Ifosfamide is one of the most famous and useful drugs for cancer but its very important that you know this pharmaceutical compound has many harmful effects on sick people , one of which is bleeding that is very danger for them and it might be so unbearable .
For ifosfamide, the dose-limiting toxicity is cystitis, if mesna is not co-admministered. If mesna is co-administered, the dose-limiting toxicity is myelosuppression. When compared with a similar drug cyclophosphamide, ifosfamide tends to induce cystitis and neurotoxicity more often. To suppress these side effects, modification of ifosfamide molecular structure would need to alter its metabolism, so that active metabolite iphosphoramide mustard is produced without urotoxic metabolite acrolein and neurotoxic metabolite chloroacetaldehyde. That would be quite challenging.
And concerning increased risk of bleeding, this is a consequence of chemotherapy-induced thrombocytopenia, and this side effect is associated with many anticancer drugs, so it is not limited specifically to ifosfamide. It was reported as most commonly associated with platinum and gemcitabine-based regimens.
After the detaiked answer of Roman I can only add that a very hugh intake of fluids and frequent voiding reduces the incidence of hemorrhagic cystitis by reducing acrolein presence in bladder.
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