Haemorrhagic cystitis cyclophosphamide

Cyclophosphamide and ifosfamide cause urothelial toxicity (haemorrhagic cystitis) which is caused by metabolite acrolein. Mesna reacts with this metabolites in the urinary tract to prevent toxicity and is used in prevention of toxicity to the urinary passage caused by oxazaphosphorins e.g. ifosfamide and cyclophosphamide. 

A metabolite, acrolein, of cyclophosphamide and ifosfamide causes haemorrhagic cystitis. A high urine volume plus use of mesna (sodium 2-mercapto-ethanesulphonate) which provides free thiol groups that bind acrolein, are used to prevent this serious complication. 

Cyclophosphamide produces severe nausea and is often used with a 5HT3 antagonist, ondansetron. Cyclophosphamide is metabolized to a toxic metabolite called acrolein, which can cause haemorrhagic cystitis, a rare but serious complication. This effect can be counteracted by a high intake of fiuid and by using a drug called mesna. Otherwise,... 

Mesna - prevents haemorrhagic cystitis with cyclophosphamide metabolite acrolein... 

Droller MJ, Sral R and Santos G. Prevention of cyclophosphamide-induced hemorrhagic cystitis. Urology 1982 20 256-258. Link H, Neef V, Niethammer D and Wilms K. Prophylaxis of haemorrhagic cystatis due to cyclophos-phamide-conditioning for bone marrow transplantation. Blut 1981 48 329-330. 

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