mesna

General

Pronunciation:
mes-na

Trade Name(s)

Mesnex
Uromitexan

Ther. Class.

antidotes

Pharm. Class.

ifosfamide detoxifying agents

Indications

Prevention of ifosfamide-induced hemorrhagic cystitis.

Unlabeled Use(s):

Prevention of cyclophosphamide-induced hemorrhagic cystitis.

Action

Binds to the toxic metabolites of ifosfamide in the kidneys.

Therapeutic Effect(s):

Prevents hemorrhagic cystitis from ifosfamide.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability; 45–79% absorbed after oral administration. Following IV with PO dosing ↑ systemic exposure.

Distribution: Minimally distributed to tissues.

Metabolism and Excretion: Rapidly converted to mesna disulfide, then back to mesna in the kidneys, where it binds to toxic metabolites of ifosfamide (18–26% excreted as free mesna in urine after IV and PO dosing).

Half-life: Mesna: 0.36 hr (IV); 1.2–8.3 hr (IV followed by PO); Mesna disulfide: 1.17 hr.

TIME/ACTION PROFILE (detoxifying action)

ROUTE	ONSET	PEAK	DURATION
PO, IV	rapid	unknown	4 hr

Contraindication/Precautions

Contraindicated in:

Hypersensitivity to mesna or other thiol (rubber) compounds;
Lactation: Lactation.

Use Cautiously in:

OB: Safety not established in pregnancy;
Pedi: Injection contains benzyl alcohol, which can cause potentially fatal "gasping syndrome" in neonates.

Adverse Reactions/Side Effects

Derm: flushing

GI: anorexia, diarrhea, nausea, unpleasant taste, vomiting

Local: injection site reactions

Neuro: dizziness, drowsiness, headache

Misc: flu-like symptoms

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None reported.

Route/Dosage

IV (Adults): Give a dose of mesna equal to 20% of the ifosfamide dose at the same time as ifosfamide and 4 and 8 hr after.

PO IV (Adults): Give a dose of IV mesna equal to 20% of the ifosfamide dose at the same time as ifosfamide; then give PO mesna equal to 40% of the ifosfamide dose 2 and 6 hr after ifosfamide (total mesna dose is 100% of ifosfamide dose).

Availability (generic available)

Solution for injection: 100 mg/mL

Tablets: 400 mg

Assessment

Monitor for development of hemorrhagic cystitis in patients receiving ifosfamide.

Lab Test Considerations:

Obtain a negative pregnancy test before starting when mesna is given with ifosfamide.

Causes a false-positive result when testing urinary ketones.

