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mesna

R05CB05

Forms & Strengths

IV solution 100 mg/mL
Oral tablets 200 mg
Lyophilized powder for reconstitution 100 mg per vial

Adult Dosing

Cyclophosphamide: 200 mg/m² IV/PO q6h, first dose 15‑30 min before chemo, total dose = 3× cyclophosphamide dose
Ifosfamide: 600 mg/m² IV q6h, first dose 15‑30 min before ifosfamide, total dose = 3× ifosfamide dose
Single high‑dose regimen: 1.0 g/m² IV over 30‑60 min, then 0.5 g/m² 4 h later, then 0.5 g/m² 8 h later

Pediatric Dosing

Cyclophosphamide: 200 mg/m² IV/PO q6h, start 15‑30 min before chemotherapy, total 3× cyclophosphamide dose
Ifosfamide: 600 mg/m² IV q6h, start 15‑30 min before ifosfamide, total 3× ifosfamide dose
Dose adjustments for renal impairment: reduce by 50% if CrCl <30 mL/min

Indications

Prevention of hemorrhagic cystitis caused by cyclophosphamide
Prevention of urotoxicity from ifosfamide therapy
Adjunct prophylaxis in high‑dose chemotherapy regimens

Mechanism of Action

Provides sulfhydryl groups that bind and inactivate acrolein, the urotoxic metabolite of cyclophosphamide/ifosfamide
Acts locally in the urinary tract after renal excretion, protecting bladder epithelium

Contraindications

Known hypersensitivity to mesna or other sulfhydryl compounds
Severe renal failure (CrCl <10 mL/min) where drug cannot be excreted

Adverse Reactions

Nausea and vomiting
Headache
Rash, pruritus, urticaria
Hypotension, especially with rapid IV infusion
Bronchospasm or dyspnea
Rare anaphylactoid reactions

Drug Interactions

Concurrent thiol‑containing drugs may diminish mesna's protective effect
May increase nephrotoxicity when combined with ifosfamide in renal impairment
Coadministration with hypotensive agents can potentiate blood pressure lowering
No clinically significant interaction with warfarin or most antibiotics

Curated Content: Needs Vetting Before Put to Clinical Use