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Class: Protective Agents
- Uroprotective Agents
- Sulfhydryl Donors
VA Class: AD900
CAS Number: 19767-45-4
Brands: Mesnex

Medically reviewed by Last updated on July 3, 2020.


Uroprotective agent; a synthetic sulfhydryl (thiol) compound.1 3 4 5

Uses for Mesna

Prophylaxis of Ifosfamide-induced Hemorrhagic Cystitis

Reduction in the incidence of ifosfamide-induced hemorrhagic cystitis;1 2 3 4 5 6 8 9 37 38 39 40 43 44 47 60 use recommended by ASCO.60 61 Designated an orphan drug by FDA for this use.27

Prophylaxis of Cyclophosphamide-induced Hemorrhagic Cystitis

Reduction in the incidence of hemorrhagic cystitis associated with high-dose cyclophosphamide in bone marrow transplantation (BMT) patients;7 9 10 11 12 13 14 26 28 45 46 60 ASCO currently recommends using either mesna plus saline diuresis or forced saline diuresis for this purpose.60 61

Designated an orphan drug by FDA for inhibition of urotoxic effects of oxazaphosphorine compounds (e.g., cyclophosphamide).27

Mesna Dosage and Administration


  • To maintain adequate urinary protection, administer mesna regimen with each dose of ifosfamide1 2 3 or cyclophosphamide.7 11 12 45 46

  • Employ adequate oral and/or IV hydration.1 3 4 To prevent ifosfamide-induced hemorrhagic cystitis, hydrate with at least 1 L of oral or IV fluid daily before and during ifosfamide therapy.1 3 4 8 10 12 15 35 38 39 41 44 52 53


Administer orally1 or IV.1 2 3 7 8 10 15 34 38 41 43 44

Oral Administration

Administer orally.1

Prior to availability of oral dosage form, extemporaneous oral solutions3 4 5 6 8 16 26 29 were prepared by diluting the appropriate dose of mesna injection in syrup, carbonated beverages, or fruit (i.e., apple, orange) juice.3 5 6 26 (See Extemporaneous Oral Solutions under Stability.)

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer diluted (20 mg/mL) solution by IV injection.1 2 3 7 8 10 15 34 38 41 43 44

Has been administered as a 20-mg/mL solution by IV infusion over 15–30 minutes.18 32

Also has been administered by continuous IV infusion.3 4 5 10 17 34 37 38 39 40 41 42 60 For continuous IV infusion, may admix with ifosfamide and administer both drugs simultaneously.3 4 5 17 18 39 40


Withdraw appropriate dose from vial containing 100 mg/mL and dilute with an appropriate volume of a compatible IV solution (see Solution Compatibility under Stability) to obtain a final solution containing 20 mg/mL.1 2 4 18



Prophylaxis of Ifosfamide-induced Hemorrhagic Cystitis

If ifosfamide dosage is increased or decreased, maintain constant mesna-to-ifosfamide ratio.1


IV injection: For daily ifosfamide dosages <2.5 g/m2,60 administer a mesna dosage equivalent to 20% weight/weight (w/w) of the daily ifosfamide dosage 15 minutes before60 or at the time of ifosfamide administration and then at 4 and 8 hours after the ifosfamide dose;1 2 3 60 61 total daily mesna dosage is equivalent to 60% w/w of the daily ifosfamide dosage.1 In patients receiving ifosfamide 1.2 g/m2, administer mesna 240 mg/m2 15 minutes60 before or at the time of ifosfamide administration, followed by 240 mg/m2 at 4 and 8 hours after the ifosfamide dose.1 2

Continuous IV infusion: For daily ifosfamide dosages <2.5 g/m2,60 ASCO recommends administering a mesna loading dose equivalent to 20% w/w of the daily ifosfamide dosage by IV injection, followed by 40% w/w of the daily ifosfamide dosage by continuous IV infusion, continued for 12–24 hours after completion of the ifosfamide infusion.60

For daily ifosfamide dosages >2.5 g/m2, there are insufficient data to recommend a mesna dosage; however, ASCO recommends more frequent and prolonged administration of mesna for maximum protection against urotoxicity.60 61 (See Prescribing Limits.)