Implementation

Initial IV bolus is to be given at time of ifosfamide administration.
PO If second and third doses are given orally, administer 2 and 6 hr after IV dose.
- If PO mesna is vomited within 2 hr of administration, repeat dose or use IV mesna.
Syringe Compatibility
- ifosfamide
Y-Site Compatibility:
- alemtuzumab
- allopurinol
- amifostine
- MORE...
  - amikacin
  - aminocaproic acid
  - aminophylline
  - amiodarone
  - amphotericin B liposomal
  - ampicillin
  - ampicillin/sulbactam
  - anidulafungin
  - argatroban
  - azithromycin
  - aztreonam
  - bivalirudin
  - bleomycin
  - bumetanide
  - buprenorphine
  - butorphanol
  - calcium acetate
  - calcium chloride
  - calcium gluconate
  - carmustine
  - caspofungin
  - cefazolin
  - cefepime
  - cefotaxime
  - cefotetan
  - cefoxitin
  - ceftriaxone
  - cefuroxime
  - chloramphenicol
  - chlorpromazine
  - ciprofloxacin
  - cisatracurium
  - cladribine
  - clindamycin
  - cyclophosphamide
  - cytarabine
  - dactinomycin
  - dexamethasone
  - dexmedetomidine
  - dexrazoxane
  - digoxin
  - diltiazem
  - diphenhydramine
  - dobutamine
  - docetaxel
  - dopamine
  - doxorubicin hydrochloride
  - doxorubicin liposomal
  - doxycycline
  - droperidol
  - enalaprilat
  - ephedrine
  - epinephrine
  - epirubicin
  - ertapenem
  - erythromycin
  - esmolol
  - etoposide
  - etoposide phosphate
  - famotidine
  - fentanyl
  - filgrastim
  - fluconazole
  - fludarabine
  - fluorouracil
  - foscarnet
  - fosphenytoin
  - furosemide
  - gemcitabine
  - gentamicin
  - glycopyrrolate
  - granisetron
  - haloperidol
  - heparin
  - hetastarch
  - hydralazine
  - hydrocortisone
  - hydromorphone
  - idarubicin
  - ifosfamide
  - imipenem/cilastatin
  - insulin, regular
  - irinotecan
  - isoproterenol
  - ketorolac
  - labetalol
  - leucovorin
  - levofloxacin
  - lidocaine
  - linezolid
  - lorazepam
  - magnesium sulfate
  - mannitol
  - melphalan
  - meperidine
  - meropenem
  - methotrexate
  - methylprednisolone
  - metoclopramide
  - metoprolol
  - metronidazole
  - micafungin
  - midazolam
  - milrinone
  - mitomycin
  - mitoxantrone
  - morphine
  - moxifloxacin
  - mycophenolate
  - nafcillin
  - nalbuphine
  - naloxone
  - nitroglycerin
  - norepinephrine
  - octreotide
  - ondansetron
  - oxaliplatin
  - paclitaxel
  - palonosetron
  - pamidronate
  - pantoprazole
  - pemetrexed
  - pentamidine
  - pentobarbital
  - phenobarbital
  - phenylephrine
  - piperacillin/tazobactam
  - potassium acetate
  - potassium chloride
  - potassium phosphate
  - procainamide
  - prochlorperazine
  - promethazine
  - propranolol
  - remifentanil
  - rituximab
  - rocuronium
  - sargramostim
  - sodium acetate
  - sodium bicarbonate
  - sodium phosphate
  - succinylcholine
  - sufentanil
  - tacrolimus
  - theophylline
  - thiotepa
  - tigecycline
  - tirofiban
  - tobramycin
  - topotecan
  - trastuzumab
  - vancomycin
  - vasopressin
  - vecuronium
  - verapamil
  - vinblastine
  - vincristine
  - vinorelbine
  - voriconazole
  - zidovudine
  - zoledronic acid
Y-Site Incompatibility:
- acyclovir
- amphotericin B deoxycholate
- amphotericin B lipid complex
- MORE...
  - dacarbazine
  - dantrolene
  - diazepam
  - ganciclovir
  - nicardipine
  - nitroprusside
  - phenytoin
  - thiopental

