Ifosfamide Brand Name– Ifex
What is Ifosfamide
Ifosfamide is an intravenous alkylating agent related to the nitrogen mustards; it is a prodrug requiring activation by CYP3A4 for its cytotoxic activity.
It is a synthetic analog of cyclophosphamide, although it has a different spectrum of activity. Ifosfamide carries a black box warning for myelosuppression, neurotoxicity, nephrotoxicity, and hemorrhagic cystitis; it should be administered with mesna and high volume IV fluids.
Ifosfamide is FDA approved for the treatment of advanced testicular cancer; however, it also has several off-label uses including sarcoma, non-Hodgkin lymphoma, and other cancers
Indications
- acute lymphocytic leukemia (ALL)
- bladder cancer
- desmoid tumor
- Ewing’s sarcoma
- non-Hodgkin’s lymphoma (NHL)
- osteogenic sarcoma
- penile cancer
- rhabdomyosarcoma
- soft-tissue sarcoma
- stem cell transplant preparation
- testicular cancer
- thymic carcinoma
- thymoma
- Wilms’ tumor
For use as a third line chemotherapeutic agent in the treatment of germ cell testicular cancer
NOTE: Ifosfamide has been designated an orphan drug by the FDA for the treatment of testicular cancer.
Side Effects
- abdominal pain
- acute cerebellar syndrome
- acute respiratory distress syndrome (ARDS)
- agitation
- agranulocytosis
- alopecia
- amenorrhea
- amnesia
- anaphylactoid reactions
- anemia
- angina
- angioedema
- anorexia
- anovulation
- anuria
- anxiety
- aphasia
- arthralgia
- asterixis
- asthenia
- ataxia
- atrial fibrillation
- atrial flutter
- atrial tachycardia
- azoospermia
- azotemia
- bleeding
- blurred vision
- bone marrow suppression
- bradycardia
- bronchospasm
- bundle-branch block
- capillary leak syndrome
- cardiac arrest
- cardiomyopathy
- cardiotoxicity
- chest pain (unspecified)
- chills
- cholestasis
- colitis
- coma
- confusion
- conjunctivitis
- constipation
- cough
- cylindruria
- delirium
- depression
- diabetes insipidus
- diarrhea
- disseminated intravascular coagulation (DIC)
- dizziness
- drowsiness
- dysarthria
- dysesthesia
- dyspnea
- dysuria
- edema
- elevated hepatic enzymes
- encephalopathy
- enterocolitis
- erythema
- Fanconi syndrome
- fatigue
- fecal incontinence
- fever
- flushing
- GI bleeding
- glycosuria
- growth inhibition
- hallucinations
- headache
- hearing loss
- heart failure
- hematuria
- hemolytic anemia
- hemolytic-uremic syndrome
- hemorrhagic cystitis
- hepatic failure
- hepatotoxicity
- hyperbilirubinemia
- hyperglycemia
- hyperhidrosis
- hypersalivation
- hypertension
- hypocalcemia
- hypoesthesia
- hypokalemia
- hyponatremia
- hypophosphatemia
- hypotension
- hypoxia
- ileus
- immunosuppression
- impaired cognition
- impaired wound healing
- infection
- infertility
- injection site reaction
- interstitial nephritis
- jaundice
- lethargy
- leukoencephalopathy
- leukopenia
- maculopapular rash
- malaise
- mania
- memory impairment
- metabolic acidosis
- methemoglobinemia
- myalgia
- myocardial infarction
- myocarditis
- myoclonia
- nausea
- nephrotoxicity
- neurotoxicity
- new primary malignancy
- ocular irritation
- oligospermia
- oliguria
- oral ulceration
- osteomalacia
- palmar-plantar erythrodysesthesia (hand and foot syndrome)
- palpitations
- pancreatitis
- paranoia
- paresthesias
- pericardial effusion
- pericarditis
- peripheral neuropathy
- petechiae
- phlebitis
- phosphaturia
- pleural effusion
- pneumonitis
- polydipsia
- polyuria
- premature atrial contractions (PACs)
- proteinuria
- pruritus
- psychosis
- pulmonary edema
- pulmonary embolism
- pulmonary fibrosis
