Sodium Mercaptopurine Sulfonate

Indications & Dose:

Prevention of urothelial toxicity including hemorrhagic cystitis, microhaematurial, and macrohaematuria in patients being treated with antineoplastics, ifosfamide and cyclophosphamide in doses considered to be urotoxic.

DOSAGE AND ADMINISTRATION: Mesna should be administered by i.v. Injection usually at 20% of respective oxazaphosphorine dose at time 0 (=administration of the cytostatic agent) , 4 hours and 8 hours. In the case of ifosfamide , the usual dose of mesna is 10 to 12 mg/kg i.v. At 0 , 4 and 8 hours after ifosfamide dose. In the treatment of children and particularly when administering very high doses , such as required when conditioning patients for bone-marrow transplantations , the mesna doses should be given at 0 . 1 , 6 , 9 and 12 hours or dosage increased to 30% of the respective oxazaphosphorine dose. Oral administration of mesna , e.g. in patients with poor veins , is also feasible . Mesna is then given either at dose of 20% of the oxazaphosphorine dose at time 0 hours by the parental route, followed by oral doses of 40% of the oxazaphosphorine dose after 4 and 8 hours, taken in juice or cola, or in 3 oral doses of 40% of the oxazaphosphorine dose at time 0 , 4 and 8 hours. 

Contraindications:

Patients hypersensitive to the drug and other thiols. 

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Adverse Effects:

Gastrointestinal effects, headache, fatigue , limb pains, depression , irritability , hypotension (but see below), tachycardia and skin rash, Bronchospasm has been reported after nebulization. Mesna may produce a false positive result in diagnostic tests for urinary ketones and may produce a false negative result in diagnostic tests for urinary erythrocytes.

Effects on blood pressure,Hypotension may occur with Mesna ; however , severe hypertension is also reported after use of mesna , either alone or with ifosfamide.

Hypersensitivity; rash, fever , nausea , facial and periorbital oedema , ulceration of mucous membranes and tachycardia have been attributed to mesna. Reactions may be more common in patients with autoimmune disorder; drug eruptions developed in 7 of 16 patients receiving mesna and cyclophosphamide for autoimmune disorders. Five of these patients had a rash , with angioedema in 2 cases and a pseudo-hypersensitivity reaction was diagnosed. 

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