Mechanism of Action

A metabolite called acrolein is produced when ifosfamide and cyclophosphamide are metabolized. This metabolite concentrates in the bladder and causes cell death via the upregulation of reactive oxygen species (ROS), and activates inducible nitric oxide synthase (iNOS) which leads to the production of nitric oxide (NO). Both ROS and NO produce products which are detrimental to lipids, proteins, and DNA strands. Furthermore, ROS stimulates gene expression of pro-inflammatory cytokines such as TNF-α AND IL-1β. Acrolein may also lead to ulceration of the bladder urothelium. Mesna protects against cyclophosphamide and ifosfamide-induced hemorrhagic cystitis by binding to their toxic metabolites. Mesna is metabolized to demesne and excreted by the kidneys. Glutathione dehydrogenase acts on the reabsorbed portion and produces free sulfhydryl groups. These free sulfhydryl groups bind acrolein in the bladder, allowing effective excretion and prevention of toxic effects. In addition, Mesna binds to and detoxifies a urotoxic ifosfamide metabolite called 4-hydroxy-ifosfamide.

Mesna reduces the toxicity of urotoxic compounds that may form after chemotherapy administration. Mesna is a water-soluble compound with antioxidant properties and is given concomitantly with the chemotherapeutic agent's cyclophosphamide and ifosfamide. Mesna concentrates in the bladder where acrolein accumulates after administration of chemotherapy and through a Michael addition, forms a conjugate with acrolein and other urotoxic metabolites.[rx] This conjugation reaction inactivates the urotoxic compounds to harmless metabolites. The metabolites are then excreted in the urine.[rx]

Indications
Mesna is a neuroprotective agent and is used prophylactically to reduce ifosfamide and cyclophosphamide-induced hemorrhagic cystitis. Mesna is a neuroprotective agent and is used prophylactically to reduce ifosfamide and cyclophosphamide-induced hemorrhagic cystitis.

(1) Osteosarcoma of bone and articular cartilage of other specified sites [co-prescribed with V03AF01];
(2) Other specified malignant neoplasms of the ovary [co-prescribed with V03AF01];
(3) Germ cell tumor of testis [co-prescribed with V03AF01];
(4) Ewing sarcoma of bone and articular cartilage of unspecified sites [co-prescribed with V03AF01];
(5) Rhabdomyosarcoma primary site [co-prescribed with V03AF01];
(6) Unspecified malignant neoplasms of ill-defined or unspecified sites [co-prescribed with V03AF01];
(7) Burkitt lymphoma including Burkitt leukemia [co-prescribed with V03AF01]; (8) Malignant neoplasms of the kidney, except renal pelvis [co-prescribed with V03AF01]
Hemorrhagic cystitis caused by cyclophosphamide
Hemorrhagic cystitis caused by ifosfamide

Use in Cancer
Mesna is approved to prevent:

Hemorrhagic cystitis (bleeding in the bladder) caused by chemotherapy with ifosfamide.

FDA-approved Indication

Mesna is a prophylactic medication to reduce the incidence of ifosfamide-induced hemorrhagic cystitis.[rx]

It is important to recognize that mesna is not indicated to decrease the risk of hematuria due to thrombocytopenia.

Non-FDA-approved Indications

Mesna is also used widely as a prophylactic medicine to reduce the incidence of cyclophosphamide-induced hemorrhagic cystitis.

Treatment of chemically-assisted dissection of recurrent and residual cholesteatoma[rx]

Reduction of the incidence of BK viruria following post-transplantation cyclophosphamide[rx]

Inhibition of propylene glycol-induced cholesteatoma formation[rx]

Treatment of pain following failed back surgery syndrome via epidural injection[rx]

Treatment of chronic cholesteatomatous otitis media in children[rx]

Contraindications

cancer metastasis to bone
dehydration
low amount of potassium in the blood
Fanconi syndrome, a condition of the kidneys resulting in excessive urination, thirst and vomiting
anemia
decreased blood platelets
low levels of white blood cells
confusion
generalized disorder of peripheral nerves
liver problems
renal tubular acidosis
decreased kidney function
inflammation and bleeding of the bladder due to chemotherapy
coma
the high amount of bilirubin in the blood
abnormal liver function tests
impaired wound healing
pregnancy
a patient who is producing milk and breastfeeding
the operation to remove kidney tissue

Dosage
Strengths: 100 mg/mL; 400 mg
American Society of clinical oncology (ASCO) guidelines recommend following protocols for administering mesna.

