Fosfa Special Precautions

Should be administered under the supervision of a qualified physician experienced in the use of anticancer agents and when adequate diagnostic and treatment facilities are readily available for the appropriate management of complications. Urotoxic side effects especially hemorrhagic cystitis has been frequently associated with the use of Ifosfamide and these effects often result in cessation of therapy. Studies report the therapeutic benefit of mesna as a uroprotective agent where the incidence of urinary tract complications reduced from 40 to 3.5%. Thus it is recommended that Ifosfamide be accompanied by uroprotective agent such as mesna. It is recommended that a urinalysis should be obtained prior to each dose of. If microscopic hematuria (greater than 10 RBCs per high power field) is present then subsequent administration should be withheld until complete resolution. Further administration of should be given with vigorous oral or parenteral hydration.
Hematopoietic system: when Ifosfamide is given in combination with other chemotherapeutic agents, severe myelosuppression can be expected and close hematologic monitoring is recommended. White blood cell (WBC) count, platelet count and hemoglobin should be obtained prior to each administration and at appropriate intervals. Unless clinically essential Ifosfamide should not be given to patients with WBC count below 2000/µL and/or platelet count below 50,000/µL.
Central Nervous System: neurologic manifestations such as somnolence, confusion, hallucinations and in some instances coma, have been reported following Ifosfamide therapy. The occurrence of these symptoms requires discontinuation of therapy. The symptoms are usually reversible and supportive therapy should be maintained until complete resolution.
Before using Ifosfamide, the risks of taking the medicine must be weighed against the good it will do. This decision has to be mutually agreed by both the patient and the doctor. For Ifosfamide, the following should be considered: Allergies: inform the doctor of any unusual or allergic reaction to Ifosfamide.
Use in Children: Although there is no specific information comparing use of Ifosfamide in children with use in other age groups, Ifosfamide is not expected to cause different side effects or problems in children than it does in adults.
Use in Elderly: Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of Ifosfamide in the elderly with use in other age groups.
Other medicines: Although certain medicines should not be used together at all, in certain unavoidable cases two different medicines may be used together even if an interaction might occur between the two. In such cases, the doctor may want to change the dose, or other precautions may be necessary. When on Ifosfamide therapy, it is especially important that the health care professional knows the concomitant use of Amphotericin B injection/Antithyroid agents (medicine for overactive thyroid)/Azathioprine/Chloramphenicol/Colchicine/Flucytosine/Ganciclovir/Interferon/Plicamycin/Zidovudine and or treatment with x-rays or other cancer medicines as Ifosfamide may increase the effects of these medicines or radiation therapy.
Other medical problems: The presence of other medical problems may affect the use of Ifosfamide. These include Chickenpox (including recent exposure)/Herpes zoster (shingles) which potentiates the risk of disease affecting other parts of the body/Infection as Ifosfamide may decrease the body's ability to fight infection/Kidney disease which may cause effects to be increased because of slower removal of Ifosfamide from the body/Liver disease where the effects may be increased or decreased because the liver works by for the action and removal of Ifosfamide from the body.
Patients receiving Ifosfamide therapy are advise to drink extra fluids to pass more urine and empty bladder frequently, including at least once during the night to prevent kidney and bladder problems. Ifosfamide passes out from the body through the urine. If too much of it appears in the urine or if the urine stays in the bladder too long, it can cause dangerous irritation. Some patients may have to drink up to 7 to 12 cups (3 quarts) of fluid a day.
Ifosfamide may also often cause nausea and vomiting. However, it is very important that patients continue to receive the medicine and ask the health care professional for ways to lessen these effects.
Since the possibility of interference with normal wound healing has been reported with other oxazaphosphorines, Ifosfamide therapy should not be initiated for at least 10-14 days after surgery.
Ifosfamide, like other alkylating agents, has been reported to have oncogenic activity in animals. Thus the possibility that it may have oncogenic potential in humans should be considered.
Use in Pregnancy: Ifosfamide for injection can be teratogenic and cause fetal resorption in experimental animals. It should not be used in pregnancy, particularly in early pregnancy, unless in the judgement of the physician the potential benefits outweigh the possible risks. As is the case with the oxazaphosphorine class of alkylating agents, Ifosfamide is excreted in breast milk and breastfeeding should be terminated prior to institution of Ifosfamide therapy. Inform the doctor if the patient is pregnant or if the patient intend to have children. There is a chance that this medicine may cause birth defects if either the male or female is taking it at the time of conception or if it is taken during pregnancy. Animal studies indicate that the drug is capable of causing gene mutations and chromosomal damage in vivo. Embryotoxic and teratogenic effects have been observed in mice, rats and rabbits at doses 0.05-0.075 times the human dose. In addition, many cancer medicines may cause sterility that could be permanent. Although sterility has not been reported with this medicine, the possibility should be kept in mind. Be sure that the patient have discussed this with the doctor before taking this medicine. It is best to use some kind of birth control while receiving Ifosfamide. The patient should tell doctor right away on becoming pregnant while receiving Ifosfamide.