Advertisement

Sign up for our daily newsletter

Advertisement

Ifosfamide dosing for obese patients and surgery: Dosing Antineoplastic Medications in Obese Patients

Adjustments have not been studied but may be reasonable for those patients for whom there is concern for greater toxicity.

Matthew Cox
Thursday, March 18, 2021
Advertisement
  • Anti Cancer Drugs. Nichols, H.

  • Monthly Newsletter. BSA was selected because it closely resembles cardiac output; thus, blood flow to the liver and kidneys where most medications are metabolized and eliminated.

  • A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.

  • The purpose of this page is to serve as a dynamic, growing repository of evidence-based recommendations regarding medication dosing in obese patients.

  • Pater, L. Next-generation mTOR inhibitors in clinical oncology: how pathway complexity informs therapeutic strategy.

References and Additional Reading

Physical activity and obesity in endometrial cancer survivors: associations with pain, fatigue, and physical functioning. Consider the following when determining an antineoplastic drug dose:. Laparoscopic colorectal cancer surgery in obese patients.

A study in NHL patients investigated the impact of obesity on disease outcomes, with the exception of obee. Impact of obesity on operative morbidity and clinical outcome in primary epithelial ovarian cancer after optimal primary tumor debulking. Similar to breast cancer, obese patients are at an increased risk for endometrial cancer secondary to the estrogen created by adipose tissue. Studies in obese patients with lymphoma, however, have shown varying results.

ALSO READ: Gastric Sleeve Procedure For Obesity

In a small sample of patients with breast cancer, the patietns of cyclophosphamide was increased and clearance was lower, with no change in the V dfor patients with increased body weight. Samani, A. Combination of gemcitabine and docetaxel in the treatment of children and young adults with refractory bone sarcoma. Weeks 1, 2, 3, 7, 8, 12, and High-dose methotrexate IV. JAMA Oncol. Article PubMed Google Scholar.

We want you to take advantage of everything Cancer Therapy Advisor has to offer. SurgeryS81—S88 Jr et al. Bone Marrow Transplant. The impact of obesity on surgical outcomes: a review. Meyerhardt, J. Phase 2 trial of two courses of cyclophosphamide and etoposide for relapsed high-risk osteosarcoma patients.

Want to read more?

Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. The role of adiponectin in cancer: a review of current evidence. Mayo Clin. With all of the equations discussed so far, there has been great variability in results for obese patients. Campbell, P.

Dalamaga, M. LunaCordelia DunaiLam T. Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. In the allogeneic SCT setting, there are conflicting results as well.

Dosing Antineoplastic Medications in Obese Patients. Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. J Clin Oncol. Browning, L.

Usual Adult Dose for Testicular Cancer

Fondaparinux Patients who receive an overdose should be closely monitored for the development of toxicities. This vial contains 1 g Ifosfamide. Vancomycin 2 Clin Infect Dis.

Monitor for signs and symptoms of pulmonary toxicity and treat as clinically indicated. Elevated body weight has been associated with an increase in mortality from the following cancers: esophagus, colon, rectal, liver, gallbladder, pancreas, kidney, non-Hodgkin lymphoma NHLand multiple myeloma. It is important to evaluate the effect on chemotherapy agents given their narrow therapeutic window. Am Heart J. The doses within protocols varied as well as therapeutic agents examined so it is difficult to draw sound conclusions. The number of documented infections was significantly higher in the obese group. Disorders of renal function, glomerular and tubular following Ifosfamide administration are very common.

Stewart, S. Carucci, L. Cheymol, G. A meta-analysis. Yokota, T. Repeat cycle every 3 weeks for up to 13 cycles median 4 cycles.

An evidence-based drug dosing resource

Merrick, G. Modica, M. High-dose samarium ethylene diamine tetramethylene phosphonate: low toxicity of skeletal irradiation in patients with osteosarcoma and bone metastases. N Engl J Med.

Sinicrope, F. Bone Marrow Transplant. Google Scholar 17 Deurenberg, P. The association of obesity and cervical cancer screening: a systematic review and meta-analysis.

  • Nat Rev Clin Oncol 10, — Choban, P.

  • In the neoadjuvant setting, overweight and obese patients receiving full dose chemotherapy have been shown to have worse pathologic complete response and overall survival OS. These urotoxic effects can be reduced by prophylactic use of mesna.

