Fluid retention alkylating drugs can cause fluid retention with oedema and dilutional hyponatraemia in younger children. Using ifosfamide may increase your risk of developing other cancers, such as leukemia. Nephrotoxicity of ifosfamide in children springerlink. Follow your doctors dosing instructions very carefully. The acute tubular dysfunction can be manifested by increased excretion of potassium, phosphorus, and magnesium. In patients with renal impairment, particularly in those with severe renal impairment, decreased renal excretion may result in increased plasma levels of ifosfamide and its metabolites. Ifex ifosfamide for injection, usp singledose vials for constitution and administration by intravenous infusion each contain 1 gram or 3 grams of sterile ifosfamide. Additionally, caa is believed to induce proximal tubular dysfunction which results in fanconis syndrome. Ifex ifosfamide dosing, indications, interactions, adverse. Cco is the ontario governments principal advisor on the cancer and renal systems, and access to care for key health services. To report on the activity of highdose prolongedinfusion ifosfamide hdifx chemotherapy in a retrospective series of patients affected by myxoid liposarcoma treated at fondazione irccs istituto nazionale dei tumori in milan, italy.
Risk factors for ifosfamide nephrotoxicity in children. Ixempra ixabepilone dosing1 the recommended dosage of ixempra is 40 mgm2 administered intravenously over 3 hours every 3 weeks 2doses for patients with body surface area greater than 2. Ifosfamide may be safely used in patients with end stage renal disease on hemodialysis article pdf available in sarcoma 200957714x. Aug, 2018 ifex ifosfamide for injection, usp singledose vials for constitution and administration by intravenous infusion each contain 1 gram or 3 grams of sterile ifosfamide. Here we report results from the use of ifx in this population. Mesna should be used to reduce the incidence of hemorrhagic cystitis. This book is distributed under the terms of the creative commons. In addition, other persons living in your house should not take oral polio vaccine since there is a chance they could pass the polio virus on to you. Renal dose adjustment guidelines for antimicrobials. Dosing and sideeffects of ifosfamide plus mesna springerlink. Eleven children and adolescents with previously normal renal function who received ifosfamide for the treatment of extrarenal solid tumours underwent detailed investigation of glomerular and renal. The fda approved regimen is ifosfamide along with mesna at a dose of.
One episode of renal tubular acidosis which progressed into chronic renal. The renal functions in pediatric cancer patients who received ifosfamide ifo treatment were evaluated and the risk factors related to ifo nephrotoxicity were determined. In clinical practice and in most ongoing studies in adult and pediatric tumours, daily shorttime infusions of ifosfamide ifo on 25 consecutive days with cycle doses between 6 gm 2 and 12 gm 2 are used at present. Cvvhd removes solutes including drugs via diffusion. Highdose ifosfamide chemotherapy in a series of patients.
Fda label information for this drug is available at dailymed. Ifosfamide is a parenterally administered alkylating agent similar to cyclophosphamide that is used in the treatment of several forms of cancer including lymphomas, sarcoma and advanced forms of solid organ cancer such as breast, testicular, ovarian, gastric and lung cancer. Dosing needs to be adjusted in renal impairment as the drug undergoes renal. Younger age group, especially patients treated at less than 4 years of age. Medlineplus information on ifosfamide a lay language summary of important information about this drug that may include the following. Adult drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in. Mar 28, 2019 detailed ifosfamide dosage information for adults. Eastern cooperative oncology group phase ii trial of. It is administered by injection into a vein common side effects include hair loss, vomiting, blood in the urine. The onset of hf can be reversible, usually resolving over 3 to 4 weeks. Ifosfamide can cause many immediate and some longlasting side effects, including a proximal tubulopathy and renal impairment. Consult the product instructions and your pharmacist for storage details. Oral mesna is taken by mouth, usually 2 and 6 hours after you receive ifosfamide. Aminoaciduria in the prediction of ifosfamideinduced.
When a patient is initiated on crrt, antimicrobial therapy often requires adjustment to ensure adequate drug concentrations are achieved. Cumulative dose of ifosfamide greater than 60 gm 2. The antitumoral properties of ifosfamide take effect in a number of sarcomas, lymphomas and other tumors, and it is also effective in patients pretreated with. Ifosfamide can also cause hypophosphatemic rickets. Dosing needs to be adjusted in renal impairment as the drug undergoes renal elimination. Dec 22, 2017 mesna should be used to reduce the incidence of hemorrhagic cystitis. Studies of ifosfamide for injection in patients with hepatic or renal impairment have not been conducted see use in specific populations 8.
Renal dose adjustment guidelines for antimicrobials crrt. Body surface area is calculated using your height and weight. The proximal tubulopathy results in phosphaturia, glycosuria, aminoaciduria, hypophosphataemia, hypokalaemia and a hyperchloraemic. Renal drug handbook gfr 2050mlsmin dose as in normal renal function.
