Ifosfamide
Pronunciation: (eye-FOS-fa-mide).
- Generic name
- ifosfamide
- Brand names
- Ifex, Ifomid, Ifosfamide Accord, Ifosfamide, Holoxan, Ifomide
- Drug class
- Alkylating agent (antineoplastic, chemotherapy)
Availability and supply rules vary by country
Trade names by country: United States · Canada
Australia: · Full directory
What ifosfamide is and how it works
Uses, formulations, monitoring, and supply rules can differ by patient, product, and country. Follow the exact local product information and professional advice.
Mechanism of action: how ifosfamide works
Ifosfamide is an alkylating agent of the oxazaphosphorine group. It is a prodrug that requires hepatic activation by cytochrome P450 enzymes to form active metabolites, which alkylate DNA, leading to cross-linking of DNA strands and inhibition of DNA replication and function. This results in cell death, particularly in rapidly dividing cancer cells. (1)
What ifosfamide is used for
Germ cell testicular cancer (FDA-labeled indication)
This is the FDA-approved indication: use in adults in combination with certain other approved antineoplastic agents for third-line chemotherapy of germ cell testicular cancer. (2)
Sarcoma (soft tissue and bone) — guideline-supported oncology use, not the FDA-labeled indication
Used in combination chemotherapy regimens per oncology treatment guidelines; this is an off-label use relative to the narrow FDA label, selected by the treating oncologist. (2)
Lymphoma (non-Hodgkin's and Hodgkin's) — guideline-supported oncology use, not the FDA-labeled indication
Used in combination chemotherapy regimens per oncology treatment guidelines; this is an off-label use relative to the narrow FDA label, selected by the treating oncologist. (2)
Lung cancer (small cell) — guideline-supported oncology use, not the FDA-labeled indication
Used in combination chemotherapy regimens per oncology treatment guidelines; this is an off-label use relative to the narrow FDA label, selected by the treating oncologist. (2)
Breast cancer — guideline-supported oncology use, not the FDA-labeled indication
Used in combination chemotherapy regimens per oncology treatment guidelines; this is an off-label use relative to the narrow FDA label, selected by the treating oncologist. (2)
Before taking ifosfamide
Do not take / not appropriate for
- Contraindicated in patients with hypersensitivity to ifosfamide or other oxazaphosphorines, and in those with severe bone marrow suppression. (Contraindication) (2)
Tell your clinician about
(2)How to take ifosfamide
- General Instructions: Ifosfamide is administered by a healthcare professional as an intravenous infusion, usually in cycles. The dose and schedule depend on your cancer type, body size, and overall health.. Adult Dosing: Typical adult doses range from 1.2 to 2.4 g/m² per day for 3–5 days, repeated every 3–4 weeks. Dosing may vary based on indication and combination regimens.. Pediatric Dosing: Pediatric dosing is individualized based on body surface area and specific cancer protocols. Close monitoring is required.. Administration: Given as an intravenous infusion over several hours. Mesna is often co-administered to protect the bladder from toxicity.. When To Stop: Treatment is stopped if there are severe side effects, lack of response, or as directed by your oncologist.. Storage: Ifosfamide vials should be stored at room temperature, protected from light. Prepared solutions should be used promptly or stored as per hospital protocols.
- This page does not provide a dose calculator. Dosing must follow the prescriber, pharmacist, or product label.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (2)
Missed dose
If you miss an appointment for your infusion, contact your healthcare provider as soon as possible to reschedule. Do not attempt to self-administer this medication.
Overdose
Ifosfamide overdose can cause severe toxicity, including neurotoxicity, kidney failure, and bone marrow suppression. Seek emergency medical attention immediately. Supportive care and symptomatic treatment are essential. (2)
Side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms to a healthcare professional.
