ifosfamide

Contraindicated in:

Hypersensitivity;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Active infections;
↓bone marrow reserve;
Renal impairment;
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children;
Geri: Drug may accumulate in older adults due to age-related renal impairment.

Adv. Reactions/Side Effects ⬆ ⬇

CV: cardiotoxicity

Derm: alopecia

GI: nausea, vomiting, anorexia, constipation, diarrhea, hepatotoxicity

GU: hemorrhagic cystitis, dysuria, renal impairment, sterility

Hemat: ANEMIA, LEUKOPENIA, THROMBOCYTOPENIA

Local: phlebitis

Neuro: confusion, sedation, disorientation, dizziness

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.
↑myelosuppression with other antineoplastics or radiation therapy.
Toxicity may be ↑ by allopurinol or phenobarbital.
May ↓ antibody response to and ↑ risk of adverse reactions from live-virus vaccines.

Drug-Food:

Grapefruit juice may ↑ levels; avoid concurrent use.

Availability ⬆ ⬇

(Generic available)

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

Route/Dosage ⬆ ⬇

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

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Following conversion to active compounds, interferes with DNA replication and RNA transcription, ultimately disrupting protein synthesis (cell-cycle phase–nonspecific).

Therapeutic effects:

Death of rapidly replicating cells, particularly malignant ones.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: alkylating agents

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Minimally distributed to tissues.

Metabolism/Excretion: Metabolized by the liver to active antineoplastic compounds.

Half-Life: 15 hr.

Time/Action Profile ⬆ ⬇

(effects on blood counts)

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

Patient/Family Teaching ⬆ ⬇

Emphasize need for adequate fluid intake throughout therapy. Patient should void frequently to decrease bladder irritation from metabolites excreted by the kidneys. Notify health care professional immediately if hematuria is noted.
Instruct patient to drink at least 8 glasses of water/day during and for 3 days after completion of therapy.
Advise patient to avoid grapefruit and grapefruit juice during therapy.
Instruct patient to notify health care professional 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 to take products containing aspirin or NSAIDs, as these may precipitate GI hemorrhage.
Discuss with patient the possibility of hair loss. Explore methods of coping.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Instruct patient not to receive any vaccinations without advice of health care professional; ifosfamide may decrease antibody response to and increase risk of adverse reactions from live-virus vaccines.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Review with patient the need for contraception during therapy and for at least 6 mo after therapy. Women should avoid pregnancy and breastfeeding, and men should avoid fathering a child during and for at least 6 mo after end of therapy. Caution patient about the potential for amenorrhea, premature menopause, and sterility from this medication.

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Indications ⬇

Contraind./Precautions ⬆ ⬇