Mesna dosing recommendations with standard-dose ifosfamide: ASCO recommends that the daily dose of mesna be calculated to be equivalent to 60% of the total daily dose of ifosfamide, given as three bolus doses given 15 minutes before and four and eight hours after administration of each dose of ifosfamide when the ifosfamide dose is less than 2.5 g/m/day administered as a short infusion. When mesna is used with continuous ifosfamide infusion, it may be given as a bolus dose equivalent to 20% of the total ifosfamide dose, followed by a constant infusion of mesna equivalent to 40% of the ifosfamide dose, given for 12 to 24 hours after completion of the ifosfamide infusion. [rx]
Mesna dosing recommendations with high-dose ifosfamide: The efficacy of mesna for the prevention of urotoxicity with very high-dose ifosfamide (2.5 g/m/day) has not been established. The half-life of ifosfamide is extended at higher doses. Consequently, prolonged mesna dosage regimens may be required for protection against urotoxicity. A higher concentration of ifosfamide (50 mg/mL) is incompatible with mesna and can decrease the stability of ifosfamide.
Mesna dosing recommendations by the oral route: ASCO recommends administering mesna as an IV bolus injection in a dose of 20% of the ifosfamide dose at the time of ifosfamide administration; mesna tablets are administered orally in a dosage equal to 40% of the ifosfamide dose at 2 and 6 hours following each dose of ifosfamide; the total daily dose of mesna is 100% of the ifosfamide dose; patients who vomit within 2 hours of taking oral mesna should repeat the dose or receive IV mesna; the dosing schedule should be repeated on each day that ifosfamide is administered.
Mesna recommendations with cyclophosphamide: Mesna plus saline diuresis or forced saline diuresis is advised to reduce the incidence of urotoxicity associated with high-dose cyclophosphamide. It is important to note that mesna injection should not be mixed with cyclophosphamide, cisplatin, carboplatin, and epirubicin. According to KDIGO (kidney disease improving global outcomes) guidelines, mesna should be administered if the cyclophosphamide dosage is considered high.[rx]

Studies have also shown mesna administration as a topical agent for chemically assisted dissection of recurrent and residual cholesteatoma, most commonly in pediatric patients.[rx] Another study showed that epidural injection of mesna reduced pain following failed back surgery syndrome (FBSS).[rx]
Hemorrhagic Cystitis Prophylaxis

This drug may be given on a fractionated dosing schedule of either 3 bolus IV injections or a single injection followed by 2 oral doses. The dosing schedule should be repeated on each day that ifosfamide is administered. When the dose of ifosfamide is adjusted, the ratio of mesna to ifosfamide should be maintained.
IV: Mesna is given at 20% of the ifosfamide dose once at the time of ifosfamide administration and 20% of the ifosfamide dose 4 and 8 Hours after each dose of ifosfamide (e.g., if ifosfamide were given at 1.2 g/m2 at 0 Hours, the dose of mesna would be 240 mg/m2 given at 0, 4, and 8 Hours after ifosfamide)
ORAL (to be given after one dose of IV mesna): Mesna is given at 40% of the ifosfamide dose at 2 and 6 Hours after each dose of ifosfamide (e.g., if ifosfamide were given at 1.2 g/m2 at Hour 0, the IV dose of mesna would be 240 mg/m2 given at the time of ifosfamide administration (0 Hour) and the oral dose of this drug would be 480 mg/m2 given at 2 and 6 Hours after ifosfamide)
In order to maintain adequate protection, the recommended dosage regimen should be repeated on each day that ifosfamide is administered.
When the dosage of ifosfamide is adjusted (either increased or decreased), the dose of mesna should also be modified accordingly.
Adequate hydration and sufficient urinary output should be maintained, as required for ifosfamide treatment, and urine should be monitored for the presence of hematuria. If severe hematuria develops when mesna is given according to the recommended dosage schedule, dosage reductions or discontinuation of ifosfamide therapy may be required.