Bone marrow suppression
Incidence: Reported in the clinician-authored database; frequency not established
Hemorrhagic cystitis
Incidence: Reported in the clinician-authored database; frequency not established
Neurotoxicity (encephalopathy)
Incidence: Reported in the clinician-authored database; frequency not established
Nausea and vomiting
Incidence: Reported in the clinician-authored database; frequency not established
Alopecia
Incidence: Reported in the clinician-authored database; frequency not established
Kidney damage
Incidence: Reported in the clinician-authored database; frequency not established
Infections
Incidence: Reported in the clinician-authored database; frequency not established
Serious warnings
FDA BOXED WARNING — serious
Symptoms: FDA BOXED WARNING: Myelosuppression can be severe and lead to fatal infections. Encephalopathy (a serious brain-function disorder causing confusion or altered consciousness) can be severe and may result in death. Nephrotoxicity (kidney damage) can be severe and result in kidney failure. Hemorrhagic cystitis (bladder bleeding) can be severe. This is the highest level of warning the FDA assigns to a medicine, and treatment requires close specialist monitoring, mandatory mesna co-administration, and adequate hydration.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
May cause severe bone marrow suppression — serious
Symptoms: May cause severe bone marrow suppression. Risk of hemorrhagic cystitis—mesna is required for bladder protection. Potential for neurotoxicity (confusion, encephalopathy). Can cause infertility and birth defects—avoid pregnancy. Increased risk of secondary cancers with long-term use.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
Contraindications recorded in the clinician database — serious
Symptoms: Contraindications recorded in the clinician database: Contraindicated in patients with hypersensitivity to ifosfamide or other oxazaphosphorines, and in those with severe bone marrow suppression. Use with caution in patients with renal or hepatic impairment, active infections, or prior neurotoxicity. Monitor closely in elderly and pediatric populations.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
The FDA label additionally lists urinary outflow obstruction as a contraindication, in addition to known hypersensitivity to ifosfamide — serious
Symptoms: The FDA label additionally lists urinary outflow obstruction as a contraindication, in addition to known hypersensitivity to ifosfamide.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Recorded interactions | Ifosfamide may interact with other chemotherapy agents, anticoagulants, phenytoin, and certain vaccines. Inform your doctor about all medicines you take. Some interactions may increase the risk of side effects or reduce effectiveness. | (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
Ifosfamide can cause fetal harm. Pregnancy status is verified before starting treatment. Females of reproductive potential are advised to use effective contraception during treatment and for 12 months after the last dose; males with partners of reproductive potential are advised to use effective contraception during treatment and for 6 months after the last dose. Discuss fertility preservation options with the treating oncologist before starting. (2)
Breastfeeding
Breastfeeding is not recommended during treatment and for 1 week after the last dose, due to the potential for serious harm to a nursing infant. (2)
Children
Frequency: Not recommended for pediatric use.. Weight Based: Not established; dosing in children is typically based on clinical trials and may vary.. Max Daily Dose: Not recommended for pediatric use.. Max Single Dose: Not recommended for pediatric use.. Age Restrictions: Safety not established in children. (2)
Renal_impairment
Renal impairment: ifosfamide's metabolites accumulate with decreased kidney function, so patients are closely monitored for adverse reactions and dose modification is considered by the treating oncologist. Hepatic impairment: ifosfamide undergoes extensive liver metabolism to both active and toxic metabolites, so patients are closely monitored for adverse reactions. (2)
Hepatic_impairment
Renal impairment: ifosfamide's metabolites accumulate with decreased kidney function, so patients are closely monitored for adverse reactions and dose modification is considered by the treating oncologist. Hepatic impairment: ifosfamide undergoes extensive liver metabolism to both active and toxic metabolites, so patients are closely monitored for adverse reactions. (2)
Monitoring
(2)Storage
Ifosfamide vials are stored at controlled room temperature, 20-25C (68-77F), protected from temperatures above 30C (86F) and from light. Prepared solutions should be used promptly or stored as per hospital pharmacy protocols.
Professional information
Clinician-facing context only. This section does not replace current product labeling.
General
Indication: Germ cell testicular cancer
Dose summary: FDA-labeled regimen (third-line germ cell testicular cancer, in combination): 1.2 g/m² IV daily for 5 consecutive days, repeated every 3 weeks or after hematologic recovery, with mandatory mesna and at least 2 L/day hydration. The clinician database also records a broader typical range (1.2-3 g/m² IV over 30-60 minutes for 5 days) reflecting variation across guideline-based regimens for other cancer types.
Renal context: Ifosfamide metabolites accumulate with decreased renal function; closely monitor for adverse reactions and consider dose modification in renal impairment. Hepatic impairment: closely monitor for adverse reactions, since ifosfamide is extensively metabolized by the liver. (1) (2)
Frequently asked questions
What types of cancer is ifosfamide used to treat?
