Hemorrhagic cystitis is such a predominant side effect of the alkylator ifosfamide that mesna always must be given with ifosfamide, along with hydration. Dosing regimens of mesna range from an equal milligram dose to the ifosfamide mixed in the same IV bag to 20% of the dose prior to ifosfamide and 20% of the dose repeated at 4 and 8 hours after the dose. The pharmacokinetics of ifosfamide are best described by a one-compartment model, with a terminal half-life of 7 to 15 hours. Approximately 50% of a dose is excreted unchanged by the kidney. Ifosfamide has shown clinical activity in the treatment of acute lymphocytic leukemia, lymphomas, and breast, ovarian, lung, and head and neck cancers. CNS side effects of confusion, delirium, and somnolence are associated with high doses infused quickly.

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