Ifosfamide
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
| ID | DRUG-IFOSFAMIDE |
|---|---|
| Type | Drug |
| Aliases | HoloxanIfexMitoxanaІфосфамід |
| Status | reviewed 2026-04-26 | pending_clinical_signoff |
| Diseases | DIS-BURKITT DIS-EATL DIS-HSTCL DIS-MPNST DIS-NK-T-NASAL DIS-PMBCL DIS-SOFT-TISSUE-SARCOMA DIS-TESTICULAR-GCT |
| Sources | SRC-NCCN-BCELL-2025 |
Drug Facts
| Class | alkylating_agent — oxazaphosphorine (nitrogen mustard analog) |
|---|---|
| Mechanism | Prodrug requiring hepatic CYP3A4 / CYP2B6 activation to 4-hydroxy- ifosfamide, which decomposes to ifosforamide mustard — the active DNA- alkylating species producing N7-guanine inter-strand crosslinks and apoptosis in proliferating cells. Side-chain oxidation also generates acrolein (urotoxic — drives hemorrhagic cystitis, neutralized by mesna) and chloroacetaldehyde (the principal neurotoxic metabolite responsible for ifosfamide-induced encephalopathy). |
| Typical dosing | ICE / RICE (R/R DLBCL pre-ASCT): 5000 mg/m² IV continuous infusion over 24 h on day 2, with mesna co-administered at 5000 mg/m² in the same bag + 2500 mg/m² infused over 12 h after end of ifosfamide. CODOX-M / IVAC (Burkitt): 1500 mg/m² IV days 1-5 with mesna. ICE pediatric (sarcoma / Wilms): 1800 mg/m² IV days 1-5 with mesna 360 mg/m² before and at 4 + 8 h after each dose. Single-agent germ-cell salvage: 1200 mg/m² IV days 1-5 with mesna. |
| Ukraine registered | True |
| NSZU reimbursed | True |
| Ukraine last verified | 2026-04-27 |
Warnings
- CNS toxicity — ifosfamide-induced encephalopathy ranges from somnolence to coma; can be fatal; treat with methylene blue 50 mg IV q4-6h
- Hemorrhagic cystitis without concurrent mesna and hydration
- Severe myelosuppression — neutropenic sepsis risk; G-CSF support standard at high-dose ICE
Notes
Mesna mandatory at 60-160% of ifosfamide dose in divided schedule (at 0, 4, 8 h after each ifosfamide dose, or in the same bag for continuous infusions). Aggressive hydration (2-3 L/day during therapy) plus daily urine dipstick for blood. Risk factors for encephalopathy: hypoalbuminemia (<3.5 g/dL), elevated creatinine, prior cisplatin exposure, low bicarbonate, pelvic disease bulk. Standard ICE includes G-CSF support starting day 5; >80% of R/R DLBCL patients receive ASCT mobilization with this regimen.
Used By
Regimens
REG-DOXORUBICIN-IFOSFAMIDE-MPNST- Doxorubicin + ifosfamide (advanced/metastatic MPNST, 1L)REG-DOXORUBICIN-IFOSFAMIDE-STS- Doxorubicin + ifosfamide (soft tissue sarcoma, AI regimen)REG-ICE- ICE (Ifosfamide + Carboplatin + Etoposide), 3 cyclesREG-R-ICE-PMBCL- R-ICE salvage with autoSCT consolidation (relapsed/refractory PMBCL)REG-RICE-BURKITT- R-ICE (Rituximab + Ifosfamide + Carboplatin + Etoposide) × 2-3 cycles → ASCT in CR2 (r/r...REG-SMILE- SMILE (Steroid + MTX + Ifosfamide + L-asparaginase + Etoposide), 2-4 cyclesREG-TIP-GCT-SALVAGE- TIP (paclitaxel + ifosfamide + cisplatin, germ cell tumor salvage)