이포스파미드

항종양제 - 알킬화제

이포스파미드는 시클로포스파미드와 구조적으로 유사한 강력한 **항종양 알킬화제**입니다. - **전구약물**: 약리학적 활성을 나타내려면 간에서 활성화되어야 합니다。 - **수의학적 용도**: 주로 개와 고양이의 림프종 및 연조직 육종(예: 고양이 백신 관련 육종)의 시험적 치료 프로토콜에 사용됩니다。 - **독성 경고**: 독성이 매우 강하며, 심각한 출혈성 방광염과 신독성을 예방하기 위해 **메스나(mesna)** 병용 투여와 적극적인 **생리식염수 이뇨**가 필수적입니다。

작용 기전: Ifosfamide is a **cell-cycle phase nonspecific** alkylating agent. - **Activation**: As a prodrug, it is metabolized primarily by hepatic cytochrome P450 enzymes (and to a lesser extent in the lungs) → **ifosfamide mustard** (the primary active alkylating metabolite). - **Mechanism**: The active mustard metabolite forms covalent bonds with DNA → **cross-linking of DNA strands** → interferes with DNA replication and RNA transcription → disrupts nucleic acid function and induces cell death.

동물 종별 용량

Cats

Vaccine-related sarcomas · 900 mg/m2 every 3 weeks. Mesna bolus and saline diuresis (30 minutes at 18.3 mL/kg/hr) were first given, then ifosfamide and saline diuresis continued for 5 hours after ifosfamide administration completed. · IV · Every 3 weeks
Neoplasia · Normal (0.9%) saline IV diuresis at a fluid rate of 6 times maintenance over 30 minutes. Ifosfamide 900 mg/m2 diluted to 20 mg/mL or less, IV over 20 minutes. Normal saline IV diuresis at 6 times maintenance over 5 hours. Mesna urothelial protectant at 1/5 the patient's calculated mg dose at time zero (immediately before ifosfamide administration), and repeated 2 and 5 hours after ifosfamide. This therapy may be repeated on a 21 day basis. · IV · Every 21 days

Dogs

Lymphomas and soft tissue sarcomas · Give IV saline at 18.3 mL/kg/hr for 6 hours. Give ifosfamide at 350 mg/m2 (if patient weighs less than 10 kg), 375 mg/m2 (if greater than 10 kg) IV during the second 30 minutes of the 6-hour infusion. Mesna at a dose of 20% of the ifosfamide dose is given as an IV bolus at the start of the IV infusion and again 2 and 5 hours after the ifosfamide infusion. Repeat every 3 weeks. · IV · Every 3 weeks · Requires saline diuresis and mesna
Lymphomas and soft tissue sarcomas · 375 mg/m2 · IV · Every 21 days · Follow cat dose 'b' protocol for diuresis and mesna administration

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

IVPOSC

금기

Hypersensitivity to ifosfamide
Severely depressed bone marrow function
Active hemorrhagic cystitis

이상반응

Myelosuppression (neutropenia at 5-7 days, potentially delayed to 14-21 days; thrombocytopenia)
Hemorrhagic cystitis (bladder epithelial damage)
Nephrotoxicity (proximal and distal tubular damage, electrolyte abnormalities)
Volume overload and pulmonary edema (secondary to required saline diuresis)
Neurotoxicity (somnolence, confusion, coma, encephalopathy)
Gastrointestinal effects (nausea, vomiting, anorexia)
Hypersensitivity reactions
Alopecia
Abnormal liver function tests

약물 상호작용

Benzodiazepines (diazepam, chlordiazepoxide, oxazepam) · May increase concentrations of active ifosfamide and increase toxicity (demonstrated in mice; clinical significance in veterinary patients undetermined)
Cisplatin · Ifosfamide may enhance cisplatin-induced ototoxicity and nephrotoxicity
Myelosuppressive drugs (chloramphenicol, flucytosine, amphotericin B, colchicine, other antineoplastics) · Additive myelosuppression

모니터링

CBC with platelets (baseline and before re-dosing)
Renal function with electrolytes (baseline and before re-dosing)
Urinalysis (baseline and periodic)
Liver function (baseline and periodic)
Other adverse effects (volume overload/pulmonary edema, neurotoxicity, GI toxicity)
Efficacy

과용량

There is limited information available on acute overdoses. Toxicity is expected to be an exacerbation of adverse effects seen at usual doses. No specific antidote (including mesna) is known; treatment is supportive. **Methylene blue** (50 mg in a ~2% aqueous solution IV over 5 minutes) has been suggested to treat ifosfamide-induced encephalopathy in humans.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.