IV, then Oral

For daily ifosfamide dosages <2 g/m2, administer a mesna dosage equivalent to 20% w/w of the daily ifosfamide dosage by IV injection at the time of ifosfamide administration, followed by 40% w/w of the daily ifosfamide dosage orally at 2 and 6 hours after the ifosfamide dose;1 60 total daily mesna dosage is equivalent to 100% w/w of the daily ifosfamide dosage.1

In patients receiving 1.2 g/m2 of ifosfamide, administer mesna 240 mg/m2 by IV injection at the time of ifosfamide administration, followed by 480 mg/m2 orally at 2 and 6 hours after the ifosfamide dose.1

If patient vomits oral dose within 2 hours of administration, repeat dose or consider IV administration.1 60

Prophylaxis of Cyclophosphamide-induced† Hemorrhagic Cystitis

Mesna dosage equivalent to 60–160% w/w of the daily cyclophosphamide dosage, given by IV injection (in 3–5 divided doses daily) or by continuous IV infusion4 10 11 14 45 46 (continued for ≥24 hours after cyclophosphamide is discontinued).7 11 45 52

Prescribing Limits


Prophylaxis of Ifosfamide-induced Hemorrhagic Cystitis

Maximum mesna dosage equivalent to 60% w/w of the daily ifosfamide dosage.61

Safety and efficacy of the recommended mesna-to-ifosfamide ratio (see Dosage) not established for ifosfamide dosages >2.5 g/m2 daily.1

IV, then Oral

Safety and efficacy of the recommended mesna-to-ifosfamide ratio (see Dosage) not established for ifosfamide dosages >2 g/m2 daily.1

Special Populations

Geriatric Patients

Cautious dosing recommended; always maintain constant mesna-to-ifosfamide ratio.1 (See Geriatric Use under Cautions.)

Cautions for Mesna


  • Known hypersensitivity to mesna or other sulfhydryl (thiol) compounds.1 2



Therapy Limitations

Does not prevent ifosfamide- or cyclophosphamide-induced hemorrhagic cystitis in all patients.1 2 36 40 Prior to each scheduled ifosfamide dose, examine morning urine specimen for presence of erythrocytes.1 2 52 If hematuria (>50 erythrocytes/HPF or WHO ≥grade 2) occurs despite mesna prophylaxis, reduce ifosfamide or cyclophosphamide dosage or discontinue these antineoplastic agents.1 2

Does not prevent ifosfamide-induced nephrotoxicity3 4 30 34 or other nonurologic toxicities (e.g., myelosuppression, neurotoxicity, alopecia).1 2 3 8 Does not reduce risk of hematuria associated with other conditions such as thrombocytopenia.1 2 14

Sensitivity Reactions

Hypersensitivity and Anaphylactic Reactions

Hypersensitivity reactions (e.g., pruritus,3 4 19 rash,20 21 23 generalized urticaria,3 19 20 decreased platelet counts,1 facial edema4 19 ) and anaphylaxis reported.1 2 Increased incidence of hypersensitivity reactions in patients with autoimmune disorders receiving cyclophosphamide and mesna; most patients received mesna orally.1

Hypersensitivity reactions may respond to antihistamines and corticosteroids.3 4 19

General Precautions

Lactose Intolerance

Each 400-mg Mesnex tablet contains 59.3 mg lactose;53 patients with a history of lactose intolerance may be sensitive to this formulation of the drug.a

Specific Populations


Category B.1


Not known whether mesna or dimesna is distributed into human milk.1 2 Discontinue nursing or the drug.1 2

Pediatric Use

Safety and efficacy not established;1 53 however, has been used in infants as young as 4 months of age without unusual adverse effects.4 32 33 34

Large amounts of benzyl alcohol (i.e., 100–400 mg/kg daily) have been associated with toxicity in neonates;54 55 56 57 58 59 each mL of mesna in multidose vials contains 1.04 mg of benzyl alcohol.1 2 Do not use multidose vials in neonates and infants (see Preparations for information regarding preservative-free preparation); use multidose vials with caution in children and adolescents.1 2

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.1 3 4 53 Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and potential for concomitant disease and drug therapy.1 (See Geriatric Patients under Dosage and Administration.)

