Brand name: Ifex    

Generic name : Ifosfamide 

Other names: Mitoxana , Isophosphamide

Therapeutic Class: alkylating agents 

Availability: Ifosfamide is available by prescription only  

Indications: Ifosfamide is used in the treatment of a variety of cancers, mainly: 

• testicular cancer 
• breast cancer 
• lung cancer 
• cervical cancer 
• ovarian cancer
• bone cancer 
• soft tissue sarcoma 
• osteogenic sarcoma (also called osteosarcoma)
• Lymphoma (Hodgkin's and Non-Hodgkin's).  

 Ifosfamide can also be prescribed for other medical conditions not mentioned in this article; talk to your doctor or pharmacist for more information.  

Dosage form: Ifosfamide is given by injection into a vein 

Dosage: Usually, before recommending an appropriate dosage of Ifosfamide, your doctor will consider several factors, mainly your health, taking other drugs or not, your body masses index and the type and severity of cancer.  

In general, Ifosfamide is given intravenously (into a vein), once a day for five days a week. The injection often last at least 30 minutes. The treatment is then repeated every three or four weeks until the full therapy is complete. Depending on your body reaction to the drug, your oncologist may change the way you are taking Ifosfamide, which makes the length of treatment can vary from one patient to another. 

Throughout the therapy and even months after, it is important that you keep all appointments with your doctor. Ifosfamide can cause serious urinary side effects and even death in fragile patients.  Ifosfamide should be administered with care by health professionals. The drug should also be given in a hospital or a medical center that has sterilization equipments needed for its preparation.  

Ifosfamide is eliminated by your bladder and kidneys. Therefore, it is important that you drink plenty of fluids every day during the treatment; 8 to 12 cups of water per day are recommended. Do your best to urinate every two hours throughout the period of wakefulness and at least once during the night; this is important to prevent damage to the bladder and kidneys. If you still develop kidney problems, contact your physician so that he can prescribe you Mesna, a drug used to reduce side effects of cancer chemotherapy involving cyclophosphamide and ifosfamide. 

Overdose:  as with any drug, ifosfamide overdose can be dangerous. An overdose of ifosfamide can damage the bone marrow, leading to cause serious urinary problems or death. In fact, even at normal doses, ifosfamide can cause serious urinary side effects. During the treatment, drink plenty of fluids; keep all appointments with your doctor.  

Missing dose: because Ifosfamide is administered in hospital, it is basically difficult for you to miss any dose if you present for the treatment. Therefore, it is very important to keep all appointments with your doctor . If for some reasons you cannot be present at the hospital for the therapy, contact your oncologist before the date scheduled for the injection.  

Contraindication: Ifosfamide is contraindicated or should be used with precaution in the following conditions:  

• Pregnancy
• breastfeeding 
• actives infections  
• kidney failure  
• liver failure 
• low number of white blood cells 
• decreased platelet count
• cystitis (bladder inflammation) 
• obstruction of urinary tract  
• allergic to Ifosfamide or one of its ingredients  
• Advanced cerebral arteriosclerosis (hardening of the arteries of the brain).  

Mechanism of action (MOA):   Ifosfamide belongs to the class of alkylating agents; it slows or stops the growth of cancer cells by attacking their DNA, a material essential for the reproduction of cells. 

Interactions:  talk you to your doctor before taking aspirin, vitamins, nutritional supplements, or any prescription medication. Certain medicines may interact with Ifosfamide. Tell your doctor or pharmacist if you are taking any of these medications: 

• Interferons (Actimmune, Avonex, Betaseron, Rebif, and others) 
• Aids/HIV medications such as didanosine (Videx) and stavudine (Zerit)  
• sulfinpyrazone (Anturane)
• Probenecid (Benuryl)
• Live vaccins vivants  
• Ganciclovir, an antiviral drug
• Azathioprine, an immune system inhibitor 
• Barbiturates, depressant drug that causes relaxation and sleepiness
• Cimetidine , a drug used to inhibit the production of acid in the stomach
• Colchicines , a medication used to treat pain of gouty arthritis 
• Cyclophosphamide (Cytoxan), a medication of the alkylating agent family used to treat a variety of cancers 
• Cyclophosphamide (Cytoxan, Cytoxan, Neosar, Procytox, Revimmune), a drug used to treat several types of cancers

Side effects: Ifosfamide not only attack cancer cells but also non malignant cells, which often leads, in most patients, to the following side effects: hair loss, constipation, diarrhea,  difficulty sleeping, decreased appetite, mild nausea and vomiting, and unusual tiredness or fatigue.

Contact your doctor immediately if you experience any of these symptoms:  

• anxiety
• depression
• painful urination or red urine 
• black, tarry stools 
• unusual bruising or bleeding 
• persistent cough 
• congestion 
• signs of infections: fever, chills, sore throat, rash, etc. 
• dizziness
• shortness of breath 
• nausea and vomiting 
• agitation, confusion, or hallucinations.  

Reference 

1 - nlm.nih.gov, Ifosfamide: side effects   

2 - santecheznous.com, Comment doit-on employer ce médicament ? (how to use this medication?)