Ifosfamid

Ifosfamide, also spelled Ifosfamid, is a chemotherapy agent in the class of alkylating nitrogen mustard analogues. It is a prodrug that is activated in the liver to the active metabolite isophosphoramide mustard, which forms DNA cross-links and inhibits replication, leading to cell death. The drug is typically given intravenously and is often combined with other cytotoxic agents.

Indications include treatment of various solid tumors and hematologic malignancies, notably germ cell tumors of the testis, soft tissue sarcomas, and certain lymphomas. It is used in combination regimens (for example VIP or related protocols) and is not usually given as a single-agent therapy.

Urotoxicity is a major risk due to toxic metabolites such as acrolein. Prophylaxis with the protective agent mesna and aggressive hydration are standard to reduce hemorrhagic cystitis. Adequate monitoring of urinary function and renal status is also advised. Some regimens use continuous infusion to modulate toxicity.

Common adverse effects include myelosuppression, nausea, vomiting, mucositis, and fatigue. Other potential toxicities include nephrotoxicity, electrolyte disturbances, alopecia, and neurotoxicity, including encephalopathy, especially at higher doses. Fertility effects may occur, and there is a risk of secondary malignancies with prolonged use.

Pharmacokinetics are characterized by hepatic metabolism with renal excretion of metabolites. Dose adjustments are required for hepatic or renal impairment. Monitoring includes complete blood counts, renal and liver function, and signs of urotoxicity or neurotoxicity. Drug interactions may affect toxicity or efficacy, particularly nephrotoxic or neurotoxic agents.