Ifosfamide & Nutrient Depletion
Also searched as Ifex. What the clinical evidence reports, what it may mean, and what to discuss with your pharmacist.
Ifosfamide has been associated with depletion of ACETYL-L-CARNITINE, L-CARNITINE, PROPIONYL-L-CARNITINE and VITAMIN E. This does not mean a deficiency will occur — it means these are worth knowing about and, if you take Ifosfamide long-term, worth raising with your pharmacist or healthcare provider.
Take more than one medication? Open the checker with Ifosfamide pre-loaded and add the rest to see overlapping nutrient signals.
Reported nutrient depletions with Ifosfamide
Each record below is shown as published in our licensed clinical database, with its evidence rating and citations. Expand a section for food sources and talking points.
ACETYL-L-CARNITINE
Insufficient EvidenceIFOSFAMIDE (Ifex)
Increased urinary losses of L-carnitine can occur during ifosfamide therapy. This might be due to binding of L-carnitine with a metabolite of ifosfamide. Theoretically, ifosfamide may also increase losses of acetyl-L-carnitine. The clinical significance of this and the role of carnitine supplements in people treated with ifosfamide are unknown.
Acetyl-L-carnitine is a compound your body uses to help cells produce energy, and it plays a role in nerve health. Ifosfamide may cause the kidneys to spill more L-carnitine into the urine, possibly because a breakdown product of the drug binds to carnitine and carries it out of the body. Whether this meaningfully affects acetyl-L-carnitine levels in practice is simply not known yet, so right now this is considered theoretical. If you are on ifosfamide and are curious about carnitine, it is worth raising with your care team rather than acting on your own.
Learn more about this nutrient: Acetyl-l-carnitine — uses, safety & interactions
References (2)
- Marthaler NP, Visarius T, Kupfer A, Lauterburg BH. Increased urinary losses of carnitine during ifosfamide chemotherapy. Cancer Chemother Pharmacol 1999;44:170-2. PubMed
- Schlenzig JS, Charpentier C, Rabier D, et al. L-carnitine: a way to decrease cellular toxicity of ifosfamide? Eur J Pediatr 1995;154:686-7. DOI
L-CARNITINE
Insufficient EvidenceIFOSFAMIDE (Ifex)
Increased urinary losses of carnitine can occur during ifosfamide therapy. This might be due to binding of L-carnitine with a metabolite of ifosfamide. The clinical significance of this finding and the role of L-carnitine supplements in people treated with ifosfamide are unknown.
L-carnitine is a compound your body uses to turn fat into usable energy, and some research has found that ifosfamide may cause more of it to leave the body through the urine. One theory is that a byproduct the body makes from ifosfamide can bind to L-carnitine, pulling it out before it can be used. That said, the evidence here is still too limited to know whether this actually causes a problem in practice, so most patients do not need to act on this right now. If you have questions or concerns, it is worth bringing up with your oncologist or pharmacist.
What Carnitine does & food sources
Carnitine shuttles fatty acids into cells' mitochondria so they can be burned for energy.
Common food sources:
- Red meat (the richest source)
- Poultry and fish
- Dairy products
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Carnitine questions come up with specific medications (for example, valproic acid) and specific situations — this is a conversation for your prescriber, who can weigh testing or supplementation.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Carnitine supplements are usually reserved for clinician-identified situations rather than general use.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Learn more about this nutrient: L-carnitine — uses, safety & interactions
References (2)
- Marthaler NP, Visarius T, Kupfer A, Lauterburg BH. Increased urinary losses of carnitine during ifosfamide chemotherapy. Cancer Chemother Pharmacol 1999;44:170-2. PubMed
- Schlenzig JS, Charpentier C, Rabier D, et al. L-carnitine: a way to decrease cellular toxicity of ifosfamide? Eur J Pediatr 1995;154:686-7. DOI
PROPIONYL-L-CARNITINE
Insufficient EvidenceIFOSFAMIDE (Ifex)
Increased urinary losses of L-carnitine can occur during ifosfamide therapy. This might be due to binding of L-carnitine with a metabolite of ifosfamide. Theoretically, ifosfamide may also increase losses of propionyl-L-carnitine. The clinical significance of this and the role of carnitine supplements in people treated with ifosfamide are unknown.
