1 What is Ifex?

Brand: Ifex

Generic: Ifosfamide

Ifex is a chemotherapeutic agent. Ifosfamide is an alkylating agent that works by interfering with the growth of cancer cells. Ifosfamide injection is used with other chemotherapeutic agents to treat testicular cancer.

Ifosfamide interferes with the growth of cancer cells until they are eventually destroyed. However, this process also affects normal cells in the body, which is a significant cause of side effects.

Some of the side effects of Ifosfamide are serious and must be brought to medical attention immediately. Other side effects, like hair loss, are not serious but still cause significant concern to the patient.

Some of the side effects may appear until months or years after Ifosfamide is used.

You and your doctor must thoroughly discuss the benefits of Ifosfamide as well as risks of treatment.  It is a common practice for certain medicines, once they are approved for marketing for a certain use, may be used to treat other medical problems depending on the available evidence. Aside from its use in testicular cancer, Ifosfamide is also used to treat patients with the following conditions:

Have a question aboutCancer Treatment?Ask a doctor now

2 What to Know Before Using

If you are about to start Ifex, speak with your doctor about what you need to know.

Before Ifosfamide is used as medicine, its benefits must be carefully weighed against potential risks – your doctor usually discusses this to you. In using Ifosfamide, the following is considered:

You need to tell your doctor if you have unusual or allergies to Ifosfamide and other medicines. You also have to let your doctor know your allergies to foods, dyes, preservatives, and animals. Make sure to read labels and packages carefully.

Pediatric use:
The safety and efficacy of the use of Ifosfamide injection to pediatric patients (below 21 years of age) are not yet fully established.

Geriatric use:
There are no studies to date demonstrating the problems of using of Ifosfamide to patients above 50 to 60 years of age. However, elderly patients are at risk of having age-related kidney problems, which may require careful adjustment of Ifosfamide dose.

Ifosfamide is an FDA pregnancy category D drug, which means studies have demonstrated that it cause harm to the fetus when used in pregnant women. It can only be used if the benefits of the drug outweigh the potential risk.

There are no adequate studies showing that Ifosfamide is safe for infants breastfeeding from mothers taking the drug. Again, the benefits of the drug must outweigh the potential risk.

Interactions with food, tobacco, and alcohol:
Alcohol and tobacco may cause interactions with medicines used with Ifosfamide treatment.

Grapefruit and grapefruit juice can interact with Ifosfamide. It is recommended to avoid consuming grapefruit or products with grapefruit while having Ifosfamide treatment.

Interactions with other medicines:
There is always a chance of interactions when using Ifosfamide with other medications. In case this occurs, the doctor may have to change doses or do other necessary precautions. You have to tell your healthcare provider all the medications you are taking while having treatment with Ifosfamide.

Do note that the following medications that interact with Ifosfamide have been selected according to their potential significance and this list is incomplete.

Using Ifosfamide with this medication is not recommended. The doctor may choose not to give you this medication, or change your other medications:

Using the following medications with Ifosfamide is not recommended. However, it is possible that using both medicines are required so doctors may change dose or schedule use:

  • Abiraterone
  • Adenovirus Vaccine Type 4, Live
  • Adenovirus Vaccine Type 7, Live
  • Amprenavir
  • Aprepitant
  • Atazanavir
  • Bacillus of Calmette and Guerin Vaccine, Live (BCG)
  • Boceprevir
  • Carbamazepine
  • Ceritinib
  • Ciprofloxacin
  • Clarithromycin
  • Cobicistat
  • Conivaptan
  • Crizotinib
  • Darunavir
  • Delavirdine
  • Diltiazem
  • Dronedarone
  • Efavirenz
  • Erythromycin
  • Etravirine
  • Fluconazole
  • Fosamprenavir
  • Fosaprepitant
  • Fosphenytoin
  • Idelalisib
  • Imatinib
  • Indinavir
  • Influenza Virus Vaccine, Live
  • Itraconazole
  • Ketoconazole
  • Lopinavir
  • Measles Virus Vaccine, Live
  • Miconazole
  • Mifepristone
  • Modafinil
  • Mumps Virus Vaccine, Live
  • Nefazodone
  • Nelfinavir
  • Nevirapine
  • Oxcarbazepine
  • Phenobarbital
  • Phenytoin
  • Pioglitazone
  • Poliovirus Vaccine, Live
  • Posaconazole
  • Rifabutin
  • Rifampin
  • Ritonavir
  • Rubella Virus Vaccine, Live
  • Saquinavir
  • Smallpox Vaccine
  • Sorafenib
  • St John's Wort
  • Telaprevir
  • Telithromycin
  • Ticagrelor
  • Tipranavir
  • Typhoid Vaccine
  • Varicella Virus Vaccine
  • Verapamil
  • Voriconazole
  • Yellow Fever Vaccine

