What is the relationship between urine ketones and Cytoxan (cyclophosphamide) with Mesna (sodium 2-mercaptoethanesulfonate)?

From the Guidelines

Monitoring urine ketones is not explicitly recommended when administering cyclophosphamide (Cytoxan) with mesna, as the primary concern is preventing hemorrhagic cystitis, which is achieved through mesna administration and adequate hydration 1. The relationship between cyclophosphamide and ketone production is not directly addressed in the provided evidence. However, it is essential to note that cyclophosphamide can cause metabolic changes, and patients with underlying metabolic conditions or nutritional deficiencies may be at risk of developing ketosis.

• The cyclophosphamide regimen typically involves dosing ranges from 500-1000 mg/m² IV, depending on the condition being treated, with mesna administered at 20% of the cyclophosphamide dose at 0,4, and 8 hours after cyclophosphamide to prevent hemorrhagic cystitis 1.
• Patients should increase fluid intake to 2-3 liters daily to help flush the bladder and reduce irritation 1.
• The guidelines for ketone testing are generally focused on individuals with diabetes or those prone to ketosis, and it is recommended to measure ketones in urine or blood if they have unexplained hyperglycemia or symptoms of ketosis 1.
• However, in the context of cyclophosphamide treatment, the primary concern is preventing hemorrhagic cystitis, and the evidence does not support routine monitoring of urine ketones in this setting 1. In summary, the primary focus when administering cyclophosphamide with mesna should be on preventing hemorrhagic cystitis through adequate hydration and mesna administration, rather than monitoring urine ketones 1.

From the Research

Relationship Between Urine Ketones and Cytoxan (Cyclophosphamide) with Mesna (Sodium 2-Mercaptoethanesulfonate)

• There is no direct evidence in the provided studies that discusses the relationship between urine ketones and Cytoxan (cyclophosphamide) with Mesna (sodium 2-mercaptoethanesulfonate) 2, 3, 4, 5, 6.
• The studies focus on the relationship between cyclophosphamide, Mesna, and hemorrhagic cystitis, with no mention of urine ketones.
• Cyclophosphamide is associated with hemorrhagic cystitis, and Mesna is used to prevent this complication, but the effectiveness of Mesna is still a topic of debate 2, 3, 4, 5, 6.
• The incidence of hemorrhagic cystitis varies depending on the dose of cyclophosphamide and the use of Mesna, but there is no discussion of urine ketones in these studies 2, 3, 4, 5, 6.

Hemorrhagic Cystitis and Cyclophosphamide

• Hemorrhagic cystitis is a significant complication of cyclophosphamide therapy, and Mesna is used to prevent this complication 2, 3, 4, 5, 6.
• The effectiveness of Mesna in preventing hemorrhagic cystitis is still a topic of debate, with some studies showing a reduction in incidence and others showing no significant difference 2, 3, 4, 5, 6.
• The dose of cyclophosphamide is a significant factor in the development of hemorrhagic cystitis, with higher doses increasing the risk of this complication 2, 3, 4, 5, 6.

Use of Mesna

• Mesna is used to prevent hemorrhagic cystitis in patients receiving cyclophosphamide therapy, but its effectiveness is still a topic of debate 2, 3, 4, 5, 6.
• Mesna is converted to a biochemically inactive compound in the blood, which is then reduced back to Mesna in the kidneys, allowing it to protect the bladder mucosa without interfering with the antineoplastic effect of cyclophosphamide 3.
• The use of Mesna is recommended in patients receiving high-dose cyclophosphamide therapy, but its use in patients receiving low-dose therapy is still a topic of debate 2, 3, 4, 5, 6.