Nurses Compass
Drug Guide
Ifosfamide
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/ADrug-Herb Interactions
N/ANursing 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.