Mesna is routinely co-administered with ifosfamide in the chemotherapy protocols for osteosarcoma and Ewing's sarcoma. Its purpose is to:

• A Reverse ifosfamide-induced encephalopathy
• B Enhance tumour cytotoxicity by inhibiting drug efflux pumps
• C Protect the myocardium from anthracycline-induced free radical injury
• D Prevent haemorrhagic cystitis by detoxifying acrolein in the bladder ✓

Explanation

Ifosfamide and cyclophosphamide are metabolised to acrolein, which is excreted in urine and causes haemorrhagic cystitis. Mesna is a thiol compound that binds acrolein in the urinary tract and renders it inert, without reducing systemic antitumour activity. It does not cross the blood brain barrier, so it cannot treat ifosfamide encephalopathy, for which methylene blue is used. Cardioprotection against doxorubicin is unrelated to mesna.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

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Written and medically reviewed by the StethoPrep medical team.