اورومیتکسان
Mesna (Mesnex)
اورومیتکسان

نام ژنریک

Mesna

شکل دارویی

اشكال دارويي:


Injection: 100 mg/ml, 4ml

موارد مصرف

موارد و مقدار مصرف


الف) جلوگيري از التهاب خونريزي دهنده مثانه ناشي از ايفسفاميد.


مقدار مصرف روزانه بايد 60 درصد مقدار ايفسفاميد مصرفي محاسبه شود. پس از آن مقدار تعيين شده در سه مقدار مساوي تقسيم و به صورت يك جا تزريق مي‌شود؛‌ مقدار اول همزمان با تزريق ايفسفاميد، و مقادير بعدي چهار و هشت ساعت بعد از تزريق ايفسفاميد تجويز مي‌شوند.


يا 4 دوز منقسم را درست قبل از تجويز ايفسفاميد و سپس 4، 8 و 12 ساعت بعد از آن تزريق نمود و يا 4 دوز را بلافاصله قبل از ايفسفاميد و سپس 3، 6 و 9 ساعت بعد از آن تزريق نمود.


برنامه مصرف مسنا به اين صورت است كه به ازاي هر g/m2 2/1 ايفسفاميد، مقدار mg/m2 240 مسنا همزمان با تزريق ايفسفاميد و چهار و هشت ساعت بعد از آن مصرف مي‌شود.


يا دوز مسنا به صورت 100% ايفسفاميد محاسبه شود و يك دوز 20% تزريق يك جا و سپس دو دوز خوراكي (هر كدام 40%) دريافت نمايد. در برنامه‌هايي كه g/m2 2/1 ايفسفاميد استفاده مي‌شود، mg/m2 240 مسنا وريدي همزمان با مصرف ايفسفاميد و سپس mg/m2 480 پس از 2 و 6 ساعت تزريق مي‌شود.


انفوزيون وريدي مداوم مسنا به صورت 100% ميزان ايفسفاميد است و مي‌تواند در همان محلول مخلوط شود. انفوزيون مسنا تا مادامي كه ايفسفاميد تزريق مي‌شود ادامه دارد و مي‌توان انفوزيون مسنا را 24-8 ساعت بعد از اتمام ايفسفاميد ادامه داد (به دليل نيمه‌ عمر كوتاه مسنا).


ب) پروفيلاكسي در بيماراني كه در پيوند مغز استخوان سيكلوفسفاميد دريافت مي‌نمايند.


بزرگسالان: دوز سيكلوفسفاميد 60%-160% دوز سيكلوفسفاميد روزانه در 5-3 دوز منقسم و يا به صورت انفوزيون مداوم تزريق شود. يا در بيماراني كه
mg/kg 60-50 سيكلوفسفاميد وريدي به مدت 4-2 دوز استفاده مي‌كنند، يك دوز بارگذاري از مسنا برابر mg/kg 10 وريدي داده شود و سپس يك انفوزيون مداوم 24 ساعته مسنا با دوز mg/kg 60 تجويز گردد.


اين رژيم درماني مسنا با هر دوز سيكلوفسفاميد داده شود و تا 24 ساعت بعد نيز ادامه يابد.

موارد منع مصرف

موارد منع مصرف و احتياط


موارد منع مصرف: حساسيت مفرط شناخته شده به اين دارو و يا ساير تركيبات تيول.

عوارض جانبی دارو

عوارض جانبي


اعصاب مرکزي: سردرد، خستگي، اضطراب، آستنيا، گيجي، سرگيجه، تب، بي‌خوابي، درد، خواب‌آلودگي.


قلبي ـ عروقي: كمي فشار خون، درد قفسه سينه، ادم، گر گرفتگي، تاکيکاردي.


دستگاه گوارش: اسهال، تهوع، استفراغ، يبوست، درد شکم، بي‌اشتهايي، سوء‌هاضمه.


ادراري ـ تناسلي: خون در ادرار.


عضلاني ـ اسكلتي: درد كمر.


خون: آنمي، گرانولوسيتوپني، لكوپني، ترومبوسيتوپني.


تنفسي: سرفه، ديسپنه، پنوموني.


پوست: ريزش مو، افزايش تعريق، تحريك در محل تزريق، رنگ پريدگي.


ساير عوارض: واکنشهاي حساسيتي.


مسموميت و درمان


گزارشي در دست نيست.

موارد قابل توجه

-

تداخل دارویی

اثر بر آزمايشهاي تشخيصي


مسنا ممكن است موجب بروز افزايش كاذب در آزمون قند خون و اسيداوريک شود.

مکانیزم اثر

اثر بر آزمايشهاي تشخيصي


مسنا ممكن است موجب بروز افزايش كاذب در آزمون قند خون و اسيداوريک شود.

فارماكوكینتیك

فارماكوكينتيك


جذب: فراهمي زيستي دارو در ادرار 45% از راه خوراکي و 79% از راه تزريق وريدي است.


پخش: در بخش عروقي باقي مي‌ماند و در سرتاسر بافتها انتشار نمي‌يابد.


متابوليسم: به سرعت به مسنادي سولفيد، تنها متابوليت خود متابوليزه مي‌شود.


دفع: در كليه‌ها 33 درصد دارو طي 24 ساعت از راه ادرار دفع مي‌شود. نيم‌عمر مسنا و مسنادي سولفيد به ترتيب 5/0 و 5/1 ساعت است.

سایر اطلاعات

طبقه‌بندي فارماكولوژيك: مشتق تيول.


طبقه‌بندي درماني: محافظت كننده دستگاه ادراري.


طبقه‌بندي مصرف در بارداري: رده B


نام‌هاي تجاري: Uromitexan


ملاحظات اختصاصي


1- بعد از باز كردن آمپول و مصرف دارو، بايد باقيمانده مسنا دور ريخته شود، زيرا مسنا بعد از قرار گرفتن در معرض اكسيژن تشكيل محصول اكسيداسيون غيرفعال (دي‌مسنا) مي‌دهد.


