Other Names/Brands

Holoxan

Mechanism of Action

Ifosfamide is a chemotherapy drug belonging to the alkylating agent class. This drug works by disrupting the DNA of cancer cells, preventing them from dividing and ultimately killing them.

After entering the body, ifosfamide is activated in the liver into an active form that can attach to DNA strands, forming cross-links between the strands. These cross-links prevent DNA replication and protein synthesis, thus preventing cancer cells from growing and reproducing. This effect is more pronounced in rapidly dividing cells, such as cancer cells, although normal, rapidly dividing cells can also be affected, resulting in side effects.

Indications

Ifosfamide is used as a chemotherapy drug to treat various types of cancer, especially aggressive or metastatic cancers. Indications include:

• Testicular cancer
• Ovarian cancer
• Lymphoma
• Soft tissue sarcoma
• Several childhood cancers

This drug is usually given when other standard therapies are ineffective or as part of a combination chemotherapy regimen to increase the effectiveness of treatment.

Contraindications

Ifosfamide is contraindicated in patients with a history of hypersensitivity to it or similar alkylating drugs. It should also not be used in patients with severe liver or kidney impairment, as its metabolism and excretion are impaired, or in patients with severe bone marrow impairment, as it may worsen blood cell suppression. Furthermore, pregnancy and breastfeeding are relative contraindications, as ifosfamide may harm the fetus or infant.

Side Effects

Ifosfamide can cause a variety of side effects, both mild and serious. Common side effects include nausea, vomiting, hair loss, and decreased blood cell counts, which increase the risk of infection, anemia, or bleeding.

Some serious effects include kidney damage, liver problems, and encephalopathy (impaired brain function) that can cause confusion or seizures. These side effects occur because ifosfamide attacks not only cancer cells but also rapidly dividing healthy cells.

Preparations

Ifosfamide is available as a dry powder for infusion or intravenous injection. Before administration, this powder must be dissolved with a special solvent as directed by a healthcare professional. This medication is administered under the supervision of a healthcare professional, as it requires close monitoring of dosage, infusion duration, and potential side effects. The preparation should be stored in a cool, dry place, protected from light, to maintain its quality.

Dosage

The dosage of ifosfamide varies depending on the type of cancer, the patient's weight, and overall health. Generally, the dose is calculated based on body weight or body surface area (mg/m²) and is usually given as an intravenous infusion over several days as part of a chemotherapy cycle. This medication is constantly monitored by medical personnel to adjust the dose if side effects or organ dysfunction, such as kidney or liver dysfunction, occur.

Safety of Drugs

Ifosfamide is classified as pregnancy category D by the FDA, meaning it may harm the fetus if used during pregnancy. This medication is only given if the benefits to the mother outweigh the risks to the fetus. Furthermore, ifosfamide carries a high risk of toxicity, so its use must be closely monitored by medical professionals, especially in patients with impaired liver or kidney function.

Drug Interactions

Ifosfamide can interact with several drugs that affect liver metabolism, particularly those metabolized by cytochrome P450 enzymes, such as phenytoin, rifampin, or CYP3A4 inhibitors. These interactions can alter the effectiveness or increase the toxicity of ifosfamide, including the risk of kidney damage or encephalopathy.

Concurrent use with other drugs that suppress the bone marrow, such as adjuvant chemotherapy or certain antibiotics, can worsen the decrease in blood cell counts and increase the risk of infection or bleeding.

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