Ifosfamide is primarily used to treat testicular cancer, sarcomas (soft tissue and bone), lymphomas, and certain other solid tumors. It may be used alone or in combination with other chemotherapy drugs.
How is ifosfamide administered?
Ifosfamide is given as an intravenous infusion by a healthcare professional, usually in a hospital or clinic setting. It is not available as a tablet or oral medication.
What are the most serious side effects of ifosfamide?
Serious side effects include bone marrow suppression, hemorrhagic cystitis (bladder bleeding), neurotoxicity (confusion, seizures), kidney damage, and increased risk of infection.
Why is mesna given with ifosfamide?
Mesna is co-administered to protect the bladder from toxic metabolites of ifosfamide, reducing the risk of hemorrhagic cystitis.
Can ifosfamide affect fertility?
Yes, ifosfamide can cause temporary or permanent infertility in both men and women. Discuss fertility preservation options with your doctor before starting treatment.
What should I do if I develop blood in my urine during treatment?
Contact your healthcare provider immediately if you notice blood in your urine, as this may indicate bladder toxicity and requires prompt medical attention.
Is ifosfamide safe during pregnancy or breastfeeding?
Ifosfamide is not safe during pregnancy or breastfeeding due to the risk of birth defects and harm to the baby. Effective contraception is recommended during and after treatment.
What happens if I take too much Ifosfamide?
Taking too much Ifosfamide can lead to severe and life-threatening side effects, including profound myelosuppression, neurotoxicity, and kidney damage. Symptoms may include extreme fatigue, unusual bleeding or bruising, and confusion. If an overdose is suspected, seek immediate emergency medical attention. Prompt intervention is crucial to manage potential complications and improve outcomes.
Can I drink alcohol while taking Ifosfamide?
It is generally advised to avoid alcohol consumption while undergoing chemotherapy with Ifosfamide. Alcohol can exacerbate certain side effects common with alkylating agents, such as nausea, vomiting, and liver toxicity. Furthermore, alcohol may interact with other medications you are taking, potentially reducing their effectiveness or increasing adverse reactions. Always consult your healthcare provider for personalized advice.
Is Ifosfamide safe during pregnancy?
Ifosfamide is generally considered unsafe during pregnancy and falls into a category where it can cause significant harm to the developing fetus. Due to its mechanism of action as an alkylating agent, it has the potential to cause birth defects and fetal toxicity. If you are pregnant or planning to become pregnant, it is crucial to discuss this with your healthcare provider to understand the risks and explore alternative treatment options.
What is the mechanism of action of ifosfamide?
Ifosfamide is an alkylating agent of the oxazaphosphorine group. It is a prodrug that requires hepatic activation by cytochrome P450 enzymes to form active metabolites, which alkylate DNA, leading to cross-linking of DNA strands and inhibition of DNA replication and function. This results in cell death, particularly in rapidly dividing cancer cells. (1)
What is the generic name of Ifosfamide?
The generic name is ifosfamide. It is sold under brand names including Ifex, Ifomid, Ifosfamide Accord, Ifosfamide, Holoxan, Ifomide.
What class of drug is ifosfamide?
Ifosfamide is classed as: Alkylating agent (antineoplastic, chemotherapy).
References
- Ifosfamide — MedGuideGlobal Clinician RecordMedGuideGlobal · International · accessed 2026-08-06 · source 1
- IFEX (ifosfamide for injection, USP) — prescribing informationU.S. National Library of Medicine (DailyMed) · United States · accessed 2026-08-06 · source 2
- Ifosfamide Injection — patient drug information (MedlinePlus)U.S. National Library of Medicine (MedlinePlus) · US · accessed 2026-08-14 · source 3
- IFOSFAMIDE — FDA approval record (Drugs@FDA NDA019763)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 4
- ifosfamide — RxNorm normalized drug concept (RXCUI 5657)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 5
Brand names by country
Single-ingredient ifosfamide names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- IFEX3 g/60mL, 1 g/20mL · baxter healthcare corporation
Canada
- IFEX (IFOSFAMIDE) 3 G/VIAL
- IFEX (IFOSFAMIDE) 1 G/VIAL