2- مقدار متناسب از دارو با دكستروز پنج درصد تزريقي، كلرور سديم 9/0 درصد تزريقي، يا لاكتات رينگر تزريقي تا حدي رقيق مي‌شود كه غلظت
mg/ml 20 حاصل شود. بعد از رقيق شدن، محلول در دماي اتاق به مدت 24 ساعت پايدار است. با اين‌حال شرکت سازنده توصيه مي‌کند که محلول در يخچال نگهداري شود و ظرف 6 ساعت مصرف شود.


3- از آنجايي كه مسنا با ايفسفاميد و ساير داروهاي شيمي‌درماني استفاده مي‌شود افتراق عوارض جانبي خاص مسنا مشكل است.


4- بيماراني كه جهت ايفسفاميد مسنا دريافت مي‌نمايند بايد به خوبي مايع درماني شود (2 ليتر مايع وريدي و يا خوراكي در حين درمان با ايفسفاميد).


5- ويالهاي حاوي چند دوز قابل نگهداري تا 8 روز مي‌باشند.


6- مسنا از نظر فيزيكو شيميايي با سيس‌پلاتين و كاربوپلاتين ناسازگار است و نبايد با اين دو دارو مخلوط شود.


7- بيماراني كه تا 2 ساعت بعد از مصرف مسناي خوراكي استفراغ مي‌كنند بايد دوز را تكرار كرده و يا مسناي تزريقي دريافت نمايند.


8- جهت بررسي خونريزي نمونه ادراري صبحگاهي ارزيابي شود.


نكات قابل توصيه به بيمار


در صورت مشاهده خون در ادرار، فوراً به پزشك اطلاع دهيد.


مصرف در كودكان: بي‌ضرري مصرف اين دارو در كودكان ثابت نشده است.


با اين‌حال دارو براي پروفيلاكسي خونريزي مثانه ناشي از ايفسفاميد در كودكان 16-4 سال و براي پروفيلاكسي خونريزي مثانه ناشي از سيكلوفسفاميد در كودكان 5 ماه به بالا استفاده شده است.


ويال‌هاي حاوي چند دوز، حاوي بنزيل الكل مي‌باشند.


مصرف در شيردهي: ترشح مسنا در شير مشخص نيست.


تداخل دارويي:


گزارشي موجود نيست.

Mesna (Mesnex)

Mesnex®
(mesna) Injection and Tablets

DRUG DESCRIPTION

Mesnex® (mesna) is a detoxifying agent to inhibit the hemorrhagic cystitis induced by ifosfamide (IFEX®).The active ingredient mesna is a synthetic sulfhydryl compound designated as sodium-2-mercaptoethane sulfonate with a molecular formula of C2H5NaO3S2 and a molecular weight of 164.18.Its structural formula is as follows:

HS-CH2-CH2SO3–Na+

Mesnex (mesna) Injection is a sterile, nonpyrogenic, aqueous solution of clear and colorless appearance in clear glass multi-dose vials for intravenous administration.Mesnex Injection contains 100 mg/mL mesna, 0.25 mg/mL edetate disodium and sodium hydroxide for pH adjustment.Mesnex (mesna) Injection multidose vials also contain 10.4 mg of benzyl alcohol as a preservative. The solution has a pH range of 7.5-8.5.

Mesnex (mesna) Tablets are white, oblong, scored biconvex film coated tablets with the imprint M4. They contain 400 mg mesna. Excipients include lactose, microcrystalline cellulose, calcium phosphate, cornstarch, povidone, magnesium stearate, hydroxypropylmethylcellulose, polyethylene glycol, titanium dioxide, and simethicone.

What are the possible side effects of mesna (Mesnex)?

Seek emergency medical attention or contact your healthcare provider immediately if you experience any of the following serious side effects:

  • an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); or
  • pink or red colored urine.

Other less serious side effects may be more likely to occur. Continue to take mesna, and contact your doctor if you experience any of the following side effects:

  • nausea or vomiting;
  • decreased appetite;
  • stomach...

Read All Potential Side Effects and See Pictures of Mesnex »

What are the precautions when taking mesna (Mesnex)?

Before taking mesna, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: overactive immune system diseases (autoimmune disorders) that may increase your risk for a mesna allergy (e.g., rheumatoid arthritis, lupus, nephritis).

This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.

Kidney function declines as you grow older. This medication is...

Read All Potential Precautions of Mesnex »

Last reviewed on RxList: 10/8/2008
This monograph has been modified to include the generic and brand name in many instances.

INDICATIONS

Mesnex (mesna) is indicated as a prophylactic agent in reducing the incidence of ifosfamide-induced hemorrhagic cystitis.

DOSAGE AND ADMINISTRATION

For the prophylaxis of ifosfamide induced hemorrhagic cystitis, Mesnex (mesna) may be given on a fractionated dosing schedule of three bolus intravenous injections or a single bolus injection followed by two oral administrations of Mesnex (mesna) Tablets as outlined below.

Intravenous Schedule

Mesnex (mesna) is given as intravenous bolus injections in a dosage equal to 20% of the ifosfamide dosage (w/w) at the time of ifosfamide administration and 4 and 8 hours after each dose of ifosfamide. The total daily dose of mesna is 60% of the ifosfamide dose.

The recommended dosing schedule is outlined below:

  0 Hours 4 Hours 8 Hours
Ifosfamide 1.2 g/m2 - -
Mesnex 240 mg/m2 240 mg/m2 240 mg/m2

Intravenous and Oral Dosing

Mesnex (mesna) Injection is given as intravenous bolus injections in a dosage equal to 20% of the ifosfamide dosage (w/w) at the time of ifosfamide administration. Mesnex (mesna) Tablets are given orally in a dosage equal to 40% of the ifosfamide dose 2 and 6 hours after each dose of ifosfamide. The total daily dose of mesna is 100% of the ifosfamide dose.