Rate: Administer over 15–30 min or as a continuous infusion.
Syringe Compatibility
- ifosfamide
Y-Site Compatibility:
- alemtuzumab
- allopurinol
- amifostine
- MORE...
  - amikacin
  - aminocaproic acid
  - aminophylline
  - amiodarone
  - amphotericin B liposomal
  - ampicillin
  - ampicillin/sulbactam
  - anidulafungin
  - argatroban
  - azithromycin
  - aztreonam
  - bivalirudin
  - bleomycin
  - bumetanide
  - buprenorphine
  - butorphanol
  - calcium acetate
  - calcium chloride
  - calcium gluconate
  - carmustine
  - caspofungin
  - cefazolin
  - cefepime
  - cefotaxime
  - cefotetan
  - cefoxitin
  - ceftriaxone
  - cefuroxime
  - chloramphenicol
  - chlorpromazine
  - ciprofloxacin
  - cisatracurium
  - cladribine
  - clindamycin
  - cyclophosphamide
  - cytarabine
  - dactinomycin
  - dexamethasone
  - dexmedetomidine
  - dexrazoxane
  - digoxin
  - diltiazem
  - diphenhydramine
  - dobutamine
  - docetaxel
  - dopamine
  - doxorubicin hydrochloride
  - doxorubicin liposomal
  - doxycycline
  - droperidol
  - enalaprilat
  - ephedrine
  - epinephrine
  - epirubicin
  - ertapenem
  - erythromycin
  - esmolol
  - etoposide
  - etoposide phosphate
  - famotidine
  - fentanyl
  - filgrastim
  - fluconazole
  - fludarabine
  - fluorouracil
  - foscarnet
  - fosphenytoin
  - furosemide
  - gemcitabine
  - gentamicin
  - glycopyrrolate
  - granisetron
  - haloperidol
  - heparin
  - hetastarch
  - hydralazine
  - hydrocortisone
  - hydromorphone
  - idarubicin
  - ifosfamide
  - imipenem/cilastatin
  - insulin, regular
  - irinotecan
  - isoproterenol
  - ketorolac
  - labetalol
  - leucovorin
  - levofloxacin
  - lidocaine
  - linezolid
  - lorazepam
  - magnesium sulfate
  - mannitol
  - melphalan
  - meperidine
  - meropenem
  - methotrexate
  - methylprednisolone
  - metoclopramide
  - metoprolol
  - metronidazole
  - micafungin
  - midazolam
  - milrinone
  - mitomycin
  - mitoxantrone
  - morphine
  - moxifloxacin
  - mycophenolate
  - nafcillin
  - nalbuphine
  - naloxone
  - nitroglycerin
  - norepinephrine
  - octreotide
  - ondansetron
  - oxaliplatin
  - paclitaxel
  - palonosetron
  - pamidronate
  - pantoprazole
  - pemetrexed
  - pentamidine
  - pentobarbital
  - phenobarbital
  - phenylephrine
  - piperacillin/tazobactam
  - potassium acetate
  - potassium chloride
  - potassium phosphate
  - procainamide
  - prochlorperazine
  - promethazine
  - propranolol
  - remifentanil
  - rituximab
  - rocuronium
  - sargramostim
  - sodium acetate
  - sodium bicarbonate
  - sodium phosphate
  - succinylcholine
  - sufentanil
  - tacrolimus
  - theophylline
  - thiotepa
  - tigecycline
  - tirofiban
  - tobramycin
  - topotecan
  - trastuzumab
  - vancomycin
  - vasopressin
  - vecuronium
  - verapamil
  - vinblastine
  - vincristine
  - vinorelbine
  - voriconazole
  - zidovudine
  - zoledronic acid
Y-Site Incompatibility:
- acyclovir
- amphotericin B deoxycholate
- amphotericin B lipid complex
- MORE...
  - dacarbazine
  - dantrolene
  - diazepam
  - ganciclovir
  - nicardipine
  - nitroprusside
  - phenytoin
  - thiopental

IV Administration

Intermittent Infusion: 2nd IV dose is given 4 hr later, 3rd dose is given 8 hr after initial dose. This schedule must be repeated with each subsequent dose of ifosfamide. Dilution: Dilute 2-, 4-, and 10-mL ampules, containing a concentration of 100 mg/mL in 8 mL, 16 mL, or 50 mL, respectively, of D5W, 0.9% NaCl, D5/0.9% NaCl, D5/0.2% NaCl, D5/0.33% NaCl, or LR. Concentration: 20 mg/mL. Refrigerate to store. Use within 6 hr. Discard unused solution.

Patient/Family Teaching

Inform patient that unpleasant taste may occur during administration.
Advise patient to notify health care professional if nausea, vomiting, or diarrhea persists or is severe.
Rep: Advise female patients of reproductive potential to use effective contraception during mesna/ifosfamide treatment and for 6 mo after last dose of mesna/ifosfamide and to avoid breastfeeding during mesna/ifosfamide treatment and for 1 wk after last dose of mesna/ifosfamide. Advise males with female partners of reproductive potential to use effective contraception during mesna/ifosfamide treatment and for 3 mo after last dose of mesna/ifosfamide. Advise patient to notify health care professional immediately if pregnancy is suspected.

Evaluation/Desired Outcomes

Prevention of hemorrhagic cystitis associated with ifosfamide therapy.

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