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MESNA

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MESNA for IFOSFAMIDE
MESNA for CYCLOPHOSPHAMIDE

1. Mesna Dosing With Standard-Dose Ifosfamide
1999-2002 ASCO Recommendations:
The daily dose of mesna to be calculated to equal 60% of the total daily dose of ifosfamide, administered as 3 bolus doses given 15 minutes before & 4 & 8 hrs after administration of each dose of ifosfamide, when the ifosfamide dose is < 2.0.5 g/m2/d administered as a short infusion.
For use with continuous-infusion ifosfamide, give bolus dose equal to 20% of the total ifosfamide dose followed by a continuous infusion of mesna equal to 40% of the ifosfamide dose, continuing for 12 - 24 hrs after completion of the ifosfamide infusion.

2. Mesna Dosing With High-Dose Ifosfamide
1999-2002 ASCO Recommendations:
Insufficient evidence on which to base a recommendation for the use of mesna with ifosfamide doses in excess of 2.5 g/m2/d.
The efficacy of mesna for urothelial protection with very high-dose ifosfamide has not been established. Given the longer half-life of ifosfamide in these dosages, more frequent and prolonged mesna dosage regimens may be necessary for maximum protection from urotoxicity.

3. Mesna Administration by the Oral Route
19992002 ASCO Recommendations: The first dose of mesna IV, at a dose equal to 20% of the total daily ifosfamide dose, followed at 2 & 8 hours by 40% weight/weight of the ifosfamide dose administered PO may be considered an acceptable alternative to the 3-dose IV mesna regimen when the total ifosfamide daily dose is <2.0 g/m2.
FDA APPROVAL:
Mesna tablets have been approved by the FDA to prevent hemorrhagic cystitis in pts receiving ifosfamide chemotherapy. The recommended dose & schedule is to administer mesna as an IV bolus injection in a dosage equal to 20% of the ifosfamide dosage (weight/weight) at the time of ifosfamide administration. Mesna tablets are given orally in a dosage equal to 40% of the ifosfamide dose at 2 & 6 hrs after each dose of ifosfamide. The total daily dose of mesna is 100% of the ifosfamide dose. Patients who vomit within 2 hours of taking oral mesna should repeat the dose or receive IV mesna. The dosing schedule should be repeated on each day that ifosfamide is administered.
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Mesna Use With Cyclophosphamide
1999 Recommendation: Mesna plus saline diuresis or forced saline diuresis is recommended to decrease the incidence of urothelial toxicity associated with high-dose cyclophosphamide in the setting of stem-cell transplantation.

2002 Recommendation: No change.

Surveillance of Patients Receiving Ifosfamide and/or Cyclophosphamide and Mesna
1999 Recommendation: There are insufficient data to make a recommendation regarding specific monitoring for hemorrhagic cystitis in patients receiving mesna to ameliorate ifosfamide or high-dose cyclophosphamide-associated urothelial toxicity. Recommendations for monitoring reflect the design of clinical trials involving mesna use and the opinion of the panel.

2002 Recommendation: No change.