The recommended dosing schedule is outlined below:

  0 Hours 2 Hours 6 Hours
Ifosfamide 1.2 g/m2 - -
Mesnex Injection 240 mg/m2 - -
Mesnex Tablets - 480 mg/m2 480 mg/m2

Patients who vomit within two hours of taking oral mesna should repeat the dose or receive intravenous mesna. The efficacy and safety of this ratio of IV and PO mesna has not been established as being effective for daily doses of IFEX® higher than 2.0 g/m2.

The dosing schedule should be repeated on each day that ifosfamide is administered. When the dosage of ifos-famide is adjusted (either increased or decreased), the ratio of Mesnex (mesna) to IFEX should be maintained.

Preparation of Intravenous Solutions/Stability

The Mesnex (mesna) multidose vials may be stored and used for up to 8 days.

For IV administration the drug can be diluted by adding the Mesnex (mesna) Injection solution to any of the following fluids obtaining final concentrations of 20 mg mesna/mL: 5% Dextrose Injection, USP

5% Dextrose and 0.2% Sodium Chloride Injection, USP
5% Dextrose and 0.33% Sodium Chloride Injection, USP
5% Dextrose and 0.45% Sodium Chloride Injection, USP
0.92% Sodium Chloride Injection, USP
Lactated Ringer's Injection, USP

For example:

One mL of Mesnex (mesna) Injection multidose vial 100 mg/mL may be added to 4 mL of any of the solutions listed above to create a final concentration of 20 mg mesna/mL.

Diluted solutions are chemically and physically stable for 24 hours at 25° C (77° F).

Mesna is not compatible with cisplatin or carboplatin.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.

HOW SUPPLIED

Mesnex® (mesna) Injection 100 mg/mL

NDC 0015-3563-02 - 1 g Multidose Vial, Box of 1 vial of 10 mL

NDC 0015-3563-03 - 1 g Multidose Vial, Box of 10 vials of 10 mL

Mesnex® (mesna) Tablets

NDC 0015-3565-12 - 400 mg scored tablets, Boxes containing 10 blisters per card Store at controlled room temperature 20° C to 25° C (68° F to 77° F).

Distributed by: Bristol-Myers Squibb Company Princeton, New Jersey 08543 USA. Mesnex® (mesna) Tablets manufactured for: Baxter Healthcare Corporation, Deerfield, IL 60015 USA. Issued May 2002. FDA rev date: 1/30/2003

Last reviewed on RxList: 10/8/2008
This monograph has been modified to include the generic and brand name in many instances.

SIDE EFFECTS

Mesnex (mesna) adverse reaction data are available from four phase I studies in which single IV bolus doses of 600-1200 mg Mesnex (mesna) Injection without concurrent chemotherapy were administered to a total of 53 subjects and single oral doses of 600-2400 mg of Mesnex (mesna) Tablets were administered to a total of 82 subjects.

The most frequently reported side effects (observed in two or more patients) for patients receiving single doses of Mesnex (mesna) IV were headache, injection site reactions, flushing, dizziness, nausea, vomiting, somnolence, diarrhea, anorexia, fever, pharyngitis, hyperaesthesia, influenza-like symptoms, and coughing. Among patients who received a single 1200-mg dose as an oral solution, rigors, back pain, rash, conjunctivitis, and arthralgia were also reported. In two phase I multiple-dose studies where patients received Mesnex (mesna) Tablets alone or IV Mesnex (mesna) followed by repeated doses of Mesnex (mesna) Tablets, flatulence and rhinitis were reported. In addition, constipation was reported by patients who had received repeated doses of IV Mesnex.

Because mesna is used in combination with ifosfamide or ifosfamide-containing chemotherapy regimens, it is difficult to distinguish the adverse reactions which may be due to Mesnex (mesna) from those caused by the concomitantly administered cytotoxic agents.

Adverse reactions reasonably associated with mesna administered IV and orally in four controlled studies in which patients received ifosfamide or ifosfamide-containing regimens are presented in Table 3.

Table 3: Incidence of Adverse Events and Incidence of Most Frequently Reported Adverse Events in Controlled Studies

Mesna Regimen IV-IV-IV IV-Oral-Oral
N exposed
Incidence of AEs
119 (100.0%)
101 (84.9%)
119 (100.0%)
106 (89.1%)
Most Frequently Reported Adverse Events (Preferred Terms)
  N (%) N (%)
Nausea 65 (54.6) 64 (53.8)
Vomiting 35 (29.4) 45 (37.8)
Constipation 28 (23.5) 21 (17.6)
Leukopenia 25 (21.0) 21 (17.6)
Fatigue 24 (20.2) 24 (20.2)
Fever 24 (20.2) 18 (15.1)
Anorexia 21 (17.6) 19 (16.0)
Thrombocytopenia 21 (17.6) 16 (13.4)
Anemia 20 (16.8) 21 (17.6)
Granulocytopenia 16 (13.4) 15 (12.6)
Asthenia 15 (12.6) 21 (17.6)
Abdominal Pain 14 (11.8) 18 (15.1)
Alopecia 12 (10.1) 13 (10.9)
Dyspnea 11 (9.2) 11 (9.2)
Chest Pain 10 (8.4) 9 (7.6)
Hypokalemia 10 (8.4) 11 (9.2)
Diarrhea 9 (7.6) 17 (14.3)
Dizziness 9 (7.6) 5 (4.2)
Headache 9 (7.6) 13 (10.9)
Pain 9 (7.6) 10 (8.4)
Sweating Increased 9 (7.6) 2 (1.7)
Back Pain 8 (6.7) 6 (5.0)
Hematuria* 8 (6.7) 7 (5.9)
Injection Site Reaction 8 (6.7) 10 (8.4)
Edema 8 (6.7) 9 (7.6)
Edema Peripheral 8 (6.7) 8 (6.7)
Somnolence 8 (6.7) 12 (10.1)
Anxiety 7 (5.9) 4 (3.4)
Confusion 7 (5.9) 6 (5.0)
Face Edema 6 (5.0) 5 (4.2)
Insomnia 6 (5.0) 11 (9.2)
Coughing 5 (4.2) 10 (8.4)
Dyspepsia 4 (3.4) 6 (5.0)
Hypotension 4 (3.4) 6 (5.0)
Pallor 4 (3.4) 6 (5.0)
Dehydration 3 (2.5) 7 (5.9)
Pneumonia 2 (1.7) 8 (6.7)
Tachycardia 1 (0.8) 7 (5.9)
Flushing 1 (0.8) 6 (5.0)
* All grades

Postmarketing Surveillance

Allergic reactions, decreased platelet counts associated with allergic reactions, hypertension, hypotension, increased heart rate, increased liver enzymes, injection site reactions (including pain and erythema), limb pain, malaise, myal-gia, ST-segment elevation, tachycardia, and tachypnea have been reported as part of postmarketing surveillance.

