Ifosfamide

How does ifosfamide work?

Ifosfamide is a type of chemotherapy drug called an ​alkylating drug. 

These drugs work by interfering with the DNA  in cancer cells. The cells can’t divide into 2 new cells so the cancer can’t grow.

How do you have ifosfamide?

You have ifosfamide into your bloodstream as a drip into a vein (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line

• PICC line

• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

Find out more about having chemotherapy into the bloodstream

Ifosfamide can irritate the lining of your bladder. So, you have a drug called mesna to prevent this. This is usually given through a drip at the same time as the ifosfamide.

You usually have a lot of fluid too, so the drugs take a long time to go through the drip. You may need to stay overnight at the hospital.

How often do you have ifosfamide?

You usually have ifosfamide as ​cycles of treatment​. Each cycle varies depending on what type of cancer you have. Your doctor or nurse will tell you more about this.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and ​HIV. This is called a viral screen.

It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your ​immune system​ and can cause the virus to become active again (reactivation).

What are the side effects of ifosfamide?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs. This is known as petechiae.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Hair Loss 

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Kidney damage

To help prevent kidney damage, it is important to drink plenty of water. You might also have fluids into your vein before, during and after treatment. You have blood tests before your treatments to check how well your kidneys are working.

Inflammation and irritation of the bladder

Ifosfamide can cause inflammation and bleeding of the bladder lining. This is called haemorrhagic cystitis. This can cause you to:

• pass urine more often than usual

• find it difficult to pass urine

• have a burning feeling or pain when you go

• not be able to wait when you need to go

• pass blood or blood clots 

It helps to drink plenty of fluids. 

Tell your nurse or doctor straight away if you have any problems passing urine.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• loss of appetite

• changes to how your liver works - you will have blood tests to check how well your liver works

• inflammation of the vein causing pain, redness and swelling - tell your nurse or doctor straight away if this happens

Rare side effects

This side effects happens in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• heart changes

• low blood pressure - symptoms include feeling dizzy, sick, confused, feeling weak and tired

• diarrhoea

• sore mouth

• tiredness and weakness (fatigue)

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

• a serious reaction to an infection - signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - Call 999 or go to accident and emergency (A&E) immediately if you have any of these symptoms

• a second cancer

• a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life threatening, alert your nurse or doctor if notice any of these symptoms

• swelling in parts of the body (oedema)

• SIADH – a syndrome where the body makes too much of the hormone that holds water in the body

• a blood disorder where your red blood cells get destroyed faster than they can be made (haemolytic anaemia)

• changes to the levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this

• abnormal thirst causing you to drink excessive amounts of fluids

• imbalance of substances in your blood (metabolic acidosis) – it can cause confusion, tiredness, shortness of breath and headaches

• changes to your mental state such as panic attacks and not being able to speak

• fits (seizures)

• changes to how your brain works

• problems with your memory

• not being able to control your bowels (incontinence)

• changes to how you move and walk

• changes to your nerves causing burning, prickling sensation or a decrease in sensation and loss of muscle control causing flapping hands

• eye problems such as red, sore eyes and problems with your eyesight

• changes to your hearing including ringing in your ears and deafness

• feeling like the room is spinning (vertigo)

• changes to your heart including irregular heartbeat and heart attack

• high blood pressure

• sore mouth and mouth ulcers

• constipation

• a blocked bowel

• a high temperature or chills

• leaking of the proteins and fluid out of the blood vessels into the tissues

• breathing problems including lung inflammation, cough and fluid on the lungs

• an organ or organs in your body such as your kidneys stop working causing sickness, severe pain, fits, swelling and chest pain

• slow wound healing. If you need to have an operation your doctor will normally stop the ifosfamide for a while beforehand. They will let you know when you can start having it again.

Coping with side effects

We have more information about side effects and tips on how to cope with them.

Read more about how to cope with side effects

What else do you need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Women must not become pregnant for at least a year after the end of treatment. Men should not get someone pregnant for at least 6 months after treatment. 

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having.

Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, and yellow fever.

You can usually have:

• other vaccines, but they might not give you as much protection as usual

• the flu vaccine (as an injection)

• the coronavirus (COVID-19) vaccine

Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.

Contact with others who have had immunisations 

You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your ​immune system​ is weakened.

Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.

Read more about immunisations and cancer treatment

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

eMC website

You can report any side effect you have to the Medicines and Healthcare products Regulatory Agency (MHRA) as part of their Yellow Card Scheme.

Report a side effect to the MHRA