ifosfamide

CV: cardiotoxicity.

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

GU: hemorrhagic cystitis, dysuria, sterility, renal toxicity.

Hemat: ANEMIA, LEUKOPENIA, THROMBOCYTOPENIA.

Neuro: CNS toxicity (somnolence, confusion, hallucinations, coma), cranial nerve dysfunction, disorientation, dizziness.

Misc: allergic reactions.

Interactions ⬆ ⬇

Drug-Drug:

CYP3A4 inhibitors, including ketoconazole, fluconazole, itraconazole, sorafenib, and aprepitant may ↓ its effectiveness.
CYP3A4 inducers, including carbamazepine, phenytoin, 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.

Route/Dosage ⬆ ⬇

Other Regimens are Used

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

Implementation ⬆ ⬇

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

IV Administration:

IV: Prepare solution by diluting each 1-g vial with 20 mL of sterile water or bacteriostatic water for injection containing parabens. Use solution prepared without bacteriostatic water within 6 hr. Solution prepared with bacteriostatic water is stable for 1 wk at 30°C or 6 wk at 5°C.
Intermittent Infusion:
Rate: Administer over at least 30 min.
Continuous Infusion: Has also been administered as a continuous infusion over 72 hr.
Y-Site Compatibility:
- acyclovir
- alemtuzumab
- alfentanil
- allopurinol
- amifostine
- amikacin
- aminocaproic acid
- aminophylline
- amiodarone
- amphotericin B cholesteryl
- amphotericin B deoxycholate
- amphotericin B lipid complex
- amphotericin B liposome
- ampicillin
- ampicillin/sulbactam
- anidulafungin
- argatroban
- 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 liposome
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fenoldopam
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- foscarnet
- fosphenytoin
- furosemide
- ganciclovir
- gemcitabine
- gentamicin
- granisetron
- haloperidol
- heparin
- hetastarch
- hydrocortisone
- hydromorphone
- idarubicin
- imipenem/cilastatin
- insulin
- isoproterenol
- ketorolac
- labetalol
- leucovorin calcium
- levofloxacin
- levorphanol
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- minocycline
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- paclitaxel
- palonosetron
- pamidronate
- pancuronium
- pemetrexed
- pentamidine
- pentobarbital
- phenobarbital
- phenylephrine
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- procainamide
- prochlorperazine
- promethazine
- propofol
- propranolol
- quinupristin/dalfopristin
- remifentanil
- rituximab
- rocuronium
- sargramostim
- sodium acetate
- sodium bicarbonate
- sodium phosphates
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiopental
- 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

US Brand Names ⬆ ⬇

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: alkylating agents

Availability ⬆ ⬇

(Generic available)

Powder for injection (requires reconstitution): 1 g/vial; 3 g/vial;
Solution for injection: 50 mg/mL;

Time/Action Profile ⬆ ⬇

(effects on blood counts)

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

Assessment ⬆ ⬇

Monitor BP, pulse, respiratory rate, and temperature frequently during administration. Report significant changes.
Monitor urinary output frequently during therapy. Notify health care professional if hematuria occurs. To reduce the risk of hemorrhagic cystitis, fluid intake should be at least 3000 mL/day for adults and 1000–2000 mL/day for children. Mesna is given concurrently to prevent hemorrhagic cystitis.
Monitor neurologic status. Ifosfamide should be discontinued if severe CNS symptoms (agitation, confusion, hallucinations, unusual tiredness) occur. Symptoms usually abate within 3 days of discontinuation of ifosfamide but may persist for longer; fatalities have been reported.
Assess nausea, vomiting, and appetite. Weigh weekly. Premedication with an antiemetic may be used to minimize GI effects. Adjust diet as tolerated.
Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, and emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for increased fatigue, dyspnea, and orthostatic hypotension.

Lab Test Considerations:

Monitor CBC, differential, and platelet count prior to and periodically during therapy. Withhold dose if WBC <2000/mm³ or platelet count is <50,000/mm³. Nadir of leukopenia and thrombocytopenia occurs within 7–14 days and usually recovers within 21 days of therapy.
- Urinalysis should be evaluated before each dose. Withhold dose until recovery if urinalysis shows >10 RBCs per high-power field.
- May cause ↑ in liver enzymes and serum bilirubin.
- Monitor AST, ALT, serum alkaline phosphatase, bilirubin, and LDH prior to and periodically during therapy. May cause ↑ in liver enzymes and serum bilirubin.
- Monitor BUN, serum creatinine, phosphate, and potassium periodically during therapy. May cause hypokalemia.

Pot. Nursing Diagnoses ⬆ ⬇

Risk for infection (Side Effects).
Disturbed body image (Side Effects).

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. Patients 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.
Review with patient the need for contraception during therapy and for at least 6 mo after therapy. Women should avoid pregnancy and breast feeding and men should avoid fathering a child during and for at least 6 mo after end of therapy.
Rep: Caution patient about the potential for amenorrhea, premature menopause, and sterility from this medication.

Evaluation/Desired Outcomes ⬆ ⬇

Decrease in size or spread of malignant germ cell testicular carcinoma.

Code ⬆

NDC Code^*

0143- Hikma Pharmaceuticals USA Inc.
0143-9530- Ifosfamide 0143-9530-01- 1 VIAL in 1 BOX (0143-9530-01) > 60 mL in 1 VIAL

0143- Hikma Pharmaceuticals USA Inc.
0143-9531- Ifosfamide 0143-9531-01- 1 VIAL in 1 BOX (0143-9531-01) > 20 mL in 1 VIAL

0338- Baxter Healthcare Corporation
0338-3991- IFEX 0338-3991-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (0338-3991-01) > 20 mL in 1 VIAL, SINGLE-DOSE

0338- Baxter Healthcare Corporation
0338-3993- IFEX 0338-3993-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (0338-3993-01) > 60 mL in 1 VIAL, SINGLE-DOSE

0703- Teva Parenteral Medicines, Inc.
0703-3427- Ifosfamide 0703-3427-11- 1 VIAL, SINGLE-USE in 1 CARTON (0703-3427-11) > 20 mL in 1 VIAL, SINGLE-USE

0703- Teva Parenteral Medicines, Inc.
0703-3429- Ifosfamide 0703-3429-11- 1 VIAL, SINGLE-USE in 1 CARTON (0703-3429-11) > 60 mL in 1 VIAL, SINGLE-USE

10019- Baxter Healthcare Corporation
10019-925- IFOSFAMIDE 10019-925-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-925-01) > 20 mL in 1 VIAL, SINGLE-DOSE (10019-925-82)

10019- Baxter Healthcare Corporation
10019-926- IFOSFAMIDE 10019-926-02- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-926-02) > 60 mL in 1 VIAL, SINGLE-DOSE (10019-926-16)

10019- Baxter Healthcare Corporation
10019-927- IFOSFAMIDE 10019-927-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-927-01) > 20 mL in 1 VIAL, SINGLE-DOSE (10019-927-20)

10019- Baxter Healthcare Corporation
10019-929- IFOSFAMIDE 10019-929-03- 1 VIAL in 1 CARTON (10019-929-03) > 60 mL in 1 VIAL (10019-929-60)

63323- Fresenius Kabi USA, LLC
63323-142- Ifosfamide 63323-142-12- 1 VIAL, SINGLE-DOSE in 1 BOX (63323-142-12) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

63323- Fresenius Kabi USA, LLC
63323-142- Ifosfamide 63323-142-10- 1 VIAL, SINGLE-DOSE in 1 BOX (63323-142-10) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

section name header

Pronunciation ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