Read the Mesnex (mesna) Side Effects Center for a complete guide to possible side effects »

DRUG INTERACTIONS

No clinical drug studies have been conducted.

Last reviewed on RxList: 10/8/2008
This monograph has been modified to include the generic and brand name in many instances.

WARNINGS

Allergic reactions to mesna ranging from mild hypersensitivity to systemic anaphylactic reactions have been reported. Patients with autoimmune disorders who were treated with cyclophosphamide and mesna appeared to have a higher incidence of allergic reactions. The majority of these patients received mesna orally.

Mesnex (mesna) has been developed as an agent to reduce the risk of ifosfamide induced hemorrhagic cystitis. It will not prevent or alleviate any of the other adverse reactions or toxicities associated with ifosfamide therapy.

Mesnex (mesna) does not prevent hemorrhagic cystitis in all patients. Up to 6% of patients treated with mesna have developed hematuria (>50 RBC/hpf or WHO grade 2 and above). As a result, a morning specimen of urine should be examined for the presence of hematuria (microscopic evidence of red blood cells) each day prior to ifosfamide therapy. If hematuria develops when Mesnex (mesna) is given with ifosfamide according to the recommended dosage schedule, depending on the severity of the hematuria, dosage reductions or discontinuation of ifosfamide therapy may be initiated.

In order to reduce the risk of hematuria, Mesnex (mesna) must be administered with each dose of ifosfamide as outlined in the DOSAGE AND ADMINISTRATION section. Mesnex (mesna) is not effective in reducing the risk of hematuria due to other pathological conditions such as thrombocytopenia.

Because of the benzyl alcohol content, the multidose vial should not be used in neonates or infants and should be used with caution in older pediatric patients.

PRECAUTIONS

Information for Patients

Healthcare providers should advise patients taking Mesnex (mesna) to drink at least a quart of liquid a day. Patients should be informed to report if their urine has turned a pink or red color, if they vomit within 2 hours of taking oral Mesnex (mesna) , or if they miss a dose of oral Mesnex. See PATIENT INFORMATION Leaflet for Mesnex (mesna) Tablets.

Laboratory Tests

A false positive test for urinary ketones may arise in patients treated with Mesnex (mesna) . In this test, a red-violet color develops which, with the addition of glacial acetic acid, will return to violet.

Carcinogenesis, Mutagenesis, and Impairment of Fertility Carcinogenesis

No long-term studies in animals have been performed to evaluate the carcinogenic potential of Mesnex.

Mutagenesis

Mesna was not genotoxic in the in vitro Ames bacterial mutagenicity assay, the in vitro mammalian lymphocyte chro-mosomal aberration assay or the in vivo mouse micronucleus assay.

Impairment of Fertility

No studies on male or female fertility were conducted. No signs of male or female reproductive organ toxicity were seen in 6-month oral rat studies (at doses up to 2000 mg/kg/day) or 29-week oral dog studies (520 mg/kg/day; both studies approximately 10-fold higher than the maximum recommended human dose on a body surface area basis).

Pregnancy

Pregnancy Category B.Reproduction studies have been performed in rats and rabbits at oral doses of 1000 mg/kg in rabbits and 2000 mg/kg in rats (approximately 10 times the maximum recommended total daily IV-oral-oral human dose on a body surface area basis) and have revealed no evidence of harm to the fetus due to mesna. There are how-ever, no adequate and well-controlled studies in pregnant women. Because animal reproductive studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

Nursing Mothers

It is not known whether mesna or dimesna is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for adverse reactions in nursing infants from mesna, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

Safety and effectiveness of Mesnex (mesna) Tablets in pediatric patients have not been established.

Because of the benzyl alcohol content in Mesnex (mesna) Injection, the multidose vial should not be used in neonates or infants and should be used with caution in older pediatric patients.

Geriatric Use

Clinical studies of mesna did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. In general, dose selection for an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. However, the ratio of ifosfamide to mesna should remain unchanged.

Last reviewed on RxList: 10/8/2008
This monograph has been modified to include the generic and brand name in many instances.

OVERDOSE

There is no known antidote for Mesnex (mesna) . Oral doses of 6.1 and 4.3 g/kg were lethal to mice and rats, respectively. These doses are approximately 15 and 22 times the maximum recommended human dose on a body surface area basis. Death was preceded by diarrhea, tremor, convulsions, dyspnea, and cyanosis.

CONTRAINDICATIONS

Mesnex (mesna) is contraindicated in patients known to be hypersensitive to mesna or other thiol compounds.

Last reviewed on RxList: 10/8/2008
This monograph has been modified to include the generic and brand name in many instances.

CLINICAL PHARMACOLOGY

Mechanism of Action

Mesnex (mesna) was developed as a prophylactic agent to reduce the risk of hemorrhagic cystitis induced by ifosfamide.

Analogous to the physiological cysteine-cystine system, mesna is rapidly oxidized to its major metabolite, mesna disulfide (dimesna).Mesna disulfide remains in the intravascular compartment and is rapidly eliminated by the kidneys.

