Ifosfamide

Ifosfamide is a chemotherapy medicine used to treat certain types of cancer.

How is ifosfamide given?

It is given as an infusion into a vein (intravenously or IV) through a cannula, central venous catheter or implantable port.

What are the side effects of ifosfamide?

Nausea and vomiting

Anti-sickness drugs can be given to reduce or prevent these symptoms. Please tell your doctor or nurse if your child’s sickness is not controlled or persists.

Hair loss

Your child may lose all of his or her hair, or it may become thinner. This is temporary and the hair will grow back once the treatment has finished.

Bone marrow suppression

There will be a temporary reduction in how well your child’s bone marrow works, which means he or she may become anaemic, bruise or bleed more easily than usual and have a higher risk of infection. Your child’s blood count will be checked regularly to see how the bone marrow is working. Please tell your nurse or doctor if your child seems unusually tired, has bruising or bleeding, or any signs of infection, especially a high temperature.

Fertility

Ifosfamide is a relatively new drug that comes from the same family as cyclophosphamide. Cyclophosphamide is known to reduce fertility if it is given over a long period of time at high doses. As ifosfamide is similar, its effect on fertility is currently being studied. Depending on the combination of drugs and the dose that your child is given, his or her fertility may be affected. If you feel you would like more information, please discuss this with your doctor.

Irritation of the bladder wall

Ifosfamide can cause irritation of the bladder wall. Your child will be given a drug called mesna and intravenous fluids to reduce or stop this irritation. He or she will also be encouraged to drink lots of fluids. Your child’s urine will be tested for blood while they are receiving ifosfamide.

Altered kidney function

Ifosfamide may change how well your child’s kidneys work, over a period of time. Your child may have a blood and urine test (TRP) or a GFR (Glomerular Filtration Rate) before treatment is started and then at stages during and after treatment to monitor kidney function.

Disorientation and sleepiness

There have been rare reports of children becoming disorientated while receiving ifosfamide. Your child will be closely observed. Subsequent drug therapy may be changed if your child experiences this side effect. If you feel you would like more information, please discuss this with your doctor.

Second cancers

If your child is given ifosfamide for a long time, there is a very small risk of him or her developing a second cancer after many years. If you feel you would like more information, please discuss this with your doctor.

Fluid retention

Ifosfamide may cause the kidneys to retain water leading to the dilution of the salts in the body. This is known as SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone). Rarely, this may lead to drowsiness, weakness or fits. If you feel you would like more information, please discuss this with your doctor.

Ifosfamide and interactions with other medicines

Some medicines can react with ifosfamide, altering how well it works. Always check with your doctor or pharmacist before giving your child any other medicine, including medicines on prescription from your family doctor (GP), medicines bought from a pharmacy (chemist) or any herbal or complementary medicines.

Compiled by: 
the Pharmacy department in collaboration with the Child and Family Information Group
Last review date: 
May 2013
Ref: 
2013F0785

Disclaimer

Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer. If you do not have a copy of the manufacturer’s patient information leaflet please talk to your pharmacist. A few products do not have a marketing authorisation (licence) as a medicine and therefore there is no PIL.

For children in particular, there may be conflicts of information between the manufacturer’s patient information leaflet (PIL) and guidance provided by GOSH and other healthcare providers. For example, some manufacturers may recommend, in the patient information leaflet, that a medicine is not given to children aged under 12 years. In most cases, this is because the manufacturer will recruit adults to clinical trials in the first instance and therefore the initial marketing authorisation (licence) only covers adults and older children.  

For new medicines, the manufacturer then has to recruit children and newborns into trials (unless the medicine is not going to be used in children and newborns) and subsequently amend the PIL with the approved information. Older medicines may have been used effectively for many years in children without problems but the manufacturer has not been required to collect data and amend the licence. This does not mean that it is unsafe for children and young people to be prescribed such a medicine ‘off-licence/off-label’. However, if you are concerned about any conflicts of information, please discuss with your doctor, nurse or pharmacist.