15 . November , 2018 - Thursday
Check todays hot topics or new products

Find a Drug: Advanced

Please Sign in or Register

All about: Ifosfamide

Big Image Pronouncation: (eye-FOSS-fuh-MIDE)
Class: Nitrogen mustard

Trade Names:
- Powder for injection 1,000 mg
- Powder for injection 3,000 mg

Mechanism of Action


Ifosfamide requires metabolic activation by microsomal liver enzymes to produce biologically active metabolites. Enzymatic oxidation of the chloroethyl side chains and subsequent dealkylation produces the major urinary metabolites, dichloroethyl ifosfamide and dichloroethyl cyclophosphamide. The alkylated metabolites of ifosfamide interact with DNA.



Requires metabolic activation by hydroxylation.


Mean t ½ is approximately 15 h (at doses of 3.8 to 5 g/m 2 ). Mean t ½ is approximately 7 h (at doses of 1.6 to 2.4 g/m 2 ). 70% to 86% is excreted in the urine.

Indications and Usage

Germ cell testicular cancer.

Unlabeled Uses

Soft-tissue, Ewing and osteogenic sarcomas; non-Hodgkin lymphomas; small cell lung, pancreatic, bladder, cervical, and ovarian carcinoma.


Continued use in patients with severely depressed bone marrow function; hypersensitivity to ifosfamide.

Dosage and Administration

Germ Cell Testicular Cancer

IV 1,200 mg/m 2 /day for 5 days, repeating this course every 3 wk. Delay further courses until platelets are least 100,000/mm 3 and WBC at least 4,000/mm 3 .

Germ Cell Testicular Cancer, Other Regimens

IV Other regimens use ifosfamide 2,000 mg/m 2 /day on days 1 through 3 (MAID regimen, total dose is 6,000 mg/m 2 over 72 h), or doses as high as 5,000 mg/m 2 continuous infusion for 24 h in combination with other antineoplastics.

General Advice

  • Reconstitute powder with sterile water for injection or bacteriostatic water for injection.
  • Reconstitute 1,000 mg ifosfamide with 20 mL diluent for a final concentration of 50 mg/mL; 3,000 mg ifosfamide with 60 mL diluent for a final concentration of 50 mg/mL.
  • Reconstituted 50 mg/mL solution may be further diluted to concentrations of 0.6 to 20 mg/mL with 5% dextrose, 0.9% sodium chloride, Lactated Ringer's solution, or sterile water for injection. Because stability is unchanged, other concentrations or mixtures of these solutions may be used, including 2.5% dextrose, 0.45% sodium chloride, or 5% dextrose with 0.9% sodium chloride.
  • Ifosfamide, at a concentration of 100 mg/mL, is incompatible with bacteriostatic water for injection with benzyl alcohol. It is compatible at ifosfamide concentrations of up to 60 mg/mL.
  • Administer by IV infusion over 30 or more minutes, continuous IV infusion.


  • Store powder at room temperature; avoid temperatures higher than 104°F.
  • Solutions reconstituted with Bacteriostatic Water for Injection are stable for 1 wk at room temperature or 3 wk under refrigeration.
  • Refrigerate solutions reconstituted with Sterile Water for Injection and use within 6 h of reconstitution.
  • Diluted solutions are chemically stable for up to 1 wk at room temperature and for up to 6 wk under refrigeration in glass or plastic bags. Consider the possibility of microbial contamination of diluted solutions. Use preservative-free solutions within 24 h.

Drug Interactions

Ifosfamide may increase the hypoprothrombinemic effect of warfarin.

Laboratory Test Interactions

None well documented.

Adverse Reactions


Somnolence; confusion; depression; hallucinations. CNS effects more common in patients with renal dysfunction, hypoalbuminemia, or receiving large single doses.




Moderate potential for nausea and vomiting; elevated liver function tests.


Hematuria, dysuria, urinary frequency; hemorrhagic cystitis, which can be prevented with the administration of mesna.


Bone marrow suppression, nadir at 7 to 14 days.


Allergic reactions observed with ifosfamide also can be attributed to mesna.


Renal tubular acidosis; Fanconi-like syndrome.




When given in combination with other chemotherapeutic agents, severe myelosuppression is frequent. It consisted mainly of leukopenia and, to a lesser extent, thrombocytopenia. A WBC count less than 3,000/mm 3 is expected in 50% of patients given ifosfamide alone at 1.2 g/m 2 /day for 5 consecutive days. At this dose level, thrombocytopenia (platelets less than 100,000/mm 3 ) occurred in approximately 20% of patients. At total dosages of 10 to 12 g/m 2 /cycle, 50% of the patients had a WBC count less than 1,000/mm 3 and 8% had platelet counts less than 50,000/mm 3 . Myelosuppression is usually reversible, and treatment can be given every 3 to 4 wk. Close hematologic monitoring is recommended.