In the kidney, the mesna disulfide is reduced to the free thiol compound, mesna, which reacts chemically with the urotoxic ifosfamide metabolites (acrolein and 4-hydroxy-ifosfamide) resulting in their detoxification. The first step in the detoxification process is the binding of mesna to 4-hydroxy-ifosfamide forming a nonurotoxic 4-sul-foethylthioifosfamide. Mesna also binds to the double bonds of acrolein and to other urotoxic metabolites.

In multiple human xenograft or rodent tumor model studies of limited scope, using IV or IP routes of administration, mesna in combination with ifosfamide (at dose ratios of up to 20-fold as single or multiple courses) failed to demonstrate interference with antitumor efficacy.

Pharmacokinetics

At doses of 2-4 g/m2, the terminal elimination half-life of ifosfamide is about 4-8 hours. As a result, in order to maintain adequate levels of mesna in the urinary bladder during the course of elimination of the urotoxic ifosfamide metabolites, repeated doses of Mesnex (mesna) are required.

IV-IV-IV Regimen

After intravenous administration of an 800-mg dose, the half-lives of mesna and dimesna in the blood are 0.36 hours and 1.17 hours, respectively. Approximately 32% and 33% of the administered dose was eliminated in the urine in 24 hours as mesna and dimesna, respectively. The majority of the dose recovered was eliminated within 4 hours. Mesna has a plasma clearance of 1.23 L/h/kg.

IV-Oral-Oral Regimen

The half-life of mesna ranged from 1.2-8.3 hours after administration of intravenous plus oral doses of Mesnex, as recommended in the DOSAGE AND ADMINISTRATION section. The urinary bioavailability of oral mesna ranged from 45-79% of intravenously administered mesna. Food does not affect the urinary availability of orally administered mesna. Approximately 18-26% of the combined intravenous and oral mesna dose appears as free mesna in the urine. When compared to intravenously administered mesna, the intravenous plus oral dosing regimen increases systemic exposures (150%) and provides more sustained excretion of mesna in the urine over a 24-hour period. Approximately 5% of the mesna dose is excreted during the 12-24 hour interval, as compared to negligible amounts in patients given the IV regimen. The fraction of the administered dose of mesna excreted in the urine is independent of dose. Protein binding of mesna is in a moderate range (69-75%).

Special Populations

Gender Effect

An analysis was conducted in four male and four female volunteers; no differences in plasma pharmacokinetics were detected.

Pediatrics and Geriatrics

Pharmacokinetic data of Mesnex (mesna) in pediatric and geriatric patients are not available.

Hepatic and Renal Insufficiency

No clinical studies were conducted to evaluate the effect of hepatic impairment or renal impairment on the phar-macokinetics of Mesnex (mesna) .

Drug-Drug Interaction

No clinical drug interaction studies have been conducted with Mesnex (mesna) .

Clinical Studies

IV Mesna

Hemorrhagic cystitis produced by ifosfamide is dose dependent (Table 1). At a dose of 1.2 g/m2 ifosfamide administered daily for 5 days, 16-26% of the patients who received conventional uroprophylaxis (high fluid intake, alkalin-ization of the urine, and the administration of diuretics) developed hematuria (>50 RBC/hpf or macrohematuria) (Morgan, Einhorna, Costanzi). In contrast, none of the patients who received Mesnex (mesna) Injection together with this dose of ifosfamide developed hematuria (Einhorna, b). In two randomized studies, (Fukuoka, Scheef), higher doses of ifos-famide, from 2 to 4 g/m2 administered for 3-5 days, produced hematuria in 31-100% of the patients. When Mesnex (mesna) was administered together with these doses of ifosfamide, the incidence of hematuria was less than 7%.

Table 1: Percent of Mesnex (mesna) Patients Developing Hematuria ( ≥ 50 RBC/hpf or macrohematuria)

Study Conventional Uroprophylaxis (number of patients) Standard Mesnex IV Regimen (number of patients)
Uncontrolled Studies
  MORGAN* 16% (7/44) -
  COSTANZI* 26% (11/43) -
  EINHORNa* 18% (7/38) 0% (0/21)
  EINHORNb* - 0% (0/32)
Controlled Studies
  FUKUOKA** 31% (14/46) 6% (3/46)
  SCHEEF** 100% (7/7) 0% (0/8)
* Ifosfamide dose 1.2 g/m2 d x 5
** Ifosfamide dose 2 to 4 g/m2 d x 3-5

Oral Mesna

Clinical studies comparing recommended intravenous and oral mesna dosing regimens demonstrated incidences of grade 3-4 hematuria of <5%. Study D07093-0018 was an open label, randomized, two-way crossover study comparing three IV doses with an initial IV dose followed by two oral doses of mesna in patients with cancer treated with ifosfamide at a dose of 1.2-2.0 g/m2 for 3-5 days. Study MED504 was a randomized, multicenter study in cancer patients receiving ifosfamide at 2.0 g/m2 for 5 days. In both studies, development of grade 3 or 4 hematuria was the primary efficacy endpoint. The percent of patients developing hematuria in each of these studies is presented in Table 2.

Table 2: Percent of Mesnex (mesna) Patients Developing Grade 3 or 4 Hematuria

Study Mesnex Dosing Regimen Standard IV Regimen (number of patients) IV + Oral Regimen (number of patients)
D07093-0018 0% (0/30) 3.6% (1/28)
MED504 3.7% (1/27) 4.3% (1/23)

A crossover pharmacokinetic study supports the low incidence of grade 3 or 4 hematuria with the recommended intravenous and oral mesna dosing regimens used in the two controlled studies.

Last reviewed on RxList: 10/8/2008
This monograph has been modified to include the generic and brand name in many instances.

PATIENT INFORMATION

Mesnex®
(mesna) Tablets

Read this information carefully before you start taking Mesnex (mesna) (MES-nex) and each time you get more Mesnex (mesna) . There may be new information. This information does not take the place of talking with your doctor about your medical condition or your treatment. If you have any questions about Mesnex (mesna) , ask your doctor. Only your doctor can determine if Mesnex (mesna) is right for you.

