Mesna, sold under the brand name Mesnex among others, is a medication used in those taking cyclophosphamide or ifosfamide to decrease the risk of bleeding from the bladder.[1] It is used either by mouth or injection into a vein.[1]
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| Pronunciation | /ˈmɛznə/ |
| AHFS/Drugs.com | Monograph |
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| Routes of administration | By mouth, intravenous |
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| Bioavailability | 45–79% (by mouth) |
| Metabolism | Oxidised in circulation |
| Elimination half-life | 0.36–8.3 hours |
| Excretion | kidney |
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| ECHA InfoCard | 100.039.336 |
| Chemical and physical data | |
| Formula | C2H5NaO3S2 |
| Molar mass | 164.17 g·mol−1 |
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Common side effects include headache, vomiting, sleepiness, loss of appetite, cough, rash, and joint pain.[1] Serious side effects include allergic reactions.[1] Use during pregnancy appears to be safe for the baby but this use has not been well studied.[2] Mesna is an organosulfur compound.[3] It works by altering the breakdown products of cyclophosphamide and ifosfamide found in the urine making them less toxic.[1]
Mesna was approved for medical use in the United States in 1988.[1] It is on the World Health Organization's List of Essential Medicines.[4]
Medical uses
editChemotherapy adjuvant
editMesna is used therapeutically to reduce the incidence of haemorrhagic cystitis and haematuria when a patient receives ifosfamide or cyclophosphamide for cancer chemotherapy. These two anticancer agents, in vivo, may be converted to urotoxic metabolites, such as acrolein.
Mesna assists to detoxify these metabolites by reaction of its sulfhydryl group with α,β-unsaturated carbonyl containing compounds such as acrolein.[5] This reaction is known as a Michael addition. Mesna also increases urinary excretion of cysteine.
Other
editOutside North America, mesna is also used as a mucolytic agent, working in the same way as acetylcysteine; it is sold for this indication as Mistabron[6] and Mistabronco.
Administration
editIt is administered intravenously or orally (through the mouth).[7] The IV mesna infusions would be given with IV ifosfamide, while oral mesna would be given with oral cyclophosphamide. The oral doses must be double the intravenous (IV) mesna dose due to bioavailability issues. The oral preparation allows patients to leave the hospital sooner, instead of staying four to five days for all the IV mesna infusions.
Mechanism of action
editMesna reduces the toxicity of urotoxic compounds that may form after chemotherapy administration. Mesna is a water-soluble compound with antioxidant properties, and is given concomitantly with the chemotherapeutic agents cyclophosphamide and ifosfamide. Mesna concentrates in the bladder where acrolein accumulates after administration of chemotherapy and through a Michael addition, forms a conjugate with acrolein and other urotoxic metabolites.[5] This conjugation reaction inactivates the urotoxic compounds to harmless metabolites. The metabolites are then excreted in the urine.[8]
Names
editIt is marketed by Baxter as Uromitexan and Mesnex. The name of the substance is an acronym for 2-mercaptoethane sulfonate Na (Na being the chemical symbol for sodium).
See also
edit- Coenzyme M—a coenzyme with the same structure used by methanogenic bacteria
References
edit- ^ a b c d e f "Mesna". The American Society of Health-System Pharmacists. Archived from the original on 11 May 2017. Retrieved 8 December 2016.
- ^ "Mesna (Mesnex) Use During Pregnancy". www.drugs.com. Archived from the original on 11 May 2017. Retrieved 20 December 2016.
- ^ Patwardhan B, Chaguturu R (2016). Innovative Approaches in Drug Discovery: Ethnopharmacology, Systems Biology and Holistic Targeting. Academic Press. p. 53. ISBN 9780128018224. Archived from the original on 2016-12-21.
- ^ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
- ^ a b Thurston DE (2007). Chemistry and Pharmacology of Anticancer Drugs. Boca Raton: CRC Press/Taylor & Francis. pp. 53–54. ISBN 978-1-4200-0890-6. Archived from the original on 2016-05-19.
- ^ "Mistabron Ampoules". South African Electronic Package Inserts. August 1973. Archived from the original on 2008-10-22. Retrieved 2008-08-12.
- ^ Mace JR, Keohan ML, Bernardy H, Junge K, Niebch G, Romeis P, et al. (December 2003). "Crossover randomized comparison of intravenous versus intravenous/oral mesna in soft tissue sarcoma treated with high-dose ifosfamide". Clinical Cancer Research. 9 (16 Pt 1): 5829–5834. PMID 14676103.
- ^ Shaw IC, Graham MI (June 1987). "Mesna--a short review". Cancer Treatment Reviews. 14 (2): 67–86. doi:10.1016/0305-7372(87)90041-7. PMID 3119211.
External links
edit- BC Cancer Agency
- NIH/MedlinePlus patient information
- Mesna at the U.S. National Library of Medicine Medical Subject Headings (MeSH)
