Ifosfamide is a chemotherapy drug that is given as a treatment for many different types of cancer. This information describes ifosfamide, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give further information and advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Ifosfamide is a clear fluid.

Ifosfamide may be given:

• As a drip (infusion) through a fine tube (cannula) inserted into a vein.
• Through a central line, which is inserted under the skin into a vein near the collarbone, or into a PICC line which is inserted into a vein in the crook of the arm.
• As an injection into the vein (intravenously) through a cannula.

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given ifosfamide, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and some of the less common ones, so  you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Ifosfamide can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next course of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Ifosfamide can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with ifosfamide you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these effects are a problem.

Feeling sick (nausea) and being sick (vomiting) If you do feel sick this may begin 2–3 hours after the treatment is given and last for up to two weeks. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Hair loss This usually starts 3–4 weeks after the first dose of ifosfamide, although it may happen earlier. Hair may be lost completely or may just thin. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and all your hair will regrow once the treatment ends.

Tiredness and feeling weak It is important to allow yourself plenty of time to rest.

Irritation of the bladder It is important to try to drink plenty of fluids to prevent any irritation. You will usually be given fluids into your vein before and after the chemotherapy is given. You may also be given a drug called mesna to protect your bladder and kidneys.

While you are having the chemotherapy you will be encouraged to pass urine every 3–4 hours during the day, and last thing at night. Your urine may be measured and tested for the presence of blood. If blood is present in the urine, further doses of mesna will be given.

Changes to nails Your nails may become ridged, but this change grows out over a few months once the treatment has finished.

Your liver may be temporarily affected Ifosfamide may cause changes in the way that your liver works. Your liver will return to normal when the treatment is finished. This is very unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver is working properly.

Skin changes Ifosfamide can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Your skin may darken, due to excess production of pigment. This usually returns to normal a few months after the treatment has finished.

Confusion, lethargy, sleepiness and loss of balance These side effects are very rare and only occur with high-dose treatment. If you notice any of these effects it is important to tell your doctor.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking ifosfamide, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

This section is based on our Ifosfamide factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Medicines.org.uk website – www.medicines.org.uk (November 2007).
• The Chemotherapy Source Book (3rd edition). Ed. Perry et al, 2001.

For further references, please see general bibliography.