What is the most important information I should know?

  • It is important to drink at least a quart (4 cups) of liquid a day whenever you take Mesnex (mesna) , whether it is intravenous (through a tube placed in a vein) or oral (by mouth).
  • A small number of patients who take Mesnex (mesna) get blood in their urine (hematuria). Therefore, it is important that your doctor check your urine in the laboratory each day that you get Mesnex (mesna) . The laboratory test can find low levels of blood in the urine that you cannot see just by looking at it.
  • If you notice that your urine has turned a pink or red color, contact your doctor as soon as possible. Certain prescription medicines and foods, such as red beets, may also cause your urine to change color. A laboratory test of your urine will show if the source of the color is due to one of these causes or hematuria.
  • You need to take your Mesnex (mesna) Tablets at the exact times your doctor tells you. If you miss a dose, take it as soon as you remember, and contact your doctor for more instructions. Do not double your dose to make up for the missed dose.
  • If you vomit within 2 hours of taking oral Mesnex (mesna) , contact your doctor right away.

What is Mesnex (mesna) ?

Mesnex (mesna) reduces the chance of your getting one of the side effects of another medicine, IFEX® (ifosfamide) for Injection.

IFEX is used to treat certain types of cancers. Mesnex (mesna) should only be given with IFEX.

Mesnex (mesna) reduces the chance of your getting hemorrhagic cystitis from IFEX. This condition causes bloody urine from damage to the bladder lining. The damage to the bladder may show up as blood in your urine (hematuria). If a very small amount of blood is in your urine, you may not be able to see it, but your doctor or nurse can test for it in the laboratory. If there is a larger amount of blood in your urine, you will see that the urine has turned a pink or red color. Mesnex (mesna) does not reduce the chance of getting other side effects of cancer chemotherapy.

When IFEX is given without Mesnex (mesna) , hematuria occurs in a large number of patients. Therefore, it is very important to always take Mesnex (mesna) when getting IFEX treatment.

Who should not take Mesnex (mesna) ?

Do not take Mesnex (mesna) if you have had an allergic reaction to Mesnex (mesna) or other medicines that contain sulfur.

Before beginning treatment with Mesnex (mesna) , check with your doctor if you are:

  • Pregnant. You and your doctor should discuss if Mesnex (mesna) is right for you.
  • Breast-feeding. Your doctor may advise you to stop breast-feeding or not to use Mesnex (mesna) .
  • Have an autoimmune disorder such as rheumatoid arthritis, systemic lupus erythematosis (SLE), or nephritis (a type of kidney problem).You may be more likely to get an allergic reaction from Mesnex (mesna) .

How should I take Mesnex (mesna) ?

Take Mesnex (mesna) at the exact times in the exact amounts your doctor tells you to. If your first dose is intravenous and the other doses are oral, you will get the intravenous dose at the same time as the IFEX. You should take the tablets 2 and 6 hours after the IFEX.

  • The dose of Mesnex (mesna) depends on the amount of the IFEX dose. Pay careful attention to the number of tablets your doctor instructs you to take. You may need to take half tablets for your dose. Each tablet has a groove in the middle that makes it easy to break the tablets in half.

For more information about how to take Mesnex (mesna) , see the section "What is the most important information I should know?"

What are the most common side effects of Mesnex (mesna) ?

The most common side effects reported for Mesnex (mesna) Tablets are headache; digestive symptoms such as nausea (feeling sick to your stomach), vomiting (throwing up), diarrhea (frequent or watery stools or bowel movements), stomach pain and low or no appetite; flu-like symptoms including dizziness, flushing, and fever; sensitive skin; sleepiness; coughing; sore throat; cold-like symptoms; injection site reactions. Some patients may get allergic reactions, rash, con-stipation, paleness, fluid retention (water stays in your body), and decreased blood pressure. These are not all the possible side effects of Mesnex (mesna) . For a complete list, ask your doctor.

If you suspect that someone may have taken more than the prescribed dose of Mesnex (mesna) , contact your local poison control center or emergency room right away.

Storage

Store Mesnex (mesna) Tablets in a cool, dry place protected from excess moisture and heat. If possible do not store in the kitchen or bathroom. Throw away any unused portion after the expiration date.

General advice about prescription medicines

Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not use Mesnex (mesna) for a condition for which it was not prescribed. Do not give Mesnex (mesna) to other people, even if they have the same symptoms you have. It may harm them.

This leaflet summarizes the most important information about Mesnex (mesna) . If you would like more information, talk with your doctor. You can ask your pharmacist or doctor for information about Mesnex (mesna) that is written for health professionals.

  • IFEX® is a registered trademark of Bristol-Myers Squibb Company.

This Patient Information Leaflet has been approved by the U.S. Food and Drug Administration.

Last reviewed on RxList: 10/8/2008
This monograph has been modified to include the generic and brand name in many instances.

>

PATIENT INFORMATION

Mesnex®
(mesna) Tablets

Read this information carefully before you start taking Mesnex (mesna) (MES-nex) and each time you get more Mesnex (mesna) . There may be new information. This information does not take the place of talking with your doctor about your medical condition or your treatment. If you have any questions about Mesnex (mesna) , ask your doctor. Only your doctor can determine if Mesnex (mesna) is right for you.

What is the most important information I should know?

  • It is important to drink at least a quart (4 cups) of liquid a day whenever you take Mesnex (mesna) , whether it is intravenous (through a tube placed in a vein) or oral (by mouth).
  • A small number of patients who take Mesnex (mesna) get blood in their urine (hematuria). Therefore, it is important that your doctor check your urine in the laboratory each day that you get Mesnex (mesna) . The laboratory test can find low levels of blood in the urine that you cannot see just by looking at it.
  • If you notice that your urine has turned a pink or red color, contact your doctor as soon as possible. Certain prescription medicines and foods, such as red beets, may also cause your urine to change color. A laboratory test of your urine will show if the source of the color is due to one of these causes or hematuria.
  • You need to take your Mesnex (mesna) Tablets at the exact times your doctor tells you. If you miss a dose, take it as soon as you remember, and contact your doctor for more instructions. Do not double your dose to make up for the missed dose.
  • If you vomit within 2 hours of taking oral Mesnex (mesna) , contact your doctor right away.