Propionyl-L-carnitine is a compound your muscles and heart use to convert fat into usable energy. Ifosfamide may cause the kidneys to spill more L-carnitine into the urine, possibly because one of the drug's breakdown products binds to carnitine and carries it out of the body. Whether this also affects propionyl-L-carnitine in a meaningful way is genuinely unknown right now, so there is no clear action to take. If you are on ifosfamide long-term and are curious about carnitine levels, it is worth bringing up with your oncologist or pharmacist.
Learn more about this nutrient: Propionyl-l-carnitine — uses, safety & interactions
References (2)
- Marthaler NP, Visarius T, Kupfer A, Lauterburg BH. Increased urinary losses of carnitine during ifosfamide chemotherapy. Cancer Chemother Pharmacol 1999;44:170-2. PubMed
- Schlenzig JS, Charpentier C, Rabier D, et al. L-carnitine: a way to decrease cellular toxicity of ifosfamide? Eur J Pediatr 1995;154:686-7. DOI
VITAMIN E
Insufficient EvidenceALKYLATING AGENTS
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your cells use to protect themselves from damage, and there is some early research suggesting that alkylating chemotherapy drugs like ifosfamide may reduce vitamin E levels in the blood, possibly because these powerful drugs affect how the body handles certain nutrients during treatment. That said, the evidence here is genuinely thin, and researchers do not yet know whether this drop is meaningful in practice. If you are on ifosfamide long-term or at high doses, it is worth mentioning this to your oncologist or pharmacist, who can help decide whether monitoring makes sense for your situation.
What Vitamin E does & food sources
Vitamin E is a fat-soluble antioxidant that protects cell membranes.
Common food sources:
- Vegetable oils
- Nuts and seeds
- Wheat germ
- Leafy greens
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Deficiency is rare; ask your provider before supplementing, particularly if you take blood thinners.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Higher-dose vitamin E can increase bleeding tendency, especially with warfarin or antiplatelet medications.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Discuss vitamin E supplements with your provider if you take any blood thinner.
Learn more about this nutrient: Vitamin E — uses, safety & interactions
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
This tool is educational and is not a substitute for professional medical advice. An association is not a diagnosis and does not mean a deficiency will occur. Always talk to your pharmacist or healthcare provider before starting, stopping, or changing any medication or supplement.
Disclaimer: This checker finds which nutrients might be depleted by prescription or over-the-counter medications. Each nutrient depletion issue is rated based on clinical significance. Use your own professional judgment prior to making clinical decisions.© 2026 Therapeutic Research Center Licensed records refresh weekly · last updated July 3, 2026.
More about Ifosfamide
What drug-induced nutrient depletion means
Some medications can, over time, lower the levels of certain vitamins, minerals, or other nutrients — through reduced absorption, increased loss, or changes in how the body uses them.
Association is not deficiency
An entry here means a depletion has been reported or studied — not that it happens to everyone, or that you are deficient. Dose, duration, diet, and your own health all matter.
Evidence varies by pair
Some drug–nutrient links (like metformin and vitamin B12) are well studied; others rest on limited or preliminary research. Each entry shows the evidence rating from our licensed clinical database.
When to ask about labs
If you take an associated medication long-term, ask your healthcare provider whether monitoring is appropriate for you. Not everyone needs testing — your provider can weigh your dose, duration, and symptoms.
Don't self-supplement blindly
Supplements are not risk-free: some can interact with medications, and some (like potassium or magnesium) can be risky with kidney disease. Talk to your pharmacist before adding anything.
Never stop a medication over this
These medications are prescribed for good reasons, and the benefit usually far outweighs a manageable nutrient consideration. Any change belongs in a conversation with your prescriber.
Food first, usually
For many nutrients, a varied diet covers the gap. Each entry lists common food sources; a supplement is a decision to make with your pharmacist or provider, not a default.
Ifosfamide & nutrients: FAQs
Does Ifosfamide deplete ACETYL-L-CARNITINE?
Should I take a supplement because I take Ifosfamide?
Should I stop taking Ifosfamide?
Where does this information come from?
Questions about Ifosfamide and your nutrition?
Ask a licensed pharmacist — free, no appointment needed.
Sources & How We Checked
Nutrient depletion records for Ifosfamide are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for drug-induced nutrient depletions, supplements, and interactions — the basis for this page.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for medication overviews across the site.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.