Ifosfamide Injection
Ifosfamide Injection is an intravenous chemotherapy medicine (an alkylating drug) used with other cancer drugs as third-line treatment for germ cell testicular cancer, always given with mesna to protect the bladder.
🧬 Where this information comes from Click to expand
The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 6 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →
Ifosfamide (Ifex) is a specialist IV chemotherapy drug, on the market since about 1987 and available as a generic, used with other cancer medicines as third-line (after earlier treatments) treatment for germ cell testicular cancer; the liver activates it into forms that cross-link DNA and kill cells. It is a tough treatment, with hair loss, nausea and vomiting the effects people notice most. Its boxed warning covers severe, sometimes fatal, low blood counts, brain toxicity (encephalopathy), kidney damage and bladder bleeding; report fever, confusion or blood in your urine promptly. Mesna and plenty of fluids protect the bladder, and blood counts, kidney function and urine are checked each cycle.
Clinical pearls
- Tell your oncology team about phenytoin, carbamazepine, phenobarbital, rifampin or St. John's Wort, which can raise ifosfamide's toxicity.
- Skip grapefruit and grapefruit juice during treatment, since they can make ifosfamide less effective.
- Kidney damage can appear months or even years after the last cycle, so keep up kidney tests at follow-up visits.
- Women who could become pregnant need effective contraception for 12 months after the last dose; men with such partners, 6 months.
⚠️ FDA Boxed Warning — the FDA’s strongest safety alert ▾
Ifosfamide can cause serious, sometimes fatal, problems with your blood, brain, kidneys and bladder.
- Low blood counts (myelosuppression): can be severe and lead to fatal infections. Your blood counts are checked before and after each cycle.
- Brain toxicity (encephalopathy): can be severe and may result in death. Your team will watch for confusion or other brain effects and stop treatment if encephalopathy develops.
- Kidney damage: can be severe and lead to kidney failure.
- Bladder bleeding (hemorrhagic cystitis): can be severe. Mesna given with ifosfamide can reduce this risk.
Patient information guide A plain-language walkthrough of Ifosfamide Injection, written from its FDA label.
What Ifosfamide Injection is used for
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Ifosfamide Injection is a chemotherapy medicine with one supported use:
- Ifosfamide for Injection is used with certain other approved cancer drugs as third-line chemotherapy for germ cell testicular cancer.
- It should be used with mesna to help prevent hemorrhagic cystitis (bladder bleeding).
How Ifosfamide Injection works
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Ifosfamide is a prodrug, so it must first be activated by liver enzymes. Its active form attaches to DNA and creates cross-links within and between DNA strands. This damage leads to cell death.
The label notes that the exact mechanism has not been fully determined.
Ifosfamide Injection dosage
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Ifosfamide is given by a healthcare professional as a slow IV infusion, lasting at least 30 minutes. It is given once daily for 5 days in a row, and the cycle is usually repeated about every 3 weeks or after blood counts recover.
- You will get at least 2 liters of fluid a day, by mouth or IV, to protect your bladder.
- Mesna is given with it to reduce bladder bleeding.
- Your doctor individualizes the dose and schedule.
Dosing details from the FDA-approved label
From the Ifosfamide Injection prescribing information (“Dosage and Administration”). Doses are set by your prescriber for your product, condition, kidney function and age — never change a dose on your own.
- Ifosfamide for Injection (recommended dosage)
- 1.2 grams per m2 per day administered as a slow intravenous infusion (lasting at least 30 minutes) for 5 consecutive days
- Treatment is repeated every 3 weeks or after recovery from hematologic toxicity
- Administer with extensive hydration of at least 2 liters of oral or intravenous fluid per day and with mesna; individualize the dose and dosing schedule based on patient risk factors and adverse reactions.
