Mesna

What it is and how it works

Mechanism of Action 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.

Indications

1. INDICATIONS AND USAGE Mesna injection is indicated as a prophylactic agent in reducing the incidence of ifosfamide-induced hemorrhagic cystitis. Limitation of Use: Mesna injection is not indicated to reduce the risk of hematuria due to other pathological conditions such as thrombocytopenia. Mesna injection is a cytoprotective agent indicated as a prophylactic agent in reducing the incidence of ifosfamide-induced hemorrhagic cystitis. Limitation of Use: Mesna injection is not indicated to reduce the risk of hematuria due to other pathological conditions such as thrombocytopenia.

Dosage and administration (summary)

2. DOSAGE AND ADMINISTRATION Mesna injection 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 outlined below. The dosing schedule should be repeated on each day that ifosfamide is administered. When the dosage of ifosfamide is adjusted, the ratio of mesna to ifosfamide should be maintained.

Contraindications

4. CONTRAINDICATIONS Mesna injection is contraindicated in patients known to be hypersensitive to mesna or to any of the excipients . Known hypersensitivity to mesna or to any of the excipients in mesna injection, including benzyl alcohol.

Warnings and precautions

5. WARNINGS AND PRECAUTIONS Hypersensitivity reactions: Anaphylactic reactions have been reported. Less severe hypersensitivity reactions may also occur. Monitor patients. If a reaction occurs, discontinue mesna injection and provide supportive care. Dermatologic toxicity: 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 mesna injection and provide supportive care.

Pregnancy

Pregnancy Risk Summary Mesna injection is used in combination with ifosfamide or other cytotoxic agents. Ifosfamide can cause fetal harm when administered to a pregnant woman. Refer to the ifosfamide prescribing information for more information on use during pregnancy. Mesna injection contains the preservative benzyl alcohol.

Storage and supply

16. HOW SUPPLIED/STORAGE AND HANDLING Mesna injection, 1 g/10 mL (100 mg/mL) is a clear, colorless solution available as: NDC CONCENTRATION PACKAGE FACTOR 55150-520-01 1 g/10 mL Multi-Dose Vial 1 Vial per Carton Store at 20° to 25°C (68° to 77°F), excursions permitted to 15° to 30°C (59° to 86°F) If mesna injection is co-administered with ifosfamid…

Source: Mesna (Mesna) — US FDA prescribing information, 2026-01-27, DailyMed. Summarised and shortened; the full label governs. Iranian registration, indications and labelling may differ.