Drug reference

Ifosfamide

Alkylating Agent · Antineoplastic

Alkylating AgentAntineoplastic

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Avoid (teratogenic and carcinogenic in animals).

FDA category + note

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Mechanism

Ifosfamide is an alkylating agent related to cyclophosphamide. It acts by damaging DNA, thereby interfering with cell replication. Its metabolite, acrolein, is responsible for urothelial toxicity.

Indications

Malignant diseaserelapsed germ cell testicular cancersarcomas (first-time treatment for pediatric or adult patients)high-dose chemotherapy regimens with bone marrow or stem cell rescueBronchogenic carcinomaBreast carcinomaTesticular carcinomaBladder carcinomaHead and neck carcinomasOsteogenic sarcomaSome lymphomas

Dosing

Adult: By intravenous infusion (consult local protocol)
Renal adjustment: Avoid if serum creatinine concentration >120 micromol/litre.
Hepatic adjustment: Avoid in hepatic impairment.

Pharmacokinetics

Onset

not specified

Peak effect

not specified

Half-life

longer and dose-dependent t½

Bioavailability

92%

Protein binding

not specified

Metabolism

activated by hepatic CYP3A4

Excretion

Low: 12–18%; High: 53.1± 9.6%

Contraindications

Severe hepatic impairment
Renal impairment (serum creatinine >120 micromol/litre)
Pregnancy

Side effects

Common

Haemorrhagic cystitisUrothelial toxicityplatelet suppression (greater than cyclophosphamide)neurotoxicitynephrotoxicityurothelial damagenauseavomitinganorexialeukopeniamyelosuppression (leukopenia nadir 6-10 days, recovery 14-21 days)Less alopecia than cyclophosphamideLess emetogenic than cyclophosphamide

Serious

Sensation abnormal
Sepsis
Severe cutaneous adverse reactions (SCARs)
SIADH
Sinusoidal obstruction syndrome
Sperm abnormalities
Status epilepticus
Tinnitus
Tumour lysis syndrome
Urinary disorders
Vasculitis
Vertigo
Visual impairment
Acute leukaemia (secondary malignancy)
severe neurological toxicity (hallucinations, coma, death with high doses, appearing 12 h to 7 days after infusion)
chronic and often irreversible renal toxicity (correlated with total dose, increased frequency in children younger than 5 years)
veno-occlusive disease (VOD) of the liver
Haemorrhagic cystitis