When This Medicine Should Not Be Used:
This medicine is not right for everyone. You should not receive it if you had an allergic reaction to ifosfamide, or if you have trouble urinating. You should not receive this medicine if you are pregnant or breastfeeding.

How to Use This Medicine:
Injectable

• Medicines used to treat cancer are very strong and can have many side effects. Before receiving this medicine, make sure you understand all the risks and benefits. It is important for you to work closely with your doctor during your treatment.
• Your doctor will prescribe your dose and schedule. This medicine is given through a needle placed in a vein.
• You will receive this medicine while you are in a hospital or cancer treatment center. A nurse or other trained health professional will give you this medicine.
• Drink extra fluids so you will urinate more often and help prevent kidney problems.
• Missed dose: This medicine needs to be given on a fixed schedule. If you miss a dose, call your doctor, home health caregiver, or treatment clinic for instructions.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some medicines and foods can affect how ifosfamide works. Tell your doctor if you have received other cancer drugs or radiation treatments. Also tell your doctor if you are using any of the following:
  
  • Aprepitant, fosaprepitant, rifampin, sorafenib, or St John's wort
  • Carbamazepine, fosphenytoin, phenobarbital, phenytoin
  • Fluconazole, itraconazole, ketoconazole
• Tell your doctor if you use anything else that makes you sleepy. Some examples are allergy medicine, narcotic pain medicine, and alcohol.
• Do not eat grapefruit or drink grapefruit juice while you are using this medicine.

Warnings While Using This Medicine:

• This medicine may cause birth defects if either partner is using it during conception or pregnancy. Tell your doctor right away if you or your partner becomes pregnant. Use effective birth control during the time you are being treated. Men should keep using birth control for 6 months after treatment ends.
• Do not breastfeed during the time you are being treated.
• Tell your doctor if you have kidney disease, liver disease, bone marrow problems, or heart disease. Tell your doctor if you have a weak immune system or an infection.
• This medicine may make you bleed, bruise, or get infections more easily. Take precautions to prevent illness and injury. Wash your hands often.
• This medicine may cause the following problems:
  
  • Increased risk for other types of cancers
  • Damage to the nervous system, bladder, kidneys, heart, lungs, or liver
  • Slow wound healing
  • Slow or delayed growth in children
• This medicine may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
• This medicine could cause infertility. Talk with your doctor before using this medicine if you plan to have children. Women might stopping having menstrual periods or experience early menopause.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Cancer medicine can cause nausea or vomiting, sometimes even after you receive medicine to prevent these effects. Ask your doctor or nurse about other ways to control any nausea or vomiting that might happen.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blistering, peeling, or red skin rash
• Change in how much or how often you urinate, red or dark brown urine, painful or burning urination
• Confusion, hallucinations, or other unusual behavior
• Fast, pounding, or uneven heartbeat
• Fever, chills, cough, sore throat, body aches
• Lightheadedness, dizziness, fainting
• Numbness, tingling, or burning pain in your hands, arms, legs, or feet
• Trouble breathing, chest pain
• Unusual bleeding, bruising, or weakness
• Vision changes, drowsiness, uncontrolled body movements, seizures

If you notice these less serious side effects, talk with your doctor:

• Hair loss
• Nausea or vomiting
• Pain, itching, swelling, or a lump under your skin where the needle is placed

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088