Clonidine, codeine, cyclophosphamide, cyclosporine, cytarabine, dapsone. Cyclophosphamide, cycloserine, cyclosporine, cyproheptadine, cytarabine, dapsone, daptomycin, daunorubicin, delavirdine, desferoxamine, desipramine. Ifosfamide ifo, sold under the brand name ifex among others, is a chemotherapy medication used to treat a number of types of cancer. Ifosfamide neurotoxicity and potential treatment with. Ixempra ixabepilone dosing and administration guide. Ifosfamide may lower your bodys resistance and there is a chance you might get the infection the immunization is meant to prevent.
The patient was referred to the renal service, while on hemodialysis, for consideration of the feasibility of ifosfamide chemotherapy in a patient with end stage renal disease. Definition from the nci drug dictionary detailed scientific definition and other names for this drug. Acute tubular necrosis, acute renal failure, and chronic renal failure secondary to ifosfamide therapy have been reported, and fatal outcome from nephrotoxicity has been documented. Ifosfamide is 32chloroethyl22chloroethylaminotetrahydro2h1,3,2oxazaphosphorine 2oxide. If you miss a dose, contact your doctor to establish a new dosing schedule. Nov 09, 2018 ifosfamide is a cancer medication that interferes with the growth and spread of cancer cells in the body. Cidofovir, ciprofloxacin, cisatracurium, cisplatin, cladribine, clarithromycin. Like cyclophosphamide, ifosfamide causes cardiotoxicity in a dosagerelated manner dosages. Cco is the ontario governments principal advisor on the cancer and renal. Ifosfamide use by either parent may cause birth defects. Oct 24, 2016 ifosfamide is a cytotoxic drug for the treatment of malignant disease. The renal drug handbook the st georges hospital, adult critical. Mesna should be used for all patients receiving ifosfamide and high dose cyclophosphamide 1gm2.
Ifosfamide, a structural isomer of cyclophosphamide, was introduced into clinical studies in 1972. Oct 18, 2019 embryolethal effects were observed in rats following the administration of 54 mgm 2 doses of ifosfamide from the 6th through the 15th day of gestation and embryotoxic effects were apparent after dams received 18 mgm 2 doses over the same dosing period. Ifosfamide for injection should be administered as a slow intravenous infusion lasting a minimum of 30 minutes. This includes testicular cancer, soft tissue sarcoma, osteosarcoma, bladder cancer, small cell lung cancer, cervical cancer, and ovarian cancer. Store intact vials at room temp or under refrigeration. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Uclh dosage adjustment for cytotoxics in renal impairment version 3 updated january2009 page 3 of 24 drug pharmacokinetics available information recommendation arsenic trioxide arsenic is stored mainly in liver, kidney, heart, lung, hair and nails. Doses based on body surface area are expressed as milligrams mg or grams g per meter squared m 2.
Abacavir abacavir lamivudine abacavir lamivudine zidovudine acarbose acebutolol acetaminophen acetazolamide acetohexamide acetohydroxamic acid acetylsalicylic acid aspirin acrivastine acyclovir adefovir adenosine albuterol inhaled albuterol oral alfentanil alfentanil allopurinol alprazolam alteplase tissuetype plasminogen activator. Purpose to evaluate the optimal dose of carboplatin as well as the efficacy and tolerability of sequential, doseintense chemotherapy with paclitaxel and ifosfamide followed by carboplatin and etoposide tice plus peripheralblood stemcell pbsc support in patients with germ cell tumors gct who are likely to experience treatment failure with conventionaldose salvage treatment. Ifosfamide can cause birth defects if a woman is exposed to it during pregnancy. Ifosfamide may be safely used in patients with end stage. Ifosfamide is also frequently used in combination with other cytotoxic drugs, radiotherapy and surgery. Ifosfamide fda prescribing information, side effects and uses.
Despite recent advances in the treatment of this disease, there continues to be a need to identify new active agents and their toxicity spectra. Mesnex mesna dosing, indications, interactions, adverse. Guidelines for the administration of mesna with ifosfamide. Case 1 was a 48yearold male who four years earlier had been diagnosed with high grade synovial sarcoma of the knee, metastatic to lungs. Purpose alkylating agents have modest activity in advanced urothelial carcinoma.
A catalogue record for this book is available from the british library. Ifosfamide injection is used in combination with other medicines to treat cancer of the testicles ifosfamide interferes with the growth of cancer cells, which are eventually destroyed. Ifosfamide is an alkylating substance and has to be activated by hepatic metabolism similar to cyclophosphamide l oehrer 1992. Ifosfamide is an antineoplastic agent useful in the treatment of a wide range of cancers including sarcomas, gynecologic cancers, lymphoma and testicular cancers. Trivalent forms of arsenic are methylated in humans and mostly excreted in urine. Ifosfamide belongs to the group of medicines called alkylating agents. Aug, 2018 using ifosfamide may increase your risk of developing other cancers, such as leukemia. It is used in patients who have already been treated with two other types of chemotherapy ifosfamide is also being studied in the treatment of other types of cancer. Consider dosage reduction in patients with renal impairment.
Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. Use effective birth control to prevent pregnancy, whether you are a man or a woman. Ifosfamide definition of ifosfamide by medical dictionary. Renal excretion of some of the nontoxic metabolites of ifosfamide, 2 and 3dechloroethyl ifosfamide, has been shown to account for between 4% of the administered ifosfamide dose. Chloracetaldehyde, a metabolite implicated in cns toxicity, has been shown to accumulate in patients with renal insufficiency 9, 11 and in an anephric. Ifosfamide is used with other cancer medicines to treat testicular cancer. Find patient medical information for ifosfamidemesna intravenous on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. Disorders of renal function, glomerular and tubular following ifosfamide administration are very common. Ifosfamide is approved to be used with other drugs to treat.
Recommended ifosfamide dosing guidelines like many chemotherapy medicines, the ifosfamide dose your healthcare provider recommends will be based on your body surface area. Chemotherapy and kidney injury american society of. Ifosfamide is also being studied in the treatment of other types of cancer. Dose reduction is to 80% of the dose if creatinine clearance crcl is 46 to 60 mlminute. We treated three patients with end stage renal disease on hemodialysis with escalating doses of ifosfamide. Dailymed ifosfamide injection, powder, lyophilized, for. Pdf ifosfamide may be safely used in patients with end. Clinical signs, such as elevation in bun or serum creatinine or decrease in creatinine clearance, were usually transient. Ifosfamide is embryotoxic to rabbits receiving 88 mgm2day doses from the 6th through the. Used as an antineoplastic agent in treatment of leukemia, lymphoma, and cancers of the lung, ovary, testes, and other organs.
However, if crcl is 31 to 45 mlminute, administer 75% of the dose and with crcl under 30 mlminute reduce to 70% of the regular dose. Ifosfamide ifx is an agent as yet unstudied in advanced urothelial carcinoma. Since the growth of normal body cells may also be affected by ifosfamide, other effects will also occur. Renal toxicity occurred in 6% of the patients treated with ifosfamide as a single agent. Acute heart failure, often occurring within 1 to 10 days of treatment, has been reported with induction therapy at doses greater than 12. Risk factors for ifosfamide nephrotoxicity include. Ifosfamide is 32chloroethyl22chloroethylaminotetrahydro2h1,3,2. Ifosfamide is a synthetic structural isomer of cyclophosphamide that has been approved for concurrent use with other drugs usually cisplatin, etoposide, or vinblastine in the treatment of metastatic germcell testicular cancer and some especially pediatric sarcomas. Mesnex mesna oralinjection uses, side effects, dosage. Ipilimumab is a novel immunotherapy agent that has shown. Use of ifosfamide is associated with an increased incidence of acute leukaemia. Ifosfamide is an alkylating antineoplastic prodrug used to treat many solid tumors. Ifosfamide side effects, dosage, interactions drugs. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may 2020.
As a single agent it has successfully produced objective remissions in a wide range of malignant conditions. Ifosfamide, carboplatin, and cisplatin can cause renal complications, including acute tubular. They were most likely to be related to tubular damage. Although the precise incidence of severe kidney dysfunction after ifosfamide expo. Ifex ifosfamide side effects, images, uses, dosage.
Ifosfamide is a chemotherapeutic agent chemically related to the nitrogen mustards and a synthetic analog of cyclophosphamide. Dosage adjustment for cytotoxics in renal impairment. Ifosfamide injection 1g summary of product characteristics. Ifosfamide may be safely used in patients with end stage renal. Burk cd, restaino i, kaplan bs, meadows at 1990 ifosfamideinduced renal tubular dysfunction and rickets in children with wilms tumor. Mechanism of action and pharmacokinetics indications and status adverse effects dosing administration guidelines special precautions interactions recommended clinical. Embryolethal effects were observed in rats following the administration of 54 mgm 2 doses of ifosfamide from the 6th through the 15th day of gestation and embryotoxic effects were apparent after dams received 18 mgm 2 doses over the same dosing period. Apr 25, 2008 ifosfamide is an antineoplastic agent useful in the treatment of a wide range of cancers including sarcomas, gynecologic cancers, lymphoma and testicular cancers. Ifosfamide is a cancer medication that interferes with the growth and spread of cancer cells in the body. However, if crcl is 31 to 45 mlminute, administer 75% of the dose and with crcl under. Adjust dose accordingly if ifosfamide dose changes. Ifosfamide is an alkylating agent that is used widely for the treatment of malignancies, including those seen in children. Ifosfamide therapy is associated with minor transient serum enzyme elevations and has been linked to cases of acute. The molecular formula is c 7 h 15 cl 2 n 2 o 2 p and its molecular weight is 261.
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