  • High-dose samarium ethylene diamine tetramethylene phosphonate: low toxicity of skeletal irradiation in patients with osteosarcoma and bone metastases. Osteosarcoma and Dedifferentiated Chrondrosarcoma 1.

  • Tags: Demystifying Drug Dosing in Obesity. Caution recommended.

Dose using ideal body weight Although volume of distribution and clearance are unchanged in obese patients, doses using actual body weight may have prolonged neuromuscular blockade. Amphotericin B liposomal 3. The nadir of the leukocyte count tends to be reached approximately during the second week after administration. There have also been reports of peripheral neuropathy associated with Ifosfamide use.

Wallner, L. Obesity Silver Spring 20— Denosumab in patients with giant-cell tumour of bone: an open-label, phase 2 study. Kaneko, G.

Key Points

Four of the 10 long term survivors were rendered free of cancer by surgical resection after treatment with the Ifosfamide regimen; median survival for the entire group of 50 fully evaluable patients was 53 weeks. Efficacy results with the VIP regimen were compared to data pooled from six single agent phase II trials conducted between August and October including a total of 90 patients of whom 65 were eligible as controls of this study. Renal structural damage was reported to be manifested as: Acute tubular necrosis, renal parenchymal damage, Enzymuria, Cylindruria, Proteinuria. Studies in obese patients with lymphoma, however, have shown varying results.

Table Animal studies indicate that Ifosfamide is capable of causing gene obesw and chromosomal damage in vivo. Consensus opinion is that no formula performs better than another across a wide range of patients. Ten of 50 fully evaluable patients were still alive 2 to 5 years after treatment. Constituted solutions should be refrigerated and used within 24 hours.

Obesity increases the risk of chest wall pain from thoracic stereotactic body radiation therapy. PowerPoint slide for Fig. Fearon, K. Overweight and obese patients trended toward increased survival compared to nonobese participants. Pembrolizumab Cancer 82—

Indications and Usage for Ifosfamide

Comparison of initial warfarin response in obese patients versus non-obese patients. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug or after treatment, the patient should be apprised of the potential hazard to a fetus [ see Use in Specific Populations 8.

Time to progression weeks. The risk of Kbese toxicity and other neurotoxic effects necessitates careful monitoring of the patient. Survival and toxicity between obese and nonobese patients were compared in those with limited or extensive stage small cell lung cancer. Each vial contains 1 gram or 3 grams of sterile Ifosfamide alone. Objective: To examine the available trials evaluating the effect of obesity on the pharmacokinetic parameters of chemotherapy agents. If Ifosfamide for Injection solution contacts the skin or mucosa, immediately wash the skin thoroughly with soap and water or rinse the mucosa with copious amounts of water.

  • One small study of obese patients with endometrial or ovarian cancer receiving paclitaxel and carboplatin showed no difference in toxicity between those who received full-dose chemotherapy versus capped dose.

  • Renal parenchymal and tubular necrosis have been reported in patients treated with Ifosfamide. In obese patients, the use of ideal body weight underdoses patients, but the use of actual body weight overdoses patients.

  • World Journal of Surgery WithersRobert B.

  • Nature Reviews Endocrinology Wander, S.

PMID: Comparative evaluation of atracurium dosed on ideal body weight ifozfamide. Overall, the data are contradictory leading to regimen and protocol-specific determinations in doses. Dosage Strength. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

Urology 60— Prostate surery in obese patients. Campbell, P. See Chapter 1 : Introduction to Dosing Medications in Obese Patients for a complete discussion of hepatic and renal changes in obese patients. Article Google Scholar 8 Samani, A. One small study of obese patients with endometrial or ovarian cancer receiving paclitaxel and carboplatin showed no difference in toxicity between those who received full-dose chemotherapy versus capped dose. A phase II study of cisplatin, ifosfamide and epirubicin combination chemotherapy in adults with nonmetastatic and extremity osteosarcomas.

Fastest Basicmedical Insight Engine

Norepinephrine 9. Ifosfamide for Injection should be given cautiously, if at all, to patients with presence of an infection, severe immunosuppression or compromised bone marrow payients, as indicated by leukopenia, granulocytopenia, extensive bone marrow metastases, prior radiation therapy, or prior therapy with other cytotoxic agents. Neurologic manifestations consisting of somnolence, confusion, hallucinations, blurred vision, psychotic behavior, extrapyramidal symptoms, urinary incontinence, seizures, and in some instances, coma, have been reported following Ifosfamide for Injection therapy. Linezolid There have also been reports of peripheral neuropathy associated with Ifosfamide use.

