• If you are allergic to anything, including medicines, dyes, additives, or foods.

• If you have ever had any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, or gout. These conditions may require that your medicine dose, regimen, or timing be changed.

• If you have any infection or problem with passing your urine. This drug may worsen these problems.

• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. If either the male or female is taking it at the time of conception or during pregnancy, there's a chance it may cause birth defects. Check with your doctor about what kinds of birth control can be used with this medicine.

• If you are breast-feeding. The drug passes into breast milk and may harm the baby.

• If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.

• If you have ever been treated for cancer with radiation or chemotherapy. Your doctor may watch you more closely for certain side effects.

• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

• anti-seizure drugs phenobarbital (Luminal) and phenytoin (Dilantin)
• rifampin (a TB drug)
• thiotepa, an anti-cancer drug (Thioplex)
• ticlopidine, a blood thinner (Ticlid)

Be sure your doctor knows if you start or stop taking any of these drugs while you are getting ifosfamide.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with ifosfamide. These include:

• vitamin E
• non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
• warfarin (Coumadin)
• ticlopidine (Ticlid)
• clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take.

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Drink plenty of fluids: 3 or more quarts of fluid a day, or at least twelve 8-oz glasses of juice, water, or sports drink (like Gatorade or Powerade) during the first 24 hours after treatment. This will flush your kidneys and make you pass your urine frequently, which will help protect your bladder.

The dose of ifosfamide depends on several factors: your size, how well your kidneys are working, your blood counts, and the type of cancer being treated.

Ifosfamide can damage the kidneys and cause serious bleeding in the bladder, so it should always be given with fluids in the vein and mesna, a drug that helps to protect the bladder wall. Your doctor should tell you how to best get all the fluids you will need. While taking this drug, drink plenty of fluids and empty your bladder often. Your doctor will check your urine for tiny amounts of blood. Call your doctor if you see any blood in your urine, or if it becomes painful to urinate.

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Ifosphamide may affect your immune system. This could make vaccinations ineffective, or even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on organs such as the kidneys. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it completely. Be sure to keep all your appointments for lab tests and doctor visits.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. A low white blood cell count increases your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Wounds may not heal well while you are getting this drug, so your doctor may want to stop the drug if you need surgery.

Avoid conceiving a baby while you are on this medicine and for some time afterward. This drug can harm a growing fetus.

• nausea*
• vomiting*
• hair loss*
• bladder irritation and bleeding, blood in the urine*
• frequent or painful urination*
• abnormal kidney function
• poor appetite
• diarrhea
• low white blood cell count with increased risk of infection*

• pain or inflammation where the drug was injected
• low platelet count with increased risk of bleeding*
• agitation
• dizziness
• constipation

• tiredness (fatigue)
• confusion*
• sleepiness*
• seizures*
• hallucinations (seeing or hearing things that aren't there)*
• severe kidney damage or kidney failure*
• allergic reaction
• abnormal heart rhythm
• death due to effects on the brain or other causes

*See "Precautions" section for more detailed information.