Editing Mesna

== '''What is Mesna?''' ==

* Mesna ('''Mesnex''') is '''a cytoprotective agent''' used to prevent [[hemorrhagic cystitis]] (bleeding in the bladder) caused by the anticancer drug [[ifosfamide]].

[[File:Mesna.svg|thumb|Mesna]]


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== '''What are the uses of this medicine?''' ==

* Mesna ('''Mesnex''') is a prescription medicine used to reduce the risk of [[inflammation]] and bleeding of the bladder ([[hemorrhagic cystitis]]) in people who receive [[ifosfamide]] (a medicine used to treat cancer).

'''Limitation of Use:'''
* Mesnex is not for use to reduce the risk of blood in the urine ([[hematuria]]) due to other medical conditions.


== '''How does this medicine work?''' ==

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* Mesna reacts '''chemically with the urotoxic ifosfamide metabolites, acrolein''' '''and 4-hydroxy-ifosfamide''', resulting in their detoxification. 
* The first step in the detoxification process is the '''binding of mesna to 4-hydroxy-ifosfamide forming a non-urotoxic 4-sulfoethylthioifosfamide'''. 
* Mesna also '''binds to the double bonds of acrolein''' and to other urotoxic metabolites and inhibits their effects on the bladder.


== '''Who Should Not Use this medicine ?''' ==

This medicine cannot be used in patients who:
* are allergic to mesna or any of the ingredients in Mesnex.


== '''What drug interactions can this medicine cause?''' ==

* Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. 


== '''Is this medicine FDA approved?''' ==

* Mesna was approved for medical use in the United States in 1988.


== '''How should this medicine be used?''' ==

'''Recommended dosage:'''
* Mesnex may be given on a fractionated dosing schedule of three [[bolus]] intravenous injections or a single bolus injection followed by two oral administrations of Mesnex tablets as below:

Intravenous Dosing Schedule:
{| class="wikitable"
|+
|-
! !! 0 Hours !! 4 Hours !! 8 Hours
|-
|Ifosfamide|| 1.2 g/m2 || - || -
|-
|Mesnex injection || 240 mg/m2 || 240 mg/m2 || 240 mg/m2
|-
|}

Intravenous and Oral Dosing Schedule:

{| class="wikitable"
|+
|-
!  !! 0 Hours !! 2 Hours !! 6 Hours
|-
| Ifosfamide || 1.2 g/m2 || - || -
|-
| Mesnex injection || 240 mg/m2 || - || -
|-
| Mesnex tablets || - || 480 mg/m2 || 480 mg/m2
|}

'''Administration:'''
* Mesnex is given on the same day that you receive [[ifosfamide]].
* Mesnex can be given by an intravenous (IV) infusion into a vein or tablets taken by mouth.

You will receive Mesnex in one of two ways:
* Mesnex intravenous (IV) infusion into a vein at the time you receive ifosfamide and 4 and 8 hours after you receive ifosfamide, OR
* Mesnex intravenous (IV) infusion into a vein at the time you receive ifosfamide and Mesnex tablets taken by mouth 2 and 6 hours after you receive ifosfamide.
* Take Mesnex tablets at the exact times and the exact dose your healthcare provider tells you to take it.
* During treatment with Mesnex intravenous (IV) infusion or Mesnex tablets, you should drink 4 to 8 cups of liquid (1 to 2 liters) each day.


== '''What are the  dosage forms and brand names of this medicine?''' ==

This medicine is available in fallowing doasage form:
* '''As Injection:''' 1g (100 mg/mL) Multidose vials
* '''Tablets:''' 400 mg with functional score

This medicine is available in fallowing brand namesː
* '''Mesnex'''


=='''What side effects can this medication cause?'''==

The most common side effects of this medicine include:
* [[nausea]]
* vomiting
* [[constipation]]
* decreased [[white blood cell]] count
* tiredness
* fever
* decreased appetite
* decreased [[platelet]] count
* decreased [[red blood cell]] count
* [[diarrhea]]
* weakness
* stomach (abdomen) pain
* headache
* hair loss
* sleepiness

Mesnex may cause serious side effects, including:
* serious allergic reactions and skin reactions


==''' What special precautions should I follow?''' ==

* Mesnex may cause systemic [[hypersensitivity]] reactions, including [[anaphylaxis]]. Anaphylactic reactions have been reported. Less severe hypersensitivity reactions may also occur. Monitor patients. If a reaction occurs, discontinue Mesnex and provide supportive care. 
* Skin rash with [[eosinophilia]] and systemic symptoms, [[Stevens-Johnson syndrome]], and [[toxic epidermal necrolysis]] have occurred. Skin rash, [[urticaria]], and [[angioedema]] have also been seen. Monitor patients. If a reaction occurs, discontinue Mesnex and provide supportive care.  
* Serious and fatal adverse reactions can occur in premature neonates and low-birth weight infants treated with [[benzyl alcohol]]-preserved drugs, including Mesnex injection. Avoid use in premature neonates and low-birth weight infants. 
* False positive tests for urinary ketones and interference with enzymatic CPK activity tests have been seen.  
* Mesnex is a [[thiol]] compound, i.e., a [[sulfhydryl]] (SH) group-containing organic compound. [[Hypersensitivity]] reactions to mesna and to amifostine, another thiol compound, have been reported. 


== '''What to do in case of emergency/overdose?''' ==

Symptoms of overdosage may include:
* [[nausea]]
* vomiting
* [[diarrhea]]
* fever
* [[hypotension]]
* shortness of breath
* asthma [[exacerbation]]
* rash
* [[flushing]]

Management of overdosage:
* There is no known [[antidote]] for Mesnex.
* In the event of an overdose, appropriate supportive treatment should be initiated.


== '''Can this medicine be used in pregnancy?''' ==

* Mesnex is used in combination with ifosfamide or other [[cytotoxic]] agents.  
* Ifosfamide can cause fetal harm when administered to a pregnant woman. 


=='''Can this medicine be used in children?'''==

* Mesnex injection contains the preservative [[benzyl alcohol]] which has been associated with serious adverse reactions and death when administered intravenously to premature neonates and low birth weight infants. 
* Avoid use of Mesnex injection in premature neonates and low-birth weight infants.


== '''What are the active and inactive ingredients in this medicine?''' ==

'''Active ingredient:''' mesna

'''Inactive ingredients:'''
* Mesnex injection: edetate disodium, sodium hydroxide, and benzyl alcohol as a preservative.
* Mesnex tablets: calcium phosphate, cornstarch, hydroxypropylmethylcellulose, lactose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, povidone, simethicone, and titanium dioxide.


== '''Who manufactures and distributes this medicine?''' ==

'''Manufactured by:''' 
* [[Baxter Healthcare Corporation]], Deerfield, IL  USA
* Made in Germany
* Baxter and Mesnex are registered trademarks of [[Baxter International|Baxter International Inc]].


== '''What should I know about storage and disposal of this medication?''' ==

* Store Mesnex tablets at room temperature between 68°F to 77°F (20°C to 25°C).


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{{Cough and cold preparations}}
{{Detoxifying agents for antineoplastic treatment}}
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[[Category:Chemotherapeutic adjuvants]]
[[Category:Thiols]]
[[Category:Expectorants]]
[[Category:Organic sodium salts]]
[[Category:Sulfonates]]