Ifosfamide

D. Masurel and F W. Wainer, Analytical and preparative high-performance liquid cliromatographic separation of the enantiomers of ifosfamide, cyclophosphamide and ti ofosfamide and their determination in plasma , 7. Chromatogr. 490 133-143 (1989). 

Ifosfamide is an isomeric form of cyclophosphamide with analogous mode of action. 

Clinical trials showed therapeutic efficacy in a broad spectrum of tumors these include SCLC, testicular tumors, sarcomas, breast cancer, renal cell cancer, pancreatic tumors and lymphomas. Ifosfamide is less myelosuppressive than cyclophosphamide but is more toxic to the bladder. Therefore it is recommended that ifosfamide is coadministered with the thiol compound mesna to avoid hemorrhagic cystitis and to reduce the risk of developing bladder cancer. Other side effects include neurotoxicity and myelosuppression. 

C,H, Cl2N02P 40722-73-4) see Ifosfamide 6-chloro-2-(chloromethyl)-4-(2-chlorophenyl)quinazoline... 

C2HftClN 689-98-5) see Fluvoxamine 2-chloroethylamine hydrochloride (C2H7CI2N 870-24-6) see Ifosfamide a-[[(2-chloroetbyl)amino]methyl]benzenemethanol hydrochloride... 

CI3OP 10025-87-3) see Cyclophosphamide Estramustine phosphate Etopophos Ifosfamide Miltefosine Torasemide Vidarabine... 

Sirianni SR, Huang CC. 1980. Comparison of induction of sister chromatid exchange, 8-azaguanine- and ouabain-resistant mutants by cyclophosphamide, ifosfamide and l-(pyridyl-3)-3,3-dimethyltriazene in Chinese hamster cells cultured in diffusion chambers in mice. Carcinogenesis 1 353-355. 

JP is receiving a highly myelosuppressive chemotherapy regimen for the next 3 days for his lymphoma. The chemotherapy orders specify ifosfamide, carboplatin, and etoposide. The goal of this cycle of chemotherapy is to put the cancer into remission so that his lymphoma can be cured with a bone marrow transplant. 

What drug is missing from his ifosfamide orders ... 

What instructions should the patient receive about ifosfamide ... 

Risk factors for the development of AML include exposure to environmental toxins, Hispanic ethnicity, and genetics.6 Of greater concern is the increased prevalence of AML as a secondary malignancy, resulting from chemotherapy and radiation treatment for other cancers. Alkylating agents, such as ifosfamide and cyclophosphamide, and topoisomerase inhibitors, such as etoposide, are linked to an increased risk of myelodysplastic syndrome (MDS) and AML.8... 

The use of effective prevention strategies can decrease the incidence of hemorrhagic cystitis to less than 5% in patients receiving cyclophosphamide or ifosfamide. There are three methods to reduce the risk administration of mesna, hyperhydration, and bladder irrigation with catheterization. 

Cyclophosphamide- or ifosfamide-induced damage to the bladder wall is caused primarily by their metabolite known as acrolein. Acrolein causes sloughing and inflammation of the bladder lining, leading to hemorrhage. This is most common when urine output is low because higher concentrations of acrolein come into contact with the bladder urothelium for longer periods of time. 

TABLE 96-9. ASCO Guidelines for the Use of Mesna with Ifosfamide and High-Dose Cyclophosphamide... 

Oral 100% of total daily dose of ifosfamide given 20% IV 15 minutes before and 40% PO 2 and 6 hours after start of ifosfamide... 

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