Ifosfamide

Generic name
Ifosfamide
Brand name
ATC Code
L01AA06
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Ifosfamide

Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

No information

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Oncological conditions
  • Intravenous
    • 0 years up to 18 years

      • NOTE: The dose and dosing frequency of cytostatic agents depend on the condition and are very much subject to new insights. Cytostatic drugs are mostly used in oncology and haematology in combinations. For this reason, please refer to the detailed treatment protocols; it is also the reason why no dose recommendations have been included.

         

Renal impaiment in children > 3 months

There is insufficient evidence to give concrete recommendations. There are two handbooks that give recommendations for ifosfamide in cases of reduced renal function. These differ from one another, however:
1. Drug Prescribing in Renal Failure, 5th ed., paediatric table:
• GFR 30-50 ml/min: 100%
• GFR 10-29 ml/min: 100%
• GFR < 10 ml/min: 75%
2. The Renal Drug Handbook, 4th ed., adults:
• GFR > 60 ml/min: 80% of the normal dose
• GFR 30-60 ml/min: 80% of the normal dose
• GFR 15-30 ml/min: 80% of the normal dose
• GFR < 15 ml/min: 60% of the standard dose

Information
There have been no studies of the use of ifosfamide in patients with reduced renal function. Ifosfamide is an inactive prodrug; it is only effective after hydrolysis by CYP3A4. Ifosfamide is excreted mainly with the urine, with 14-34% of it in unchanged form. It is likely that reduced renal function affects the clearance of ifosfamide.

Clinical consequences
Dose-related side effects: inter alia abnormal blood counts, such as leukopenia.
Haemorrhagic cystitis occurs in 1-10% of patients. Haemorrhagic cystitis is caused by a high concentration of the toxic metabolite acrolein in the bladder. Reduction of renal function has been observed in approx. 4% of cases. Renal impairment is especially related to the tubular system. In children in particular, the abnormalities can be irreversible and Fanconi syndrome can arise.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects

No information is present at this moment.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications

No information available on specific contra indications in children.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Extravasation: Await developments, cool with ice if necessary.

The risk of haemorrhagic cystitis is reduced by administering mesna, substantial diuresis and alkalization of the urine.

General cytostatic: a range of cytostatics can trigger hypersensitivity reactions. An emergency set (containing epinephrine, clemastine and hydrocortisone) should be present in the treatment room. The emergency set also contains specific antidotes.

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

ALKYLATING AGENTS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

Nitrogen mustard analogues
L01AA01

Reference

  1. Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007

Changes

Therapeutic Drug Monitoring


Overdose