What is a significant risk associated with Ifosfamide (Ifex)?

Ifosfamide (Ifex) is an alkylating agent commonly used in chemotherapy, and among its various side effects, altered mental status is a notably significant risk. This specific risk is primarily due to the neurotoxicity associated with ifosfamide, which can lead to symptoms such as confusion, disorientation, or even encephalopathy, particularly if the drug is administered at high doses or without adequate hydration and supportive measures.

The mechanism behind this neurotoxicity may involve the accumulation of the metabolite chloroacetaldehyde, which can cross the blood-brain barrier and impact central nervous system function. Therefore, monitoring for altered mental status in patients receiving ifosfamide is crucial, and preventative measures, such as co-administering mesna to protect against certain toxic effects, may help reduce this risk.

While other side effects, such as myelosuppression, pulmonary fibrosis, or visual changes, may occur with ifosfamide, the alteration in mental status poses an acute and often critical risk that requires immediate attention, highlighting its significance in the context of patient safety and management during chemotherapy.