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Ifosfamide (Mitoxana)

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This page tells you about the chemotherapy drug ifosfamide and its possible side effects. There are sections about


What ifosfamide is

Ifosfamide is used to treat a wide variety of cancers including breast cancer, testicular cancer and lung cancer, as well as some types of lymphoma. 


How ifosfamide works

Ifosfamide works by sticking the cancer cell’s DNA (the cell’s genetic code) together so that it can't come apart again. This means that the cell can't divide and grow.


How you have ifosfamide

You have ifosfamide into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.

You can read our information about having chemotherapy into a vein.

You always have a drug called mesna with ifosfamide. You either have this through your drip in a separate bag, before or after the ifosfamide, or they can be mixed together in one bag. Usually you have a lot of fluid too, so the drugs take a long time to go through the drip. You may need to stay overnight at the hospital.

You usually have chemotherapy as a course of several cycles of treatment, which means you have the drug and then a break with no treatment. The treatment plan for ifosfamide depends on which type of cancer you have.

The side effects of ifosfamide are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link, see the cancer drugs side effects section or use the search box at the top of the screen.


Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have bleeding gums after brushing your teeth or nosebleeds. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia)
  • Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal from 6 months to a year after their treatment finishes
  • Feeling or being sick – this is generally well controlled with anti sickness injections and tablets. If it happens, it usually starts a few hours after each treatment and may last for about 3 days. Sometimes there is delayed sickness lasting up to 2 weeks. If your sickness is not controlled, tell your doctor or nurse
  • Loss of appetite
  • Hair loss – it is very common to get complete head and body hair loss with ifosfamide, especially if you have it with other chemotherapy drugs. Hair loss usually starts about 3 to 4 weeks after the first treatment. Remember this is only temporary and your hair will grow back
  • Irritation of the bladder and kidneys – drink as much water as possible to flush out the ifosfamide. You may have fluids into your drip before and after your treatment. You will have a drug called mesna to protect your bladder and kidneys. Make sure that you pass urine often and before you go to sleep
  • Your nails may become ridged

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Liver changes that are very mild and unlikely to cause symptoms – these will almost certainly go back to normal when treatment ends but you will have regular blood tests to check how well your liver is working
  • A skin rash, which may be itchy
  • Your skin may become darker temporarily
  • About one person in 8 has confusion, sleepiness or extreme lack of energy (lethargy) and hallucinations – if you have any of these, it is important to tell your doctor or nurse straight away
  • A sore mouth and throat
  • Women may stop having periods (amenorrhoea) – this may only be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment

Important points to remember

You may have a few of the side effects mentioned on this page. They may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Do not breastfeed during this treatment because the drug may come through in the breast milk.

Slow wound healing

Ifosfamide can slow wound healing. If you need to have an operation your doctor will normally stop the ifosfamide for a while beforehand. They will let you know when you can start having it again.


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


More information about ifosfamide

This information does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.


Related information

You can find information about types of cancer.

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Updated: 9 February 2015