Common Adverse Effects

Mesna monotherapy: Headache, injection site reactions, flushing, dizziness, nausea, vomiting, somnolence, diarrhea, anorexia, fever, pharyngitis, hyperesthesia, influenza-like symptoms, coughing, constipation, flatulence, rhinitis, rigors, back pain, rash, conjunctivitis, arthralgia.1

Mesna with ifosfamide: Nausea, vomiting, constipation, leukopenia, fatigue, fever, anorexia, thrombocytopenia, anemia, granulocytopenia, asthenia, abdominal pain, alopecia, dyspnea, chest pain, hypokalemia, diarrhea, dizziness, headache, pain, increased sweating, back pain, hematuria, injection site reaction, edema, peripheral edema, somnolence, anxiety, confusion, facial edema, insomnia, coughing, dyspepsia, hypotension, pallor, dehydration, pneumonia, tachycardia, flushing.1

Interactions for Mesna

No formal drug interaction studies to date.1

Specific Drugs, Therapies, and Laboratory Tests

Drug, Therapy, or Test



Antineoplastic agents (cyclophosphamide, doxorubicin, ifosfamide, methotrexate, vincristine)

Pharmacologic interaction (loss of antineoplastic effects) unlikely1 2 8 9

Irradiation, total body

Pharmacologic interaction (loss of antineoplastic effects) unlikely7 9 10 11 12 46

May safely use with regimens that include total body irradiation7 9 10 11 12 46

Sodium nitroprusside tests for urinary ketones

Possible false-positive results1 2 3 48 due to interaction between sulfonate group in mesna and sodium nitroprusside reagent4 48

Mesna Pharmacokinetics



In systemic circulation, mesna is rapidly and almost completely oxidized to dimesna.1 2 3 4 5 29 Following oral administration, peak plasma concentrations of mesna and dimesna are achieved within 4 and 3 hours, respectively.29 Higher systemic exposure with oral (consisting of IV and oral doses) than with IV regimen.1

Peak urine concentrations of mesna and dimesna are achieved within 4 hours after IV administration or 8 hours after oral administration.29

Urinary bioavailability following oral administration is approximately 45–79% of that following IV administration.1


Food does not appear to affect urinary bioavailability of orally administered mesna.1



Hydrophilic; does not enter most cells, including tumor cells.3 4 5 7 8 9

Not known whether mesna or dimesna is distributed into human milk.1 2

Does not cross the blood-brain barrier.6

Plasma Protein Binding

Approximately 69–75%.1



In systemic circulation, mesna is rapidly and almost completely oxidized to dimesna, a chemically stable, pharmacologically inert metabolite.1 2 3 4 5 29

Mesna and dimesna do not undergo hepatic metabolism.1 2 4

Elimination Route

Dimesna is rapidly filtered and eliminated by the kidneys; in the kidneys, dimesna is partially reduced to the active drug, mesna.1 2 3 4 5 29 62

Excreted principally in urine as mesna (18–32%) or dimesna (33%);1 29 majority of IV dose excreted within 4 hours.1 2

More sustained urinary excretion over 24-hour period with IV and oral regimen than with IV regimen.1


IV regimen: 0.36 hours (for mesna) or 1.17 hours (for dimesna).1 2 4 29

IV and oral regimen: 1.2–8.3 hours (for mesna).1








15–30°C.1 2 For multidose vials, may store and use for up to 8 days after initial entry.1 For preservative-free ampuls, discard unused portion.4 18

When diluted as directed (see Dilution under Dosage and Administration and also Solution Compatibility under Stability), stable at 25°C for up to 24 hours.1 2

Do not store in glass or plastic syringes with Luer-Lok fittings for >12 hours because particulates may form.4 18 53


For information on systemic interactions resulting from concomitant use, see Interactions.


Extemporaneous Oral Solutions

Mesna 20 or 50 mg/mL in flavored syrup is stable at 24°C for up to 7 days;26 mesna 1, 10, or 50 mg/mL in carbonated beverages or apple or orange juice is stable at 5°C for at least 24 hours.26


Solution CompatibilityHID


Dextrose 5% in sodium chloride 0.2 or 0.45%1

Dextrose 5% in water

Ringer’s injection, lactated

Sodium chloride 0.9%

Drug Compatibility
Admixture CompatibilityHID


Hydroxyzine HCl







Y-Site CompatibilityHID


Allopurinol sodium





Doxorubicin HCl liposome injection

Etoposide phosphate


Fludarabine phosphate

Gallium nitrate

Gemcitabine HCl

Granisetron HCl


Melphalan HCl

Methotrexate sodium

Micafungin sodium

Ondansetron HCl


Pemetrexed disodium

Piperacillin sodium–tazobactam sodium


Sodium bicarbonate



Vinorelbine tartrate


Amphotericin B cholesteryl sulfate complex


  • Exhibits detoxification activity in urinary tract only; does not appear to alter systemic activity or nonurologic toxicity of oxazaphosphorine derivatives (e.g., ifosfamide, cyclophosphamide).62