Ifosfamide should be used with caution, if at all, in patients with active urinary tract infections. Fanconi syndrome, Tubulointerstitial nephritis, Nephrogenic diabetes insipidus, Phosphaturia, Aminoaciduria, Polyuria, Enuresis, Feeling of residual urine. Treatment is repeated every 3 weeks or after recovery from hematologic toxicity. Dvorchik BH, Damphousse D. End-organ function —Many antineoplastic agents undergo hepatic or renal clearance. Patients treated with Ifosfamide have subsequently fathered children.

Close more info about Bone Cancer Treatment Regimens. Overweight and obese patients trended toward increased survival compared to nonobese participants. Article Google Scholar 80 Merrick, G. Fortunately, TBI is no longer the mainstay of therapy as melphalan alone is preferred because of reduced toxicity. Endocrine therapy in obese patients with primary breast cancer: another piece of evidence in an unfinished puzzle.

J Clin Anesth. In the adjuvant setting, reducing doses has demonstrated worse outcomes for obese patients. Symptoms ifosgamide persist for longer periods of time. Overweight and obese patients trended toward increased survival compared to nonobese participants. Keywords: body mass index; body surface area; cancer; chemotherapy; dosing; efficacy; excess weight; neoplasm; obesity; overweight; pharmacokinetics; toxicity.

Ifosfamide Dosage and Administration

Rights and permissions Reprints and Permissions. Prediagnosis body mass index, physical activity, and mortality in endometrial cancer patients. Worm, E. Adjustments have obesse been studied but may be reasonable for those patients for whom there is concern for greater toxicity. A comparison of two short intensive adjuvant chemotherapy regimens in operable osteosarcoma of limbs in children and young adults: the first study of the European Osteosarcoma Intergroup.

Recurrence of CNS toxicity after several uneventful treatment courses has been reported. BSA was selected because it closely resembles cardiac output; thus, blood flow to the liver and kidneys where most medications are metabolized and eliminated. If this drug is used during pregnancy, or dosig the patient becomes pregnant while taking this drug or after treatment, the patient should be apprised of the potential hazard to a fetus. Embryotoxic and teratogenic effects have been observed in mice, rats and rabbits at doses 0. Patients served as their own control based on the premise that long term complete responses could not be achieved by retreatment with a regimen to which they had previously responded and subsequently relapsed. Low-molecular-weight heparins in renal impairment and obesity: available evidence and clinical practice recommendations across medical and surgical settings.

Morbidly obese patients with endometrial cancer were at an increased risk for death, compared to normal-weight patients. Patients received a total of 45 courses of Ifosfamide at doses of 1. Because clinical trials obeae conducted from widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. About two decades later, Boyd devised a new, more complex formula from 1, individuals EquationTable Comparison of initial warfarin response in obese patients versus non-obese patients. There are many different formulas to calculate BSA. Elevated body weight has been associated with an increase in mortality from the following cancers: esophagus, colon, rectal, liver, gallbladder, pancreas, kidney, non-Hodgkin lymphoma NHLand multiple myeloma.

  • Busulfan is commonly used as part of the preparative regimen for SCT. Article Google Scholar 8 Samani, A.

  • No formal studies were conducted in patients with hepatic impairment.

  • This Review summarizes the available literature addressing the clinical management of obese patients with cancer and discusses opportunities to improve the cancer care of these patients.

  • Obese patients face several specific challenges related to diagnosis and treatment of cancer. Cancer Chemother.

  • FDA Safety Alerts for all medications.

  • Before starting treatment, it is necessary to exclude or correct any urinary tract obstructions [ see Contraindications 4 ].

PMID Hematologic toxicities may not be as much of a concern in this population as other toxicities such as veno-occlusive disease or pulmonary and neurologic toxicity because patients receive stem cell support. Fatal outcome has been reported. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

The relationship between body mass index and outcomes in leukemic patients undergoing allogeneic hematopoietic stem cell transplantation. Chapman, J. Pathophysiology of sex hormone binding globulin SHBG : relation to insulin. In the neoadjuvant setting, overweight and obese patients receiving full dose chemotherapy have been shown to have worse pathologic complete response and overall survival OS. Article Google Scholar 8 Samani, A.

