Ifosfamide
Ifosfamide is an antineoplastic alkylating agent used in the treatment of various cancers, including testicular cancer, soft tissue sarcomas, and certain lymphomas. It is a prodrug that requires metabolic activation by hepatic cytochrome P450 enzymes to produce its cytotoxic metabolites, which work by cross-linking DNA and interfering with DNA replication in rapidly dividing cells.
Ifosfamide is a chemotherapy drug that treats certain cancers by damaging cancer cell DNA after being activated by liver enzymes.
This medication carries a boxed (black box) warning — the strongest type of FDA warning. Review the full prescribing information before use.
Key facts at a glance
- ATC
- L01AA06
- RxNorm
- 5657
- Generic
- Ifosfamide
- Class
- atc-l01
- Brands
- Ifex
- Availability
- rx
- Lactation
- unknown
- Routes
- —
- Forms
- injection
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 500mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 250mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 400mg daily
- Maximum
- consult physician
- Frequency
- once daily
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
10 groupspregnancy
first trimesteravoid if possible
avoid use during pregnancy unless benefits outweigh risks; discuss potential fetal harm with patient
regular fetal monitoring, ultrasound assessments
Use of this medication in this population requires careful consideration of risks and benefits.
pregnancy
second trimesteruse only if clearly needed
use only when benefits outweigh risks; consider alternative therapies when possible
fetal growth monitoring, regular ultrasounds
Use with caution and monitor for adverse effects.
pregnancy
third trimesteruse only if clearly needed
consider delaying treatment until after delivery if clinically appropriate
fetal monitoring, assessment of fetal well-being
Use with caution and monitor for adverse effects.
lactation
breastfeedingdiscontinue breastfeeding
do not breastfeed during ifosfamide treatment and for at least 24 hours after last dose
not applicable
Use of this medication in this population requires careful consideration of risks and benefits.
geriatric
elderly over 65consider dose reduction
use with caution; start at lower end of dosing range; monitor renal and hepatic function
monitor renal function, hepatic function, complete blood counts
Use with caution and monitor for adverse effects.
pediatric_age
children under 18weight-based dosing required
used in pediatric cancers; doses calculated by body surface area; monitor for hemorrhagic cystitis
monitor CBC, renal function, urinalysis for hematuria
Use with caution and monitor for adverse effects.
renal_impairment
severe renal impairmentreduce dose by 25-50%
reduce dose in patients with creatinine clearance <30 mL/min; monitor renal function closely
frequent monitoring of renal function, serum electrolytes
Use with caution and monitor for adverse effects.
renal_impairment
moderate renal impairmentreduce dose by 15-25%
adjust dose based on creatinine clearance; consider hydration protocol
monitor renal function before each cycle
Use with caution and monitor for adverse effects.
hepatic_impairment
severe hepatic impairmentuse with extreme caution
use only if benefits outweigh risks; ifosfamide is metabolized in liver
monitor hepatic function tests, bilirubin
Use with caution and monitor for adverse effects.
hepatic_impairment
mild to moderate hepatic impairmentno major adjustment needed
use with caution; monitor liver function tests
regular hepatic function monitoring
Use with caution and monitor for adverse effects.
Statistics and clinical data
Commonly prescribed since
General prescribing information
Drug class
Drug class information
Common uses
Common therapeutic uses
Mechanism of action
Pharmacological mechanism
Ifosfamide is primarily used to treat testicular cancer, soft tissue and bone sarcomas (including osteosarcoma and Ewing's sarcoma), Hodgkin's and non-Hodgkin's lymphomas, and is sometimes used for other solid tumors such as cervical cancer and lung cancer. It is often used in combination regimens when other treatments have been insufficient.
Ifosfamide is a prodrug that requires activation by hepatic cytochrome P450 isoenzymes, particularly CYP3A4. This metabolic activation produces 4-hydroxyifosfamide and related cytotoxic metabolites that function as alkylating agents, causing cross-linking of DNA strands and preventing DNA replication and cell division in rapidly proliferating cancer cells.
Ifosfamide carries a significant risk of hemorrhagic cystitis (bladder bleeding), which is typically prevented with mesna (a uroprotective agent) and aggressive hydration. Other important side effects include myelosuppression, nephrotoxicity, neurotoxicity, and alopecia. Due to its teratogenic potential, it should not be used during pregnancy. Close monitoring of blood counts, kidney function, and neurologic status is required during treatment.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy