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Drug Interactions between ifosfamide / mesna and Optiray 160

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

ifosfamide ioversol

Applies to: ifosfamide / mesna and Optiray 160 (ioversol)

Before you undergo any imaging procedure where ioversol may be given by injection, let your doctor know if you are currently being treated with ifosfamide. Injection of ioversol and similar contrast agents can sometimes cause kidney damage, and combining it with other medications that can also affect the kidney such as ifosfamide may increase that risk. If you have been receiving ifosfamide, your doctor may need to take special precautionary measures before, during and after the contrast injection, particularly if you also have other risk factors such as diabetes, preexisting kidney problems, dehydration, old age, congestive heart failure, low blood pressure, anemia, and multiple myeloma. Alternatively, if the risk is too great, your doctor may choose to perform a different imaging procedure where injection of a contrast is not needed. Following the procedure, you should drink plenty of fluids to keep yourself hydrated and to help flush the contrast agent out of your kidneys. Seek medical attention if you develop signs and symptoms that may suggest kidney damage such as nausea, vomiting, loss of appetite, increased or decreased urination, sudden weight gain or weight loss, fluid retention, swelling, shortness of breath, muscle cramps, tiredness, weakness, dizziness, confusion, and irregular heart rhythm. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Drug and food interactions

Moderate

ifosfamide food

Applies to: ifosfamide / mesna

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Grapefruit and/or grapefruit juice may reduce the efficacy of ifosfamide, whose anticancer effect is dependent on its activation to the 4-hydroxyifosfamide metabolite via CYP450 3A4. The proposed mechanism is inhibition of CYP450 3A4 metabolism by certain compounds present in grapefruit. There are no data available about the effects of grapefruit on ifosfamide. However, in a small study, 8 patients with incurable malignancies received ifosfamide 3 g/m2 by infusion with the potent CYP450 3A4 inhibitor ketoconazole 200 mg orally twice daily for 4 days starting 1 day before the ifosfamide infusion. Ketoconazole decreased the clearance of ifosfamide by 11%, decreased systemic exposure (AUC) of the active metabolite 4-hydroxyifosfamide by 30%, and increased the AUC of the inactive but potentially neurotoxic metabolite 2-dechloroethylifosfamide by 23%, as compared to control. Because pharmacokinetic interactions involving grapefruit juice are often subject to a high degree of interpatient variability, the extent to which a given patient may be affected is difficult to predict.

GENERALLY AVOID: Alcohol may potentiate the neurotoxic effects of ifosfamide. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills. In addition, ifosfamide therapy may cause gastrointestinal disorders and alcohol consumption may increase nausea and vomiting.

MANAGEMENT: Given the potential for reduced efficacy of ifosfamide and increased risk of neurotoxicity and nephrotoxicity it may be advisable for patients to avoid consumption of grapefruit, grapefruit juice, or supplements that contain grapefruit during treatment with ifosfamide. In addition, patients receiving ifosfamide should be warned of the increased risk of neurotoxicity, nausea and vomiting when used in combination with alcohol. Patients should avoid or limit the consumption of alcohol during treatment with ifosfamide.

References

  1. "Product Information. Ifosfamide (ifosfamide)." Hikma USA (formerly West-Ward Pharmaceutical Corporation) (2019):
  2. Kerbusch T, jansen rlh, mathot raa, huitema adr, Jansen RNM, Rijswijk REN, Beijen JH "Modulation of the cytochrome P450-mediated metabolism of ifosfamide by ketoconazole and rifampin" Clin Pharmacol and Therapeutic 70 (2001): 132-141
  3. "Product Information. Ifex (ifosfamide)." Baxter Pharmaceutical Products, Inc (2018):
  4. "Product Information. Holoxan (iFOSFamide)." Baxter Healthcare Pty Ltd (2018):
  5. "Product Information. Ifosfamide (ifosfamide)." Baxter Healthcare Ltd (2022):
  6. "Product Information. Ifex (ifosfamide)." Baxter Corporation (2018):
View all 6 references

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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