Ifosfamide (Intravenous)

Ifosfamide is an antineoplastic chemotherapy treatment that is used in patients suffering from testicular cancer.

Overview

Ifosfamide is an antineoplastic alkylating agent that is used as a chemotherapy treatment for testicular cancer. It is used either alone or in combination with other medications.

The medication works by disrupting the growth of cancer cells so that they may be destroyed by the body. The treatment is not able to distinguish between healthy cells and cancerous cells, however, so normal cell development will also be affected and side effects will occur from use of Ifosfamide. Ifosfamide can cause a range of side effects including hair loss which may not be serious but which may cause concern for the patient. Other side effects can occur that may require immediate attention from the doctor. Side effects could also continue to occur for months or even years following use of the treatment.

This medication is a very serious treatment and it is vital that you understand the risks of using it. You should discuss the benefits of use with your doctor in relation to the risks that you will also face from use.

This medication should only ever be administered under the direct supervision of a doctor and is available as a solution or as a powder for solution to be injected into the vein.

Condition treated

Testicular cancer

Type Of Medicine

Alkylating agent

Antineoplastic chemotherapy

Side Effects

In addition to the required effects of using Ifosfamide, other unwanted effects can also occur from use. This is because the medication will also attack healthy cells in the body. When these side effects do occur you may need to seek medical attention immediately.

Occurring more commonly:

  • Agitation
  • Bloody urine
  • Chest pains
  • Chills
  • Confusion or disorientation
  • Coughing
  • Feverishness
  • Hallucinations
  • Hoarseness
  • Increased frequency of urination
  • Lower back
  • Pain or difficulty experienced during urination
  • Paleness of the skin
  • Shortness of breath without exertion
  • Side pain
  • Soreness of the throat
  • Sores and ulcers on and around the mouth
  • Stools with a black or tarry appearance
  • Swelling of glands
  • Troubled breathing with exertion
  • Unusual bleeding
  • Unusual bruising
  • Unusual tiredness
  • Unusual weakness
  • White spots appearing on the lips mouth

Occurring less commonly:

  • Abdominal pains
  • Bleeding of the gums
  • Bluish color to skin
  • Changed skin color
  • Darkened urine
  • Decrease in appetite
  • Dizziness
  • Headaches
  • Itching
  • Lost appetite
  • Nausea
  • Pain
  • Red spots appearing on the skin
  • Skin rash
  • Stomach pain and/or tenderness
  • Stools with a claylike coloration
  • Swelling of the feet
  • Swelling of the lower legs
  • Vomiting
  • Yellowing of the eyes
  • Yellowing of the skin

Occurring only rarely:

  • Awkwardness
  • Blurring of the vision
  • Burning, tingling, numbness or pain
  • Confusion or disorientation
  • Convulsions or seizures
  • Faintness or dizziness experienced when rising suddenly from sitting or lying
  • Increased heartbeat
  • Irregularity of heartbeat
  • Sweating
  • Trouble with breathing
  • Unsteadiness
  • Weakness in the arms, hands, feet or legs

Other side effects can also occur that would not normally require that you seek medical attention. These side effects will usually abate over time and are usually less serious. If they are ongoing or bothersome, however, then you should consult your doctor about how best to alleviate them.

  • Diarrhea
  • Hair loss
  • Thinning of the hair
  • Weight loss
  • Occurring at the site of injection:

O Redness
O Swelling
O Irritation

Other side effects that have not been listed here could also occur. If you experience any other side effects that have not been listed then you should contact your doctor for advice on how to react. If you are concerned about your immediate health, however, then you should always contact the emergency services.

Dosage

This medication will always be administered by a nurse or other trained medical professional under the supervision of a doctor. It is administered through a needle into the vein of the patient and must be slowly infused. The process of administration will take around 30 minutes.

When undergoing treatment with Ifosfamide you will usually be given a dose in 5 day sessions. In these sessions you will receive 5 doses over 5 days before a break of 3 weeks is taken. This will be repeated as your body is able to cope with the treatment.

Often you will be taking this treatment alongside another medication for the treatment of your condition. In this case it is very important that you take the other medications as directed for the best effect. If you are taking oral medications then you must ask your doctor how best to take them in conjunction with this treatment.

This medication will pass out of the body through the kidneys and into the bladder. When the Ifosfamide is present in the bladder and kidneys it poses a significant risk to the patient and increases the chance of irritation and of kidney problems and bladder cancers. To minimize this risk you need to drink many more fluids than normal to ensure that you are using the toilet more frequently. You should urinate at least once during the night and you should carefully follow your doctor's instructions to drink more fluids.

Ifosfamide will be likely to make you nauseous and cause vomiting. It is vital that you continue use of the treatment despite this so that it can have proper effects on the body. Do not stop taking treatment because you are vomiting and consult your doctor for advice on how to alleviate these side effects.

