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mesna (Rx)Brand and Other Names:Mesnex

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 100mg/mL

tablet

  • 400mg
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With Ifosfamide

240 mg/sq.meter (if receiving 1.2 g/sq.meter ifosfamide dose) IVP 15 minutes before & 4 & 8 hours after ifosfamide admin OR 

240 mg/sq.meter (if receiving 1.2 g/sq.meter ifosfamide dose) IVP 15 minutes before & 480 mg/sq.meter PO 2 & 6 hours after ifosfamide admin

Adjust dose accordingly if ifosfamide dose changes

Also given by alternative IVP regimens, intermittent infusion or continuous infusion-see IV Info

With Cyclophosphamide (Off-label)

60-160% of cyclophosphamide daily dosage divided 3-5 doses IVP OR by continuous IV infusion

Other Indications & Uses

Ifosfamide-induced hemorrhagic cystitis

Off-label: Cyclophosphamide-induced hemorrhagic cystitis

Safety & efficacy not established

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Adverse Effects

>10%

Nausea (>50%)

Vomiting (29%)

Anorexia

Asthenia

Fatigue

Fever

Abdominal pain

Constipation

Anemia

Granulocytopenia

Leukopenia

Thrombocytopenia

Alopecia

1-10%

Anxiety

Confusion

Dizziness

Headache

Insomnia

Pain

Somnolence

Chest pain

Edema

Flushing

Tachycardia

Cough

Dyspnea

Pneumonia

Diarrhea

Hematuria

Hypokalemia

Back pain

Dehydration

Injection site reaction

Pallor

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Warnings

Contraindications

Hypersensitivity to mesna or other thiol compounds

Cautions

Does NOT prevent nephrotoxicity, myelosuppression, or neurotoxicity

Contains benzyl alcohol as preservative ( associated w/ potentially fatal "Gasping Syndrome" in preemies)

If pt vomits within 2 hr after PO dose, repeat dose or give IV

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Pregnancy & Lactation

Pregnancy Category: B

Lactation: not known if 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

Half-Life:

Mesna: 0.36 hr

Dimesna: 1.17 hr

Peak Plasma

Time

  • Mesna: 4 hr
  • Dimesna: 3 hr

Concentration:

  • Mesna: 3.3 mcg/mL (PO)
  • Dimesna: 7.3 mcg/mL (PO)

Other Information

Bioavailability: 76%

Protein Bound: 69-75% (mesna+dimesna)

Vd: 0.65 L/kg

Metabolism: kidney

Metabolites: mesna disulfide

Excretion: urine

Mechanism of Action

Mesna: synthetic sulfhydryl (thiol) compound: binds & detoxifies ifosfamide metabolites in bladder/kidney

Mesna disulfide (dimesna): inert metabolite

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Administration

IV Incompatibilities

Additive: carboplatin, cisplatin, ifosfamide/epirubicin

Syringe: ifosfamide/epirubicin

Y-site: amphotericin B cholesteryl sulfate

IV Compatibilities

Solution: D5W, NS, LR, D5/½NS

Additive: ifosfamide, hydroxyzine

Syringe: ifosfamide

Y-site (partial list): allopurinol, docetaxel, gemcitabine, doxorubicin liposomal, linezolid, granisetron, ondansetron, vinorelbine

IV Preparation

Reconstitute w/ D5W, NS, dextrose/saline or LR to a final concentration of 20 mg/mL

IV Administration

IVP: bolus 15 min before ifosfamide

Intermittent infusion over 15-30 min

Continuous Infusion: may be added to ifosfamide/cyclophosphamide in infusion bag

  • Additive compatibility w/ cyclophosphamide shown only in D5W & LR

Multiple protocols exist; check institutional guidelines

Storage

Store unopened vials at 20-25°C (68-77°F)

Opened ampoules will oxidize to dimesna upon exposure to air

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Images

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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.

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  • View the formulary and any restrictions for each plan.
  • Manage and view all your plans together – even plans in different states.
  • 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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