How does this medication work? What will it do for me?

Ifosfamide belongs to the group of cancer-fighting medications known as antineoplastics, and specifically to the group of antineoplastics known as alkylating agents. Ifosfamide prevents the growth of cancer cells by interfering with the genetic material DNA, which is needed for reproduction of cells. Ifosfamide is used to treat many types of cancer including cancers of the cervix, soft tissues, and pancreas.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Ifosfamide for injection by Pharmaceutical Partners of Canada, Inc. is no longer being manufactured for sale in Canada. For brands that may still be available, search under ifosfamide. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

The recommended dose of ifosfamide varies widely according to the specific condition being treated, the response to therapy, and the other medications being used. The dose is based on body weight or body size. It is available as an intravenous (into the vein) injection. It is injected through a specially prepared site on the skin by the nurse or doctor.

The dosing regimen varies widely. Often the prescribed amount of medication is injected into a vein for a period of at least 30 minutes once a day for 5 days. This treatment is then repeated every 3 to 4 weeks until the total treatment cycle is complete.

Very careful handling of this medication is required. It is always given by the doctor or someone under direct supervision of the doctor in a hospital or similar setting with access to sterile equipment for preparation.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor.

Ifosfamide is excreted through your urine. Your bladder will become irritated if the urine containing ifosfamide stays inside the bladder for too long. It is therefore important that you drink plenty of fluids (8 to 12 cups a day) on the day of your treatment and the day after your treatment. You should empty your bladder (urinate) every 2 hours while you are awake and at bedtime, and once during the night, for at least 24 hours after your last treatment. This helps to prevent bladder and kidney problems. A medication such as mesna may also be given to you to help prevent bladder problems.

As well as interfering with the genetic material DNA of cancer cells, ifosfamide can interfere with some of your normal cells. This can cause a number of side effects such as hair loss and mouth sores. Keep track of any side effects and report them to your doctor as suggested in the section "What side effects are possible with this medication?"

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use this medication if you:

  • are allergic to ifosfamide or any ingredients of this medication
  • are breast-feeding
  • have a condition called advanced cerebral arteriosclerosis (hardening of arteries in brain)
  • have an active infection
  • have an obstruction to the urine flow
  • have cystitis
  • have low platelet counts
  • have severe liver or kidney dysfunction
  • have severely low white blood cell counts

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • decreased appetite
  • decrease in number of menstrual periods
  • diarrhea
  • nausea and vomiting
  • skin rash
  • temporary loss of hair (returns after treatments end although texture or colour may change)

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • blurred vision
  • constipation
  • cough or shortness of breath
  • dizziness
  • numbness or tingling in the hands or feet
  • redness, swelling, or pain where medication has been injected
  • seizures
  • sores in mouth or on lips
  • unusual bruising or bleeding

Contact your doctor immediately if any of the following side effects occur:

  • black, tarry stools or blood in stools
  • blood in urine
  • confusion or agitation
  • dark urine, pale stools, yellow eyes or skin
  • fast or irregular heartbeat
  • fever or chills with cough or hoarseness
  • frequent urination
  • lower back or side pain with fever or chills
  • hallucinations (seeing things that are not true or real)
  • painful urination or burning upon urination
  • seizures
  • signs of allergic reaction (swelling of the mouth or tongue, difficulty breathing)
  • unusual tiredness

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Blood clotting: This medication can reduce the number of platelet cells in the blood. Platelets help the blood to clot, and a shortage could make you bleed more easily. Tell your doctor of any signs that your blood is not clotting as quickly. Such symptoms may include black and tarry stools, blood in the urine, easy bruising, or cuts that won't stop bleeding.

Birth control: If you or your partner could become pregnant, talk to your doctor about appropriate birth control while using this medication.

Heart problems: This medication may increase the risk of heart problems such as abnormal heart rhythm, congestive heart failure, and a weakened heart (cardiomyopathy). People with existing heart disease, or who have risk factors for heart disease may be more at risk. Your doctor will monitor you closely for these problems.

Infection: As well as killing cancer cells, this medication can reduce the number of cells that fight infection in the body (white blood cells). Avoid contact with people with contagious infections and tell your doctor if you begin to notice signs of an infection, such as fever or chills.

Kidney function: Ifosfamide may damage the kidneys. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Ifosfamide may not be as effective when used by people with severely reduced liver function. If you have reduced liver function or liver disease, discuss with your doctor whether any special monitoring is needed.

Nervous system problems: Ifosfamide can cause brain problems including symptoms of abnormal behaviour, hallucinations, confusion, extreme sleepiness, vision changes, seizures, and possibly coma. If you experience any of these symptoms, get medical attention as soon as possible.

Secondary cancers: Anticancer medications such as ifosfamide may cause other types of cancer to develop, including leukemia. Talk to your doctor if you have concerns about this.

Urinary tract problems: Ifosfamide can cause damage to the bladder. The risk of developing bladder problems can be reduced by making sure that you consume a large amount of water. It is also important to empty your bladder (urinate) on a regular basis. If you experience symptoms of burning or pain on urination, or blood in your urine, contact your doctor as soon as possible.

Pregnancy: Ifosfamide may be harmful if used during pregnancy. It is best to use birth control while being treated with this drug. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: Ifosfamide passes into breast milk. Women should not breast-feed while receiving ifosfamide treatment due to the risk of potential harm to the infant.

Seniors: People over the age of 65 years may be more at risk of side effects from this medication.

What other drugs could interact with this medication?

There may be an interaction between ifosfamide and any of the following:

  • 5-aminosalicylic acid medications (e.g., mesalamine, olsalazine, sulfasalazine)
  • apalutamide
  • aprepitant
  • "azole" antifungals (e.g., fluconazole, itraconazole, ketoconazole, voriconazole)
  • baricitinib
  • BCG
  • bosentan
  • bupivacaine
  • other cancer medications
  • carbamazepine
  • cobicistat
  • conivaptan
  • clozapine
  • diltiazem
  • dronedarone
  • echinacea
  • efavirenz
  • enzalutamide
  • etravirine
  • fluconazole
  • grapefruit juice
  • HIV protease inhibitors (e.g., atazanavir, darunavir, indinavir)
  • leflunomide
  • lumacaftor and ivacaftor
  • macrolide antibiotics (e.g., clarithromycin, erythromycin)
  • mifepristone
  • modafinil
  • natalizumab
  • ocrelizumab
  • phenobarbital
  • phenytoin
  • pimecrolimus
  • protein kinase inhibitors (e.g., crizotinib, dabrafenib, imatinib, lorlatinib)
  • rifabutin
  • rifampin
  • St. John's wort
  • sedatives (sleeping pills; e.g., benzodiazepines, zopiclone, zolpidem)
  • sphingosine 1-phosphate (S1P) receptor modulators (e.g., fingolimod, ozanimod, ponesimod, siponimod)
  • tacrolimus
  • tofacitinib
  • upadacitinib
  • vaccines
  • verapamil
  • warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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