Pediatric Dose for Hemorrhagic Cystitis Prophylaxis

Do not give this drug to premature neonates and low-birth-weight infants. This drug may be given on a fractionated dosing schedule of either 3 bolus IV injections or a single injection followed by 2 oral doses. The dosing schedule should be repeated on each day that ifosfamide is administered. When the dose of ifosfamide is adjusted, the ratio of mesna to ifosfamide should be maintained.
IV: Mesna is given at 20% of the ifosfamide dose once at the time of ifosfamide administration and 20% of the ifosfamide dose 4 and 8 Hours after each dose of ifosfamide (e.g., if ifosfamide were given at 1.2 g/m2 at 0 Hours, the dose of mesna would be 240 mg/m2 given at 0, 4, and 8 Hours after ifosfamide)
ORAL (to be given after one dose of IV mesna): Mesna is given at 40% of the ifosfamide dose at 2 and 6 Hours after each dose of ifosfamide (e.g., if ifosfamide were given at 1.2 g/m2 at Hour 0, the IV dose of mesna would be 240 mg/m2 given at the time of ifosfamide administration (0 Hour) and the oral dose of this drug would be 480 mg/m2 given at 2 and 6 Hours after ifosfamide)
In order to maintain adequate protection, the recommended dosage regimen should be repeated on each day that ifosfamide is administered.
When the dosage of ifosfamide is adjusted (either increased or decreased), the dose of mesna should also be modified accordingly.
Adequate hydration and sufficient urinary output should be maintained, as required for ifosfamide treatment, and urine should be monitored for the presence of hematuria. If severe hematuria develops when mesna is given according to the recommended dosage schedule, dosage reductions or discontinuation of ifosfamide therapy may be required.

General:

Do not mix this drug with epirubicin, cyclophosphamide, cisplatin, carboplatin, or nitrogen mustard.
The benzyl alcohol contained in the injection vials can reduce the stability of ifosfamide. Ifosfamide and mesna may be mixed in the same bag provided the final concentration of ifosfamide does not exceed 50 mg/mL. Higher concentrations of ifosfamide may not be compatible with mesna and may reduce the stability of ifosfamide.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Any solutions which are discolored, hazy, or contain visible particulate matter should not be used.

PATIENT COUNSELING INFORMATION

Advise the patient to discontinue this drug and seek immediate medical attention if they experience a hypersensitivity reaction, including systemic anaphylactic reactions.
Advise the patient to take this drug at the exact time and in the exact amount as prescribed.
Advise the patient to contact their healthcare provider if they miss a dose or if they vomit within 2 hours of taking the oral formulation.
This drug does not prevent hemorrhagic cystitis in all patients nor does it prevent or alleviate any of the other adverse reactions or toxicities associated with ifosfamide.
Advise the patient to report to their healthcare provider if his/her urine turns a pink or red color.
Advise the patient to drink 1 to 2 liters of fluid each day during the therapy.
Advise the patient that Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms, and bullous and ulcerative skin and mucosal reactions have occurred.

