Ifosfamide: High Dose for Stem Cell Transplant (Generic Name)

Other Names: Ifex®

About This Drug

Ifosfamide is used to treat cancer. It may be included in pre-transplant chemotherapy. Ifosfamide is often given to patients who will get a peripheral stem cell transplant. This drug is given in the vein (IV) and may be given with the drug mesna.

Possible Side Effects (More Common)

  • Nausea and throwing up (vomiting). These symptoms may happen within a few hours after your treatment and may last up to 48 to 72 hours. Medicines are available to stop or lessen these side effects.
  • Bone marrow depression. This is a decrease in the number of white blood cells, red blood cells, and platelets. Bone marrow depression usually occurs seven days after the drug is given and may raise your risk of infection, fatigue, and bleeding. You may need to get a transfusion of blood products.
  • Tiredness that may last up to eight hours after the drug is stopped.
  • Congestive heart failure. You may be short of breath.  Your arms, hands, legs and feet may swell.
  • Changes in the tissue of the heart. Some changes may occur that can cause your heart to have less ability to pump blood. Changes may also lead to an abnormal heart beat. Your heart function will be checked as needed.
  • Changes in your central nervous system can happen. The central nervous system is made up of your brain and spinal cord. You could have extreme tiredness, agitation, confusion, hallucinations (see or hear things that are not there), trouble understanding or speaking, loss of control of your bowels or bladder, vision changes, numbness or weakness to your arms, legs, face, or body, and coma. If you get any of these symptoms let your doctor know right away.
  • Hair loss is often complete scalp hair loss and can involve loss of eyebrows, eyelashes, and pubic hair. You may notice this a few days or weeks after treatment has started. Most often hair loss is temporary; your hair should grow back when treatment is done.
  • Effects on the bladder. This drug may cause irritation and bleeding in the bladder. You may have blood in your urine. To help stop this, you will get extra fluids to help you pass more urine. You may get a drug called mesna, which helps to decrease irritation and bleeding. You may also get a medicine to help you pass more urine. You may have a catheter (tube) placed in your bladder so that your bladder will be washed with this drug.
  • Confusion
  • Decreased appetite (decreased hunger)
  • Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.

Possible Side Effects (Less Common)

  • Changes in your liver function.  Your doctor will check your liver function as needed. 
  • Phlebitis, which is redness and tenderness of a vein
  • Electrolyte changes.  Your blood will be checked for electrolyte changes as needed.
  • This drug may affect how your kidneys work. Your kidney function will be checked as needed.

Infusion Reactions

While you are getting this drug in your vein (IV), you may have a reaction to the drug.  Your nurse will check you closely for these signs: fever or shaking chills, flushing, facial swelling, feeling dizzy, headache, trouble breathing, rash, itching, chest tightness, or chest pain.  

These reactions may happen for the first 24 hours after you get this drug.  If you have any of these symptoms call 911 for emergency care.

Treating Side Effects

  • Drink 6-8 cups of fluids every day unless your doctor has told you to restrict your fluid intake due to another medical condition. A cup is 8 ounces of fluid. If you vomit or have diarrhea, you should drink more fluids so that you do not become dehydrated. Drinking fluids will also help to protect your bladder from irritation and bleeding.
  • Mouth care is very important. Your mouth care should consist of gentle cleaning of your teeth or dentures and rinsing your mouth with a mixture of 1/2 teaspoon salt in 8 ounces of water or 1/2 teaspoon sodium bicarbonate (baking soda) in 8 ounces of water. This should be done at least after each meal and at bedtime.
  • Avoid mouthwash that contains alcohol. Also avoid alcohol and smoking because they can irritate your mouth and throat.
  • Talk with your nurse about obtaining a wig before you lose your hair.  Also, call the American Cancer Society at 800-ACS-2345 to find out information about the “Look Good...Feel Better” program close to where you live. It is a free program where women undergoing chemotherapy learn about wigs, turbans and scarves as well as makeup techniques and skin and nail care.

Food and Drug Interactions

There are no known interactions of ifosfamide with food. This drug may interact with other medicines. Tell your doctor and pharmacist about all the medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. The safety and use of dietary supplements and alternative diets are often not known. Using these might affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's help.

When to Call the Doctor

Call your doctor or nurse right away if you have any of these symptoms:

  • Fever of 100.5 F (38 C) or higher
  • Chills
  • Easy bleeding or bruising
  • Wheezing or trouble breathing
  • Rash or itching
  • Feeling dizzy or lightheaded
  • Feeling that your heart is beating in a fast or not normal way (palpitations)
  • Loose bowel movements (diarrhea) more than 4 times a day or diarrhea with weakness or lightheadedness
  • Blurred vision or other changes in eyesight
  • Pain when passing urine; blood in urine
  • Pain in your lower back or side
  • Confusion or agitation
  • Nausea that stops you from eating or drinking
  • Throwing up more than 3 times a day
  • Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back. It can feel like pressure, squeezing, fullness, or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911.
  • Symptoms of a stroke such as sudden numbness or weakness of your face, arm, or leg, mostly on one side of your body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, feeling dizzy, loss of balance or coordination; or sudden, bad headache with no known cause.  If you have any of these symptoms for 2 minutes, call 911. 
  • Signs of liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skin.

Call your doctor or nurse as soon as possible if any of these symptoms happen:

  • Change in hearing, ringing in the ears
  • Blurred vision or other changes in eyesight
  • Decreased urine
  • Unusual thirst or passing urine often
  • Pain in your mouth or throat that makes it hard to eat or drink
  • Nausea that is not relieved by prescribed medicines
  • Rash that is not relieved by prescribed medicines
  • Heavy menstrual period that lasts longer than normal
  • Numbness, tingling, decreased feeling or weakness in fingers, toes, arms, or legs
  • Trouble walking or changes in the way you walk, feeling clumsy when buttoning clothes, opening jars, or other routine hand motions
  • Swelling of the legs, ankles, or feet
  • Weight gain of 5 pounds in one week (fluid retention)
  • Lasting loss of appetite or rapid weight loss of five pounds in a week
  • Fatigue that interferes with your daily activities
  • Headache that does not go away
  • Painful, red, or swollen areas on your hands or feet.
  • No bowel movement for 3 days or you feel uncomfortable
  • Extreme weakness that interferes with normal activities

Sexual Problems and Reproduction Concerns

  • Sexual problems and reproduction concerns may happen. In both men and women, this drug may affect your ability to have children. This cannot be determined before your treatment. Talk with your doctor or nurse if you plan to have children.  Ask for information on sperm or egg banking. 
    • In men, this drug may interfere with your ability to make sperm, but it should not change your ability to have sexual relations.
    • In women, menstrual bleeding may become irregular or stop while you are getting this drug. Do not assume that you cannot become pregnant if you do not have a menstrual period.
    • Women may go through signs of menopause (change of life) like vaginal dryness or itching. Vaginal lubricants can be used to lessen vaginal dryness, itching, and pain during sexual relations. 
    • Genetic counseling is available for you to talk about the effects of this drug therapy on future pregnancies. Also, a genetic counselor can look at the possible risk of problems in the unborn baby due to this medicine if an exposure happens during pregnancy.
  • Pregnancy warning:  This drug may have harmful effects on the unborn baby, so effective methods of birth control should be used by both men and women during your cancer treatment and for at least 6 months after treatment is done.
  • Breast feeding warning:  Women should not breast feed during treatment because this drug could enter the breast milk and badly harm a breast feeding baby.

Revised August 2014

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