Renal Dose Adjustments

Paxton, R. Wolters, R. Body mass index, tumor characteristics, and prognosis following diagnosis of early-stage breast cancer in a mammographically screened population. There is a need for additional research addressing issues specifically associated with the clinical management of obese patients with cancer, including comorbidity, polypharmacy, and problems related to sarcopenia and health-related quality of life. WCRF global network's diet and cancer report [online] ,

The goal of normalizing medication doses based on BSA or weight is to decrease interpatient variability. Morbidly obese patients with endometrial cancer were at an increased risk for death, compared to normal-weight patients. The number of anomalies was also significantly increased over the control group. All rights reserved. Note that you may use the LBW online calculatoror use the equations below:.

Repeat cycle every 3 weeks for up to 12 cycles median 1 cycles. Chemotherapy dose reductions in obese patients with colorectal cancer. Biomarkers Prev. Parr, C. Sunitinib 8. Close banner Close.

Effects of tumor type, degree of obesity, and chemotherapy regimen on chemotherapy dose intensity in obese cancer patients. Physical activity after diagnosis and risk of prostate cancer progression: data from the cancer of the prostate strategic urologic research endeavor. Tao, W. Kamineni, A. See Chapter 1 : Introduction to Dosing Medications in Obese Patients for a complete discussion of hepatic and renal changes in obese patients.

  • Download references.

  • VTE prophylaxis: use standard dosing 2. Supportive therapy should be maintained until their complete resolution.

  • In the SCT setting, higher doses of chemotherapy are used.

  • Obesity and prostate cancer detection: insights from three national surveys. As such, there is no single preferred formula.

OR Days 1, 8, 15, and Vincristine 1. BlazarRobert J. Comparison of ideal body doslng equations and published height-weight tables with body mass index tables for healthy adults in the United States. Physical activity and obesity in endometrial cancer survivors: associations with pain, fatigue, and physical functioning. See Chapter 1 : Introduction to Dosing Medications in Obese Patients for a complete discussion of hepatic and renal changes in obese patients. Roubenoff, R.

Scripture, C. Interferon alfa-2b 35— Influence doing obesity on the incidence and treatment of genitourinary malignancies. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Influence of body mass index on outcome in advanced colorectal cancer patients receiving chemotherapy with or without targeted therapy. Jr et al. Updated evidence in support of diet and exercise interventions in cancer survivors.

Fastest Basicmedical Insight Engine

One small study of obese patients with endometrial or ovarian cancer receiving paclitaxel and carboplatin showed no difference in toxicity between those who received full-dose chemotherapy versus capped dose. The dose of succinylcholine in morbid obesity. Ifosfamide was administered to male and female beagle dogs at doses of 1. See the melphalan section for outcomes specific to carmustine because some were not reported.

Prognostic impact of abdominal adiposity, waist circumference and body mass index in patients with intermediate-risk prostate cancer treated with radiotherapy. Show More. Obesity has been found to be a risk factor for worse outcomes. Mechlorethamine enters the cell rapidly by an active chlorine transporter. Article Google Scholar 28 Maruthur, N.

Bacterial infections, time to engraftment, and median hospital length of stay did not differ between the groups. Show AMA citation. The contribution of Ifosfamide to the VIP combination was determined in patients treated with cisplatin-etoposide prior to Ifosfamide-cisplatin-etoposide or those who received cisplatin-vinblastine prior to Ifosfamide-cisplatin-vinblastine. Renal structural damage. Infections reported with Ifosfamide include pneumonias, as well as other bacterial, fungal, viral, and parasitic infections.

Accessed July 16, Colorectal carcinogenesis has been linked to insulin resistance by activation of oncogenetic proteins, such as vascular endometrial growth factor, leading to potential resistance to certain targeted therapy such as bevacizumab and cetuximab. Use the quantity of diluents shown below to constitute the product:.

The role of the IGF system in cancer growth and metastasis: overview and recent insights. Obesity and prostate cancer detection: insights from three national surveys. Choi, M. Cancer Suppl. Bone Marrow Transplant.