Read the label’s full dosing text
2 DOSAGE AND ADMINISTRATION • Administer Ifosfamide for Injection with extensive hydration consisting of at least 2 liters of oral or intravenous fluid per day to reduce the incidence or severity of bladder toxicity. ( 2.1 , 5.3 ) • Administer mesna with Ifosfamide for Injection to reduce the incidence or severity of hemorrhagic cystitis. ( 2.1 , 5.3 ) • Administer Ifosfamide for Injection as a slow intravenous infusion (at least 30 minutes) at a dose of 1.2 grams per m2 per day for 5 consecutive days. Repeat every 3 weeks or after recovery from hematologic toxicity. ( 2.2 ) • Individualize the dose and dosing schedule of Ifosfamide for Injection based on patient risk factors and adverse reactions. ( 2.2 ) • See Full Prescribing Information for instructions on preparation and administration. ( 2.3 ) 2.1 Important Administration Instructions Administer Ifosfamide for Injection with extensive hydration consisting of at least 2 liters of oral or intravenous fluid per day to reduce the incidence or severity of bladder toxicity. Administer Ifosfamide for Injection with mesna to reduce the incidence or severity of hemorrhagic cystitis [see Warnings and Precautions (5.3) ] . 2.2 Recommended Dosage The recommended dosage of Ifosfamide for Injection is 1.2 grams per m 2 per day administered as a slow intravenous infusion (lasting at least 30 minutes) for 5 consecutive days. Treatment is repeated every 3 weeks or after recovery from hematologic toxicity. Individualize the dose and dosing schedule of Ifosfamide for Injection based on patient risk factors and adverse reactions. 2.3 Preparation and Administration Ifosfamide for Injection is a hazardous drug. Follow applicable special handling and disposal procedures. 1 Skin reactions associated with accidental exposure to Ifosfamide for Injection may occur. To minimize the risk of dermal exposure, always wear impervious gloves when handling vials and solutions containing Ifosfamide for Injection. If Ifosfamide for Injection solution contacts the skin or mucosa, immediately wash the skin thoroughly with soap and water or rinse the mucosa with copious amounts of water. Prepare Ifosfamide for Injection for intravenous use by adding Sterile Water for Injection, USP or Bacteriostatic Water for Injection, USP (benzyl alcohol or parabens preserved) to the vial and shaking to dissolve.
Excerpted — the section continues on the label. Read the full Dosage and Administration section on DailyMed →
Ifosfamide Injection side effects
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The most common side effects seen in studies were:
Common side effects
- Hair loss
- Nausea and vomiting
- Low white blood cell count (leukopenia)
- Anemia (low red blood cells)
- Central nervous system effects (such as drowsiness or confusion)
- Blood in the urine
- Infection
When to get medical help
- Signs of infection, such as fever or chills, because ifosfamide can lower your white blood cells and immune defenses
- Confusion, hallucinations, severe drowsiness, blurred vision, seizures or unusual behavior
- Blood in your urine, painful urination, or reduced urination
- Unusual bleeding or bruising
- Irregular heartbeat, chest pain, swelling, or new shortness of breath
- New cough or trouble breathing
- Signs of a severe allergic reaction, such as swelling, hives or trouble breathing
Call your care team right away for fever, confusion, hallucinations, seizures, bloody urine, chest symptoms, breathing trouble or signs of allergic reaction.
Ifosfamide Injection warnings and precautions
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- Low blood counts and infection: can be severe and fatal. The lowest white cell count usually occurs about 2 weeks after a dose.
- Brain toxicity: may cause drowsiness, confusion, hallucinations, blurred vision, seizures or coma. It may impair driving.
- Kidney and bladder damage: can cause kidney failure and hemorrhagic cystitis. Kidney problems can appear months or years later.
- Heart toxicity: arrhythmias and cardiomyopathy (weakened heart muscle) can occur, and risk is dose dependent.
- Lung toxicity: pneumonitis and pulmonary fibrosis (lung scarring) can occur.
- Other cancers: secondary cancers, including leukemia, may develop years later.
- Also reported: liver veno-occlusive disease, slowed wound healing, allergic reactions and infertility.
Ifosfamide Injection interactions
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Some drugs and foods change how ifosfamide is processed by the liver.
- CYP3A4 inducers (carbamazepine, phenytoin, fosphenytoin, phenobarbital, rifampin, St. John's Wort): may increase toxic by-products, so close monitoring is needed.
