mesna; 2-mercaptoethane sulfonate; 2-sulfanylethanesulfonic acid (Mesnex, Uromitexan, Mistabronco)
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Introduction
main ingredient is 2-mercaptoethanesulfonate.
Tradename: Mesnex
Indications
- uroprotective agent used to decrease the incidence of hemorrhagic cystitis in patients receiving cyclophosphamide or ifosfamide
Contraindications
* incompatible with cisplatin
Dosage
- mesna is used in combination with cyclophosphamide & ifosfamide
- 60% of ifosfamide or cyclophosphamide dose
- 20% before 20% 4 hours after 20% 8 hours after ifosfamide or cyclophosphamide dose, or
- equal to ifosfamide or cyclophosphamide dose, delivered continuously
- dose just prior to chemotherapy should be IV
- 4 & 8 hours doses may be oral or IV
- oral doses should be mixed in tomato juice, orange juice, or a carbonated drink
- 60% of ifosfamide or cyclophosphamide dose
Injection: 100 mg/mL (2 mL, 4 mL, 10 mL).
Storage
Diluted solutions are stable for 24 hours at room temerature, but recommendations are for refrigeration & use within 6 hours.
Pharmacokinetics
- rapidly oxidized in blood to dimesna which is eliminated in the urine
- dimesna is reabsorbed by the kidney & converted to mesna
- 50% is absorbed orally
- elimination 1/2life is 1 hour
elimination via urine
1/2life = 1 hour
Adverse effects
- not common (1-10%)
- hypotension, malaise, headache, diarrhea, nausea/vomiting (mild), taste disturbance, limb pain, soft stools
- uncommon (< 1%)
Drug interactions
- mesna inhibits anti-neoplastic effects of cisplatin & carboplatin
Test interactions
false positive urine ketone test
Mechanism of action
- sulfhydryl compound that binds to irritating metabolites of ifosfamide & cyclophosphamide producing a non-toxic thiol ether
- slows the rate of acrolein formation
More general terms
Additional terms
- cyclophosphamide (Cytoxan, Neosar, Procytox {Canadian}) [CPM, CTX, CYT, NSC 26271]
- ifosfamide (Ifex, Friedman acid)