ifosfamide: clinical use

Prescribing considerations

• Administer only through a specialist oncology service with facilities for clinical, biochemical and haematological monitoring.
• Use mesna and adequate hydration for uroprotection; monitor fluid balance and urine for haematuria and proteinuria.
• Assess factors increasing encephalopathy risk, including hypoalbuminaemia, renal impairment, poor performance status, pelvic disease and nephrotoxic therapy.
• Consider fertility preservation before treatment because gonadal toxicity may be permanent.
• Renal tubular injury can emerge or progress after treatment, requiring appropriate longer-term follow-up.

Contraindications and cautions

• Hypersensitivity to ifosfamide
• Urinary outflow obstruction
• Severely impaired bone-marrow function
• Cystitis
• Impaired renal function
• Hepatic impairment
• Acute infection

Monitoring

• Full blood count and clinical evidence of infection or bleeding
• Glomerular and tubular kidney function before, during and after treatment
• Serum and urine chemistry, including potassium and phosphate where appropriate
• Urine output, haematuria, proteinuria and symptoms of cystitis
• Neurological and mental status, especially with encephalopathy risk factors
• Fluid balance and evidence of cardiac, pulmonary or hepatic toxicity

Clinical pharmacology

A liver-activated oxazaphosphorine prodrug whose active metabolites alkylate DNA and form DNA cross-links, blocking progression through the late S and early G2 cell-cycle phases. Metabolites are eliminated principally through the kidneys.

Formulation and product differences

• The selected product is a white powder for concentrate for solution for infusion.
• It contains no listed excipients and requires reconstitution and dilution by trained personnel.
• Benzyl alcohol-containing solutions may reduce its stability.
• It is a hazardous cytotoxic preparation requiring designated handling and disposal procedures.

Injection

Route: Parenteral

Strengths: 1 g, 2 g