IFEX is indicated for use in third-line chemotherapy of germ cell testicular cancer in combination with other approved antineoplastic agents. It should be used in conjunction with mesna to prevent hemorrhagic cystitis.

Testicular Cancer

• Dosage and duration of treatment, as well as treatment intervals, are determined by the combination therapy scheme, the patient's overall health and organ function, and the results of laboratory monitoring.
• Ifosfamide should be administered as a slow intravenous infusion lasting a minimum of 30 minutes at a dose of 1.2 grams per m² per day for 5 consecutive days.
• Treatment is repeated every 3 weeks or after recovery from hematologic toxicity. 
• To prevent bladder toxicity, Ifosfamide should be given with extensive hydration consisting of at least 2 liters of oral or intravenous fluid per day.
• Mesna should be used to reduce the incidence of hemorrhagic cystitis. 

The most common adverse reactions associated with Ifosfamide therapy were-

• alopecia
• nausea/vomiting
• leukopenia
• anemia
• CNS toxicity
• hematuria
• infection

Alopecia

Nausea

Leukopenia

CNS Disorder

• Myelosuppression: Can be severe and lead to fatal infections.  Check blood counts before and after treatment.
• Neurotoxicity: Severe and fatal neurotoxicity is possible. Monitor the patient for CNS toxicity and other neurotoxic effects. If encephalopathy develops, discontinue treatment.
• Urotoxicity:  Severe nephrotoxicity with renal failure and death is possible. Serum and urine chemistry should be checked for nephrotoxicity.  Mesna should be used to treat hemorrhagic cystitis.
• Cardiotoxicity:Arrhythmias, other ECG changes, and cardiomyopathy can all occur and lead to death. Use with caution in patients with  cardiac risk factors or preexisting cardiac disease.  Cardiotoxicity is dose dependent.
• Pulmonary toxicity: Interstitial pneumonitis, pulmonary fibrosis, and other forms of pulmonary toxicity with fatal outcomes are possible. Monitor for signs and symptoms of pulmonary toxicity and treat as clinically indicated (5.5)  Secondary malignancies as late sequelae have occurred. 
• Pregnancy: Can cause fetal harm. Women should not become pregnant and men should not father a child during therapy.
• Anaphylactic/anaphylactoid reactions have been reported.