Mesna

(mes-na) Mesnex Pregnancy Category B

Mechanism of Action
Converted to its metabolite, mesna disulphide, which in the kidneys then is converted to the free thiol, mesna. The free thiol reacts chemically with the urotoxic ifosfamide metabo -lites, resulting in their detoxification.

Indications

As a prophylactic agent in reducing the incidence of hemorrhagic cystitis associated with ifosfamide therapy. Orphan drug use: Reduction of hemorrhagic cystitis in cyclophos -phamide therapy.

Metabolism/Excretion
Excreted by the kidneys. Half-life: 0.36 to 1.7 hours.

Dosage Range

For adults and children, the recommended dose of mesna is equivalent to 20% of the ifosfamide dose. The mesna dose is given at the time of the ifosfamide infusion and at 4 hours and 8 h ours after. With this fractionated dosing schedule, the total daily dose is equivalent to 60% of the ifosfamide dose. The cycle is repeated on each day of ifosfamide administration. If the ifosfamide dose is adjusted, the same should be done with the mesna dose. Mesna may be given orally at twice the IV dose. For higher doses of ifosfamide, Mesna at 100% of the ifosfamide dose is admixed with ifosfamide and given as a continuous infusion.

Drug Preparation/Stability

Dilute with 5% dextrose, 5% dextrose and 0 .2% sodium chloride injection, 5% dextrose and 0.33% sodium chloride injection, 5% dextrose and 0.45% sodium chloride injection, 0.92% sodium chloride injection, or lactated Ringers injection. The final concentration yields 20 mg/mL mesna. The reconstitut ed P.305 solution is stable for 24 hours at 25C. Use the solution within 8 hours.

Drug Administration
IV bolus injection.

Drug Interaction

Incompatible with cisplatin. Produces a false -positive result for urinary ketones.

Side Effects and Toxicities

Nausea, vomiting, diarrhea.

Special Considerations
Contraindicated in patients with known hypersensitivity to mesna or other thiol compounds. Use with caution in older children. Do not use the multidose vial in neonates and infants because of its benzyl alcohol content. Mesna does not prevent hemorrhagic cystitis in all patients. Test for hematuria before each days ifosfamide therapy. If hematuria occurs despite mesna, ifosfamide doses should be adjusted or discontinued