Ifosfamide (Mitoxana)

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. It 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 reproduce itself.

Ifosfamide is a clear liquid that you have 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 just before your course of treatment starts and it stays in place as long as you need it. 

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. Your doctor may ask you to stay overnight at the hospital.

You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for ifosfamide depends on which type of cancer you have. To find out more about the way chemotherapy treatment is planned go to the planning chemotherapy section of CancerHelp UK.

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 click on search at the top of the screen.

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

Temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery
• 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 nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• 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
• 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

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 – the liver will almost certainly go back to normal when treatment is finished, 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 immediately
• Women may stop having periods (amenorrhoea) – this may only be temporary
• Loss of fertility – you may not be able to get pregnant or father a child after treatment with this drug. It is important to talk to your doctor about your fertility before starting treatment if having a baby is important to you 
• Harm to a developing baby – it is important not to get pregnant or father a child during treatment with ifosfamide. Talk to your doctor about contraception before your treatment starts

The side effects above 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

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

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

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.