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Ifosfamide

(eye-foss-fuh-mide)

Trade/other name(s): Ifex, isophosphamide

Why would this drug be used?

Ifosfamide is used to treat certain testicular cancers. It is sometimes used for bone and soft tissue sarcomas or other types of cancer.

How does this drug work?

Ifosfamide is a member of a group of chemotherapy drugs known as alkylating agents. It stops or slows the growth of cancer cells.

Before taking this medicine

Tell your doctor…

  • 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 an infection or problem with passing urine. This drug may worsen these problems.
  • If you have ever been treated with radiation or chemotherapy. Your doctor may watch you more closely for certain side effects.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug can cause problems if taken at the time of conception or during pregnancy (see “Precautions” section).
  • If you are breast-feeding. This drug passes into breast milk and may harm the baby. Women should not breast-feed while getting this drug.
  • If you think you might want to have children in the future. This drug can cause early menopause, as well as fertility problems in both males and females. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • 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.

Interactions with other drugs

The following drugs may affect ifosfamide levels in your body:

  • Anti-seizure drugs such as phenobarbital (Luminal), phenytoin (Dilantin), and carbamazepine (Tegretol)
  • Rifampin (a drug used to treat tuberculosis)
  • The anti-cancer drugs thiotepa (Thioplex) and sorafenib (Nexavar)
  • Anti-fungal drugs such as ketoconazole, fluconazole, itraconazole, and voriconazole
  • The herbal supplement St. John’s wort

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)
  • Dabigatran (Pradaxa)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Any type of heparin injections, such as enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep)

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.

There have been reports of more brain and nerve damage when this drug is used with the anti-nausea drug aprepitant (Emend)

Alcohol or any drug that makes you sleepy or affects the brain (such as nausea medicines, narcotic pain relievers, and antihistamines) can worsen ifosfamide’s effects on the brain (see “Precautions” section).

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

Interactions with foods

Alcohol is not recommended while taking this drug. Grapefruit and grapefruit juice might decrease the effects of this drug. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Ifosfamide is given in a vein over a period of time from half an hour to 24 hours for a few days. Because ifosfamide can hurt your kidneys and bladder, you will likely be given fluids in the vein to help flush out the drug. You should also be given mesna, a drug that helps protect the bladder. If you take mesna by mouth, make sure you take it exactly as prescribed by your doctor.

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.

Precautions

This drug can affect the brain. Do not drive or do anything requiring alertness until you know how the drug affects you. Call your doctor if you notice extreme sleepiness, dizziness, confusion, depression, seizures, blurred vision, or hallucinations (seeing or hearing things that aren’t there). These symptoms usually go away when the drug is stopped, but you may need extra help until they do.

Ifosfamide can damage the kidneys and cause serious bleeding in the bladder, so it should always be given with fluids in the vein and with mesna, a drug that helps to protect the bladder. 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. Kidney damage may continue for months or even years after the drug is stopped.

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. Ifosfamide 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 (see “Interactions with other drugs”). 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.

This drug may affect the heart and its rhythm, inflame the lining around the heart, or cause heart failure. Call your doctor right away if you have heart palpitations or chest pain, or if you retain fluid (swollen feet or ankles), have trouble getting your breath, or notice rapid weight gain.

This drug can damage the lungs, which in some cases might even be life threatening. Tell your doctor or nurse if you have symptoms such as trouble breathing, chest tightness, or a new cough.

This drug can slow wound healing, so your doctor may want to stop the drug if you need any type of surgery or dental procedure.

Rarely, this drug can cause allergic reactions. Tell your doctor or nurse right away if you develop possible symptoms such as rash, hives (itchy welts), fever and chills, or red blotches on your skin. If you have trouble breathing or swallowing, if you have tightness in your throat, swelling of your tongue, lips, or eyes or other serious symptoms, get emergency help.

Men and women should avoid conceiving a baby while on this medicine and for 6 months afterward. This drug should not be taken during pregnancy since it can harm a growing fetus.

This drug might rarely cause a second cancer later in life, sometimes many years after treatment, such as leukemia, lymphoma, thyroid cancer, and sarcoma.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • Nausea*
  • Vomiting*
  • Hair loss
  • Bladder irritation and bleeding, blood in the urine*
  • Frequent or painful urination*
  • Abnormal kidney function
  • Poor appetite
  • Low white blood cell count with increased risk of infection*
  • Anemia (low red blood cell count, which can cause weakness, paleness, shortness of breath)

Less common

  • Pain or inflammation where the drug was injected
  • Low platelet count with increased risk of bleeding*
  • Agitation
  • Dizziness
  • Constipation
  • Mouth pain and sores

Rare

  • Tiredness (fatigue)
  • Confusion*
  • Sleepiness*
  • Seizures*
  • Blurred vision*
  • Ear problems, such as deafness, ringing in the ears, or feeling like the room is spinning or tilting
  • Hallucinations (seeing or hearing things that aren't there)*
  • Severe kidney damage or kidney failure*
  • Allergic reaction*
  • Diarrhea
  • Abnormal heart rhythm*
  • Lung damage*
  • Death due to effects on the brain, lung damage, kidney damage, heart problems, or other causes

*See “Precautions” section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1988.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 11/12/2014
Last Revised: 11/12/2014