- pulmonary hypertension
- pulmonary toxicity
- radiation recall reaction
- rash
- renal failure (unspecified)
- renal tubular acidosis (RTA)
- renal tubular necrosis
- restlessness
- rhabdomyolysis
- seizures
- SIADH
- sinusoidal obstruction syndrome (SOS)
- skin hyperpigmentation
- skin necrosis
- spermatogenesis inhibition
- ST-T wave changes
- Stevens-Johnson syndrome
- stomatitis
- supraventricular tachycardia (SVT)
- testicular atrophy
- thrombocytopenia
- thrombosis
- tinnitus
- toxic epidermal necrolysis
- tremor
- tumor lysis syndrome (TLS)
- urinary incontinence
- urticaria
- vasculitis
- veno-occlusive disease (VOD)
- ventricular fibrillation
- ventricular tachycardia
- vertigo
- visual impairment
- vomiting
Monitoring Parameters
- CBC
- serum creatinine/BUN
- serum phosphate
- serum potassium
- urinalysis
Contraindications
- anemia
- bladder obstruction
- bone marrow suppression
- breast-feeding
- cardiac disease
- cardiotoxicity
- children
- chronic lung disease (CLD)
- contraception requirements
- encephalopathy
- females
- geriatric
- hematuria
- hemorrhagic cystitis
- herpes infection
- hypoalbuminemia
- immunosuppression
- infection
- infertility
- leukopenia
- nephrotoxicity
- neurotoxicity
- pregnancy
- pulmonary disease
- pulmonary toxicity
- radiation therapy
- renal failure
- renal impairment
- reproductive risk
- thrombocytopenia
- urinary tract infection (UTI)
- urinary tract obstruction
- vaccination
- varicella
Interactions
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Amiodarone
- Amobarbital
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Apalutamide
- Aprepitant, Fosaprepitant
- Articaine; Epinephrine
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Atazanavir
- Atazanavir; Cobicistat
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Bexarotene
- Bosentan
- Bupivacaine
- Bupivacaine Liposomal
- Bupivacaine; Lidocaine
- Butabarbital
- Carbamazepine
- Cenobamate
- Ceritinib
- Chloramphenicol
- Chloroprocaine
- Ciprofloxacin
- Cisplatin
- Clarithromycin
- Cobicistat
- Conivaptan
- Crizotinib
- Dabrafenib
- Danazol
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Delavirdine
- Dexamethasone
- Diltiazem
- Docetaxel
- Dronedarone
- Duvelisib
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Enzalutamide
- Erythromycin
- Erythromycin; Sulfisoxazole
- Eslicarbazepine
- Etravirine
- Fedratinib
- Fluconazole
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluvoxamine
- Fosamprenavir
- Fosphenytoin
- grapefruit juice
- Idelalisib
- Imatinib
- Indinavir
- Isavuconazonium
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Itraconazole
- Ketoconazole
- Lefamulin
- Letermovir
- Lidocaine
- Lidocaine; Prilocaine
- Live Vaccines
- Lopinavir; Ritonavir
- Lorlatinib
- Lumacaftor; Ivacaftor
- Mephobarbital
- Mepivacaine
- Mepivacaine; Levonordefrin
- Mitotane
- Modafinil
- Nafcillin
- Nefazodone
- Nelfinavir
- Netupitant, Fosnetupitant; Palonosetron
- Nevirapine
- Nilotinib
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole; Amoxicillin; Rifabutin
- Palifermin
- Penicillamine
- Penicillin G Benzathine; Penicillin G Procaine
- Penicillin G Procaine
- Phenobarbital
- Phenytoin
- Posaconazole
- Prilocaine
- Prilocaine; Epinephrine
- Primidone
- Quinine
- Ribociclib
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Ropivacaine
- Saquinavir
- St. John’s Wort, Hypericum perforatum
- Telithromycin
- Tetracaine
- Tipranavir
- Trandolapril; Verapamil
- Tuberculin Purified Protein Derivative, PPD
- Tucatinib
- Vasopressin, ADH
- Verapamil
- Voriconazole