What is Mesnex (mesna) ?

Mesnex (mesna) reduces the chance of your getting one of the side effects of another medicine, IFEX® (ifosfamide) for Injection.

IFEX is used to treat certain types of cancers. Mesnex (mesna) should only be given with IFEX.

Mesnex (mesna) reduces the chance of your getting hemorrhagic cystitis from IFEX. This condition causes bloody urine from damage to the bladder lining. The damage to the bladder may show up as blood in your urine (hematuria). If a very small amount of blood is in your urine, you may not be able to see it, but your doctor or nurse can test for it in the laboratory. If there is a larger amount of blood in your urine, you will see that the urine has turned a pink or red color. Mesnex (mesna) does not reduce the chance of getting other side effects of cancer chemotherapy.

When IFEX is given without Mesnex (mesna) , hematuria occurs in a large number of patients. Therefore, it is very important to always take Mesnex (mesna) when getting IFEX treatment.

Who should not take Mesnex (mesna) ?

Do not take Mesnex (mesna) if you have had an allergic reaction to Mesnex (mesna) or other medicines that contain sulfur.

Before beginning treatment with Mesnex (mesna) , check with your doctor if you are:

  • Pregnant. You and your doctor should discuss if Mesnex (mesna) is right for you.
  • Breast-feeding. Your doctor may advise you to stop breast-feeding or not to use Mesnex (mesna) .
  • Have an autoimmune disorder such as rheumatoid arthritis, systemic lupus erythematosis (SLE), or nephritis (a type of kidney problem).You may be more likely to get an allergic reaction from Mesnex (mesna) .

How should I take Mesnex (mesna) ?

Take Mesnex (mesna) at the exact times in the exact amounts your doctor tells you to. If your first dose is intravenous and the other doses are oral, you will get the intravenous dose at the same time as the IFEX. You should take the tablets 2 and 6 hours after the IFEX.

  • The dose of Mesnex (mesna) depends on the amount of the IFEX dose. Pay careful attention to the number of tablets your doctor instructs you to take. You may need to take half tablets for your dose. Each tablet has a groove in the middle that makes it easy to break the tablets in half.

For more information about how to take Mesnex (mesna) , see the section "What is the most important information I should know?"

What are the most common side effects of Mesnex (mesna) ?

The most common side effects reported for Mesnex (mesna) Tablets are headache; digestive symptoms such as nausea (feeling sick to your stomach), vomiting (throwing up), diarrhea (frequent or watery stools or bowel movements), stomach pain and low or no appetite; flu-like symptoms including dizziness, flushing, and fever; sensitive skin; sleepiness; coughing; sore throat; cold-like symptoms; injection site reactions. Some patients may get allergic reactions, rash, con-stipation, paleness, fluid retention (water stays in your body), and decreased blood pressure. These are not all the possible side effects of Mesnex (mesna) . For a complete list, ask your doctor.

If you suspect that someone may have taken more than the prescribed dose of Mesnex (mesna) , contact your local poison control center or emergency room right away.

Storage

Store Mesnex (mesna) Tablets in a cool, dry place protected from excess moisture and heat. If possible do not store in the kitchen or bathroom. Throw away any unused portion after the expiration date.

General advice about prescription medicines

Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not use Mesnex (mesna) for a condition for which it was not prescribed. Do not give Mesnex (mesna) to other people, even if they have the same symptoms you have. It may harm them.

This leaflet summarizes the most important information about Mesnex (mesna) . If you would like more information, talk with your doctor. You can ask your pharmacist or doctor for information about Mesnex (mesna) that is written for health professionals.

  • IFEX® is a registered trademark of Bristol-Myers Squibb Company.

This Patient Information Leaflet has been approved by the U.S. Food and Drug Administration.

Last reviewed on RxList: 10/8/2008
This monograph has been modified to include the generic and brand name in many instances.

Disclaimer

Mesnex Consumer

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

MESNA - ORAL

(MESS-na)

COMMON BRAND NAME(S): Mesnex

USES: This medication is used to reduce the risk of bleeding in the bladder (hemorrhagic cystitis), which is a very serious side effect of treatment with a cancer chemotherapy drug called ifosfamide. Mesna helps to protect the lining of the bladder against damage from ifosfamide. The body breaks down ifosfamide to form a product that can harm the bladder, and mesna works by making this product less harmful. However, mesna does not change ifosfamide's anti-cancer effects.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This drug may also be used to reduce the risk of bleeding in the bladder caused by another cancer chemotherapy drug called cyclophosphamide.

HOW TO USE: Read the Patient Information Leaflet provided by your pharmacist before you start taking mesna and each time you get a refill. If you have any questions, consult your doctor or pharmacist.

Take this medication by mouth. Follow the dosing schedule as directed by your doctor. Dosage is based on your body size and your dose of ifosfamide (or cyclophosphamide).

While taking this medication, drink at least a quart (4 cups or 1 liter) of liquid each day unless directed otherwise by your doctor. Doing so will also help to reduce the bladder side effects from ifosfamide.

Tell your doctor immediately if you vomit within 2 hours of taking a dose. Your doctor will determine if you should repeat the dose or receive mesna by injection into a vein.

Mesna is very effective in reducing the risk of hemorrhagic cystitis in most patients. However, it may not work in a small number of patients. Therefore, tell your doctor immediately if you notice that your urine is pink, red, or bloody.