  • Sulfydryl donor; contains free sulfhydryl groups that interact chemically (in urine) with urotoxic metabolites of ifosfamide or cyclophosphamide and their precursors, resulting in detoxification of these metabolites.1 2 3 4 5

  • Enhances urinary excretion of cysteine, which can react chemically with acrolein, thus further contributing to uroprotective activity.5 6

  • Reduces the viscosity of pulmonary secretions.5 8

Advice to Patients

  • Importance of drinking at least 1 quart (4 cups) of liquid a day.1 Importance of notifying clinician if discoloration of urine (e.g., pink, red) occurs.1

  • Importance of notifying clinician if vomiting occurs within 2 hours of administering tablets or if a dose is missed.1

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses (e.g., autoimmune disorders).1

  • Importance of women informing their clinician if they are or plan to become pregnant or to breast-feed.1

  • Importance of informing patients of other important precautionary information.1 (See Cautions.)


Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Although not commercially available, a preservative-free formulation (containing 200 mg of mesna in single-use ampuls) is available through a compassionate use program for selected patients.53 For more information, contact the manufacturer at 800-437-0994.53

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name



Dosage Forms


Brand Names




400 mg


Bristol-Myers Squibb



100 mg/mL*

Mesna Injection


Bristol-Myers Squibb

AHFS DI Essentials™. © Copyright 2021, Selected Revisions July 13, 2013. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.


1. Bristol-Myers Squibb. Mesnex (mesna) injection and tablets prescribing information. Princeton, NJ; 2002 May.

2. American Pharmaceutical Partners, Inc. Mesna injection prescribing information. Los Angeles, CA; 2001 Jun.

3. Dechant KL, Brogden RN, Pilkington T et al. Ifosfamide/mesna: a review of its antineoplastic activity, pharmacokinetic properties and therapeutic efficacy in cancer. Drugs. 1991; 42:428-67.

4. Schoenike SE, Dana WJ. Ifosfamide and mesna. Clin Pharm. 1990; 9:179-91.

5. Shaw IC, Graham MI. Mesna—a short review. Cancer Treat Rev. 1987; 14:67-86.

6. Shaw IC. Mesna and oxazaphosphorine cancer chemotherapy. Cancer Treat Rev. 1987; 14:359-64.

7. Hows JM, Mehta A, Ward L et al. Comparison of mesna with forced diuresis to prevent cyclophosphamide induced haemorrhagic cystitis in marrow transplantation: a prospective randomised study. Br J Cancer. 1984; 50:753-6.

8. Burkert H. Clinical overview of mesna. Cancer Treat Rev. 1983; 10:175-81.

9. Cronin SM, Sensenbrenner LL. Effect of mesna on cyclophosphamide. DICP. 1989; 23:798-9.

10. Nicolau DP, Hogan KR. National survey of use of mesna for the prevention of cyclophosphamide-induced hemorrhagic cystitis in recipients of bone marrow transplants. May Clin Proc. 1992; 67:611-2.

11. Shepherd JD, Pringle LE, Barnett MJ et al. Mesna versus hyperhydration for the prevention of cyclophosphamide-induced hemorrhagic cystitis in bone marrow transplantation. J Clin Oncol. 1991; 9:2016-20.

12. Letendre L, Hoagland HC, Gertz MA. Hemorrhagic cystitis complicating bone marrow transplantation. Mayo Clin Proc. 1992; 67:128-30.

13. Armitage JO. Allogeneic bone marrow transplantation: problems and prospects. Mayo Clin Proc. 1992; 67:195-7.

14. DeVries CR, Freiha FS. Hemorrhagic cystitis: a review. J Urol. 1990; 143:1-9.

15. Fukuoka M, Negoro S, Masuda N et al. Placebo-controlled double- blind comparative study on the preventive efficacy of mesna against ifosfamide- induced urinary disorders. J Cancer Res Clin Oncol. 1991; 117:473-8.

16. Dorr RT. Bioavailability of orally administered mesna. In: Oral administration of the uroprotector mesna with ifosfamide. Mead Johnson. Princeton, NJ; 1992 Apr.