Side Effects
The Most Common

nausea
Back pain
bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
vomiting
constipation
loss of appetite or weight
diarrhea
abdominal pain
headache
tiredness
dizziness
hair loss
pain or redness at the place where the injection was given
loss of strength and energy
fever
sore throat
cough
flushing
pink or red-colored urine or blood in the urine
swelling of the face, arms, or legs
hives
rash
itching
difficulty breathing or swallowing
chest pain
fast, irregular, or pounding heartbeat
unusual bleeding or bruising

More common

Black, tarry stools
bleeding gums
bloating or swelling of the face, arms, hands, lower legs, or feet
blood in the urine or stools
chest pain
chills
cough
decreased urination
dizziness
dry mouth
fainting
fast, pounding, or irregular heartbeat or pulse
fever
increased thirst
lightheadedness
loss of appetite
mood changes
muscle pain or cramps
nausea
numbness or tingling in the hands, feet, or lips
painful or difficult urination
pinpoint red spots on the skin
rapid breathing
rapid weight gain
seizures
sore throat
sores, ulcers, or white spots on the lips or in the mouth
sunken eyes
swelling
swollen glands
tightness in the chest
trouble breathing
unusual bleeding or bruising
unusual tiredness or weakness
unusual weight gain or loss
vomiting
wrinkled skin

Rare

Blurred vision
confusion
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
sweating
Coughing or spitting up blood
dark urine
general tiredness and weakness
headache
light-colored stools
nervousness
pounding in the ears
slow heartbeat
upper right abdominal or stomach pain
yellow eyes and skin
diarrhea
difficulty having a bowel movement
hair loss
increased sweating
lack or loss of strength
sleepiness or unusual drowsiness
stomach pain
trouble sleeping
weight loss
Belching
feeling of warmth
heartburn
indigestion
redness of the face, neck, arms, and occasionally, upper chest
stomach discomfort or upset

Drug Interactions

anisindione
dicumarol
warfarin
prematurity
autoimmune disorders

Pregnancy and Lactation
FDA pregnancy category B
Pregnancy
As per the manufacturer's labeling information, it is considered the former FDA pregnancy category B medicine. Clinicians should also inform the risk associated with ifosfamide/cyclophosphamide therapy. According to ACOG, in addition to pretreatment fertility conservation counseling, sexually active young women should be informed about the risks of becoming pregnant during cancer treatment. Clinicians should also guide, and women should also receive counseling regarding effective contraception.[rx]
Lactation
An essential consideration of mesna administration is the breastfeeding status of females of reproductive age.[rx] It is not well understood if mesna is present in breast milk; however, benzyl alcohol is often a component of mesna intravenous formulations. The manufacturer indicated that exposure to the breastfeeding infant is unlikely in part due to maternal metabolism. Nonetheless, benzyl alcohol has been linked to adverse events in infants, and therefore breastfeeding is not recommended for at least one week after the last mesna injection.[rx]

Why is this medication prescribed?

Mesna is used to reduce the risk of hemorrhagic cystitis (a condition that causes inflammation of the bladder and can result in serious bleeding) in people who receive ifosfamide (a medication used for the treatment of cancer). Mesna is in a class of medications called cytoprotectants. It works by protecting against some of the harmful effects of certain chemotherapy medications.

How should this medicine be used?

Mesna comes as a solution (liquid) to be injected intravenously (into a vein) by a doctor or nurse in a medical facility. It is usually given at the same time as you receive your chemotherapy treatment and then 4 and 8 hours after your chemotherapy treatment.

Drink at least 1 quart (4 cups; about 1 liter) of fluid daily while you are receiving mesna injection.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Other uses for this medicine

Mesna is also sometimes used to reduce the risk of hemorrhagic cystitis in people who receive the chemotherapy drug cyclophosphamide. Talk to your doctor about the risks of using this medication for your condition.

What special precautions should I follow?

Question

Mechanism of Action





A metabolite called acrolein is produced when ifosfamide and cyclophosphamide are metabolized. This metabolite concentrates in the bladder and causes cell death via the upregulation of reactive oxygen species (ROS), and activates inducible nitric oxide synthase (iNOS) which leads to the production of nitric oxide (NO). Both ROS and NO produce products which are detrimental to lipids, proteins, and DNA strands. Furthermore, ROS stimulates gene expression of pro-inflammatory cytokines such as TNF-α AND IL-1β. Acrolein may also lead to ulceration of the bladder urothelium. Mesna protects against cyclophosphamide and ifosfamide-induced hemorrhagic cystitis by binding to their toxic metabolites. Mesna is metabolized to demesne and excreted by the kidneys. Glutathione dehydrogenase acts on the reabsorbed portion and produces free sulfhydryl groups. These free sulfhydryl groups bind acrolein in the bladder, allowing effective excretion and prevention of toxic effects. In addition, Mesna binds to and detoxifies a urotoxic ifosfamide metabolite called 4-hydroxy-ifosfamide.