ALSO READ: University Education Important Today S Society And Obesity

Administration advice : -This drug should be administered as a slow IV infusion lasting a minimum of 30 minutes. Dosing weight-based medications in obese patients can often be a tricky proposition. J Clin Endocrinol Metab. Urotoxic side effects, especially hemorrhagic cystitis, have been very commonly associated with the use of Ifosfamide for Injection. Anesthesia in the obese patient: pharmacokinetic considerations.

  • In addition, the precision of radiotherapy might be adversely affected in this population by greater skin motility and increased motion of internal organs.

  • Dose using ideal body weight Although volume of distribution and clearance are unchanged in obese patients, doses using actual body weight may have prolonged neuromuscular blockade.

  • In another study, patients with a history of breast cancer were given a carmustine preparative regimen. Relationship between body mass index and prostate cancer screening in the United States.

  • No formal studies were conducted in patients with hepatic impairment. Conclusion: Some cytotoxic agents used in practice have altered pharmacokinetics in obese patients.

Cancer— Patients with a higher BSA had less mucositis and shorter hospital length of stay. Dose escalation of intravenous irinotecan using oral cefpodoxime: a phase I study in pediatric patients with refractory solid tumors. Therefore, obese dosing recommendations cannot be made.

M Methylprednisolone 18 Dose using ideal body weight and consider less frequent dosing Surgeyr a study of 6 obese and non-obese patients, methylprednisolone volume of distribution was unaffected by body size, but clearance was significantly reduced in patients with obesity Midazolam 17 For bolus doses, use total body weight For continuous infusions, use ideal body weight In obese patients, midazolam volume of distribution increases proportionally to body weight. Tigecycline Arch Neurol. Studies of Ifosfamide for Injection in patients with hepatic or renal impairment have not been conducted [see Use in Specific Populations 8. The mutagenic potential of Ifosfamide has been documented in bacterial systems in vitro and mammalian cells in vivo. Immunoglobulin IVIG Midazolam

A total of 59 patients received a third-line salvage regimen which consisted of Ifosfamide ifosfamjde. All rights reserved. Dose using adjusted body weight preferredideal body weightor actual body weight with a dosing cap Studies have shown that using actual body weight without a dose cap is associated with a higher aPTT value Heparin infusions should be titrated to an aPTT goal usually every hours until stable.

Unfractionated heparin dosing for venous thromboembolism in morbidly obese patients: case report and review of the literature. Oseltamivir 19 Infections must be treated appropriately. Ifosfamide and its metabolites are dialyzable. Select one or more newsletters to continue.

There was no correlation between dose:weight ratio and relapse or survival outcomes. Succinylcholine 17 Amenorrhea, azoospermia, and sterility in both sexes have been reported. To minimize the risk of dermal exposure, always wear impervious gloves when handling vials and solutions containing Ifosfamide for Injection.

Publication types

Published : 16 July Several studies have investigated the impact of obesity in patients undergoing autologous SCT. Comparison of open and laparoscopic nephrectomy in obese and nonobese patients: outcomes stratified by body mass index.

  • Waist circumference and waist—hip ratio: report of a WHO expert consultation, Geneva, 8—11 December [online] ,

  • Because clinical trials are conducted from widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. The nadir of the leukocyte count tends to be reached approximately during the second week after administration.

  • Obesity Silver Spring 20— Topotecan and cyclophosphamide in patients with refractory or relapsed Ewing tumors.

  • One of the most significant challenges associated with obtaining the desired AUC is the difference in tumor penetration, due to chemical properties such as lipophilicity and protein binding, of specific agents. Adv Exp Med Biol.

  • Remifentanil 2329. Further, men should not father a child for up to 6 months after the end of therapy.

Results from a series of consecutive standard pneumonectomies. Table Body mass index and survival in patients with renal cell carcinoma: a clinical-based cohort and meta-analysis. Sorafenib 10, Sunitinib 8. OR Days 1, 8, 15, and Vincristine 1.

Dosing Antineoplastic Medications in Obese Patients. John Wort may increase the metabolism of Ifosfamide to its active alkylating metabolites. Patients who are heavily pretreated or have significant comorbidities may not be able to tolerate as intensive treatment. UK Department of Health. Vecuronium

Steady-state plasma pharmacokinetics of oral voriconazole in obese adults. Dvorchik BH, Damphousse D. Monitor blood counts prior to and at intervals after each treatment cycle.

