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Ifosfamide Side Effects

Medically reviewed by Last updated on Jan 14, 2023.


Commonly reported side effects of ifosfamide include: central nervous system toxicity, confusion, drowsiness, and hallucination. Continue reading for a comprehensive list of adverse effects.

Applies to ifosfamide: intravenous powder for solution, intravenous solution.


Intravenous route (Powder for Solution)

Myelosuppression can be severe and lead to fatal infections. Monitor blood counts prior to and at intervals after each treatment cycle. CNS toxicities can be severe and result in encephalopathy and death. Monitor for CNS toxicity and discontinue treatment for encephalopathy. Nephrotoxicity can be severe and result in renal failure. Hemorrhagic cystitis can be severe and can be reduced by the prophylactic use of mesna.

Serious side effects of Ifosfamide

Along with its needed effects, ifosfamide may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking ifosfamide:

More common

  • Agitation
  • black, tarry stools
  • blood in the urine
  • chest pain
  • confusion
  • cough or hoarseness
  • fever or chills
  • frequent urination
  • hallucinations (seeing, hearing, or feeling things that are not there)
  • lower back or side pain
  • painful or difficult urination
  • pale skin
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Less common

  • Abdominal or stomach pain or tenderness
  • bleeding gums
  • bluish color
  • changes in skin color
  • clay colored stools
  • dark urine
  • decreased appetite
  • dizziness
  • headache
  • itching
  • loss of appetite
  • nausea and vomiting
  • pain
  • pinpoint red spots on the skin
  • skin rash
  • swelling of the feet or lower legs
  • yellow eyes or skin


  • Blurred vision
  • burning, numbness, tingling, or painful sensations
  • confusion
  • convulsions (seizures)
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • fast or irregular heartbeat
  • sweating
  • troubled breathing
  • unsteadiness or awkwardness
  • weakness in the arms, hands, legs, or feet

Other side effects of Ifosfamide

Some side effects of ifosfamide may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Less common

  • Redness, swelling, or pain at place of injection
  • weight loss

For Healthcare Professionals

Applies to ifosfamide: intravenous powder for injection, intravenous solution.


Very common (10% or more): Hemorrhagic cystitis, hematuria, dysuria, urinary frequency, urinary incontinence, urinary retention

Frequency not reported: Infertility, ovarian failure, premature menopause, amenorrhea, ovulation disorder, azoospermia, oligospermia[Ref]


Very common (10% or more): Renal dysfunction, acute renal failure

Frequency not reported: Acute renal failure, chronic renal failure, aminoaciduria, phosphaturia, Fanconi syndrome, tubulointerstitial nephritis, renal structural damage, nephrogenic diabetes insipidus, polyuria, enuresis, feeling of residual urine[Ref]


Very common (10% or more): Leukopenia (44%), anemia (38%)

Common (1% to 10%): Thrombocytopenia

Frequency not reported: Agranulocytosis, hemolytic anemia, methemoglobinemia, febrile bone marrow aplasia, disseminated intravascular coagulation, hemolytic uremic syndrome, neonatal anemia[Ref]


Very common (10% or more): Nausea/vomiting (47%)

Uncommon (0.1% to 1%): Diarrhea, stomatitis

Frequency not reported: Enterocolitis, pancreatitis, ileus, GI hemorrhage, mucosal ulceration, constipation, abdominal pain, salivary hypersecretion[Ref]

Nervous system

Very common (10% or more): CNS toxicity (e.g., abnormal behavior, affect lability aggression, agitation, anxiety, aphasia, asthenia, ataxia, cerebellar syndrome, cerebral function deficiency, cognitive disorder, coma, confusional state, convulsions, cranial nerve dysfunction, depressed state of consciousness, depression, disorientation, dizziness, electroencephalogram abnormal, encephalopathy, flat affect. hallucinations, headache, ideation, lethargy, memory impairment, mood change, motor dysfunction, muscle spasms, myoclonus, progressive loss of brainstem reflexes, psychotic reaction, restlessness, somnolence, tremor, urinary incontinence) (15%)

Uncommon (0.1% to 1%): Peripheral neuropathy[Ref]


Very common (10% or more): Alopecia

Rare (0.01% to 0.1%): Dermatitis, papular rash

Frequency not reported: Angioedema, urticaria, toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome, palmar-plantar erythrodysesthesia syndrome, radiation recall dermatitis, skin necrosis, facial swelling, rash, pruritus, erythema, skin hyperpigmentation, hyperhidrosis, nail disorder[Ref]


Common (1% to 10%): Hepatotoxicity (increases in liver enzymes, i.e., serum alanine aminotransferase, serum aspartate aminotransferase, alkaline phosphatase, gamma-glutamyltransferase and lactate dehydrogenase), increased bilirubin, jaundice, hepatorenal syndrome

Frequency not reported: Hepatic failure, veno-occlusive liver disease, portal vein thrombosis, cytolytic hepatitis[Ref]


Frequency not reported: Respiratory failure, acute respiratory distress syndrome, pulmonary hypertension, interstitial lung disease (as manifested by pulmonary fibrosis), pneumonitis, pulmonary edema, pleural effusion, dyspnea, hypoxia, cough[Ref]


Frequency not reported: Hypersensitivity, anaphylactic reaction[Ref]


Uncommon (0.1% to 1%): Cardiotoxicity (e.g., congestive heart failure, tachycardia, pulmonary edema), hypotension

Frequency not reported: Arrythmia (including supraventricular and ventricular arrhythmia), atrial fibrillation, premature atrial contractions, bradycardia, cardiac arrest, myocardial infarction, cardiac failure, myocardial hemorrhage, angina pectoris, cardiomyopathy (including congestive cardiomyopathy), electrocardiogram ST-segment abnormal, electrocardiogram T-wave inversion, electrocardiogram QRS complex abnormal[Ref]


Frequency not reported: Syndrome of inappropriate antidiuretic hormone secretion (SIADH)[Ref]


Very common (10% or more): Infection (10%)

Frequency not reported: Sepsis, septic shock, immunosuppression[Ref]


Frequency not reported: Injection/infusion site reactions[Ref]


Frequency not reported: Rhabdomyolysis, osteomalacia, rickets, growth retardation, myalgia, arthralgia, muscle twitching[Ref]


Frequency not reported: Visual impairment, conjunctivitis, eye irritation[Ref]


Common (1% to 10%): Anorexia

Frequency not reported: Tumor lysis syndrome, metabolic acidosis, hypokalemia, hypocalcemia, hypophosphatemia, hyperglycemia, polydipsia[Ref]


Frequency not reported: Mutism, mental status change (e.g., mania, paranoia, delusion, delirium, catatonia, amnesia, panic attack), echolalia, perseveration[Ref]


Frequency not reported: Secondary malignancies, myelodysplastic alterations, acute leukemia, lymphoma, thyroid cancer, sarcomas[Ref]


Frequency not reported: Secondary tumors (e.g., urinary tract carcinoma, myelodysplastic syndrome, acute leukemia, acute lymphocytic leukemia, lymphoma [Non-Hodgkin's lymphoma], sarcomas, renal cell carcinoma, thyroid cancer), progressions of underlying malignancies, deafness tinnitus, vertigo, fetal growth retardation, phlebitis, fatigue, malaise, multiorgan failure, general physical deterioration, edema, pain, pyrexia, chills[Ref]


1. Product Information. Ifosfamide (ifosfamide). Hikma USA (formerly West-Ward Pharmaceutical Corporation). 2019.

Further information

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

Some side effects may not be reported. You may report them to the FDA.