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
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
Hypersensitivity
- May cause systemic hypersensitivity reactions, including anaphylaxis; these reactions may include fever, cardiovascular symptoms (hypotension, tachycardia), acute renal impairment, hypoxia, respiratory distress, urticaria, angioedema, laboratory signs of disseminated intravascular coagulation, hematological abnormalities, increased liver enzymes, nausea, vomiting, arthralgia, and myalgia
- These reactions may occur with first exposure or after several months of exposure; monitor for signs or symptoms; discontinue therapy and provide supportive care
- This drug is a thiol compound, eg, a sulfhydryl (SH) group-containing organic compound; hypersensitivity reactions to mesna and to amifostine, another thiol compound, reported; it is not clear whether patients who experienced an adverse reaction to a thiol compound are at increased risk for a hypersensitivity reaction to this drug
Dermatologic toxicity
- Drug rash with eosinophilia and systemic symptoms and bullous and ulcerative skin and mucosal reactions, consistent with Stevens-Johnson syndrome or toxic epidermal necrolysis reported
- Therapy may cause skin and mucosal reactions characterized by urticaria, rash, erythema, pruritus, burning sensation, angioedema, periorbital edema, flushing, and stomatitis
- These reactions may occur with first exposure or after several months of exposure; discontinue therapy and provide supportive care
Benzyl alcohol toxicity
- Serious adverse reactions including fatal reactions and “gasping syndrome” occurred in premature neonates and low-birth-weight infants who received benzyl alcohol dosages of 99 to 234 mg/kg/day (blood levels of benzyl alcohol were 0.61 to 1.378 mmol/L)
- Symptoms associated with “gasping syndrome” and other potential adverse reactions include gradual neurological deterioration, seizures, intracranial hemorrhage, hematological abnormalities, skin breakdown, hepatic and renal failure, hypotension, bradycardia, and cardiovascular collapse
- Premature neonates and low-birth-weight infants may be more likely to develop these reactions because they may be less able to metabolize benzyl alcohol; the minimum amount of benzyl alcohol at which toxicity may occur is not known
- Injection formulation contains 10.4 mg/mL of preservative benzyl alcohol; avoid use in premature neonates and low-birth-weight infants; tablets do not contain benzyl alcohol
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
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Mesnex oral - | 400 mg tablet |  | |
| mesna intravenous - | 100 mg/mL vial |  | |
| mesna intravenous - | 100 mg/mL vial |  | |
| mesna intravenous - | 100 mg/mL vial |  | |
| mesna intravenous - | 100 mg/mL vial |  | |
| mesna intravenous - | 100 mg/mL vial |  | |
| mesna intravenous - | 100 mg/mL vial |  | |
| mesna intravenous - | 100 mg/mL vial |  | |
| Mesnex intravenous - | 100 mg/mL vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
mesna oral
MESNA - ORAL
(MESS-na)
COMMON BRAND NAME(S): Mesnex
USES: This medication is used to reduce the risk of bleeding in the bladder (hemorrhagic cystitis), which is a very serious side effect of treatment with a cancer chemotherapy drug called ifosfamide. Mesna helps to protect the lining of the bladder against damage from ifosfamide. The body breaks down ifosfamide to form a product that can harm the bladder, and mesna works by making this product less harmful. However, mesna does not change ifosfamide's anti-cancer effects.
HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start taking mesna and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth. Follow the dosing schedule as directed by your doctor. The dosage is based on your body size and your dose of ifosfamide (or cyclophosphamide).While taking this medication, drink at least a quart (4 cups or 1 liter) of liquid each day unless directed otherwise by your doctor. Doing so will also help to reduce the bladder side effects from the chemotherapy drug.Tell your doctor right away if you vomit within 2 hours of taking a dose. Your doctor will determine if you should repeat the dose or receive mesna by injection into a vein.Mesna is very effective in reducing the risk of hemorrhagic cystitis in most patients. However, it may not work in a small number of patients. Tell your doctor right away if you notice that your urine is pink, red, or bloody.
SIDE EFFECTS: Headache, flushing, dizziness, drowsiness, nausea, vomiting, loss of appetite, diarrhea, constipation, sensitive skin, or flu-like symptoms (such as sore throat, cough, body aches) may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fast heartbeat, swelling ankles/feet, muscle weakness.Get medical help right away if you have any very serious side effects, including: chest pain.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking mesna, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Tell your doctor if you are pregnant or plan to become pregnant. Since mesna is used with a chemotherapy drug, you should not become pregnant during treatment because the chemotherapy drug may harm an unborn baby. Ask about reliable forms of birth control while using this medication and chemotherapy. If you become pregnant, talk to your doctor right away about the risks and benefits of mesna and the chemotherapy drug.It is unknown if this drug passes into breast milk. Since mesna is given with a chemotherapy drug, breast-feeding while using this medication is not recommended during treatment and for 1 week after the last dose of mesna or the chemotherapy drug. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.This medication may interfere with certain lab tests (such as urine ketone test), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.This medication does not protect you from other side effects of ifosfamide. Consult your doctor or pharmacist for more information on how to manage other side effects.Small amounts of blood in the urine cannot be seen without a microscope. A lab test to check for blood in your urine should be done before each dose of ifosfamide. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: It is important to take each dose of this medication as scheduled. If you miss a dose, take it as soon as you remember and contact your doctor for further instructions. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised August 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
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.
