Mesna Altan (Mesna)

Mesna is used to protect the urinary tract and mucosal surfaces during chemotherapy that generates the toxic metabolite acrolein.

• Hemorrhagic cystitis (cyclophosphamide therapy): reduces the incidence and severity of bladder bleeding.
• Hemorrhagic cystitis (ifosfamide therapy): provides uroprotection against acrolein‑induced damage.
• Mucosal protection during chemotherapy: safeguards oral and gastrointestinal mucosa from toxic metabolites.

• Mesna supplies sulfhydryl groups that rapidly bind the electrophilic metabolite acrolein, forming a non‑toxic conjugate that is eliminated in the urine. By neutralising acrolein before it contacts urothelial and other mucosal cells, Mesna prevents oxidative injury and inflammation, preserving the integrity of the bladder wall and related tissues during and after chemotherapy.

Mesna may be associated with a range of adverse reactions, most of which are mild and reversible.

Common Side Effects

• Nausea
• Vomiting
• Headache
• Mild skin rash
• Altered taste perception
• Low‑grade fever

Serious or Rare Side Effects

• Anaphylactic reaction
• Stevens‑Johnson syndrome
• Hemolytic anemia
• Acute renal failure
• Pulmonary edema

When prescribing Mesna, clinicians should observe several safety considerations to minimise risk.

• Renal function assessment: evaluate baseline kidney function before initiating therapy.
• Pulmonary status review: ensure adequate respiratory function for inhalation administration.
• Hypersensitivity monitoring: watch for signs of allergic reaction during treatment.
• Timing with chemotherapy: coordinate dosing with cyclophosphamide or ifosfamide to maintain protective effect.
• Pregnancy and lactation counseling: discuss unknown safety profile with women of child‑bearing potential.
• Store at ambient temperature: keep in original container, protect from moisture and direct sunlight.

Mesna can interact with other medicines, requiring attention to timing and monitoring.

Major Interactions (Avoid)

• Cyclophosphamide/Ifosfamide: dosing must be synchronized to avoid reduced chemotherapy efficacy.
• Nitrofurantoin: concurrent use may increase risk of hemolysis.
• High‑dose thiol‑containing agents: may cause additive toxicity.

Moderate Interactions (Monitor Closely)

• Aminoglycoside antibiotics: monitor renal function due to combined nephrotoxic potential.
• Loop diuretics: watch electrolyte balance and urine output.
• Warfarin: observe INR values as Mesna may affect anticoagulant control.