How is ifosfamide toxicity treated?

Methylene blue has been described as a potential therapy for ifosfamide-induced neurotoxicity. Methylene blue is a treatment for methemoglobinemia and cyanide poisoning — it is unclear how it might help reverse neurotoxicity caused by ifosfamide metabolites.

What is ifosfamide toxicity?

Central nervous system (CNS) toxicity has been reported in approximately 10%–30% of patients receiving intravenous infusions of ifosfamide. Encephalopathy is a rare but serious CNS adverse reaction in these patients, and although usually transient and reversible, may cause persistent neurological dysfunction or death.

Does ifosfamide cause neurotoxicity?

Frequent side effects of ifosfamide include myelotoxicity, hemorrhagic cystitis and neurotoxicity (mental confusion, drowsiness, hallucinations, disorientation, and coma) [1].

Which side effects of ifosfamide limit its use as anticancer agent?

Other toxicities include the following:

  • Hemorrhagic Cystitis. Before the availability of mesna, the main adverse effect was hemorrhagic cystitis.
  • Neurotoxicity.
  • Hematologic Toxicity.
  • Nephrotoxicity.
  • Miscellaneous Toxicities.
  • Malignancy of Ureter and Bladder.

How does methylene blue work for ifosfamide toxicity?

Methylene blue is thought to help in cases of ifosfamide neurotoxicity due to its inhibition of monoamine oxidase (MAO). This enzyme is responsible for producing chloroacetaldehyde, the neurotoxic metabolite of ifosfamide.

How does ifosfamide cause encephalopathy?

The exact pathophysiology of ifosfamide-induced encephalopathy is not fully understood but its metabolites, chloroacetaldehyde and chloroethylamine are thought likely to be the major contributing factors. They are known to be neurotoxic and are able to penetrate the blood–brain barrier.

What is ifosfamide-induced encephalopathy?

One of the most serious of these is central nervous system (CNS) depression known as ifosfamide-induced encephalopathy. The clinical picture can range from mild somnolence or agitation over confusion or hallucinations to deep coma.

What are the side effects of ifosfamide?

Common side effects

  • Increased risk of getting an infection.
  • Breathlessness and looking pale.
  • Bruising, bleeding gums or nosebleeds.
  • Tiredness and weakness (fatigue) during and after treatment.
  • Feeling or being sick.
  • Loss of appetite.
  • Hair loss.
  • Irritation of the bladder and kidneys.

What drug should always be given with ifosfamide?

Mesna helps protect your bladder to prevent irritation and bleeding. Mesna is always given with ifosfamide.