17. Brade WP, Herdrich K, Kachel-Fischer U et al. Dosing and side-effects of ifosfamide plus mesna. J Cancer Res Clin Oncol. 1991; 117:5164-8.

18. Mesna. In: Trissel LA. Handbook on Injectable Drugs. 12th ed. Bethesda, MD. American Society of Health-System Pharmacists; 2002:905-8.

19. Pratt CB, Sandlund JT, Meyer WH et al. Mesna-induced urticaria. Drug Intell Clin Pharm. 1988; 22:913-4.

20. Zonzits E, Aberer W, Tappeiner G. Drug eruptions from mesna: after cyclophosphamide treatment of patients with systemic lupus erythematosus and dermatomyositis. Arch Dermatol. 1992; 128:80-2.

21. Seidel A, Andrassy K, Ritz E et al. Allergic reactions to mesna. Lancet. 1991; 338:381.

22. Gross WL, Mohr J, Christophers E. Allergic reactions to mesna. Lancet. 1991; 338:381-2.

23. D’Cruz D, Haga H, Hughes GRV. Allergic reactions to mesna. Lancet. 1991; 338:705-6.

24. Reinhold-Keller E, Mohr J, Christophers E. Mesna side effects which imitate vasculitis. Clin Investig. 1992; 70:698-704.

25. Gilleece MH, Davies JM. Mesna therapy and hypertension. DICP. 1991; 25:867.

26. Goren MP. Mesna stability. In: Oral administration of the uroprotector mesna with ifosfamide. Mead Johnson. Princeton, NJ; 1992 Apr.

27. Food and Drug Adminstration. Orphan designations pursuant to Section 526 of the Federal Food and Cosmetic Act as amended by the Orphan Drug Act (P.L. 97-414), to March 31, 1995. Rockville, MD; 1995 Apr.

28. Vose JM, Pipert G, Reed EC et al. Randomized trial comparing mesna to bladder irrigation for prevention of hemorrhagic cystitis following high-dose cyclophosphamide and bone marrow transplantation. Blood.

29. James CA, Mant TGK, Rogers HJ. Pharmacokinetics of intravenous and oral sodium 2-mercaptoethane sulphonate (mesna) in normal subjects. Br J Clin Pharmacol. 1987; 23:561-8.

30. Wagner T. Ifosfamide clinical pharmacokinetics. Clin Pharmacokinet. 1994; 26:439-56.

31. Burkert H, Lücker PW, Wetzelsberger N et al. Bioavailability of orally administered mesna. Arzneim Forsch Drug Res. 1984; 34:1597- 1600.

32. Miser JS, Kinsella TJ, Triche TJ et al. Ifosfamide with mesna uroprotection and etoposide: an effective regimen in the treatment of recurrent sarcomas and other tumors of children and young adults. J Clin Oncol. 1987; 5:191-8.

33. Demeocg F, Oberlin O, Benz-Lemoine E et al. Initial chemotherapy including ifosfamide in the management of Ewing’s sarcoma: preliminary results a protocol of the French Pediatric Oncology Society (SFOP). Cancer Chemother Pharmacol. 1989; 24:S45-7.

34. Skinner R, Sharkey IA, Pearson ADJ et al. Ifosfamide, mesna, and nephrotoxicity in children. J Clin Oncol. 1993; 11:173-90.

35. Markman M, Hakes T, Reichman B et al. Ifosfamide and mesna in previously treated advanced epithelial ovarian cancer: activity in platinum- resistant disease. J Clin Oncol. 1992; 10:243-8.

36. Sutton GP, Blessing JA, Homesley HD et al. Phase II trial of ifosfamide and mesna in advanced ovarian carcinoma: a gynecologic oncology group study. J Clin Oncol. 1989; 7:1672-6.

37. Ghosn M, Droz JP, Theodore C et al. Salvage chemotherapy in refractory germ cell tumors with etoposide (VP-16) plus ifosfamide plus high- dose cisplatin. Cancer. 1988; 62:24-7.

38. Loehrer PJ, Lauer R, Roth BJ et al. Salvage therapy in recurrent germ cell cancer: ifosfamide and cisplatin plus either vinblastine or etoposide. Ann Intern Med. 1988; 109:540-6.

39. Elias A, Ryan L, Sulkes A et al. Response to mesna, doxorubicin, ifosfamide, and dacarbazine in 108 patients with metastatic or unresectable sarcoma and no prior chemotherapy. J Clin Oncol. 1989; 7:1208-16.