Mesna reduces the toxicity of urotoxic compounds that may form after chemotherapy administration. Mesna is a water-soluble compound with antioxidant properties and is given concomitantly with the chemotherapeutic agent's cyclophosphamide and ifosfamide. Mesna concentrates in the bladder where acrolein accumulates after administration of chemotherapy and through a Michael addition, forms a conjugate with acrolein and other urotoxic metabolites.[rx] This conjugation reaction inactivates the urotoxic compounds to harmless metabolites. The metabolites are then excreted in the urine.[rx]



Indications
Mesna is a neuroprotective agent and is used prophylactically to reduce ifosfamide and cyclophosphamide-induced hemorrhagic cystitis. Mesna is a neuroprotective agent and is used prophylactically to reduce ifosfamide and cyclophosphamide-induced hemorrhagic cystitis.

 	(1) Osteosarcoma of bone and articular cartilage of other specified sites [co-prescribed with V03AF01];
 	(2) Other specified malignant neoplasms of the ovary [co-prescribed with V03AF01];
 	(3) Germ cell tumor of testis [co-prescribed with V03AF01];
 	(4) Ewing sarcoma of bone and articular cartilage of unspecified sites [co-prescribed with V03AF01];
 	(5) Rhabdomyosarcoma primary site [co-prescribed with V03AF01];
 	(6) Unspecified malignant neoplasms of ill-defined or unspecified sites [co-prescribed with V03AF01];
 	(7) Burkitt lymphoma including Burkitt leukemia [co-prescribed with V03AF01]; (8) Malignant neoplasms of the kidney, except renal pelvis [co-prescribed with V03AF01]
 	Hemorrhagic cystitis caused by cyclophosphamide
 	Hemorrhagic cystitis caused by ifosfamide

Use in Cancer
Mesna is approved to prevent:


 	Hemorrhagic cystitis (bleeding in the bladder) caused by chemotherapy with ifosfamide.

FDA-approved Indication

 	
Mesna is a prophylactic medication to reduce the incidence of ifosfamide-induced hemorrhagic cystitis.[rx]
 	
It is important to recognize that mesna is not indicated to decrease the risk of hematuria due to thrombocytopenia.

Non-FDA-approved Indications

 	
Mesna is also used widely as a prophylactic medicine to reduce the incidence of cyclophosphamide-induced hemorrhagic cystitis.
 	
Treatment of chemically-assisted dissection of recurrent and residual cholesteatoma[rx]
 	
Reduction of the incidence of BK viruria following post-transplantation cyclophosphamide[rx]
 	
Inhibition of propylene glycol-induced cholesteatoma formation[rx]
 	
Treatment of pain following failed back surgery syndrome via epidural injection[rx]
 	
Treatment of chronic cholesteatomatous otitis media in children[rx]

Contraindications

 	cancer metastasis to bone
 	dehydration
 	low amount of potassium in the blood
 	Fanconi syndrome, a condition of the kidneys resulting in excessive urination, thirst and vomiting
 	anemia
 	decreased blood platelets
 	low levels of white blood cells
 	confusion
 	generalized disorder of peripheral nerves
 	liver problems
 	renal tubular acidosis
 	decreased kidney function
 	inflammation and bleeding of the bladder due to chemotherapy
 	coma
 	the high amount of bilirubin in the blood
 	abnormal liver function tests
 	impaired wound healing
 	pregnancy
 	a patient who is producing milk and breastfeeding
 	the operation to remove kidney tissue

Dosage
Strengths: 100 mg/mL; 400 mg
American Society of clinical oncology (ASCO) guidelines recommend following protocols for administering mesna.

