No

Antidote

Detoxifying agent used as a protectant against hemorrhagic cystitis induced by ifosfamide and cyclophosphamide

B

Hypersensitivity to mesna or other thiol compounds

Examine morning urine specimen for hematuria prior to ifosfamide or cyclophosphamide treatment; if hematuria (>50 RBC/HPF) develops, reduce the ifosfamide/cyclophosphamide dose or discontinue the drug; will not prevent or alleviate other toxicities associated with ifosfamide or cyclophosphamide and will not prevent hemorrhagic cystitis in all patients. Allergic reactions have been reported in patients with autoimmune disorders. Symptoms ranged from mild hypersensitivity to systemic anaphylactic reactions.

1% to 10%:

Cardiovascular: Hypotension

Central nervous system: Malaise, headache

Gastrointestinal: Diarrhea, nausea, vomiting, bad taste in mouth, soft stools

Neuromuscular & skeletal: Limb pain

<1%: Skin rash, itching

Decreased effect: Warfarin: Questionable alterations in coagulation control

Diluted solutions are chemically and physically stable for 24 hours at room temperature; polypropylene syringes are stable for 9 days at refrigeration or room temperature; injection diluted for oral administration is stable 24 hours at refrigeration

Incompatible with cisplatin

Compatible with bleomycin, cyclophosphamide, dexamethasone, etoposide, lorazepam, potassium chloride

Binds with and detoxifies acrolein and other urotoxic metabolites of ifosfamide and cyclophosphamide; detoxifying agent used to prevent hemorrhagic cystitis induced by ifosfamide and cyclophosphamide. In the kidney, mesna is reduced to a free thiol compound which reacts chemically with the acrolein and 4-hydroxy-ifosfamide resulting in detoxification.

Absorption: From the GI tract

Peak plasma levels: 2-3 hours after administration

Distribution: No tissue penetration; following glomerular filtration, mesna disulfide is reduced in renal tubules back to mesna

Metabolism: Rapidly oxidized intravascularly to mesna disulfide; mesna disulfide is reduced in renal tubules back to mesna following glomerular filtration.

Half-life: Parent drug: 24 minutes; Mesna disulfide: 72 minutes

Elimination: Unchanged drug and metabolite are excreted primarily in the urine; time it takes for maximum urinary mesna excretion: 1 hour after I.V. and 2-3 hours after an oral mesna dose

Children and Adults (refer to individual protocols); oral dose is approximately equivalent to 2 times the I.V. dose

Ifosfamide: 20% W/W of ifosfamide dose 15 minutes before ifosfamide administration and 4 and 8 hours after each dose of ifosfamide; total daily dose is 60% to 100% of ifosfamide; for high dose ifosfamide: 20% W/W 15 minutes before ifosfamide administration, and every 3 hours for 3-6 doses, some regimens use up to 160% of the total ifosfamide dose

Cyclophosphamide: 20% W/W of cyclophosphamide dose 15 minutes prior to cyclophosphamide administration and 4 and 8 hours after each dose of cyclophosphamide; total daily dose = 60% to 200% of cyclophosphamide dose

Oral: 40% W/W of the ifosfamide or cyclophosphamide agent dose in 3 doses at 4-hour intervals OR 20 mg/kg/dose every 4 hours x 3 (oral mesna is not recommended for the first dose before ifosfamide or cyclophosphamide)

Urinalysis

False-positive urinary ketones with Multistix® or Labstix®

May cause malaise

None reported

This drug is given (I.V.) to help prevent side effects of other chemotherapeutic agents you are taking. Breast-feeding precautions: Do not breast-feed.

Used concurrent with and/or following high-dose ifosfamide or cyclophosphamide; mesna also has been administered orally with carbonated beverages or juice (most palatable in grape juice); administer by I.V. infusion over 15-30 minutes or per protocol; mesna can be diluted in D₅W or NS to a final concentration of 1-20 mg/mL

Injection: 100 mg/mL (2 mL, 4 mL, 10 mL)

Ben Yehuda A, Heyman A and Steiner Salz D, "False Positive Reaction for Urinary Ketones With Mesna," Drug Intell Clin Pharm, 1987, 21(6): 547-8.

Brock N and Pohl J, "The Development of Mesna for Regional Detoxification," Cancer Treat Rev, 1983, 10(Suppl A):33-43.

"Cancer Chemotherapy," Med Lett Drugs Ther, 1989, 31(793):49-56.

Pohl J, "Toxicology, Pharmacology, and Interactions of Sodium 2-Mercaptoethane Sulfonate (Mesna)," Curr Chemotherapy, 1981, 2:1387-9.

Schoenike SE and Dana WJ, "Ifosfamide and Mesna," Clin Pharm, 1990, 9(3):179-91.