40. Antman K, Crowley J, Balcerzak SP et al. An intergroup phase III randomized study of doxorubicin and dacarbazine with or without ifosfamide and mesna in advanced soft tissue and bone sarcomas. J Clin Oncol. 1993; 11:1276-85.

41. Loehrer PJ, Rynard S, Ansari R et al. Etoposide, ifosfamide, and cisplatin in extensive small cell lung cancer. Cancer. 1992; 69:669-73.

42. Thatcher N, Lind M, Stout R et al. Carboplatin, ifosfamide and etoposide with mid-course vincristine and thoracic radiotherapy for ’limited’ stage small cell carcinoma of the bronchus. Br J Cancer. 1989; 60:98-101.

43. Sutton GP, Blessing JA, Adcock L et al. Phase II study of ifosfamide and mesna in patients with previously-treated carcinoma of the cervix. Invest New Drugs. 1989; 7:341-3.

44. Coleman RE, Harper PG, Gallagher C et al. A phase II study of ifosfamide in advanced and relapsed carcinoma of the cervix. Cancer Chemother Pharmacol. 1986; 18:280-3.

45. Haselberger MB, Schwinghammer TL. Efficacy of mesna for prevention of hemorrhagic cystitis after high-dose cyclophosphamide therapy. Ann Pharmacother. 1995; 29:918-21.

46. Bedi A, Miller CB, Hanson JL et al. Association of BK virus with failure of prophylaxis against hemorrhagic cystitis following bone marrow transplantation. J Clin Oncol. 1995; 13:1103-9.

47. Katz A, Epelman S, Anelli A et al. A prospective randomized evaluation of three schedules of mesna administration in patients receiving an ifosfamide-containing chemotherapy regimen: sustained efficiency and simplified administration. J Cancer Res Clin Oncol. 1995; 121:128-31.

48. Ben Yehuda A, Heyman A, Shiner Salz D. False positive reaction for urinary ketones with mesna. Drug Intell Clin Pharm. 1987; 21:547-8.

49. Mead Johnson. Ifex (sterile ifosfamide) product information. Princeton, NJ; 1992 Dec.

50. Tolcher A, Cown K, Riley J et al. Phase I study of paclitaxel (T) and cyclophosphamide (CTX) and G-CSF in metastatic breast cancer. Proc Ann Meet Am Soc Clin Oncol. 1994; 13:A93.

51. Reynolds JEF, ed. Martindale: the extra pharmacopoeia. 30th ed. London: The Pharmaceutical Press; 1993:741.

52. Reviewers’ comments (personal observations).

53. Bristol-Myers Squibb, Plainsboro, NJ: Personal communication.

54. American Academy of Pediatrics Committee on Fetus and Newborn and Committee on Drugs. Benzyl alcohol: toxic agent in neonatal units. Pediatrics. 1983; 72:356-8.

55. Anon. Benzyl alcohol may be toxic to newborns. FDA Drug Bull. 1982; 12:10-1.

56. Anon. Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982; 31:290-1.

57. Gershanik J, Boecler B, Ensley H et al. The gasping syndrome and benzyl alcohol poisoning. N Engl J Med. 1982; 307:1384-8.

58. Menon PA, Thach BT, Smith CH et al. Benzyl alcohol toxicity in a neonatal intensive care unit: incidence, symptomatology, and mortality. Am J Perinatol. 1984; 1:288-92.

59. Anderson CW, Ng KJ, Andresen B et al. Benzyl alcohol poisoning in a premature newborn infant. Am J Obstet Gynecol. 1984; 148:344-6.

60. Schuchter LM, Hensley ML, Meropol NJ et al. 2002 update of recommendations for the use of chemotherapy and radiotherapy protectants: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2002; 12:2895-903.

61. Hensley ML, Schuchter LM, Lindley C et al. American Society of Clinical Oncology clinical practice guidelines for the use of chemotherapy and radiotherapy protectants. J Clin Oncol. 1999; 17:3333-55.

62. Links M and Lewis C. Chemoprotectants: a review of their clinical pharmacology and therapeutic efficacy. Drugs. 1999; 57:293-308.

HID. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013:749-52.

a. AHFS drug information 2003. McEvoy GK, ed. Mesna. Bethesda, MD: American Society of Health-System Pharmacists; 2004:3693-7.