Usual Adult Dose for Hemorrhagic Cystitis Prophylaxis

This drug may be given on a fractionated dosing schedule of either 3 bolus IV injections or a single injection followed by 2 oral doses. The dosing schedule should be repeated on each day that ifosfamide is administered. When the dose of ifosfamide is adjusted, the ratio of mesna to ifosfamide should be maintained.

IV: Mesna is given at 20% of the ifosfamide dose once at the time of ifosfamide administration and 20% of the ifosfamide dose 4 and 8 Hours after each dose of ifosfamide (e.g., if ifosfamide were given at 1.2 g/m2 at 0 Hours, the dose of mesna would be 240 mg/m2 given at 0, 4, and 8 Hours after ifosfamide)

ORAL (to be given after one dose of IV mesna): Mesna is given at 40% of the ifosfamide dose at 2 and 6 Hours after each dose of ifosfamide (e.g., if ifosfamide were given at 1.2 g/m2 at Hour 0, the IV dose of mesna would be 240 mg/m2 given at the time of ifosfamide administration (0 Hour) and the oral dose of this drug would be 480 mg/m2 given at 2 and 6 Hours after ifosfamide)

Comments:

• In order to maintain adequate protection, the recommended dosage regimen should be repeated on each day that ifosfamide is administered.
• When the dosage of ifosfamide is adjusted (either increased or decreased), the dose of mesna should also be modified accordingly.
• Adequate hydration and sufficient urinary output should be maintained, as required for ifosfamide treatment, and urine should be monitored for the presence of hematuria. If severe hematuria develops when mesna is given according to the recommended dosage schedule, dosage reductions or discontinuation of ifosfamide therapy may be required.

Usual Pediatric Dose for Hemorrhagic Cystitis Prophylaxis

Do not give this drug to premature neonates and low-birth weight infants.

This drug may be given on a fractionated dosing schedule of either 3 bolus IV injections or a single injection followed by 2 oral doses. The dosing schedule should be repeated on each day that ifosfamide is administered. When the dose of ifosfamide is adjusted, the ratio of mesna to ifosfamide should be maintained.

IV: Mesna is given at 20% of the ifosfamide dose once at the time of ifosfamide administration and 20% of the ifosfamide dose 4 and 8 Hours after each dose of ifosfamide (e.g., if ifosfamide were given at 1.2 g/m2 at 0 Hours, the dose of mesna would be 240 mg/m2 given at 0, 4, and 8 Hours after ifosfamide)

ORAL (to be given after one dose of IV mesna): Mesna is given at 40% of the ifosfamide dose at 2 and 6 Hours after each dose of ifosfamide (e.g., if ifosfamide were given at 1.2 g/m2 at Hour 0, the IV dose of mesna would be 240 mg/m2 given at the time of ifosfamide administration (0 Hour) and the oral dose of this drug would be 480 mg/m2 given at 2 and 6 Hours after ifosfamide)

Comments:

• In order to maintain adequate protection, the recommended dosage regimen should be repeated on each day that ifosfamide is administered.
• When the dosage of ifosfamide is adjusted (either increased or decreased), the dose of mesna should also be modified accordingly.
• Adequate hydration and sufficient urinary output should be maintained, as required for ifosfamide treatment, and urine should be monitored for the presence of hematuria. If severe hematuria develops when mesna is given according to the recommended dosage schedule, dosage reductions or discontinuation of ifosfamide therapy may be required.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

CONTRAINDICATIONS:

• Hypersensitivity to the active component or any of the ingredients

Dialysis

Data not available

Other Comments

Stability:

• The multidose vials may be stored and used for up to 8 days after initial puncture.
• Store diluted solutions at 25C (77F) and use within 24 hours.
• Store tablets in refrigerator at 20C to 25C (68F to 77F), excursions permitted to 15C to 30C (59F to 86F).

• Do not mix this drug with epirubicin, cyclophosphamide, cisplatin, carboplatin, or nitrogen mustard.
• The benzyl alcohol contained in the injection vials can reduce the stability of ifosfamide. Ifosfamide and mesna may be mixed in the same bag provided the final concentration of ifosfamide does not exceed 50 mg/mL. Higher concentrations of ifosfamide may not be compatible with mesna and may reduce the stability of ifosfamide.
• Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Any solutions which are discolored, hazy, or contain visible particulate matter should not be used.

• Advise the patient to discontinue this drug and seek immediate medical attention if they experience a hypersensitivity reaction, including systemic anaphylactic reactions.
• Advise the patient to take this drug at the exact time and in the exact amount as prescribed.
• Advise the patient to contact their healthcare provider if they miss a dose or if they vomit within 2 hours of taking the oral formulation.
• This drug does not prevent hemorrhagic cystitis in all patients nor does it prevent or alleviate any of the other adverse reactions or toxicities associated with ifosfamide.
• Advise the patient to report to their healthcare provider if his/her urine turns a pink or red color.
• Advise the patient to drink 1 to 2 liters of fluid each day during therapy.
• Advise the patient that Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic symptoms and bullous and ulcerative skin and mucosal reactions have occurred.