- CYP3A4 inhibitors (ketoconazole, fluconazole, itraconazole, sorafenib, aprepitant, fosaprepitant): may reduce effectiveness.
- Grapefruit and grapefruit juice: may reduce effectiveness.
- Sedatives, narcotics, antihistamines and anti-nausea drugs: effects on the brain can add up.
Interactions listed in the FDA-approved label
From the Ifosfamide Injection prescribing information (“Drug Interactions”): what the manufacturer studied or reported to the FDA.
- CYP3A4 inducers (e.g., carbamazepine, phenytoin, fosphenytoin, phenobarbital, rifampin, St. John Wort): May increase the metabolism of ifosfamide to its active alkylating metabolites and may increase the formation of the neurotoxic/nephrotoxic metabolite chloroacetaldehyde. Closely monitor patients taking ifosfamide with CYP3A4 inducers for toxicities and consider dose adjustment.
- CYP3A4 inhibitors (e.g., ketoconazole, fluconazole, itraconazole, sorafenib, aprepitant, fosaprepitant, grapefruit, grapefruit juice): May decrease the metabolism of ifosfamide to its active alkylating metabolites, perhaps decreasing the effectiveness of ifosfamide treatment.
Read the label’s full interactions text
7 DRUG INTERACTIONS Ifosfamide is a substrate for both CYP3A4 and CYP2B6. • CYP3A4 Inducers: monitor for increased toxicity when used in combination with CYP3A4 inducers. (7.1) • CYP3A4 Inhibitors: use in combination with CYP3A4 inhibitors could decrease the effectiveness of ifosfamide. (7.2) 7.1 Inducers of CYP3A4 CYP3A4 inducers (e.g., carbamazepine, phenytoin, fosphenytoin, phenobarbital, rifampin, St. John Wort) may increase the metabolism of ifosfamide to its active alkylating metabolites. CYP3A4 inducers may increase the formation of the neurotoxic/nephrotoxic ifosfamide metabolite, chloroacetaldehyde. Closely monitor patients taking ifosfamide with CYP3A4 inducers for toxicities and consider dose adjustment. 7.2 Inhibitors of CYP3A4 CYP3A4 inhibitors (e.g., ketoconazole, fluconazole, itraconazole, sorafenib, aprepitant, fosaprepitant, grapefruit, grapefruit juice) may decrease the metabolism of ifosfamide to its active alkylating metabolites, perhaps decreasing the effectiveness of ifosfamide treatment.
7.1 Inducers of CYP3A4 CYP3A4 inducers (e.g., carbamazepine, phenytoin, fosphenytoin, phenobarbital, rifampin, St. John Wort) may increase the metabolism of ifosfamide to its active alkylating metabolites. CYP3A4 inducers may increase the formation of the neurotoxic/nephrotoxic ifosfamide metabolite, chloroacetaldehyde. Closely monitor patients taking ifosfamide with CYP3A4 inducers for toxicities and consider dose adjustment.
7.2 Inhibitors of CYP3A4 CYP3A4 inhibitors (e.g., ketoconazole, fluconazole, itraconazole, sorafenib, aprepitant, fosaprepitant, grapefruit, grapefruit juice) may decrease the metabolism of ifosfamide to its active alkylating metabolites, perhaps decreasing the effectiveness of ifosfamide treatment.
Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.
Before taking Ifosfamide Injection
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- Do not use with a known allergy to ifosfamide or with urinary outflow obstruction.
- Tell your doctor about kidney, liver, heart or lung disease, and any infection.
- Pregnancy: it can harm a fetus. Pregnancy status should be checked first, and effective contraception is advised during treatment (12 months after for females, 6 months after for males).
- Do not breastfeed during treatment and for one week after the last dose.
- It may affect fertility in women and men.
- Children: safety and effectiveness have not been established.
- Older adults: closer monitoring of kidney function and side effects is needed.
Ifosfamide Injection overdose
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No specific antidote is known. Overdose can worsen brain toxicity, kidney damage, low blood counts and mouth sores. Treatment is supportive care with close monitoring, and mesna may help limit bladder effects. Ifosfamide can be removed by dialysis.
