Ifosfamide

Indications
 Intravenous
Lymphoma
Adult: Different licensed dosage regimens are available. Regimen 1: 8-12 g/m2 divided over 3-5 days, repeat course every 2-4 wk. Regimen 2: 6 g/m2 divided over 5 days, repeat course every 3 wk. Regimen 3: 5-6 g/m2 (max: 10 g), give as a single 24-hr infusion, repeat course every 3-4 wkly.
CrCl (ml/min)Dosage Recommendation
<10Administer 75% of dose.

Intravenous
Sarcoma
Adult: Different licensed dosage regimens are available. Regimen 1: 8-12 g/m2 divided over 3-5 days, repeat course every 2-4 wk. Regimen 2: 6 g/m2 divided over 5 days, repeat course every 3 wk. Regimen 3: 5-6 g/m2 (max: 10 g), give as a single 24-hr infusion, repeat course every 3-4 wkly.
CrCl (ml/min)Dosage Recommendation
<10Administer 75% of dose.

Intravenous
Solid tumours
Adult: Different licensed dosage regimens are available. Regimen 1: 8-12 g/m2 divided over 3-5 days, repeat course every 2-4 wk. Regimen 2: 6 g/m2 divided over 5 days, repeat course every 3 wk. Regimen 3: 5-6 g/m2 (max: 10 g), give as a single 24-hr infusion, repeat course every 3-4 wkly.
CrCl (ml/min)Dosage Recommendation
<10Administer 75% of dose.

Intravenous
Germ cell testicular carcinoma
Adult: 1.2 g/m2/day for 5 days via slow infusion over at least 30 minutes, repeat treatment every 3 wk or after recovery from haematological toxicity. To be given with mesna and adequate hydration of at least 2 L of oral or IV fluid per day.
CrCl (ml/min)Dosage Recommendation
<10Administer 75% of dose.


Reconstitution: Add 20 ml of sterile water for inj or sterile bacteriostatic water for inj containing benzyl alcohol or parabens for each 1 g of the drug to produce solutions of 50 mg/ml.
Incompatibility: Y-site admin: Cefepime, methotrexate. Admixture or in syringe: Mesna with epirubicin.
Contraindications
 Hypersensitivity; severe bone-marrow depression. Pregnancy, lactation.
Warnings / Precautions
 Hepatic or renal dysfunction, compromised bone marrow reserve. Use with mesna and ensure high oral/IV fluid intake to reduce urotoxic effects.
Adverse Reactions
 Confusion, alopoecia, nausea, vomiting, phloebitis, somnolence, depression, hallucinations. Wound healing may be impaired during ifosfamide use.
Potentially Fatal: Severe myelosuppression, haemorrhagic cystitis, nephrotoxicity, cardiotoxicity, coma.
Drug Interactions
 Causes enhanced toxicity with allopurinol, cisplatin. Ifosfamide enhances the anticoagulant effect of warfarin. CYP2A6 inducers (e.g. amobarbital, pentobarbital, phenobarbital, rifampin and secobarbital) may reduce serum levels of ifosfamide while the inhibitors (e.g. isoniazid, methoxsalen and miconazole) may increase its serum levels. CYP3A4 inducers (e.g. aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins) may reduce serum levels of ifosfamide while the inhibitors (e.g. azole antifungals, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid) may increase its serum levels.
See Below for More ifosfamide Drug Interactions
Food Interactions
 St John's wort may reduce its serum levels.
Mechanism of Actions
 Ifosfamide is converted to its active metabolites via hepatic microsomal enzymes. These active metabolites act as alkylating agents, disrupting DNA and protein synthesis of the target cells. It is routinely given with mesna to reduce urothelial toxicity.
Absorption: Well absorbed from the GI tract (oral).
Metabolism: It is a prodrug that is extensively hepatically metabolised to a mixture of active and inactive metabolites.
Excretion: Urine (as unchanged drug and metabolites).
Storage Conditions
 Intravenous: Store at 20-25°C.
ATC Classification
 L01AA06 - ifosfamide ; Belongs to the class of alkylating agents, nitrogen mustard analogues. Used in the treatment of cancer.
Storage
 Intravenous: Store at 20-25°C.
Available As
  • Ifosfamide 1 gm
  • Ifosfamide 1000 mg
  • Ifosfamide 2 gm
  • Ifosfamide 2000 mg

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