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ifosfamide (Rx)Brand and Other Names:Ifex

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

kit: powder with mesna solution

  • 1g/vial
  • 3g/vial

solution

  • 1g/20mL
  • 3g/60mL
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Germ Cell Testicular Cancer

Indicated in combination with other antineoplastic agents for third-line germ cell testicular cancer

1.2 g/m²/day IV infusion over 30 minutes on days 1-5 q3-4wk or after recovering from hematologic toxicity (>100,000 cells/mm³ plateletes or ≥4,000 cells/mm³ WBC) 

Off-label: 2 g/m²/day IV infusion on days 1-3 (MAID regimen, for total dose of 6 g/m²); doses as high as 5 g/m² over 24hr via continuous IV infusion in combination with other antineoplastic agents used

Administration

Use concomitant mesna (240 mg/m² IV at 0, 4, 8 hr) to prevent hemorrhagic cystitis

Maintain oral or IV hydration >2 L fluid/day

Monitor: CBCs

Bone Sarcomas (Orphan)

Orphan indication sponsor

  • Bristol-Myers Squibb Company; P.O. Box 4000, Mail Stop D12-02; Princeton, NJ 08543-4000

Soft Tissue Sarcomas (Orphan)

Orphan indication sponsor

  • Bristol-Myers Squibb Company; P.O. Box 4000, Mail Stop D12-02; Princeton, NJ 08543-4000

Renal Impairment

Dose adjustments not described in package insert; some clinicians have used the following guidelines

CrCl >60 mL/min: 100% of regular dose

CrCl 30-60 mL/min: 75% of regular dose

CrCl 10-30 mL/min: 50% of regular dose

CrCl <10 mL/min: Not recommended

Hepatic Impairment

Dose adjustments not described in package insert; some clinicians have used the following guidelines

Bilirubin >3 mg/dL: 25% of regular dose

Other Indications & Uses

Off-label: Cancer of lung, breast, ovary, cervix, pancreas, bladder, and stomach; NHL; sarcomas

Safety and efficacy not established

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Interactions

Interaction Checker

ifosfamide and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Alopecia (83%)

            Nausea (58%)

            Vomiting (58%)

            Leukopenia (50%)

            Hematuria (46%)

            Metabolic acidosis (31%)

            Thrombocytopenia (20%)

            CNS toxicity (12%)

            Neurotoxicity (10-20%)

            1-10%

            Infection (8%)

            Nephrotoxicity (6%)

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            Warnings

            Black Box Warnings

            The drug should be administered under the supervision of an experienced cancer chemotherapy physician

            Bone marrow suppression may occur

            Hemorrhagic cystitis reported

            Confusion and coma due to CNS toxicity have been associated with therapy. Discontinue therapy if it occurs.

            Dose-related severe myelosuppression reported

            Contraindications

            Hypersensitivity

            Severe myelosuppression

            Cautions

            Avoid pregnancy

            May interfere with wound healing

            Use caution in renal impairment

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            Pregnancy & Lactation

            Pregnancy Category: D

            Lactation: excreted in breast milk, do not nurse

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Synthetic analog of cyclophosphamide; cross-links DNA strands; inhibits DNA synthesis and protein synthesis

            Absorption

            Bioavailability: 90-100%

            Peak plasma time: 20-30 minutes

            Distribution

            Vd: 33 L

            Metabolism

            Extensively metabolized

            Metabolites: 3-dechloroethylifosfamide, 2-dechloroethylifosfamide, and carboxyifosfamide

            Elimination

            Half-life elimination: 15 hr (high dose of 3800-5000 mg/m²); 7 hr (low dose of 1800-2400 mg/m²)

            Excretion: Urine 70-86% (high dose of 5000 mg/m²); 12-16% (low dose of 1600-2400)

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            Administration

            IV Incompatibilities

            Syringe: mesna with epirubicin

            Y-site: cefepime, methotrexate

            IV Compatibilities

            Solution: D5/Ringer's, D5/NS, D5W, LR, ½NS, NS, Na-Lactate (1/6 M)

            Additive: carboplatin, carboplatin w/ etoposide, cisplatin, cisplatin w/etoposide, epirubicin, etoposide, fluorouracil, mesna

            Syringe: epirubicin, mesna

            Y-site (partial list): allopurinal, amphotericin B cholesteryl sulfate, etoposide phosphate, filgrastim, fludarabine, gemcitabine, granisetron, linezolid, melphalan, ondansetron, paclitaxel, propofol, NaHCO3, teniposide, thiotepa

            IV Preparation

            Reconstitute with SWI or NS to a concentration of 50 mg/mL

            Standard dilution

            • IV push: dose/syringe (concentration: 50 mg/mL)
            • IVPB: dose/100-1000 mL D5W or NS

            IV Administration

            Slow IV infusion over 30 min, or continuous infusion over 5 d

            Mesna should be administered concomitantly (20% of the ifosfamide dose 15 min before, 4 hr after, & 8 hr after ifosfamide administration)

            Adequate hydration (at least 2 L/day) before & for 72 hr after therapy is recommended to minimize risk of hemorrhagic cystitis

            Storage

            Store intact vials at room temp or under refrigeration

            Syringe & IVPB are stable for 7 days at room temp& 6 wk under refrigeration

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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