What Ifosfamide Injection does in the body
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Ifosfamide's active forms cross-link DNA, which kills cells. Breakdown products can also be toxic. Acrolein irritates the bladder, and chloroacetaldehyde is linked to brain and kidney toxicity.
How your body processes Ifosfamide Injection
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Ifosfamide is heavily processed by the liver, and this varies between patients. The half-life is about 7 hours at lower doses and about 15 hours at higher single doses. It spreads through body water and binds little to plasma proteins. It is cleared mostly through the kidneys, as the drug and its by-products.
How to store Ifosfamide Injection
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Store at controlled room temperature 20°C to 25°C (68°F to 77°F). Protect from temperatures above 30°C (86°F).
Written from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
Supplements & herbs that interact with Ifosfamide Injection
149 supplements and herbal products have documented interactions with Ifosfamide Injection in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.
- Major · 5
- Moderate · 102
- Minor · 42
Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.
Nutrient depletion considerations
Ifosfamide Injection has been associated with lower levels of 4 nutrients in the clinical literature. This does not mean a deficiency will occur — it means these may be worth discussing with your pharmacist or healthcare provider, especially with long-term use.
Educational information from a licensed clinical database (Natural Medicines) — not medical advice. Do not start or stop medications or supplements without professional guidance.
Ifosfamide Injection: pharmacist answers to common questions
Quick, plain-English answers to the questions patients ask most about Ifosfamide Injection — the kind of thing our pharmacy team would talk through with you at the counter.
What is ifosfamide being used for?
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How will I receive it?
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What side effects should I expect?
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When should I call my care team right away?
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Do my other medicines or foods matter?
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What about pregnancy and having children?
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Is Ifosfamide Injection available over the counter?
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When was Ifosfamide Injection first available?
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Who makes Ifosfamide Injection?
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Answers drafted from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
More about Ifosfamide Injection on HelloPharmacist
Ifosfamide Injection forms and strengths (how it comes)
Ifosfamide Injection is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.
Injection
How this form is used
- Ifosfamide for Injection is used with other approved cancer drugs as third-line chemotherapy for germ cell testicular cancer.
- Ifosfamide for Injection should be used with mesna to help prevent hemorrhagic cystitis.
- Ifosfamide for Injection is given as a slow intravenous infusion lasting at least 30 minutes.
- Ifosfamide for Injection is given with at least 2 liters of fluid per day and with mesna to protect the bladder.
- Ifosfamide for Injection is a hazardous drug and requires special handling and disposal.
Ifosfamide Injection on the U.S. market: products, makers and brands
How Ifosfamide Injection appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.
5 companies list 10 Ifosfamide Injection product records with the FDA, mostly as injection; the earliest marketing or approval year on record is 1987. Brand names on the directory include Ifex; the rest are generics.
Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.
How widely Ifosfamide Injection is used (Medicaid data)
A general measure of how commonly Ifosfamide Injection is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.
Think of this as a proxy for how widely Ifosfamide Injection is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.
How commonly is Ifosfamide Injection prescribed? Of the 1,601 medications we measure, Ifosfamide Injection ranks #1,352 by Medicaid prescriptions — more than 16% of them.
Utilization by Ifosfamide Injection product
Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.
ifosfamide 3000 MG Injection Most dispensed
Summed across the 1 of 5 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 1791588
20 ML ifosfamide 50 MG/ML Injection
Summed across the 1 of 3 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 1791599
ifosfamide 1000 MG Injection
Summed across the 2 of 7 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 1791593
60 ML ifosfamide 50 MG/ML Injection
Summed across the 1 of 3 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 1791597
Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.
Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Ifosfamide Injection, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 5 of 18 listed Ifosfamide Injection NDCs with Medicaid activity.