Interactions

You should never use certain medications in conjunction with one another. To do so risks the occurrence of drug interactions. In the most serious cases these interactions can be life threatening and in other cases medications may be prevented from working effectively by others. To avoid any medication interactions you must inform your doctor of all medications that you take before you begin treatment with Ifosfamide. This includes all kinds of medication including over the counter treatments, herbal remedies and prescription medications. It is especially important that you inform your doctor if you are taking any of the following medications during treatment:

The use of Ifosfamide with the following medications is not recommended. If you are taking any of the following then your doctor may delay treatment:

  • Varicella Virus Vaccine
  • Rubella Virus Vaccine, Live
  • Rotavirus Vaccine, Live
  • Mumps Virus Vaccine, Live
  • Measles Virus Vaccine, Live

The use of the following medications in conjunction with Ifosfamide is not normally recommended. In some cases you may be prescribed with both but your doctor may need to adjust the dose or frequency of use of one or both of the medications:

  • Yellow Fever Vaccine
  • Voriconazole
  • Verapamil
  • Typhoid Vaccine
  • Tipranavir
  • Ticagrelor
  • Telithromycin
  • Telaprevir
  • St John's Wort
  • Sorafenib
  • Smallpox Vaccine
  • Saquinavir
  • Ritonavir
  • Rifampin
  • Rifabutin
  • Posaconazole
  • Poliovirus Vaccine, Live
  • Pioglitazone
  • Phenytoin
  • Phenobarbital
  • Oxcarbazepine
  • Nevirapine
  • Nelfinavir
  • Nefazodone
  • Modafinil
  • Mifepristone
  • Miconazole
  • Lopinavir
  • Ketoconazole
  • Influenza Virus Vaccine, Live
  • Indinavir
  • Imatinib
  • Idelalisib
  • Fosphenytoin
  • Fosaprepitant
  • Fosamprenavir
  • Fluconazole
  • Etravirine
  • Erythromycin
  • Efavirenz
  • Dronedarone
  • Diltiazem
  • Delavirdine
  • Darunavir
  • Crizotinib
  • Conivaptan
  • Cobicistat
  • Clarithromycin
  • Ciprofloxacin
  • Cholera Vaccine, Live
  • Ceritinib
  • Carbamazepine
  • Boceprevir
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Atazanavir
  • Amprenavir
  • Adenovirus Vaccine
  • Abiraterone

The use of the following medications in conjunction with Ifosfamide can increase the risk of certain side effects occurring. While the combination can have serious impacts, the use of both could still be the best treatment for you. In these cases your doctor may prescribe both but may need to change the dose or frequency of use of both medications:

  • Warfarin
  • Thiotepa

Other medications that have not been listed herein could also interact with Ifosfamide. Patients must inform their doctor of all medications they are taking and no other treatments should be taken in conjunction with Ifosfamide unless they have been approved by the prescribing doctor.

Foods, drinks and tobacco products can also interact with such treatments. You should discuss use of these with your doctor before use of Ifosfamide. In particular patients will need to avoid the consumption of the following to prevent interactions from occurring:

  • Grapefruit juice

Other medical problems that you suffer from can also have an impact on the use of this medication. You must inform your doctor if you are suffering from any other medical conditions or problems and this is especially important in the following cases

The following conditions may be worsened by use:

  • Anemia
  • Bone marrow problems
  • Bone problems
  • Brain disease
  • Fanconi syndrome
  • Heart disease
  • Lung disease
  • Sepsis
  • Urinary tract infection
  • Veno-occlusive liver disease
  • Infection

The following conditions may make the effects and side effects greater when taking Ifosfamide:

  • Kidney disease
  • Liver disease

Patients with the following condition should not be treated with Ifosfamide:

  • Urinary blockage

Other medical conditions could also impact the use of Ifosfamide that have not been listed here. You must inform your doctor of all conditions from which you suffer before you begin treatment.

Warnings

Before you make the decision to take this medication it is very important that you understand the risks of doing so. You should make the decision to undergo this treatment with your doctor having weighed the benefits against the risks. For the use of Ifosfamide you should ensure that you have considered all of the following factors before beginning treatment.

Allergies – You should inform your doctor of any unusual reactions you have had to medications in the past. You should also inform them of any other types of allergies to foods, dyes, preservatives, animals or other substances from which you suffer. Allergies can sometimes prohibit the use of certain medications.

Pediatric – The safety and efficiency of this medication has not been established for use in children. You should discuss use with your doctor.

Geriatric – There are no known limitations to the use of this treatment in elderly patients. Elderly patients are, however, more likely to have age-related problems of the kidney and liver that may require the dose given to be adjusted. Caution should be used when treating elderly patients with this medication.