The following medications with Ifosfamide may result in increased risk of side effects. However, a combination of Ifosfamide with these medications may be necessary. In that case, the doctor may change dosage or schedule of use of medications:

  • Thiotepa, also a chemotherapeutic drug used for cancers in the breast, ovary, and bladder
  • Warfarin, a drug that reduce blood clotting

Other medical problems:
Certain medical problems may affect the use of Ifosfamide. You have to tell your doctor if you have the following health conditions:

  • Anemia
  • Problems in bone marrow functioning such as granulocytopenia, leukopenia, neutropenia or thrombocytopenia
  • Problems in the bones like osteomalacia
  • Brain diseases like encephalopathy
  • Kidney diseases like Franconi syndrome
  • Heart conditions
  • Lung diseases such as interstitial pneumonitis or pulmonary fibrosis
  • Sepsis or severe infection in the bloodstream
  • Urinary tract infection
  • Ifosfamide may worsen veno-occlusive liver disease
  • Ifosfamide may reduce the body’s ability to fight Infections caused by bacteria, viruses or fungi
  • Liver or kidney disease, Ifosfamide must be used with caution
  • Ifosfamide must not be used in patients with urinary blockage

3 Proper Usage

Proper usage of Ifex requires strict adherence to your doctor’s orders.

Ifosfamide injection is given by a doctor, nurse or other trained health professional in a hospital or cancer treatment centers. It is given through a needle placed into a vein (intravenous or IV route). The IV tube stays in place for 30 minutes because Ifosfamide must be injected slowly.

Ifosfamide injections are given on a schedule. Ifosfamide is usually given for five consecutive days, and given every 3 weeks or when your body can tolerate the medication.

Ifosfamide injections are often given with other medications. Maintain good communication with your doctor if you are prescribed with a combination of medicines.

Always make sure you take them at the proper time and avoid mixing them. Make sure to ask your doctor for help so you can better remember taking your medications at the right times. 

Ifosfamide is highly irritating to the kidneys and bladder. It is very important that you drink extra fluids so you will pass out more urine and avoid buildup of the drug in the urinary tract. Always make sure to empty your bladder frequently, including at least once during the night.

Urinating frequently can avoid Ifosfamide from causing kidney or bladder problems. Follow your doctor’s instructions on your fluid intake requirements per day. 

Ifosfamide can make you feel ill because it causes nausea and vomiting as side effects. However, it is still important that you still have to continue taking Ifosfamide even if you feel ill. For help on side effects, ask your doctor.

4 Precautions to Take

Before using Ifex, there are some precautions you must take.

Sticking to scheduled checkups are very important during Ifosfamide treatment. In that way, your doctor can check your progress and assess for side effects. During visits, you may have to have blood and urine tests to check for side effects.

Ifosfamide is very harmful to the fetus. Women taking Ifosfamide are recommended to use effective forms of birth control to avoid getting pregnant. Men should also avoid fathering a child while having Ifosfamide treatment, and at least 6 months after treatment has ended. If you became pregnant during treatment, tell your doctor immediately.

Do note that use of Ifosfamide may have unwanted effects on the way vaccines work in your body, even for some time after treatment has ended. Do not have immunizations without asking your doctor first when and after treatment.

Ifosfamide may lower your immune system so you might get diseases from live vaccines. Also, make sure other persons living with you should not take oral polio vaccines because of chances of passing polio viruses to you. You have to avoid individuals who have taken polio vaccine within past several months. Do not get close to them and avoid staying in the same room with them. If these situations are unavoidable, wear a protective face mask that completely covers your mouth and nose.

Ifosfamide can have adverse effects on the bone marrow and reduce numbers of white blood cells (which maintains immunity) and platelets (necessary for clotting) in your blood. Therefore, you may experience delayed wound healing and become more prone to infections and bleeding. You have to take the following precautions to reduce risk of injury and infections:

  • Avoid persons with infections or who are visibly ill. If you think you have infection call your doctor immediately, especially if you have a fever, chills, cough, hoarse voice, lower back pain, pain in the flanks, painful or difficulties in urinating.
  • Call your doctor if you have signs and symptoms of bleeding, such as having black tarry stools, blood in urine or stool, having pinpoint red or purple spots on the skin, and unusual bleeding or bruising.
  • Exercise extra care when using toothbrushes, dental flosses or picks, which can cause wounds in your mouth that can take too long to heal due to effects of Ifosfamide. Call your doctor or dentist for other ways to clean your teeth and gums. Also, call your doctor first before having any dental work done.
  • Wash your hands regularly and often use alcohol-based hand sanitizer to avoid infections. Avoid touching your eyes and insides of your nose, and refrain from touching surfaces.
  • Protect yourself from cuts or wounds. Be careful in using sharp objects like razors, knives or cutters.
  • Avoid participating in contact or rough sports or other activities where bruising and injury could occur
  • Ifosfamide treatment may cause increased risk of a brain disease called encephalopathy.