Compare Ifosfamide Injection products
A representative set of FDA-listed product records for Ifosfamide Injection — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)
| Strength | Route | Manufacturer / Labeler | Category ⓘ | Details |
|---|---|---|---|---|
| 💊Injection | ||||
| 1 g/20 mL | Intravenous | Baxter Healthcare Company × 2 listings | NDA | View NDC → |
| 3 g/60 mL | Intravenous | Baxter Healthcare Company × 2 listings | NDA | View NDC → |
| 1 g/20 mL | Intravenous | Baxter Healthcare Corporation | NDA | View NDC → |
| 3 g/60 mL | Intravenous | Baxter Healthcare Corporation | NDA | View NDC → |
| 1 g | Intravenous | Fresenius Kabi USA, LLC | ANDA | View NDC → |
| 50 mg/mL | Intravenous | Hikma Pharmaceuticals USA Inc. × 2 listings | ANDA | View NDC → |
| 1 g | Intravenous | SteriMax Inc. | UNAPPROVED DRUG FOR USE IN DRUG SHORTAGE | View NDC → |
Showing 10 of 10 products — FDA National Drug Code Directory. See every product, package size and price: browse all 10 Ifosfamide Injection NDCs →
Ifosfamide Injection side effects reported to the FDA (FAERS)
After a medicine reaches the market, patients, doctors and drugmakers can send the FDA reports of problems they think may be linked to it. Here’s what’s been reported for Ifosfamide Injection — a signal of what to watch for, not proof the drug caused it.
Source: openFDA, from the FDA Adverse Event Reporting System (FAERS). These are voluntary reports — they don’t prove the drug caused the effect, and counts reflect how often something was reported, not how often it actually happens. Reports also often name the very problem the medicine is taken for — a common reason to file one is that the drug didn’t help — so for a pain reliever you may see “pain” high on the list; that points to why the report was filed, not to the drug causing the symptom. This counts every report that lists Ifosfamide Injection in any role, so the total runs higher than the FDA’s official dashboard, which counts only cases where the drug is the suspect. For the authoritative figures, see the FDA FAERS Public Dashboard. Always talk to your pharmacist or doctor.
Ifosfamide Injection FDA approval history
How Ifosfamide Injection went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
Ifosfamide Injection recall history
A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.
The FDA’s enforcement reports list no Ifosfamide recalls since July 2021.
✅No Ifosfamide recalls on record since July 2021Source: FDA enforcement (recall) reports, via openFDA; our copy was last updated Sep 24, 2026.
RxNorm Concept Web — From Ingredient to Every Form and Strength
This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.
RxCUI 5657 1 dose form · 4 strengths
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Dose form (SCDF) Injection RxCUI 1791587In current FDA listingsClinical drug / strength (SCD) 20 ML ifosfamide 50 MG/MLRxCUI 179159960 ML ifosfamide 50 MG/MLRxCUI 17915971000 MGRxCUI 17915933000 MGRxCUI 1791588
Look up RxCUI 5657 in the RxCUI Atlas →
RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.
Ifosfamide Injection supply and shortage status
Whether Ifosfamide Injection is in short supply in the U.S. right now, plus any shortage history the FDA has on record. A shortage usually reflects a manufacturing or demand issue — not a safety problem with the drug.
Source: openFDA, from the FDA Drug Shortages database.
Ifosfamide Injection brand names
Ifosfamide Injection is sold under one brand name in the FDA directory — Ifex. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.
Who makes Ifosfamide Injection: manufacturers and labelers
5 companies list Ifosfamide Injection products with the FDA. By number of product records, the largest are Baxter Healthcare Company, Baxter Healthcare Corporation, Hikma Pharmaceuticals USA Inc.. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.
Ifosfamide Injection drug class (RxNorm)
Ifosfamide Injection belongs to the Alkylating Drug class.
Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.
Sources for this Ifosfamide Injection page
Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.
How this page is built
HelloPharmacist combines public FDA and NLM records and does not author the underlying clinical facts. The plain-language sections are written with AI from the FDA-approved label text and reviewed by our pharmacy team before publication. Baxter Healthcare Corporation is the representative DailyMed label linked for verification and dates. This is general education, not medical advice: always talk to your doctor or pharmacist about your own medicines. How we build and review drug pages →