Ifosfamide

IFEX

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Pronunciation: eye-FOS-fa-mide

Ifosfamide ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Ifosfamide ballicule

Ifosfamide IFEX mascot mnemonic cartoon — Visual mnemonic: Ifosfamide mascot
**“Eye fossil effects”**

What it isAlkylating prodrug related to cyclophosphamide; sarcoma, testicular and cervical cancer.

Why this oneIt has activity in sarcoma where cyclophosphamide does not.

What limits it⚑ Chloroacetaldehyde encephalopathy may require methylene blue. Hemorrhagic cystitis requires mesna and hydration.

Ifosfamide molecular structure (skeletal formula) — Molecular structure: Ifosfamide

FDA-approved for

testicular cancer (1988)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Myelosuppression (severe, fatal infections), encephalopathy (may be fatal), nephrotoxicity/renal failure, and hemorrhagic cystitis (reduced by mesna).

FDA dosing	Population	Start	Target	Max
Antineoplastic (individualize per regimen)	Adults	1.2 g/m²/day IV ×5 consecutive days	1.2 g/m²/day ×5 days, repeat q3wk

Renal Closely monitor and consider dosage modifications (renally excreted; dialyzable)

Hepatic Closely monitor for adverse reactions

Repeat every 3 weeks or after recovery from hematologic toxicity

Instructions

Administer mesna to reduce hemorrhagic cystitis
Extensive hydration ≥2 L oral/IV fluid per day
Slow IV infusion over at least 30 minutes
Individualize dose/schedule; repeat every 3 weeks or after hematologic recovery

Available strengths

inj 1, 3 g

Contraindications

Urinary outflow obstruction

Cautions

Myelosuppression
Encephalopathy/CNS toxicity
Nephrotoxicity and urotoxicity
Cardiotoxicity
Pulmonary toxicity
Secondary malignancies
Veno-occlusive liver disease
Embryo-fetal toxicity
Infertility
Anaphylactic/anaphylactoid reactions

Adverse reactions

Alopecia
Nausea/vomiting
Hematuria
Leukopenia
Anemia
CNS toxicity
Infection

Pregnancy Can cause fetal harm; fetal growth retardation and neonatal anemia reported

Lactation Excreted in breast milk; do not breastfeed during and for 1 week after last dose

Cost

Ifosfamide (IFEX)

Strength		#/mo	generic $/unit	CostPlus
1 g	inj	per unit		not offered
3 g	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Ifosfamide is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

⚠ BOXED WARNINGS

Hemorrhagic cystitis
Neurotoxicity
Myelosuppression

Classes and tags

Clinical profile

Therapeutic safety burden4 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk3 / 4

Legacy pregnancy categoryD

Defining liabilityEncephalopathy, hemorrhagic cystitis and renal/marrow toxicity

Active metabolites

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Memory aids: interaction avatars

CYP2B6 substrate

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