Disclaimer

Mesnex Consumer (continued)

SIDE EFFECTS: Headache, flushing, dizziness, drowsiness, nausea, vomiting, loss of appetite, diarrhea, constipation, sensitive skin, or flu-like symptoms (e.g., sore throat, fever, chills, shivering, cough, body aches) may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur: chest pain, fast heartbeat, swelling ankles/feet, muscle weakness.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Read the Mesnex (mesna) Side Effects Center for a complete guide to possible side effects »

PRECAUTIONS: Before taking mesna, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: overactive immune system diseases (autoimmune disorders) that may increase your risk for a mesna allergy (e.g., rheumatoid arthritis, lupus, nephritis).

This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.

Kidney function declines as you grow older. This medication is removed by the kidneys. The elderly may be more sensitive to the effects of this drug.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is not known whether this drug passes into breast milk. Since this medication is given with a cancer chemotherapy drug, breast-feeding while using mesna is not recommended. Consult your doctor before breast-feeding.

Disclaimer

Mesnex Consumer (continued)

DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use.

This medication may interfere with a certain laboratory test (for urinary ketones), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center.

NOTES: Do not share this medication with others.

This medication does not protect you from other side effects of ifosfamide. Consult your doctor or pharmacist for more information on how to manage other side effects.

Small amounts of blood in the urine cannot be seen without a microscope. Therefore, a laboratory test to check for blood in your urine should be performed before each dose of ifosfamide to monitor how well mesna is working. Consult your doctor for more details.

MISSED DOSE: It is important to take each dose of this medication as scheduled. If you miss a dose, take it as soon as you remember and contact your doctor for further instructions. Do not double the dose to catch up.

STORAGE: Store at room temperature between 68-77 degrees F (20-25 degrees C) away from heat and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-800-854-1166 (USA) or 1-800-668-1507 (Canada).

Information last revised May 2010. Copyright(c) 2010 First Databank, Inc.

Mesnex Patient Information Including Side Effects

Brand Names: Mesnex

Generic Name: mesna (Pronunciation: MEZ nah)

What is mesna (Mesnex)?

Mesna is detoxifying agent. It reduces the harmful effects of certain metabolites (breakdown products) of the cancer chemotherapy medicine ifosfamide (Ifex).

Mesna is used to prevent bleeding in the bladder (hemorrhagic cystitis) during chemotherapy with ifosfamide (Ifex).

Mesna may also be used for purposes other than those listed here.

What are the possible side effects of mesna (Mesnex)?

Seek emergency medical attention or contact your healthcare provider immediately if you experience any of the following serious side effects:

  • an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); or
  • pink or red colored urine.

Other less serious side effects may be more likely to occur. Continue to take mesna, and contact your doctor if you experience any of the following side effects:

  • nausea or vomiting;
  • decreased appetite;
  • stomach pain;
  • diarrhea;
  • dizziness;
  • flushing;
  • fever;
  • sensitive skin or skin rash;
  • paleness of the skin;
  • sleepiness;
  • coughing or cold symptoms;
  • pain, redness, or irritation at the injection site;
  • swelling or water retention; or
  • low blood pressure.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

Read the Mesnex (mesna) Side Effects Center for a complete guide to possible side effects »

What is the most important information I should know about mesna (Mesnex)?

It is important to drink at least one quart (4 cups) of liquid each day during treatment with mesna, whether it is taken by mouth or by injection.

If you see blood in the urine or notice that it has a pink or red color, contact your doctor as soon as possible. Some foods or dyes may cause a red color in the urine, however it will be necessary to determine if the color is due to blood in the urine.

Side Effects Centers

Mesnex Patient Information including How Should I Take

What should I discuss with my healthcare provider before taking mesna (Mesnex)?

Do not take mesna without first talking to your doctor if you have

  • had a previous allergic reaction to mesna or to another medicine that contains sulfur; or
  • an autoimmune disorder such as rheumatoid arthritis, systemic lupus erythematosus (SLE), or nephritis (a type of kidney problem).

You may not be able to take mesna, or you may require a dosage adjustment or special monitoring during treatment.

Mesna is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby. Do not take mesna without first talking to your doctor if you are pregnant or could become pregnant during treatment.

It is not known whether mesna passes into breast milk. Do not take mesna without first talking to your doctor if you are breast-feeding a baby.

How should I take mesna (Mesnex)?

Take mesna exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each oral dose with a full glass of water.

If vomiting occurs within 2 hours of taking a dose of mesna, contact your healthcare provider.

Mesna is also available as an injection. Your healthcare provider will administer injectable mesna. If you are using injectable mesna at home, your healthcare provider will give you detailed instructions regarding preparation, administration, and storage of the medication.

It is important to drink at least one quart (4 cups) of liquid each day during treatment with mesna, whether it is taken by mouth or by injection.

A small number of patients who take mesna get blood in the urine (hematuria). Your doctor will check your urine each day that mesna is taken. Laboratory tests can detect blood in the urine that is not visible just by looking at it.

If you see blood in the urine or notice that it has a pink or red color, contact your doctor as soon as possible. Some foods or dyes may cause a red color in the urine, however it will be necessary to determine if the color is due to blood in the urine.

Store mesna at room temperature away from moisture and heat.

Side Effects Centers

Mesnex Patient Information including If I Miss a Dose

What happens if I miss a dose (Mesnex)?

Contact your healthcare provider if a dose of mesna is missed.

What happens if I overdose (Mesnex)?

Seek emergency medical attention if an overdose is suspected.

Symptoms of a mesna overdose may include diarrhea, tremor, seizures, shortness of breath, and bluish color of the skin.

What should I avoid while taking mesna (Mesnex)?

There are no restrictions on foods, beverages, or activities during treatment with mesna unless otherwise directed by your doctor.

What other drugs will affect mesna (Mesnex)?

It is not known whether other medicines will interact with mesna. Talk to your doctor and pharmacist before taking any other prescription or over-the-counter medicines, including vitamins, minerals and herbal products.

Where can I get more information?

Your pharmacist has more information about mesna written for health professionals that you may read.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.04. Revision date: 12/15/2010.

Your use of the content provided in this service indicates that you have read,understood and agree to the End-User License Agreement,which can be accessed by clicking on this link.

Healthwise

Side Effects Centers

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