 	Mesna dosing recommendations with standard-dose ifosfamide: ASCO recommends that the daily dose of mesna be calculated to be equivalent to 60% of the total daily dose of ifosfamide, given as three bolus doses given 15 minutes before and four and eight hours after administration of each dose of ifosfamide when the ifosfamide dose is less than 2.5 g/m/day administered as a short infusion. When mesna is used with continuous ifosfamide infusion, it may be given as a bolus dose equivalent to 20% of the total ifosfamide dose, followed by a constant infusion of mesna equivalent to 40% of the ifosfamide dose, given for 12 to 24 hours after completion of the ifosfamide infusion. [rx]
 	Mesna dosing recommendations with high-dose ifosfamide: The efficacy of mesna for the prevention of urotoxicity with very high-dose ifosfamide (>2.5 g/m/day) has not been established. The half-life of ifosfamide is extended at higher doses. Consequently, prolonged mesna dosage regimens may be required for protection against urotoxicity. A higher concentration of ifosfamide (50 mg/mL) is incompatible with mesna and can decrease the stability of ifosfamide.
 	Mesna dosing recommendations by the oral route: ASCO recommends administering mesna as an IV bolus injection in a dose of 20% of the ifosfamide dose at the time of ifosfamide administration; mesna tablets are administered orally in a dosage equal to 40% of the ifosfamide dose at 2 and 6 hours following each dose of ifosfamide; the total daily dose of mesna is 100% of the ifosfamide dose; patients who vomit within 2 hours of taking oral mesna should repeat the dose or receive IV mesna; the dosing schedule should be repeated on each day that ifosfamide is administered.
 	Mesna recommendations with cyclophosphamide: Mesna plus saline diuresis or forced saline diuresis is advised to reduce the incidence of urotoxicity associated with high-dose cyclophosphamide. It is important to note that mesna injection should not be mixed with cyclophosphamide, cisplatin, carboplatin, and epirubicin. According to KDIGO (kidney disease improving global outcomes) guidelines, mesna should be administered if the cyclophosphamide dosage is considered high.[rx]

Studies have also shown mesna administration as a topical agent for chemically assisted dissection of recurrent and residual cholesteatoma, most commonly in pediatric patients.[rx] Another study showed that epidural injection of mesna reduced pain following failed back surgery syndrome (FBSS).[rx]
Hemorrhagic Cystitis Prophylaxis

 	This drug may be given on a fractionated dosing schedule of either 3 bolus IV injections or a single injection followed by 2 oral doses. The dosing schedule should be repeated on each day that ifosfamide is administered. When the dose of ifosfamide is adjusted, the ratio of mesna to ifosfamide should be maintained.
 	IV: Mesna is given at 20% of the ifosfamide dose once at the time of ifosfamide administration and 20% of the ifosfamide dose 4 and 8 Hours after each dose of ifosfamide (e.g., if ifosfamide were given at 1.2 g/m2 at 0 Hours, the dose of mesna would be 240 mg/m2 given at 0, 4, and 8 Hours after ifosfamide)
 	ORAL (to be given after one dose of IV mesna): Mesna is given at 40% of the ifosfamide dose at 2 and 6 Hours after each dose of ifosfamide (e.g., if ifosfamide were given at 1.2 g/m2 at Hour 0, the IV dose of mesna would be 240 mg/m2 given at the time of ifosfamide administration (0 Hour) and the oral dose of this drug would be 480 mg/m2 given at 2 and 6 Hours after ifosfamide)
 	In order to maintain adequate protection, the recommended dosage regimen should be repeated on each day that ifosfamide is administered.
 	When the dosage of ifosfamide is adjusted (either increased or decreased), the dose of mesna should also be modified accordingly.
 	Adequate hydration and sufficient urinary output should be maintained, as required for ifosfamide treatment, and urine should be monitored for the presence of hematuria. If severe hematuria develops when mesna is given according to the recommended dosage schedule, dosage reductions or discontinuation of ifosfamide therapy may be required.

