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μ΄ν¬μ€νλ―Έλλ μν΄λ‘ν¬μ€νλ―Έλμ ꡬ쑰μ μΌλ‘ μ μ¬ν κ°λ ₯ν **νμ’ μ μν¬νμ **μ λλ€. - **μ ꡬμ½λ¬Ό**: μ½λ¦¬νμ νμ±μ λνλ΄λ €λ©΄ κ°μμ νμ±νλμ΄μΌ ν©λλ€γ - **μμνμ μ©λ**: μ£Όλ‘ κ°μ κ³ μμ΄μ λ¦Όνμ’ λ° μ°μ‘°μ§ μ‘μ’ (μ: κ³ μμ΄ λ°±μ κ΄λ ¨ μ‘μ’ )μ μνμ μΉλ£ νλ‘ν μ½μ μ¬μ©λ©λλ€γ - **λ μ± κ²½κ³ **: λ μ±μ΄ λ§€μ° κ°νλ©°, μ¬κ°ν μΆνμ± λ°©κ΄μΌκ³Ό μ λ μ±μ μλ°©νκΈ° μν΄ **λ©μ€λ(mesna)** λ³μ© ν¬μ¬μ μ κ·Ήμ μΈ **μ리μμΌμ μ΄λ¨**κ° νμμ μ λλ€γ
μμ© κΈ°μ : 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) β **ifosfamide mustard** (the primary active alkylating metabolite). - **Mechanism**: The active mustard metabolite forms covalent bonds with DNA β **cross-linking of DNA strands** β interferes with DNA replication and RNA transcription β disrupts nucleic acid function and induces cell death.
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- Vaccine-related sarcomas Β· 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. Β· IV Β· Every 3 weeks
- Neoplasia Β· 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. Β· IV Β· Every 21 days
- Lymphomas and soft tissue sarcomas Β· 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. Β· IV Β· Every 3 weeks Β· Requires saline diuresis and mesna
- Lymphomas and soft tissue sarcomas Β· 375 mg/m2 Β· IV Β· Every 21 days Β· Follow cat dose 'b' protocol for diuresis and mesna administration
μ©λμ λ©΄ν μμ μ λ¬Έκ°λ₯Ό μν μμ μ°Έκ³ μλ£μ λλ€. νμ μ΅μ λΌλ²¨κ³Ό κ°λ³ νμμ λν΄ νμΈνμμμ€.
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- Hypersensitivity to ifosfamide
- Severely depressed bone marrow function
- Active hemorrhagic cystitis
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- 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
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- Benzodiazepines (diazepam, chlordiazepoxide, oxazepam) Β· May increase concentrations of active ifosfamide and increase toxicity (demonstrated in mice; clinical significance in veterinary patients undetermined)
- Cisplatin Β· Ifosfamide may enhance cisplatin-induced ototoxicity and nephrotoxicity
- Myelosuppressive drugs (chloramphenicol, flucytosine, amphotericin B, colchicine, other antineoplastics) Β· Additive myelosuppression
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- 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
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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 μ½λ¬Ό λ νΌλ°μ€λ λ©΄ν μμ μ λ¬Έκ°λ₯Ό μν μμ μμ¬κ²°μ 보쑰 λꡬμ΄λ©°, μ λ¬Έμ νλ¨μ΄λ μ μ‘°μ¬μ μ΅μ λΌλ²¨μ λμ νμ§ μμ΅λλ€.