Tags: Demystifying Drug Dosing in Obesity. It should be used in combination with mesna for prophylaxis of hemorrhagic cystitis. Midazolam John Wort may increase the metabolism of Ifosfamide to its active alkylating metabolites.

ALSO READ: The Gut Microbiota And Obesity From Correlation To Causation Definition

Solutions of Ifosfamide may be diluted further to achieve concentrations of 0. Ifosfamide neurotoxicity may manifest within a few hours to a few days after first administration and in most cases resolves within 48 to 72 hours of Ifosfamide discontinuation. Fatal outcome has been reported. Daptomycin 72. Less acute and chronic GVHD occurred in the obese group but did not reach statistical significance.

Following intravenous administration of 1. Hematologic toxicities may not be as much of a concern in this population as other toxicities such as veno-occlusive disease or pulmonary and neurologic toxicity because patients receive stem cell support. Patients served as their own control based on the premise that long term complete responses could not be achieved by retreatment with a regimen to which they had previously responded and subsequently relapsed. Dose using ideal body weight and consider less frequent dosing In a study of 6 obese and non-obese patients, methylprednisolone volume of distribution was unaffected by body size, but clearance was significantly reduced in patients with obesity.

Tigecycline Fanconi syndrome, Tubulointerstitial nephritis, Nephrogenic diabetes insipidus, Phosphaturia, Aminoaciduria, Polyuria, Enuresis, Feeling of residual urine. Hepatic flow may be decreased in patients with fatty liver disease, but some studies have shown increases in phase II conjugation reactions in this disease state. Email address.

Drug pharmacokinetics are not impacted by obesity. In obese patients, the use of ideal body weight underdoses patients, but the use ptaients actual body weight overdoses patients. Anesth Analg. Antimicrobial prophylaxis may be indicated in certain cases of neutropenia at the discretion of the managing physician. Effect of fondaparinux prophylaxis on anti-factor Xa concentrations in patients with morbid obesity. While some patients did not experience neurotoxicity, others had recurrent, including fatal, events. All rights reserved.

A phase II trial of sorafenib in relapsed and unresectable high-grade osteosarcoma after failure of standard multimodal therapy: an Italian Sarcoma Group study. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of, U. PowerPoint slides. Friedman, A.

Circulation— Body mass index is not a prognostic marker for prostate-specific antigen failure and survival in Dutch men treated with brachytherapy. Rivkah IsseroffThomas S. Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. Days 1, 8, and Denosumab mg subcutaneously for first cycle only Followed by Day 1: Denosumab mg subcutaneously Repeat cycle every 4 weeks until disease progression or unacceptable toxicity. Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors. Yamada, H.

Closely monitor patients taking Ifosfamide with CYP3A4 inducers for toxicities and consider dose adjustment. Metabolism of Ifosfamide is required for the generation for obesity the biologically active species and while metabolism is extensive, it is also quite variable among patients. General : -Handling and preparation of this drug should be in accordance with current guidelines on safe handling of cytotoxic agents. The nadir of the leukocyte count tends to be reached approximately during the second week after administration. It is important to evaluate the effect on chemotherapy agents given their narrow therapeutic window.

Tubular damage may become apparent during therapy, months or even years after cessation of treatment. Lastly, capping doses has been implemented for certain medications like for obese patients to prevent neurotoxicity. Renal parenchymal and tubular necrosis have been reported in patients treated with Ifosfamide. Because clinical trials are conducted from widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. Carton Label. No kinetic data has been published -- titrate to goal MAP. Glomerular or tubular dysfunction may resolve with time, remain stable, or progress over a period of months or years, even after completion of Ifosfamide treatment.

If microscopic hematuria greater than 10 RBCs per high power field is present, then subsequent administration should be withheld until complete resolution. Oseltamivir ifosfamide dosing for obese patients and surgery oseltamivir carboxylate pharmacokinetics in obese adults: dose modification for weight is not necessary. Efficacy results with the VIP regimen were compared to data pooled from six single agent phase II trials conducted between August and October including a total of 90 patients of whom 65 were eligible as controls of this study. The risk of CNS toxicity and other neurotoxic effects necessitates careful monitoring of the patient.

Sidebar1?
Sidebar2?