Mesna

Mesna (chemoprotectant): Contraindications, Side Effects, Uses, and Brand Names

A synthetic sulfhydryl compound Mesna; is a chemo-protective agent used to prevent ifosfamide-induced hemorrhagic cystitis. It can be given intravenously or orally. The drug is rapidly oxidized to mesna disulfide, which is its main metabolite (dimesna). In the kidney, dimesna is reduced to a free thiol, which interacts with ifosfamide metabolites and causes their detoxification.

Mesna Mechanism of Action

Mesna’s free thiol acts as a nucleophilic sink for active electrophiles generated by ifosfamide or other alkylating chemicals breakdown. This protects the local tissue regions of organs such as the bladder, which might have large concentrations of such compounds. The likely ‘‘target” of mesna for cyclophosphamide is acrolein.

Pharmacokinetics

The drug shows bioavailability of 45-79% following oral and IV administration. 67-75% of the drug is protein bound and the plasma half-life of Mesna drug is approximately 0.36-1.17 hours after administration of an IV dosage of 800mg. The drug is primarily eliminated from the body through urine.

What is Mesna Used for?

FDA-approved indication

The drug is used as a Prophylactic agent for ifosfamide-induced hemorrhagic cystitis.

Non-FDA approved

  • Used in the prophylaxis of Cyclophosphamide-induced hemorrhagic cystitis.
  • Treatment of recurrent and persistent cholesteatoma using chemically assisted dissection.
  • Following post-transplantation cyclophosphamide, the incidence of BK viruria was reduced.
  • To inhibit propylene glycol-induced cholesteatoma creation.
  • Epidural injections are used to treat pain caused by failed back surgery syndrome.
  • To treat Chronic cholesteatomata’s otitis media in children.

Contraindications

Use of Mesna is contraindicated if some have hypersensitivity to the drug or thiolate compounds.

Side Effects

Commonly occurring side effects

  • Fatigue
  • Headache
  • Limb pain
  • Nausea
  • Diarrhea
Mesna Side Effects
Headache

Serious Side effects

  • Hypotension

Mesna Interactions

  • Combining it with epirubicin results in epirubicin inactivation, which should be avoided.
  • Mesna therapy may induce false-positive urine tests based on nitroprusside sodium for ketone bodies.
  • Tillman’s reagent-based urine screening tests for ascorbic acid may show false-positive results after the therapy.
  • The absorption and disposal of mesna are unaffected by food.

Is Mesna a chemotherapy drug?

It is a medication that is used in conjunction with some kinds of chemotherapy to protect the bladder against discomfort. The effectiveness of cancer chemotherapy is determined by the amount of medication accumulated at the site of action and the existence of the target. Mesna is a medication that is used to lessen the negative effects of some chemotherapy treatments.

A “chemoprotective agent” is what it’s called. It helps to protect the bladder lining against the effects of ifosfamide. Ifosfamide is broken down by the body into a substance that might damage the bladder, and mesna acts by reducing the severity of this product.

The initial dosage of the drug is generally administered as an intravenous injection at the same time as the patient is receiving chemotherapy. After then, the doctor may decide to continue the pill treatment. It’s generally administered between 2 and 6 hours following chemotherapy.

Is Mesna safe in Pregnancy?

There have been no appropriate and well-controlled studies in pregnant women, and its ability to damage a fetus or impair reproductive capability is unclear. Only use during pregnancy if necessary, according to the manufacturer.

Toxicity of Mesna / Mesna overdose

There is no known antidote to Mesna. It is generally administered as an IV bolus or an oral tablet, and unlike drips, it cannot be discontinued promptly if side effects appear. Supportive treatment with fluid administration is suggested if a hypersensitive response occurs after administration.

Does Mesna appear in the breast milk?

The breastfeeding status of females of reproductive age is an essential concern while administering mesna. Although it is unknown if it is present in breast milk, benzyl alcohol is frequently used in mesna intravenous preparations. As per the manufacturer’s guidelines, exposure to the breastfeeding child because of the mother’s metabolism is rare.

However, because benzyl alcohol has been related to adverse outcomes in newborns, breastfeeding should be avoided for at least one week following the final injection.

Precautions

Mesna should be taken precisely as prescribed. Do not take more or less of it, or take it more frequently than your doctor has advised.

Common brand names of Mesna

Mesnex

Is Mesna Generic?

Yes, it is a cytoprotective agent available under the brand name MESNEX. When referring to the generic medication name mesna, health care providers may use the commercial name Mesnex. It is a prescription-only drug.

References

https://link.springer.com/article/10.1007/BF00685881
https://doi.org/10.1016/B978-008055232-3.63703-1
https://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=1131&context=etd
https://www.pdr.net/drug-summary/Mesnex-mesna-1733
https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/mesna#:~:text=Mesna%20is%20a%20drug%20given,protect%20the%20bladder%20from%20irritation.
https://www.rxlist.com/mesnex-drug.htm
https://chemocare.com/chemotherapy/drug-info/mesna.aspx
https://www.webmd.com/drugs/2/drug-63804/mesna-oral/details
https://www.ncbi.nlm.nih.gov/books/NBK556021/
https://www.medicines.org.uk/emc/product/1838/smpc#gref

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