Home Drug Guide Ifosfamide

Drug Guide

Generic Name

Ifosfamide

Brand Names Ifex

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Alkylating agent

FDA Approved Indications

  • Treatments of various cancers including testicular germ cell tumors, sarcomas, and lymphoma

Mechanism of Action

It works by cross-linking DNA strands, inhibiting DNA synthesis, leading to cell death, especially in rapidly dividing cancer cells.

Dosage and Administration

Adult: Dose varies based on type of cancer; typically IV infusion, with dosing schedules tailored per treatment protocol.

Pediatric: Dosing based on body surface area or weight; administered via IV infusion under careful monitoring.

Geriatric: Adjusted dose due to potential increased toxicity; start at lower dose and titrate as tolerated.

Renal Impairment: Use caution; dose adjustment may be necessary as renal clearance is affected.

Hepatic Impairment: Use with caution; hepatic metabolism may be impaired, requiring dose adjustments.

Pharmacokinetics

Absorption: Not applicable; administered parenterally.

Distribution: Widely distributed in body water, crosses the blood-brain barrier.

Metabolism: Primarily hepatic metabolism via cytochrome P450 enzymes, producing active and inactive metabolites.

Excretion: Renal excretion of metabolites; some excretion via bile.

Half Life: Approximately 7 to 14 hours, depending on renal function.

Contraindications

  • Hypersensitivity to ifosfamide or other oxazolidines.
  • Bone marrow suppression.
  • Active infections.

Precautions

  • Use with caution in patients with renal or hepatic impairment, as dose adjustments are necessary.
  • Adequate hydration is essential to prevent hemorrhagic cystitis.

Adverse Reactions - Common

  • Nausea and vomiting (Very common)
  • Hemorrhagic cystitis (Common)
  • Myelosuppression (neutropenia, thrombocytopenia, anemia) (Common)

Adverse Reactions - Serious

  • Severe myelosuppression leading to infection or bleeding (Serious)
  • CNS disturbances (confusion, hallucinations, coma) (Less common)
  • Secondary malignancies (e.g., secondary leukemia) (Rare)

Drug-Drug Interactions

  • Other myelosuppressive agents; nephrotoxic drugs; drugs affecting hepatic enzymes.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood counts, renal function, hepatic function, and hydration status.

Diagnoses:

  • Risk for infection
  • Imbalanced fluid volume
  • Risk for bleeding

Implementation: Ensure adequate hydration before, during, and after administration; monitor labs regularly; observe for signs of hemorrhagic cystitis.

Evaluation: Assess blood counts, renal function, and for adverse effects; evaluate treatment response.

Patient/Family Teaching

  • Report any signs of bleeding, infection, or urinary changes.
  • Maintain hydration and follow dietary restrictions.
  • Understand the importance of routine labs and follow-up appointments.

Special Considerations

Black Box Warnings:

  • Hemorrhagic cystitis, secondary malignancies, and neurotoxicity.

Genetic Factors: Patients with certain genetic polymorphisms affecting hepatic enzymes may require dose adjustments.

Lab Test Interference: May cause anemia, leukopenia, thrombocytopenia; monitor applicable labs.

Overdose Management

Signs/Symptoms: Severe myelosuppression, neurotoxicity, hemorrhagic cystitis.

Treatment: Supportive care, hydration, and possibly use of mesna for uroprotection; symptomatic management.

Storage and Handling

Storage: Store in a secure, dry place, protected from light.

Stability: Stable under recommended storage conditions; check manufacturer's instructions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.