• Mesna is a cytoprotective agent (chemical that protect cells from harmful substances).
• It is used to reduce the bleeding risk from the bladder in patients taking the cancer treating medicine cyclophosphamide or ifosfamide.
Mesna is prescribed as a preventive medicine to reduce the risk of hemorrhagic cystitis caused by the chemotherapy drugs ifosfamide and cyclophosphamide.
Hemorrhagic cystitis is a condition characterized by bleeding from the bladder. Mesna works by detoxifying the metabolites of the above drugs that cause hemorrhagic cystitis in the urine.
Some preparations of mesna have been used to break thick mucus of the respiratory tract.
Mesna should not be used in:
• The treatment of hematuria (blood in urine) due to disease conditions such as thrombocytopenia (low blood platelet count)
• Patients allergic to mesna injection or tablets or medicines that contain a chemical group called thiol e.g. amifostine
• Neonates, premature infants, and infants with low birth weight due to the presence of benzyl alcohol which can be toxic in these babies and can result in gasping syndrome and even death.
• The intravenous injection comes in multidose vials containing 1g mesna (in a concentration of 100mg/ml).
• The intravenous injection is administered at a dosage equal to 20% of ifosfamide dose weight by weight during ifosfamide administration, and 4 hours and 8 hours after giving ifosfamide.
• The total daily dose of mesna in the intravenous dose schedule is 60% of ifosfamide dose.
Intravenous and oral dosage:
• Mesna injection is given with the dosage equal to 20% of the ifosfamide dose weight by weight during the time of administration of ifosfamide.
• This is followed by mesna tablets taken orally in a dose equal to 40% of the ifosfamide dose after 2 hours and again 6 hours after ifosfamide.
• The total daily dose of mesna in the intravenous and oral dosage schedule is 100% of ifosfamide dose.
• Mesna comes as a tablet of 400mg taken by mouth and also in an injection form which has to be given intravenously (into the vein). The injection is administered in three boluses (large volume) injections.
• Mesna tablets can be taken with the strong tasting liquid or mixed with carbonated beverages, juice or milk to mask its unpleasant taste.
• The dose has to be repeated if the patients vomit within 2 hours after taking mesna tablets.
• Adequate urinary output should be maintained by drinking 1 to 2 liters of water.
• The presence of benzyl alcohol as a preservative in the intravenous solution of mesna may affect the stability of ifosfamide. So, mixing of high concentration of ifosfamide along with mesna must be avoided.
• Mesna can result in false positive tests for urinary ascorbic acid and ketones. It may also cause false negative tests for creatinine phosphokinase (CPK) enzyme.
• Women should inform their doctor if they are pregnant/breastfeeding or planning a pregnancy.
• Mesna injection should not be mixed with other anti-cancer drugs such as epirubicin, cisplatin, carboplatin and nitrogen mustards.
• Gastrointestinal: Loss of appetite, nausea, vomiting, indigestion, unpleasant taste, gas and constipation
• Central Nervous System: Headache, dizziness, confusion, and drowsiness
• Cardiovascular system: Decrease or increase in blood pressure, abnormal heart rate, chestpain, accumulation of fluid in legs, face and around the eyes
• Respiratory: Breathlessness, cough, rhinitis, pharyngitis, pneumonia
• Skin: Rash, injection site reaction, itching, loss of hair, ulceration of the skin and mucosa, serious reactions like toxic epidermal necrolysis and Stevens-Johnson syndrome
• Musculoskeletal: Back pain, muscle pain, pain in the joints, extreme tiredness or weakness
• Blood: Anemia (low red blood cell), leukopenia (low white blood cell), thrombocytopenia (low platelet count), granulocytopenia (low count of granulocytes, which are types of white blood cells
• Allergic reactions: Allergic reactions may be severe and include anaphylaxis
• Monitoring blood cell count and urine analysis to check the presence of blood in urine should be performed during the treatment.
• It is necessary to advise the patient to empty the bladder frequently during chemotherapy treatment especially in the first 24 hours after taking the medication.
• The patient should be advised to report immediately for any discoloration (pink or red color) of urine that may occur.
• Medicines that are injected into the vein must be pre-checked for any visible particulate matter, discoloration and leakage.
• Patients who feel stomach discomfort can take limited but frequent meals. Self-care tips to maintain adequate nutrition and plenty of rest can be advised.
• There are no currently known drug interactions with mesna.
• However, caution is advised when using with any other medication.
• The tablets and the multidose vials should be stored at around 20-25°C, and the vials may be used up to 8 days from initial puncture.
• Store the diluted solutions at room temperature but must be used within 24 hours.
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