Mesna (4 brand names, 2 dosage forms, 3 routes)
Available dosage forms: INJECTABLE, TABLET.
Routes of administration: INTRAVENOUS, INJECTION, ORAL.
Brand Names
- IFEX/MESNEX KIT
- IFOSFAMIDE/MESNA KIT
- MESNA
- MESNEX
Indications and Usage
Mesna is indicated as a prophylactic agent in reducing the incidence of ifosfamide-induced hemorrhagic cystitis. Limitation of Use: Mesna is not indicated to reduce the risk of hematuria due to other pathological conditions such as thrombocytopenia.
Contraindications
Mesna is contraindicated in patients known to be hypersensitive to mesna or to any of the excipients [see Warnings and Precautions (5.1)].
Adverse Reactions
The following are discussed in more detail in other sections of the labeling. •Hypersensitivity Reactions [ see Warnings and Precautions (5.1) ] •Dermatological Toxicity [ see Warnings and Precautions (5.2) ] •Benzyl Alcohol Toxicity [ see Warnings and Precautions (5.3) ] •Laboratory Test Interferences [ see Warnings and Precautions (5.4) ] •Use in Patients with a History of Adverse Reactions to Thiol Compounds [ see Warnings and Precautions (5.5) ]
Drug Interactions
No clinical drug interaction studies have been conducted with mesna.
Mechanism of Action
Mesna reacts chemically with the urotoxic ifosfamide metabolites, acrolein and 4-hydroxy-ifosfamide, resulting in their detoxification. The first step in the detoxification process is the binding of mesna to 4‑hydroxy-ifosfamide forming a non-urotoxic 4-sulfoethylthioifosfamide. Mesna also binds to the double bonds of acrolein and to other urotoxic metabolites and inhibits their effects on the bladder.
Overdosage
There is no known antidote for mesna. In a clinical trial, 11 patients received intravenous mesna 10 mg/kg to 66 mg/kg per day for 3 to 5 days. Patients also received ifosfamide or cyclophosphamide. Adverse reactions included nausea, vomiting, diarrhea and fever. An increased rate of these adverse reactions has also been found in oxazaphosphorine-treated patients receiving ≥80 mg mesna per kg per day intravenously compared with patients receiving lower doses or hydration treatment only. Postmarketing, administration of 4.5 g to 6.9 g of mesna resulted in hypersensitivity reactions including mild hypotension, shortness of breath, asthma exacerbation, rash, and flushing.