Pediatric Dose for Hemorrhagic Cystitis Prophylaxis

 	Do not give this drug to premature neonates and low-birth-weight infants. This drug may be given on a fractionated dosing schedule of either 3 bolus IV injections or a single injection followed by 2 oral doses. The dosing schedule should be repeated on each day that ifosfamide is administered. When the dose of ifosfamide is adjusted, the ratio of mesna to ifosfamide should be maintained.
 	IV: Mesna is given at 20% of the ifosfamide dose once at the time of ifosfamide administration and 20% of the ifosfamide dose 4 and 8 Hours after each dose of ifosfamide (e.g., if ifosfamide were given at 1.2 g/m2 at 0 Hours, the dose of mesna would be 240 mg/m2 given at 0, 4, and 8 Hours after ifosfamide)
 	ORAL (to be given after one dose of IV mesna): Mesna is given at 40% of the ifosfamide dose at 2 and 6 Hours after each dose of ifosfamide (e.g., if ifosfamide were given at 1.2 g/m2 at Hour 0, the IV dose of mesna would be 240 mg/m2 given at the time of ifosfamide administration (0 Hour) and the oral dose of this drug would be 480 mg/m2 given at 2 and 6 Hours after ifosfamide)
 	In order to maintain adequate protection, the recommended dosage regimen should be repeated on each day that ifosfamide is administered.
 	When the dosage of ifosfamide is adjusted (either increased or decreased), the dose of mesna should also be modified accordingly.
 	Adequate hydration and sufficient urinary output should be maintained, as required for ifosfamide treatment, and urine should be monitored for the presence of hematuria. If severe hematuria develops when mesna is given according to the recommended dosage schedule, dosage reductions or discontinuation of ifosfamide therapy may be required.

General:

 	Do not mix this drug with epirubicin, cyclophosphamide, cisplatin, carboplatin, or nitrogen mustard.
 	The benzyl alcohol contained in the injection vials can reduce the stability of ifosfamide. Ifosfamide and mesna may be mixed in the same bag provided the final concentration of ifosfamide does not exceed 50 mg/mL. Higher concentrations of ifosfamide may not be compatible with mesna and may reduce the stability of ifosfamide.
 	Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Any solutions which are discolored, hazy, or contain visible particulate matter should not be used.

PATIENT COUNSELING INFORMATION

 	Advise the patient to discontinue this drug and seek immediate medical attention if they experience a hypersensitivity reaction, including systemic anaphylactic reactions.
 	Advise the patient to take this drug at the exact time and in the exact amount as prescribed.
 	Advise the patient to contact their healthcare provider if they miss a dose or if they vomit within 2 hours of taking the oral formulation.
 	This drug does not prevent hemorrhagic cystitis in all patients nor does it prevent or alleviate any of the other adverse reactions or toxicities associated with ifosfamide.
 	Advise the patient to report to their healthcare provider if his/her urine turns a pink or red color.
 	Advise the patient to drink 1 to 2 liters of fluid each day during the therapy.
 	Advise the patient that Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms, and bullous and ulcerative skin and mucosal reactions have occurred.

Side Effects
The Most Common

 	nausea
 	Back pain
 	bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
 	vomiting
 	constipation
 	loss of appetite or weight
 	diarrhea
 	abdominal pain
 	headache
 	tiredness
 	dizziness
 	hair loss
 	pain or redness at the place where the injection was given
 	loss of strength and energy
 	fever
 	sore throat
 	cough
 	flushing
 	pink or red-colored urine or blood in the urine
 	swelling of the face, arms, or legs
 	hives
 	rash
 	itching
 	difficulty breathing or swallowing
 	chest pain
 	fast, irregular, or pounding heartbeat
 	unusual bleeding or bruising

