Ifosfamide (Mitoxana ®)
Ifosfamide is a chemotherapy drug used to treat different cancers including testicular cancer, sarcoma and some types of lymphoma.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
How ifosfamide is given
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You will usually have ifosfamide in the chemotherapy day unit or during a stay in hospital. A chemotherapy nurse will give it to you. You may have it with other chemotherapy drugs. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness drugs and sometimes a steroid as an injection into a vein. They will give you the drugs and chemotherapy through one of the following:
a short thin tube (cannula) that the nurse puts into a vein in your arm or hand
a fine tube that goes under the skin of your chest and into a vein close by (central line)
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse will usually give you ifosfamide as a drip (infusion) into your cannula or line over a few hours. They run the drip through a pump, which gives you the treatment over a set time.
Sometimes, ifosfamide is given as an injection into your cannula or line.
Your course of chemotherapy
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. This will depend on the type of cancer you have. Your doctor or nurse will tell you more about this and the number of cycles you are likely to have.
Before you go home, the nurse or pharmacist will give you anti-sickness drugs to take. Take all your tablets exactly as they have explained to you.
Possible side effects of ifosfamide
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We explain the most common side effects of ifosfamide here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. If you are having other chemotherapy drugs as well, you may have some side effects that we don’t list here. Always tell your doctor or nurse about the side effects you have.
Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you. Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers to call the hospital if you feel unwell or need advice any time of day or night. Save these numbers in your mobile phone or keep them somewhere safe.
Risk of infection
Ifosfamide can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
Ifosfamide can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
Ifosfamide can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. They may also give you a steroid drug to help. Take the drugs exactly as your nurse or pharmacist explains. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick, or vomit twice or more in 24 hours, contact the hospital on the numbers they gave you as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you. Some people may need to go to hospital for a short time so the doctors and nurses can control their sickness.
Loss of appetite
You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two. If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.
Your hair will thin or you may lose all the hair from your head. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun. Your nurse can give you advice about coping with hair loss.
Ifosfamide may irritate your bladder and cause discomfort when you pass urine. Drink plenty of fluids - at least two litres (three and a half pints) - during the 24 hours following chemotherapy. It is also important to empty your bladder regularly and to try to pass urine as soon as you feel the need to go.
You will usually be given fluids through a drip (infusion) and a drug called mesna (Uromitexan ®) as an infusion and/or tablets. This helps to prevent bladder irritation.
Contact the hospital straight away if you feel any discomfort or stinging when you pass urine, or if you notice any blood in it.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s over. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Less common side effects
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Effects on the nervous system
Ifosfamide can affect the nervous system. You may feel very drowsy or confused, or you may have hallucinations. You may feel dizzy or unsteady. Rarely, this treatment can cause seizures (fits). Tell your doctor or nurse straight away if you notice any of these symptoms. They may make some changes to your treatment if they become a problem for you.
It’s important not to drive or operate machinery if you notice these effects.
Changes in the way the liver works
Ifosfamide may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Ifosfamide can cause a rash, which may be itchy. Rarely, your skin may darken. It will return to its normal colour after you finish treatment. If you’ve had radiotherapy (either recently or in the past), the area that was treated may become red or sore. Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
It is important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about ifosfamide
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Blood clot risk
Cancer increases the chances of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs. You may be advised to avoid eating grapefruit or drinking grapefruit drinks.
Ifosfamide can affect your fertility (being able to get pregnant or father a child). If you are worried about this, talk to your doctor before treatment starts.
Your doctor will advise you not to become pregnant or father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using a number of reliable sources, including:
Alvarez-Gonzalez I et al. Medicines and Healthcare Products Regulatory Agency. mhra.gov.uk (accessed August 2013).
British National Formulary. 65th edition. 2013. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Truven Health Analytics Inc. Micromedex® 2.0. micromedexsolutions.com (accessed October 2013).
With thanks to: Bruce Burnett, Teacher Practitioner in Clinical Pharmacy Practice; and the people affected by cancer who reviewed this edition.
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