Mesna

How it works

In the urinary tract its free thiol group binds and detoxifies acrolein and other urotoxic metabolites of these alkylating agents, preventing damage to the bladder urothelium.

Prescribing in practice

• It protects only the urinary tract and provides no protection against systemic chemotherapy toxicity, so it must accompany rather than replace standard supportive care.
• Hypersensitivity reactions, including skin and mucosal reactions, have been reported and may be more frequent in patients with autoimmune disorders.
• Dosing is scheduled in relation to the cytotoxic agent and may be given by injection or by mouth as set out in the SPC.

Monitoring

Monitor for haematuria and other signs of bladder toxicity throughout the chemotherapy course.

Counselling the patient

• This medicine protects your bladder from side effects of your chemotherapy.
• Report blood in the urine or any rash or mouth soreness promptly.
• Maintaining a good fluid intake helps protect the bladder.

Evidence & guidelines

Co-administration of mesna with ifosfamide and high-dose cyclophosphamide to prevent haemorrhagic cystitis is standard, evidence-based oncology practice.