ifosfamide

ROUTE	ONSET	PEAK	DURATION
IV	unknown	7–14 days	21 days

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

Neuro: confusion, sedation, dizziness, ENCEPHALOPATHY, extrapyramidal symptoms, hallucinations, psychosis, SEIZURES

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

CYP3A4 inhibitors, including ketoconazole, fluconazole, itraconazole, sorafenib, and aprepitant, may ↓ its effectiveness.
CYP3A4 inducers, including carbamazepine, phenytoin, phenobarbital, and rifampin, may ↑ the formation of a toxic metabolite and may ↑ risk of toxicity.
↑risk of myelosuppression with other antineoplastics or radiation therapy.
Toxicity may be ↑ by allopurinol or phenobarbital.
Nephrotoxic drugs (including cisplatin), CNS depressants, or alcohol may ↑ risk of encephalopathy.
Busulfan may ↑ risk of hemorrhagic cystitis.
May ↓ antibody response to and ↑ risk of adverse reactions from live-virus vaccines.

Drug-Food:

Grapefruit juice may ↑ levels; avoid concurrent use.

Route/Dosage ⬆ ⬇

IV (Adults ): 1.2 g/m²/day for 5 days; coadminister with mesna. May repeat cycle every 3 wk.

Availability ⬆ ⬇

(Generic available)

Powder for injection: 1 g/vial; 3 g/vial
Solution for injection: 50 mg/mL

Assessment ⬆ ⬇

Monitor BP, HR, respiratory rate, and temperature frequently during administration.
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.
Assess nausea, vomiting, and appetite. Weigh weekly. Premedication with an antiemetic may be used to minimize GI effects. Adjust diet as tolerated.
Monitor for myelosuppression. Assess for bleeding (bleeding gums; bruising; petechiae; guaiac stools, urine, or emesis) and avoid IM injections and rectal temperatures. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for fatigue, dyspnea, and orthostatic hypotension.

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 AST, ALT, serum alkaline phosphatase, bilirubin, and LDH prior to and periodically during therapy. May ↑ liver enzymes and bilirubin.
- 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.

Implementation ⬆ ⬇

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.
Prepare solution in a biologic cabinet. Wear gloves, gown, and mask while handling IV medication. Discard IV equipment in specially designated containers.

IV Administration:

Ifosfamide is an irritant. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient's extremity and apply dry cold compresses for 20 min 4 times day for 1–2 days.
IV: Diluent: Dilute 1-g vial with 20 mL and 3-g vial with 60 mL sterile water or bacteriostatic water for injection; shake to dissolve completely. Do not infuse solution if cloudy, discolored or contains particulates. Concentration: 50 mg/mL.
Intermittent Infusion: Diluent: Dilute 1-g vial with 20 mL and 3-g vial with 60 mL sterile water or bacteriostatic water for injection (resulting concentration = 50 mg/mL) ; shake to dissolve completely. Do not infuse solution if cloudy, discolored or contains particulates. May be further diluted in D5W, 0.9% NaCl, LR, or sterile water for injection. Concentration: 0.6–20 mg/mL. Refrigerate reconstituted and further diluted solutions and use within 24 hr.
Rate: Administer over ≥30 min.
Y-Site Compatibility:
- acyclovir
- alemtuzumab
- allopurinol
- amikacin
- aminocaproic acid
- aminophylline
- amiodarone
- amphotericin B deoxycholate
- amphotericin B liposomal
- ampicillin
- ampicillin/sulbactam
- anidulafungin
- argatroban
- arsenic trioxide
- atracurium
- azithromycin
- aztreonam
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- carboplatin
- caspofungin
- cefazolin
- cefotaxime
- cefotetan
- cefoxitin
- ceftazidime
- ceftriaxone
- cefuroxime
- chlorpromazine
- ciprofloxacin
- cisatracurium
- cisplatin
- clindamycin
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daptomycin
- 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
- ganciclovir
- gemcitabine
- gemtuzumab ozogamicin
- gentamicin
- granisetron
- haloperidol
- heparin
- hydrocortisone
- hydromorphone
- idarubicin
- imipenem/cilastatin
- insulin, regular
- isoproterenol
- ketorolac
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methadone
- methohexital
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- minocycline
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- paclitaxel
- palonosetron
- pamidronate
- pemetrexed
- pentamidine
- pentobarbital
- phenobarbital
- phenylephrine
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- procainamide
- prochlorperazine
- promethazine
- propofol
- propranolol
- remifentanil
- rituximab
- rocuronium
- sargramostim
- sodium acetate
- sodium bicarbonate
- sodium phosphates
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- trimethoprim/sulfamethoxazole
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- cefepime
- diazepam
- methotrexate
- pantoprazole
- phenytoin
- potassium phosphates

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
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.
Advise patient to avoid grapefruit and grapefruit juice during therapy.
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.
Discuss with patient the possibility of hair loss. Explore methods of coping.
Instruct patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Instruct patient not to receive any vaccinations without advice of health care provider; ifosfamide may ↓ antibody response to and ↑ risk of adverse reactions from live-virus vaccines.
Rep: May cause fetal harm. Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected. Instruct women of reproductive potential and men with female partners of reproductive potential to use contraception during and for ≥6 mo after therapy and to avoid breastfeeding during and for 1 wk after last dose. Caution patient about potential for amenorrhea, premature menopause, and sterility.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