Mesna (mesna)

Mesna dosage for prophylaxis of oxazaphosphorine-induced bladder toxicity (e.g., hemorrhage cystitis, hematuria) in patients receiving ifosfamide or cyclophosphamide+ is based on the dosage of the oxazaphosphorine derivative. Various mesna dosages have been used, and optimum dosages and methods of administration have not been established.

The manufacturers currently make no specific dosage recommendations for use of mesna in patients with renal and/or hepatic impairment, and mesna dosage in these patients should be based on the ifosfamide or cyclophosphamide dosage.

Mesna usually is administered IV by direct injection or orally. Some clinicians state that the drug may be administered IV by infusion over 15-30 minutes+ or bycontinuous infusion+.

Patients receiving mesna for the prevention of ifosfamide-induced hemorrhagic cystitis should be adequately hydrated (i.e., at least 1 liter of oral or IV fluid daily, prior to and during ifosfamide therapy).

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

Myelosuppressives; Immunomodulators/Sodium Iodide I 131

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Sodium iodide I 131 can cause depression of the hematopoetic system. Myelosuppressives and immunomodulators also suppress the immune system.(1)

CLINICAL EFFECTS: Concurrent use of sodium iodide I 131 with agents that cause bone marrow depression, including myelosuppressives or immunomodulators, may result in an enhanced risk of hematologic disorders, including anemia, blood dyscrasias, bone marrow depression, leukopenia, and thrombocytopenia. Bone marrow depression may increase the risk of serious infections and bleeding.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: The US manufacturer of sodium iodide I 131 states that concurrent use with bone marrow depressants may enhance the depression of the hematopoetic system caused by large doses of sodium iodide I 131.(1) Sodium iodide I 131 causes a dose-dependent bone marrow suppression, including neutropenia or thrombocytopenia, in the 3 to 5 weeks following administration. Patients may be at increased risk of infections or bleeding during this time. Monitor complete blood counts within one month of therapy. If results indicate leukopenia or thrombocytopenia, dosimetry should be used to determine a safe sodium iodide I 131 activity.(1)

DISCUSSION: Hematologic disorders including death have been reported with sodium iodide I 131. The most common hematologic disorders reported include anemia, blood dyscrasias, bone marrow depression, leukopenia, and thrombocytopenia.(1)

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

• No disease contraindications

There is no enhanced messaging for this drug.

More Frequent

• Granulocytopenic disorder
• Leukopenia
• Thrombocytopenic disorder

Rare or Very Rare

• Abnormal hepatic function tests
• Allergic dermatitis
• Anaphylaxis
• Angioedema
• Eosinophilia
• Hemoptysis
• Hepatitis
• Seizure disorder
• ST segment changes
• Stevens-johnson syndrome
• Toxic epidermal necrolysis

More Frequent

• Acute abdominal pain
• Alopecia
• Anemia
• Anorexia
• Constipation
• Diarrhea
• Drowsy
• Fatigue
• Fever
• General weakness
• Headache disorder
• Nausea
• Vomiting

Less Frequent

• Arthralgia
• Back pain
• Chest pain
• Chills
• Conjunctivitis
• Cough
• Dizziness
• Dysgeusia
• Dyspnea
• Dysuria
• Flu-like symptoms
• Hyperhidrosis
• Hypertension
• Hypoesthesia
• Hypotension
• Injection site sequelae
• Lymphadenopathy
• Nasal congestion
• Paresthesia
• Photophobia
• Pleuritis
• Xerostomia

Rare or Very Rare

• Flushing
• Malaise
• Myalgia
• Pharyngitis
• Skin rash
• Tachycardia
• Tachypnea
• Urticaria

No enhanced messaging available.

No enhanced messaging available.

Reproductive studies using mesna oral dosages up to 1 g/kg in rabbits and 2 g/kg in rats (approximately 10 times the maximum recommended total daily human dosage (administered as 1 IV and 2 oral doses) on a body surface area basis) have not revealed evidence of harm to the fetus. Mesna has not been shown to be teratogenic in rats and rabbits. However, there are no adequate and controlled studies to date using mesna in pregnant women, and the drug should be used during pregnancy only when clearly needed.

It is not known whether mesna or dimesna is distributed into human milk. Because of the potential for adverse reactions to mesna in nursing infants if the drug were distributed into milk, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman.

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