Pregnancy – There is a known risk to the use of this treatment in pregnant women. This medication is not normally prescribed to women but if it is then the doctor must be informed of pregnancy. You should avoid becoming pregnant during use of this treatment and must inform the doctor immediately if pregnancy occurs. Male patients should not father a child during use of this medication and for 6 months after treatment has ended. If you believe that your partner has become impregnated then you should inform your doctor immediately. Patients may be advised to store some sperm before treatment. Counseling relating to fertility may be provided.

Breastfeeding – The risks of beastfeeding an infant during use of this medication is unknown. You should discuss this with your doctor when it is relevant. A decision will need to be reached based on the risk to the infant in relation to the benefits of breastfeeding.

During treatment you will need to have your progress checked regularly by a doctor to ensure that the treatment is working well and effectively. The doctor will also check for any unwanted side effects that may be occurring. You will be asked to give blood and urine tests for this purpose.

While receiving treatment for Ifosfamide and for a period afterwards you should not receive any immunizations without first checking this with your doctor. As Ifosfamide can lower the immune system in a patient there is a risk that you could become infected with the condition that you are trying to immunize yourself against. Other people in your home and other people you come into regular contact with should also avoid taking an oral polio vaccination. To do so may expose you to risk of infection and you must avoid people who have received this vaccination within the past few months. If there is someone in your household who has taken this vaccine recently then you should consider wearing a protective mask when you are in their presence.

The number of white blood cells and platelets will be temporarily lowered during treatment with this medication and this can significantly increase the risk of infection and of bleeding problems. To avoid complications you should follow these steps wherever it is possible to do so:

  • Avoid coming into contact with people carrying infections. You should avoid busy and enclosed public spaces and should wear a mask to prevent exposure where you are unable to avoid these areas.
  • Report any signs of infection to your doctor as soon as you recognise them. Even minor infections like coughs or colds will need to be treated promptly to prevent a worsening of condition.
  • Report any unusual bruising or bleeding to your doctor straight away. This includes any changes to excretion that may indicate a bleed.
  • Take extra care with your oral hygiene. Normal methods of cleaning the mouth may cause bleeding so you may need to consult your dentist for advice on how best to keep your mouth clean.
  • Wash your hands and face thoroughly with soap before touching the inside of your nose or ears or touching your eyes.
  • Regularly wash and sanitize your hands throughout the day and ensure you maintain a high standard of hygiene.
  • Take extra care when you are shaving, cutting your nails or using sharp items near your body.
  • Take extra care when preparing food and particularly when handling hot items and sharp implements.
  • Avoid contact sports and any other situations in which bruising or injury may occur.

Patients may develop a disease of the brain during treatment. This is very serious so you should report any of the following symptoms to your doctor immediately:

  • Agitation
  • Pain in the back
  • Blurring of vision
  • Coma
  • Confusion or disorientation
  • Dizziness
  • Drowsiness
  • Fever
  • Hallucination
  • Headache
  • Irritability
  • Mood changes
  • Mental changes
  • Seizures or convulsions
  • Stiffness of the neck
  • Unusual tiredness
  • Unusual weakness

You may become less alert and have less control of thoughts and movements while receiving this medication. You should not operate a vehicle or machinery or do anything that could put you or others at risk until you are certain that you are fully alert and competent. Remember that it is your legal responsibility to ensure that you are safe to drive and carry out other such tasks before doing so.

This medication can increase the effects of alcohol and other CNS suppressants. These include a wide range of medications including treatments for hay fever and allergies. You should not take any such treatments or any other treatments at all during the use of Ifosfamide unless your doctor has explicitly approved the use.

This medication can stunt growth. If your child is receiving this treatment then you should discuss this with your doctor before beginning use.

The risk of developing other cancer including cancer of the lymph nodes will be increased by the use of this medication. Discuss this with your doctor before use.

If you plan to have children in the future then you should discuss this with your doctor before use. Both men and women will be at risk of becoming infertile from the use of this medication.

Storage

Vials of the powder for solution should be stored at a controlled room temperature of 20-25°C.

Vials of the solution should be stored at a controlled 2-8°C.

Once reconstituted solutions can be refrigerated for up to 24 hours.

This medication should only ever be stored in a hospital or cancer clinic. They are not for patient use.

Summary

Ifosfamide is a treatment used to destroy cancerous cells in the testicles of the patient. It is an aggressive chemotherapy drug that attacks the developing cells so that they may be destroyed. Ifosfamide cannot distinguish between the cancerous cells and healthy cells in the body, however, so patients will be exposed to unwanted side effects. Some of these are very serious and will need immediate medical care.

Before you begin using this treatment you should be alert to the risks of use. You should discuss the potential risks with your doctor. Some side effects, such as the development of lympnoma, may not occur for months or years after treatment.

You should not take any other medication with this treatment unless you have been directed to do so by your doctor.

This medication may cause infertility in males and females. Discuss this with your doctor before use if you plan to have children in the future.