compounds;
Lactation: Lactation.

Use Cautiously in:

OB: Safety not established in pregnancy;
Pedi: Injection contains benzyl alcohol, which can cause potentially fatal gasping syndrome in neonates.

Derm: flushing

GI: anorexia, diarrhea, nausea, unpleasant taste, vomiting

Local: injection site reactions

Neuro: dizziness, drowsiness, headache

Misc: flu-like symptoms

Drug-drug:

None reported.

IV (Adults ): Give a dose of mesna equal to 20% of the ifosfamide dose at the same time as ifosfamide and 4 and 8 hr after.
PO IV (Adults ): Give a dose of IV mesna equal to 20% of the ifosfamide dose at the same time as ifosfamide; then give PO mesna equal to 40% of the ifosfamide dose 2 and 6 hr after ifosfamide (total mesna dose is 100% of ifosfamide dose).

(Generic available)

Solution for injection: 100 mg/mL
Tablets: 400 mg

Monitor for development of hemorrhagic cystitis in patients receiving ifosfamide.

Lab Test Considerations:

Verify negative pregnancy test before initiating therapy when given with ifosfamide.
Causes a false-positive result when testing urinary ketones.

Initial IV bolus is to be given at time of ifosfamide administration.
PO: If 2nd and 3rd doses are given orally, administer 2 and 6 hr after IV dose.
- If PO mesna is vomited within 2 hr of administration, repeat dose or use IV mesna.
Rate: Administer over 15–30 min or as a continuous infusion.
Syringe Compatibility:
- ifosfamide
Y-Site Compatibility:
- alemtuzumab
- allopurinol
- amikacin
- aminocaproic acid
- aminophylline
- amiodarone
- amphotericin B liposomal
- ampicillin/sulbactam
- anidulafungin
- argatroban
- arsenic trioxide
- atracurium
- azithromycin
- aztreonam
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- busulfan
- butorphanol
- calcium chloride
- calcium gluconate
- carmustine
- caspofungin
- cefazolin
- cefepime
- cefotaxime
- cefotetan
- cefoxitin
- ceftazidime
- ceftolozane/tazobactam
- ceftriaxone
- cefuroxime
- chlorpromazine
- ciprofloxacin
- cisatracurium
- cladribine
- clindamycin
- cyclophosphamide
- cytarabine
- dactinomycin
- daptomycin
- defibrotide
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- foscarnet
- fosphenytoin
- furosemide
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- haloperidol
- heparin
- hydralazine
- hydrocortisone
- hydromorphone
- idarubicin
- ifosfamide
- imipenem/cilastatin
- insulin, regular
- irinotecan
- isavuconazonium
- isoproterenol
- ketorolac
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- meropenem/vaborbactam
- methadone
- methotrexate
- methyprednisolone
- metoclopramide
- metoprolol
- metronidazole
- micafungin
- midazolam
- milrinone
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- mycophenolate
- nafcillin
- nalbuphine
- naloxone
- nitroglycerin
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- paclitaxel
- palonosetron
- pamidronate
- pantoprazole
- pemetrexed
- pentamidine
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- piperacillin/tazobactam
- plazomicin
- potassium acetate
- potassium chloride
- potassium phosphates
- procainamide
- prochlorperazine
- promethazine
- propranolol
- remifentanil
- rituximab
- rocuronium
- sargramostim
- sodium acetate
- sodium bicarbonate
- sodium phosphates
- succinylcholine
- sufentanil
- sulbactam/durlobactam
- tacrolimus
- tedizolid
- theophylline
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- trimethoprim/sulfamethoxazole
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- acyclovir
- amphotericin B deoxycholate
- dacarbazine
- dantrolene
- diazepam
- ganciclovir
- gemtuzumab ozogamicin
- nicardipine
- nitroprusside
- phenytoin

IV Administration:

Intermittent Infusion: 2nd IV dose is given 4 hr later; 3rd dose is given 8 hr after initial dose. This schedule must be repeated with each subsequent dose of ifosfamide. Diluent: Dilute 2-, 4-, and 10-mL ampules, containing a concentration of 100 mg/mL in 8 mL, 16 mL, or 50 mL, respectively, of D5W, 0.9% NaCl, D5/0.9% NaCl, D5/0.2% NaCl, D5/0.33% NaCl, or LR.Concentration: 20 mg/mL. Refrigerate to store. Use within 6 hr. Discard unused solution.

Inform patient that unpleasant taste may occur during administration.
Advise patient to notify health care provider if nausea, vomiting, or diarrhea persists or is severe.
Rep: Advise women of reproductive potential to use effective contraception during therapy and for 6 mo after last dose and to avoid breastfeeding during therapy and for 1 wk after last dose. Advise men with female partners of reproductive potential to use effective contraception during therapy and for 3 mo after last dose. Advise patient to notify health care provider immediately if pregnancy is suspected.

Prevention of hemorrhagic cystitis associated with ifosfamide therapy.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Canadian Brand Names ⬆