Mesna


Concise Prescribing Info
Indications/Uses
Prophylaxis against urothelial toxicity.
Dosage/Direction for Use
Adult : PO Calculate dosage equivalent to 40% w/w of the IV bolus dose of oxazaphosphorine (ifosfamide or cyclophosphamide), given 2 hours before, then 2 and 6 hours after antineoplastic admin (total 3 doses). IV Calculate dosage equivalent to 20% w/w of the IV bolus dose of oxazaphosphorine (ifosfamide or cyclophosphamide), given simultaneously over 15-30 minutes. Repeat dose at 4 and 8 hours after the first dose. Dose may increase to 40% of the antineoplastic dose, given for 4 doses at 3 hourly intervals (0,3,6,9 hours), if necessary.
Dosage Details
Intravenous
Prophylaxis against urothelial toxicity
Adult: Calculate dosage equivalent to 20% w/w of the IV bolus dose of oxazaphosphorine (ifosfamide or cyclophosphamide), given simultaneously over 15-30 minutes. Repeat dose at 4 and 8 hours after the first dose. Dose may increase to 40% of the antineoplastic dose, given for 4 doses at 3 hourly intervals (0,3,6,9 hours), if necessary.
Child: Shortened interval between doses and/or increased individual doses may be required.

Oral
Prophylaxis against urothelial toxicity
Adult: Calculate dosage equivalent to 40% w/w of the IV bolus dose of oxazaphosphorine (ifosfamide or cyclophosphamide), given 2 hours before, then 2 and 6 hours after antineoplastic admin (total 3 doses).
Child: Shortened interval between doses and/or increased individual doses may be required.
Administration
May be taken with or without food.
Incompatibility
IV: Incompatible with platinum derivatives (e.g. carboplatin, cisplatin, nitrogen mustard) and epirubicin.
Contraindications
Hypersensitivity.
Special Precautions
Patient with autoimmune disorders, urothelium damage associated with oxazaphosphorines or pelvic irradiation, conditions associated with inadequate response at standard doses (e.g. history of urinary tract disease), history of hypersensitivity to thiol compounds. Children. Pregnancy and lactation.
Adverse Reactions
Significant: Dermatological toxicities [e.g. rash with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome, toxic epidermal necrolysis]; haematuria.
Blood and lymphatic system disorders: Lymphadenopathy.
Cardiac disorders: Palpitations, chest pain, dyspnoea.
Eye disorders: Conjunctivitis, photophobia, blurred vision.
Gastrointestinal disorders: Abdominal pain or colic, diarrhoea, nausea, vomiting, dry mouth, mucosal irritation, constipation, flatulence, gingival bleeding, epigastric pain or burning.
General disorders and administration site conditions: Fatigue, malaise, pyrexia, infusion site reactions (IV), influenza-like illness.
Hepatobiliary disorders: Increased transaminase levels.
Immune system disorders: Bronchospasm.
Metabolism and nutrition disorders: Decreased appetite.
Musculoskeletal and connective tissue disorders: Arthralgia, myalgia, back pain, pain in extremity, pain in jaw, rigors.
Nervous system disorders: Headache, light headedness, lethargy or drowsiness, dizziness, paraesthesia, hyperesthesia, hypoesthesia, syncope.
Psychiatric disorders: Disturbance in attention.
Renal and urinary disorders: Dysuria.
Respiratory, thoracic and mediastinal disorders: Epistaxis, nasal congestion, cough, laryngeal discomfort, pleuritic pain, hypoxia, respiratory distress.
Skin and subcutaneous tissue disorders: Rash, pruritus, hyperhidrosis.
Vascular disorders: Flushing.
Potentially Fatal: Hypersensitivity (e.g. anaphylaxis, severe bullous and ulcerative skin).
IV/Parenteral/PO: B
Patient Counseling Information
This drug may cause drowsiness and dizziness, if affected, do not drive or operate machinery.
MonitoringParameters
Monitor urine for haematuria and proteinuria.
Overdosage
Symptoms: Nausea, vomiting, abdominal pain or colic, diarrhoea, headache, fatigue, limb and joint pains, rash, flushing, hypotension, bradycardia, tachycardia, paraesthesia, fever, bronchospasm.
Lab Interference
May cause false positive reactions in nitroprusside sodium-based urine tests (e.g. dipstick tests) for ketone bodies. May cause false positive reactions in Tillman’s reagent-based urine screening tests for ascorbic acid. May interfere with enzymatic creatine phosphokinase (CPK) activity tests that use a thiol compound for CPK reactivation thus, may result in a falsely low CPK level.
Action
Description: Mesna is first oxidized into mesna-disulphide or dimesna which is then reduced back into mesna in the renal tubuli epithelium. In the urine, mesna supplies free thiol group that reacts chemically with urotoxic oxazaphosphorine metabolites (e.g. acrolein) of ifosfamide and cyclophosphamide thereby reducing incidence of toxicities (e.g. haemorrhagic cystitits and haematuria) and enhancing excretion of cysteine which may increase uroprotective effect.
Pharmacokinetics:
Absorption: Bioavailability: 58% (range: 45-71%) as free mesna. Time to peak plasma concentration: 1.5-4 hours (free mesna).
Distribution: Volume of distribution: 0.65 ± 0.24 L/kg. Plasma protein binding: 60-75%.
Metabolism: Rapidly metabolised via oxidation into mesna-disulphide or dimesna in the intravascular compartment.
Excretion: Via urine (32% as mesna, 33% as dimesna). Elimination half-life: Approx 22 minutes (mesna), approx 70 minutes (dimesna).
Chemical Structure

Chemical Structure Image
Mesna

Source: National Center for Biotechnology Information. PubChem Database. Mesna, CID=23662354, https://pubchem.ncbi.nlm.nih.gov/compound/Mesna (accessed on Jan. 22, 2020)

Storage
Store between 20-25°C.
ATC Classification
V03AF01 - mesna ; Belongs to the class of detoxifying agents used in antineoplastic treatment.
References
Anon. Mesna. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 26/07/2017.

Anon. Mesna. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 26/07/2017.

Buckingham R (ed). Mesna. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 26/07/2017.

Joint Formulary Committee. Mesna. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 26/07/2017.

Mesna Injection 1 g/10 mL (Fresenius Kabi USA, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 26/07/2017.

Mesnex® Mesna Tablets 400 mg (Baxter Healthcare Ltd). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 26/07/2017.

Disclaimer: This information is independently developed by MIMS based on Mesna from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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