ifosfamide (eye-foss-fam-ide) Ifex

 Indications

Germ cell testicular carcinoma (with other agents).

Used with mesna, which prevents ifosfamide-induced

hemorrhagic cystitis.

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.

Pharmacokinetics

Absorption: Administered IV only; inactive prior to

conversion to metabolites.

Distribution: Excreted in breast milk.

Metabolism and 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

Contraindications/Precautions

Contraindicated in: Hypersensitivity; OB, Lactation:

Pregnancy or lactation.

Use Cautiously in: Patients with childbearing potential;

Active infections;pbone marrow reserve; Geri:

Geriatric patients; Other chronic debilitating illness; Renal

impairment; Pedi: Children.

Adverse Reactions/Side Effects

CNS: CNS toxicity (somnolence, confusion, hallucinations,

coma), cranial nerve dysfunction, disorientation,

dizziness. CV: cardiotoxicity. GI: nausea, vomiting, anorexia,

constipation, diarrhea, hepatotoxicity. GU:

hemorrhagic cystitis, dysuria, sterility, renal toxicity.

Derm: alopecia. Hemat: ANEMIA, LEUKOPENIA,

THROMBOCYTOPENIA. Local: phlebitis. Misc: allergic

reactions.

Interactions

Drug-Drug: CYP3A4 inhibitors, including ketoconazole,

fluconazole, itraconazole, sorafenib,

and aprepitant maypits effectiveness. CYP3A4 inducers,

including carbamazepine, phenytoin, phenytoin,

phenobarbital, and rifampin mayqthe formation

of a toxic metabolite and mayqrisk of toxicity.

qmyelosuppression with other antineoplastics or radiation

therapy. Toxicity may beqby allopurinol or

phenobarbital. Maypantibody response to andq

risk of adverse reactions from live-virus vaccines.

Drug-Food: Grapefruit juice mayqlevels; 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 q 3 wk.

Availability (generic available)

Powder for injection (requires reconstitution): 1

g/vial, 3 g/vial. Solution for injection: 50 mg/mL.