Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 100mg/mL
tablet
- 400mg
Prevention of Ifosfamide Induced Hemorrhagic Cystitis
240 mg/m² (if receiving 1.2 g/m² ifosfamide dose) IVP 15 minutes before & 4 & 8 hours after ifosfamide admin OR
240 mg/m² (if receiving 1.2 g/m² ifosfamide dose) IVP 15 minutes before & 480 mg/m² of mesna tablets 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
Prevention of Cyclophosphamide Induced Hemorrhagic Cystitis (Off-label)
20% of cyclophosphamide dose when injected, 4 and 8 hours after each dose
Safety & efficacy not established
Adverse Effects
>10%
Nausea
Vomiting
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
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)
Will not prevent hemorrhagic cystitis in all patients; examine morning urine specimen for hematuria prior to ifosfamide or cyclophosphamide treatment
Does not prevent or improve other toxicities associated with ifosfamide or cyclophosphamide
If patient vomits within 2 hr after PO dose, repeat dose or give IV
Mesna does not prevent thrombocytopenia-related hematuria
Injection contains preservative benzyl alcohol which has been associated with serious adverse reactions and death when administered intravenously to premature neonates and low birth weight infants; avoid use
Pregnancy & Lactation
Pregnancy
Drug is used in combination with ifosfamide or other cytotoxic agents; ifosfamide can cause fetal harm when administered to a pregnant woman; refer to the ifosfamide prescribing information for more information on use during pregnancy
Mesna injection contains the preservative benzyl alcohol; because benzyl alcohol is rapidly metabolized by a pregnant woman, benzyl alcohol exposure in the fetus is unlikely
Animal data
- In embryo-fetal development studies, oral administration of mesna to pregnant rats (500, 1000, 1500, and 2000 mg/kg) and rabbits (500 and 1000 mg/kg) during period of organogenesis revealed no adverse developmental outcomes at doses approximately 10 times maximum recommended total daily human equivalent dose based on body surface area
Pregnancy testing
- Verify pregnancy status of females of reproductive potential prior to initiation of drug in combination with ifosfamide
Contraception
- Females: Advise females of reproductive potential to use effective contraception during treatment in combination with ifosfamide and for 6 months after last dose
- Males: Advise males with female partners of reproductive potential to use effective contraception during treatment in combination with ifosfamide and for 3 months after last dose
Lactation
Used in combination with ifosfamide or other cytotoxic agents; ifosfamide is excreted in breast milk; refer to the ifosfamide prescribing information for more information on use during lactation; there are no data on presence of mesna in human or animal milk, effect on breastfed child, or on milk production
Formulation contains preservative benzyl alcohol; because benzyl alcohol is rapidly metabolized by a lactating woman, benzyl alcohol exposure in breastfed infant is unlikely; because of potential for serious adverse reactions in breastfed child, advise lactating women not to breastfeed during treatment and for 1 week after last dose
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.
Pharmacology
Mechanism of Action
Oxidized to dimesna in the blood, and is in turn reduced back to mesna in the kidney; synthetic sulfhydryl (thiol) compound binds & detoxifies ifosfamide metabolite acrolein in bladder/kidney
Mesna disulfide (dimesna): Inert metabolite
Pharmacokinetics
Bioavailability: 45-79 %
Protein Bound: 69-75% (mesna plus dimesna)
Metabolism: Kidney
Metabolites: Mesna disulfide
Excretion: Urine (18-32% as mesna; 33% as dimesna)
Distribution: Does not penetrate tissue
Half-life: 0.36 hr (Mesna); 1.17 hr (dimesna)
Peak plasma time: 4 hr (mesna); 3 hr (dimesna)
Peak plasma concentration: 3.3 mcg/mL (PO; mesna); 7.3 mcg/mL (PO; dimesna)
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
Images
Patient Handout
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
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.
- 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.
