Brand and Other Names:Mesnex
- Classes: Uroprotectants
Dosing & Uses
Dosage Forms & Strengths
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
Injection site reaction
Hypersensitivity to mesna or other thiol compounds
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
Pregnancy & Lactation
Pregnancy Category: B
Lactation: not known if excreted in breast milk, do not nurse
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.
Mesna: 0.36 hr
Dimesna: 1.17 hr
- Mesna: 4 hr
- Dimesna: 3 hr
- Mesna: 3.3 mcg/mL (PO)
- Dimesna: 7.3 mcg/mL (PO)
Protein Bound: 69-75% (mesna+dimesna)
Vd: 0.65 L/kg
Metabolites: mesna disulfide
Mechanism of Action
Mesna: synthetic sulfhydryl (thiol) compound: binds & detoxifies ifosfamide metabolites in bladder/kidney
Mesna disulfide (dimesna): inert metabolite
Additive: carboplatin, cisplatin, ifosfamide/epirubicin
Y-site: amphotericin B cholesteryl sulfate
Solution: D5W, NS, LR, D5/½NS
Additive: ifosfamide, hydroxyzine
Y-site (partial list): allopurinol, docetaxel, gemcitabine, doxorubicin liposomal, linezolid, granisetron, ondansetron, vinorelbine
Reconstitute w/ D5W, NS, dextrose/saline or LR to a final concentration of 20 mg/mL
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
Store unopened vials at 20-25°C (68-77°F)
Opened ampoules will oxidize to dimesna upon exposure to air
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