Mesna (sodium 2-mercaptoethanesulfonate)

Mesna Brand Name– Mesnex

What is Mesna

Mesna (sodium 2-mercaptoethanesulfonate) is a chemoprotectant that protects against hemorrhagic cystitis from ifosfamide and other oxazaphosphorine chemotherapy agents (e.g., cyclophosphamide).

Chemoprotectants differ from other rescue medications such as hematopoietic rescue with colony-stimulating factors or replacement therapy with leucovorin in that they are administered prior to the chemotherapy to prevent toxicities.

Mesna provides more effective urinary prophylaxis of hemorrhagic cystitis than other regimens consisting of fluids, administration of diuretics and forced diuresis, and intravesical administration of other sulfhydryl-compounds such as N-acetylcysteine.

Mesna is a superior uroprotectant agent as compared to other sulfhydryl compounds because it remains in the intravascular fluid, is concentrated in the bladder, and is less likely to be absorbed by tumor cells.

Mesna does not interfere with the antitumor activity of ifosfamide or cyclophosphamide. Mesna is indicated as a prophylaxis agent to reduce the incidence of ifosfamide-induced hemorrhagic cystitis.

The FDA approved mesna injection in 1988 and mesna tablets in March 2002.

Indications

  • hemorrhagic cystitis

For prophylaxis of ifosfamide-induced or cyclophosphamide-induced† hemorrhagic cystitis

NOTE: Mesna has been designated an orphan drug by the FDA for this indication.

Side Effects

  1. abdominal pain
  2. alopecia
  3. anaphylactoid reactions
  4. anemia
  5. angioedema
  6. anorexia
  7. anxiety
  8. arthralgia
  9. asthenia
  10. back pain
  11. bullous rash
  12. chest pain (unspecified)
  13. chills
  14. colic
  15. confusion
  16. conjunctivitis
  17. constipation
  18. cough
  19. dehydration
  20. diarrhea
  21. disseminated intravascular coagulation (DIC)
  22. dizziness
  23. drowsiness
  24. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  25. dysgeusia
  26. dyspepsia
  27. dyspnea
  28. dysuria
  29. edema
  30. elevated hepatic enzymes
  31. erythema
  32. fatigue
  33. fever
  34. flatulence
  35. flushing
  36. headache
  37. hematuria
  38. hemoptysis
  39. hepatitis
  40. hyperesthesia
  41. hyperhidrosis
  42. hypertension
  43. hypokalemia
  44. hypotension
  45. hypoxia
  46. influenza
  47. injection site reaction
  48. insomnia
  49. leukopenia
  50. lymphadenopathy
  51. malaise
  52. myalgia
  53. nasal congestion
  54. nausea
  55. pallor
  56. paresthesias
  57. peripheral edema
  58. pharyngitis
  59. photophobia
  60. pruritus
  61. rash
  62. rhinitis
  63. seizures
  64. sinus tachycardia
  65. skin ulcer
  66. Stevens-Johnson syndrome
  67. stomatitis
  68. thrombocytopenia
  69. toxic epidermal necrolysis
  70. urticaria
  71. vomiting
  72. xerostomia

Monitoring Parameters

  • pregnancy testing
  • urinalysis

Contraindications

  • autoimmune disease
  • benzyl alcohol hypersensitivity
  • breast-feeding
  • contraception requirements
  • hematuria
  • infants
  • laboratory test interference
  • neonates
  • polyarteritis nodosa
  • pregnancy
  • pregnancy testing
  • rheumatoid arthritis
  • systemic lupus erythematosus (SLE)

Mesna is contraindicated in patients with hypersensitivity to thiol compounds.

Interactions

There are no drug interactions associated with Mesna products.

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