Call your doctor immediately if you have the following symptoms while taking Ifosfamide:

Encephalopathy may progress to coma, so it is important to get medical help immediately if you feel these symptoms.
Treatment with Ifosfamide can cause changes in mental functioning, like drowsiness, trouble thinking, difficulty controlling movements and trouble seeing things clearly, which can be a problem when you drive or operate heavy machinery.

Make sure you understand how your body reacts to Ifosfamide before you do these things or perform activities that require you to be alert and have coordinated body movements.

The lethargic side effects of Ifosfamide may be enhanced by taking alcohol and other CNS depressants like diazepam (Valium), alprazolam (Xanax), zolpidem (Ambien) and barbiturates (phenobarbital, pentobarbital). Note that antihistamines used as medications for hay fever, allergies, colds and other sedatives, pain killers, muscle relaxants, anesthetics, dental anesthetics, and tranquilizers are also CNS depressants. Ask your doctor or dentist before taking any of these medications if you are on Ifosfamide treatment.

Ifosfamide may increase your risk of having certain types of cancer such as lymphoma (cancer of the lymph nodes), leukemia, sarcoma and thyroid cancer. If you have concerns, discuss it with your doctor.

Ifosfamide treatment may cause a serious type of allergic reaction called anaphylaxis, which can be life-threatening and requires immediate medical intervention. Symptoms of anaphylaxis include having a rash, itchiness, hoarseness of voice, difficulty breathing and swallowing, and swelling of the face, mouth, feet and hands.

If you have these symptoms, call your doctor right away and go to the nearest hospital. Do not take any supplements, herbal products, multivitamins, prescription and non-prescription (over-the-counter) drugs without asking your doctor first.

Do not consume grapefruit juice or any product containing grapefruit when taking Ifosfamide. Grapefruit contains substances that interfere with the metabolism of drugs like Ifosfamide.

Ifosfamide may cause slowed growth in children. Also, Ifosfamide may cause infertility to men and women. Make sure to discuss these things with your doctor.

5 Potential Side Effects

As with many medications, there are several potential side effects associated with Ifex.

You may not have all of these side effects when using Ifosfamide.

Ifosfamide has certain side effects, however, require immediate medical attention if they happen. Call your doctor or nurse immediately if you have these symptoms:

These symptoms are more common

These are less common side effects, but still need to be brought to medical attention

  • Bleeding gums
  • Bluish color of the skin, lips, and fingernail beds
  • Clay colored stools
  • Dark urine
  • Reduced or loss of appetite
  • Pain or tenderness in the abdomen
  • Dizziness
  • Headache
  • Unexplained itching
  • Nausea and vomiting
  • Unexplained pain
  • Pinpoint red or purple spots on the skin
  • Swelling of the feet and legs
  • Yellowing of the skin and eyes
  • Skin rash

Here are rare but serious side effects of Ifosfamide that require medical attention:

  • Feeling sensations of burning, tingling or pain
  • Confusion
  • Blurring of vision
  • Seizures or convulsions
  • Sudden onset of dizziness, lightheadedness and feeling of about to faint when getting up from sitting or lying position
  • Palpitations, or fast rapid heartbeat
  • Weakness of the hands, arms and feet
  • Unsteady balance or awkwardness
  • Sweating
  • Trouble breathing

The following are side effects of Ifosfamide that are not life-threatening but still cause concern and require medical attention. These side effects tend to disappear as your body adjusts to the effects of Ifosfamide. Seeking medical help can give your health provider opportunity to reduce or avoid these side effects:

  • Diarrhea
  • Hair loss, causing thinning scalp or baldness
  • Swelling or inflammation of the mouth
  • Redness, swelling or pain at the side of injection
  • Unintended weight loss

Call your doctor if these side effects continue to bother you. Ifosfamide may also cause side effects not listed in some patients. If you notice any other side effects, discuss them with your doctor.