Mesna
MESNEX
Pronunciation: MES-na (MES-nex)
What it isThiol compound that binds urinary acrolein; prevention of ifosfamide- and high-dose cyclophosphamide-induced hemorrhagic cystitis.
Why this oneIt protects the urothelium without shielding the tumor; the parent drugs' neuro-, nephro-, and myelotoxicity remain.
What limits itProtection fails if administration does not cover urinary metabolite exposure; hydration remains necessary, and hypersensitivity can occur.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Prophylaxis of ifosfamide-induced hemorrhagic cystitis — IV schedule | adults | 240 mg/m2 IV bolus at 0, 4, and 8 h after each ifosfamide dose (each dose = 20% of ifosfamide dose w/w) | total daily mesna = 60% of ifosfamide dose | maintain 60% ratio; scale with ifosfamide dose |
| Prophylaxis of ifosfamide-induced hemorrhagic cystitis — IV + oral schedule | adults | 240 mg/m2 IV bolus at 0 h (20% of ifosfamide dose), then 480 mg/m2 PO tablets at 2 h and 6 h (each 40% of ifosfamide dose) | total daily mesna = 100% of ifosfamide dose | IV+oral ratio not established for ifosfamide >2 g/m2/day |
Renal Undefined
Hepatic Undefined
Injection multidose vials usable up to 8 days after first puncture; diluted solutions within 24 h
Instructions
- Repeat dosing schedule on each day ifosfamide is given; when ifosfamide dose changes, maintain the mesna:ifosfamide ratio
- If vomiting within 2 h of oral mesna, repeat the dose or give IV mesna
- Maintain adequate hydration and urinary output; monitor urine for hematuria — if severe hematuria despite recommended schedule, ifosfamide dose reduction or discontinuation may be required
- Do not mix injection with epirubicin, cyclophosphamide, cisplatin, carboplatin, or nitrogen mustard; may mix with ifosfamide if ifosfamide ≤50 mg/mL
Available strengths
- tab 400 mg
- inj 100 mg/mL
Cautions
- Systemic hypersensitivity incl. anaphylaxis — may occur on first exposure or after months; discontinue and give supportive care
- Dermatologic toxicity incl. DRESS and SJS/TEN — discontinue
- Benzyl alcohol (injection only) — avoid injection in premature neonates and low-birth-weight infants (gasping syndrome); tablets contain no benzyl alcohol
- Lab interference: false-positive urine ketones (nitroprusside tests) and ascorbic acid (Tillman's reagent); falsely low enzymatic CPK
- Prior reactions to thiol compounds (e.g., amifostine) — cross-risk unclear
Adverse reactions
- >10% (with ifosfamide): nausea, vomiting, constipation, leukopenia, fatigue, fever, anorexia, thrombocytopenia, anemia, granulocytopenia, diarrhea, asthenia, abdominal pain, headache, alopecia, somnolence
- Mesna alone (volunteers): headache, injection-site reactions, flushing, dizziness, transient lymphopenia
- Postmarketing: hypertension, dysgeusia, hepatitis, convulsion, hemoptysis
Pregnancy Used with ifosfamide, which can cause fetal harm — see ifosfamide labeling; mesna alone showed no adverse developmental outcomes in rats/rabbits at ~10x human dose
Lactation Do not breastfeed during treatment and for 1 wk after last dose of mesna or ifosfamide
Cost
| Strength | #/mo | generic $ | CostPlus | |
|---|---|---|---|---|
| 400 mg | tab | 30 qd | not offered | |
| 100 mg/mL | inj | per unit | not offered |
NO BOXED WARNINGS
Principal riskHypersensitivity and dermatologic reactions
Classes and tags
Clinical profile
Defining liabilitySystemic hypersensitivity and severe cutaneous reactions