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Mesna information from DrugsUpdate  

See Available Brands of Mesna in India

P - Caution when used during pregnancy
L - Caution when used during lactation
LI - Lab *

Mesna is an adjuvant used in cancer chemotherapy involving cyclophosphamide and ifosfamide. It is marketed by Baxter as Uromitexan and Mesnex. MESNA is an acronym for 2-MercaptoEthane Sulfonate sodium(NA).

Pharmacodynamics

Pharmacokinetics

Mesna is used to prevent urothelial toxicity associated with oxazaphosphorine, ifosfamide or cyclophosphamide. It acts in the kidney; reacting with thiol groups of urotoxic metabolites (e.g. acrolein) of ifosfamide and cyclophosphamide. It is used as a mucolytic in the management of some respiratory tract conditions e.g. cystic fibrosis where other mucolytics have failed. It acts by reducing the viscosity of pulmonary secretions; the drug's free sulfhydryl group is thought to reduce disulfide linkages of mucoproteins.

Absorption

Oral bioavailability: 45-79%. Time to plasma peak: 2-3 hours.

Distribution
No tissue penetration. Protein-binding: 69-75%.

Metabolism
In blood, rapidly oxidised to mesna disulfide and then reduced back to mesna after glomerular filtration into renal tubules.

Excretion
Via urine: As unchanged drug (18-26%) and metabolites. Half-life elimination: Mesna: 24 minutes; Mesna disulfide: 72 minutes.

Mesna Indications / Mesna Uses

Information Not Available

Mesna Adverse Reactions / Mesna Side Effects

Nausea, vomiting, colic, diarrhoea, anorexia, dyspepsia, unpleasant taste, constipation; headache, malaise, fatigue, depression, irritability, somnolence, hyperaesthesia, dizziness, confusion; rash, pruritus, generalised urticaria, alopecia, inj site reactions, flushing; leucopenia, thrombocytopenia, anaemia, granulocytopenia, chest pain, oedema (peripheral, facial and periorbital), hypotension, tachycardia, hypertension, increased heart rate, ST-segment elevation; dyspnoea, coughing, pneumonia, tachypnea; fever; hypocalcaemia; increased sweating; back pain, limb pain, myalgia; increased hepatic enzyme concentrations; pharyngitis; ulceration of mucous membranes. In patients receiving oral and/or IV mesna and were specifically not treated with concurrent cytotoxic therapy: flatulence; rhinitis; rigors; back pain; rash; conjunctivitis; arthralgia. Inhalation: bronchospasm.

Potentially Fatal: May cause haemorrhagic cystitis, systemic anaphylactic reactions.

Precautions

Information Not Available

Special Precautions

Protective effect applies only to the urinary tract; pregnancy, lactation. Patients with auto-immune disorders. IV formulation may contain benzyl alcohol as a preservative; avoid in neonates or infants. Instruct patients to seek medical attention if discolouration of urine occurs. During treatment, monitor urine for erythrocytes and haematuria. Maintain adequate hydration in all patients. Patients who vomit within 2 hr of oral dose should repeat dose or receive IV dose.

Other Drug Interactions

Information Not Available

Other Interactions

Information Not Available

Dosage

Oral
Prophylaxis against urothelial toxicity
Adult: Refer to individual and local protocol. Dose calculated according to cytotoxic dose. Normally given at a dose ≥cytotoxic dose. Duration of treatment should be as long as cytotoxic treatment; plus the time it takes for concentration of antineoplastic metabolites in urine to fall.
Child: Refer to individual and local protocol.

Intravenous

Prophylaxis against urothelial toxicity
Adult: Refer to individual and local protocol. Dose calculated according to cytotoxic dose. Normally given at a dose ≥cytotoxic dose. Duration of treatment should be as long as cytotoxic treatment; plus the time it takes for concentration of antineoplastic metabolites in urine to fall. Administered either by short (15-30 minutes) or continuous (24 hours) infusion.
Child: Refer to individual and local protocol. Has been used in children >4 months.

Inhalation

Mucolytic in cystic fibrosis
Adult: Used when other mucolytics have failed to reduce sputum viscosity. 3-6 ml of 20% solution is nebulised bid.
Child: Used when other mucolytics have failed to reduce sputum viscosity. 3-6ml of 20% solution is nebulised bid.

Reconstitution

Dilute in flavoured syrup, water, milk, carbonated drinks or apple or orange juice.

Food(before/after)

May be taken with or without food

List of Contraindications

Mesna and Pregnancy

Caution when used during pregnancy

Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).

Mesna and Lactation

Caution when used during lactation

Mesna and Children

Safety and efficacy not established

Mesna and Geriatic

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.

Mesna and Other Contraindications

Hypersensitivity to thiol-containing compounds

Storage

Inhalation
Injection 15-30°C. Multi-dose vials may be used for 8 days after 1st entry. Discard single use vials immediately after use; mesna is easily oxidised when exposed to the atmospere. After dilution with a suitable diluent, concentrations of mesna 20 mg/ml are chemically and physically stable for 24 hours at 25°C.

Intravenous
Injection 15-30°C. Multi-dose vials may be used for 8 days after 1st entry. Discard single use vials immediately after use; mesna is easily oxidised when exposed to the atmosphere. After dilution with a suitable diluent, concentrations of mesna 20 mg/ml are chemically and physically stable for 24 hours at 25°C. Do store in glass or plastic syringes with Luer-Lok® fittings for >12 hours as particulates may form. Chemically stable for at least 24 hours when admixed with ifosfamide and cyclophosphamide in 5% dextrose or lactated Ringer's.

Oral
Tablet: Store at 20-25°C. Oral solution: Solutions containing mesna 20 or 50 mg/ml in flavoured syrup are stable for 7 days at 25°C. Solutions containing mesna 2, 10 or 50 mg/ml in carbonated drinks or apple or orange juice are stable for at least 24 hours at 5°C.

Lab interference

Inhalation
Injection 15-30°C. Multi-dose vials may be used for 8 days after 1st entry. Discard single use vials immediately after use; mesna is easily oxidised when exposed to the atmospere. After dilution with a suitable diluent, concentrations of mesna 20 mg/ml are chemically and physically stable for 24 hours at 25°C.

Intravenous
Injection 15-30°C. Multi-dose vials may be used for 8 days after 1st entry. Discard single use vials immediately after use; mesna is easily oxidised when exposed to the atmosphere. After dilution with a suitable diluent, concentrations of mesna 20 mg/ml are chemically and physically stable for 24 hours at 25°C. Do store in glass or plastic syringes with Luer-Lok® fittings for >12 hours as particulates may form. Chemically stable for at least 24 hours when admixed with ifosfamide and cyclophosphamide in 5% dextrose or lactated Ringer's.

Oral
Tablet: Store at 20-25°C. Oral solution: Solutions containing mesna 20 or 50 mg/ml in flavoured syrup are stable for 7 days at 25°C. Solutions containing mesna 2, 10 or 50 mg/ml in carbonated drinks or apple or orange juice are stable for at least 24 hours at 5°C.

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