mesna: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
mesna: clinical details
Prescribing considerations
- Coordinate mesna exposure with the period during which urotoxic oxazaphosphorine metabolites remain in the urine.
- Maintain adequate urinary output and hydration measures required by the accompanying cytotoxic treatment.
- Mesna is not completely protective; continue surveillance for urinary-tract toxicity.
- Assess previous hypersensitivity to mesna and adverse reactions to other thiol compounds such as amifostine, penicillamine or captopril.
- Consider sodium content with injection and lactose content with tablets.
Contraindications and cautions
- Known hypersensitivity to mesna or any formulation excipient.
Monitoring
- Monitor urine for haematuria and proteinuria throughout the relevant treatment period.
- Monitor urinary output and adherence to the prescribed hydration plan.
- Watch for immediate or delayed hypersensitivity, including reactions that may resemble sepsis or autoimmune-disease exacerbation.
- Be aware of possible false-positive nitroprusside-based urine ketone tests and ascorbic-acid screens, and possible interference with thiol-dependent creatine phosphokinase assays.
Clinical pharmacology
Mesna is rapidly oxidised to dimesna intravascularly, transported to the kidneys and reduced back to free mesna in renal tubular epithelium. Active urinary mesna chemically detoxifies urotoxic oxazaphosphorine metabolites. Oral urinary availability is lower, later and more prolonged than after intravenous administration.
Formulation and product differences
- The injection is an aqueous solution for intravenous use and, when specifically directed, oral administration in a flavoured drink.
- Tablets are film-coated oral preparations and contain lactose.
- The injection contains sodium and must be visually inspected; discoloured, hazy solutions or those containing particles must not be used.
mesna preparations and strengths
Tablet
Route: Oral
Strengths: 400 mg, 600 mg
mesna interactions
The selected product information does not identify a clinically important interaction that reduces the effects of ifosfamide, cyclophosphamide or other listed anticancer medicines. Mesna can interfere with some urine and laboratory tests, so laboratories should be told it is being used.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.