More common

 	Black, tarry stools
 	bleeding gums
 	bloating or swelling of the face, arms, hands, lower legs, or feet
 	blood in the urine or stools
 	chest pain
 	chills
 	cough
 	decreased urination
 	dizziness
 	dry mouth
 	fainting
 	fast, pounding, or irregular heartbeat or pulse
 	fever
 	increased thirst
 	lightheadedness
 	loss of appetite
 	mood changes
 	muscle pain or cramps
 	nausea
 	numbness or tingling in the hands, feet, or lips
 	painful or difficult urination
 	pinpoint red spots on the skin
 	rapid breathing
 	rapid weight gain
 	seizures
 	sore throat
 	sores, ulcers, or white spots on the lips or in the mouth
 	sunken eyes
 	swelling
 	swollen glands
 	tightness in the chest
 	trouble breathing
 	unusual bleeding or bruising
 	unusual tiredness or weakness
 	unusual weight gain or loss
 	vomiting
 	wrinkled skin

Rare

 	Blurred vision
 	confusion
 	dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
 	sweating
 	Coughing or spitting up blood
 	dark urine
 	general tiredness and weakness
 	headache
 	light-colored stools
 	nervousness
 	pounding in the ears
 	slow heartbeat
 	upper right abdominal or stomach pain
 	yellow eyes and skin
 	diarrhea
 	difficulty having a bowel movement
 	hair loss
 	increased sweating
 	lack or loss of strength
 	sleepiness or unusual drowsiness
 	stomach pain
 	trouble sleeping
 	weight loss
 	Belching
 	feeling of warmth
 	heartburn
 	indigestion
 	redness of the face, neck, arms, and occasionally, upper chest
 	stomach discomfort or upset

Drug Interactions

 	anisindione
 	dicumarol
 	warfarin
 	prematurity
 	autoimmune disorders

Pregnancy and Lactation
FDA pregnancy category B 
Pregnancy
As per the manufacturer's labeling information, it is considered the former FDA pregnancy category B medicine. Clinicians should also inform the risk associated with ifosfamide/cyclophosphamide therapy. According to ACOG, in addition to pretreatment fertility conservation counseling, sexually active young women should be informed about the risks of becoming pregnant during cancer treatment. Clinicians should also guide, and women should also receive counseling regarding effective contraception.[rx]
Lactation
An essential consideration of mesna administration is the breastfeeding status of females of reproductive age.[rx] It is not well understood if mesna is present in breast milk; however, benzyl alcohol is often a component of mesna intravenous formulations. The manufacturer indicated that exposure to the breastfeeding infant is unlikely in part due to maternal metabolism. Nonetheless, benzyl alcohol has been linked to adverse events in infants, and therefore breastfeeding is not recommended for at least one week after the last mesna injection.[rx]





Why is this medication prescribed?




Mesna is used to reduce the risk of hemorrhagic cystitis (a condition that causes inflammation of the bladder and can result in serious bleeding) in people who receive ifosfamide (a medication used for the treatment of cancer). Mesna is in a class of medications called cytoprotectants. It works by protecting against some of the harmful effects of certain chemotherapy medications.







How should this medicine be used?




Mesna comes as a solution (liquid) to be injected intravenously (into a vein) by a doctor or nurse in a medical facility. It is usually given at the same time as you receive your chemotherapy treatment and then 4 and 8 hours after your chemotherapy treatment.

Drink at least 1 quart (4 cups; about 1 liter) of fluid daily while you are receiving mesna injection.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.







Other uses for this medicine




Mesna is also sometimes used to reduce the risk of hemorrhagic cystitis in people who receive the chemotherapy drug cyclophosphamide. Talk to your doctor about the risks of using this medication for your condition.







What special precautions should I follow?

Accepted Answer

Before receiving a mesna injection, tell your doctor and pharmacist if you are allergic to mesna, any other medications, or any of the ingredients in mesna injection. Ask your pharmacist for a list of the ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. tell your doctor if you have or have ever had an autoimmune disorder (a condition that occurs when your immune system&hellip;

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