Neurologic manifestations

Somnolence, confusion, hallucinations, and, in some instances, coma occurred.

Urotoxic side effects

Hemorrhagic cystitis frequently associated with ifosfamide. Obtain a urinalysis prior to each dose. Use ifosfamide with a protector, such as mesna, to prevent hemorrhagic cystitis.


Category D .


Excreted in breast milk.


Safety and efficacy not established.

Renal Function

Use with caution. Clinical signs (eg, elevation in BUN or serum creatinine or decrease in Ccr) were usually transient and most likely related to tubular damage.


At doses of 1.2 g/m 2 /day for 5 consecutive days without a protector, microscopic hematuria is expected in approximately 50% of the patients and gross hematuria in approximately 8% of patients. Dose fractionation, vigorous hydration (at least 2 L/day) and a protector (eg, mesna) can significantly reduce hematuria incidence, especially gross hematuria, associated with hemorrhagic cystitis.


Can cause local irritation or phlebitis. Refer to your institution-specific protocol.

Compromised bone marrow reserve

Administer cautiously to patients with leukopenia, granulocytopenia, extensive bone marrow metastases, prior therapy with radiation or other cytotoxic agents.

Wound healing

Ifosfamide may interfere with normal wound healing.

Patient Information

  • Notify health care provider of the following: unusual bleeding/bruising; fever; chills; sore throat; cough; shortness of breath; seizures; lack of menstrual flow; unusual lumps or masses; flank, stomach, or joint pain; sores in mouth or on lips; yellow discoloration of skin or eyes.
  • Contraceptive measures are recommended during therapy for men and women.

Recent Drug Updates at DrugIndexOnline:

ammonium lactate and urea topical ammonium lactate and urea topical
Generic Name: ammonium lactate and urea (topical) (a MONE ee um LAK tayt) Brand Names: Ultralytic, Ultralytic 2 What is ammonium lactate and urea? Ammonium lactate is a combination of lactic acid and ammonium hydroxide. Ammonium lactate is a moisturizer. Urea loosens thick or scaly skin more...

Aristocort D Topical Aristocort D Topical
Some commonly used brand names are: In the U.S.— Alphatrex 3 Aristocort 20 Aristocort A 20 Betatrex 3 Beta-Val 3 Bio-Syn 9 Cordran 11 Cordran SP 11 Cormax 4 Cutivate 12 Cyclocort 1 Delta-Tritex 20 Dermabet 3 Dermatop 19 Diprolene 3 Diprolene AF 3 Diprosone 3 Elocon 18 Florone 7 Florone E more...

Cefepime Cefepime
Some commonly used brand names are: In the U.S.— Ancef 4 Ceclor 1 Ceclor CD 1 Cedax 17 Cefadyl 23 Cefditoren 8 Cefizox 18 Cefobid 10 Cefotan 12 Ceftin 20 Cefzil 15 Ceptaz 16 Claforan 11 Duricef 2 Fortaz 16 Keflex 21 Keftab 21 Kefurox 20 Kefzol 4 Mandol 3 Maxipime 6 Mefoxin 13 Monocid 9 Om more...

clofibrate clofibrate
Generic Name: clofibrate (kloe FIB rate) Brand Names: Atromid-S What is clofibrate? Clofibrate is used to lower high levels of cholesterol (a type of fat) in the blood. Clofibrate is especially good at lowering triglycerides and very-low-density lipoprotein (VLDL) (a form of cholesterol) more...

Dexasol Drops Dexasol Drops
Generic Name: Dexamethasone Eye Drops (DEX-ah-METH-ah-sone) Brand Name: DexasolDexasol Drops is used for:Treating swelling, itching, redness, and irritation of the eyes and eyelids. It may also be used in the ear canal to treat inflammation of the outer ear. It may also be used to treat other co more...

Metipranolol Metipranolol
Dosage Form: Solution / drops DESCRIPTION Metipranolol ophthalmic solution 0.3% is a sterile solution that contains Metipranolol, a non-selective beta-adrenergic receptor blocking agent. Metipranolol is a white, odorless, crystalline powder. The chemical name of Metipranolol is (±)-1-(4-H more...

Moxifloxacin Hydrochloride Moxifloxacin Hydrochloride
Pronouncation: (MOX-i-FLOX-a-sin hye-droe-KLOR-ide) Class: Antibiotic, Fluoroquinolone Trade Names: Avelox - Tablets 400 mg Trade Names: Avelox IV - Injection (premix) 400 mg Trade Names: Vigamox - Solution, ophthalmic 0.5% (5 mg/mL) Mechanism of Action Pharmacology Interferes with microbial DNA sy more...

Propulsid Propulsid
Generic Name: cisapride (oral) (SISS a pride) Brand Names: Propulsid What is cisapride? Cisapride increases the rate at which your esophagus, stomach, and intestines move during digestion. It also increases the rate at which your stomach empties into your intestines and increases the str more...