[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Chemotherapy supportive agents](https://durgical.com/en/pharmacology/classes/chemotherapy-supportive-agents/) › Mesna

[Pharmacology](https://durgical.com/en/pharmacology/) · [Chemotherapy supportive agents](https://durgical.com/en/pharmacology/classes/chemotherapy-supportive-agents/)

# Mesna

A thiol drug that binds acrolein in the urine and protects the bladder from haemorrhagic cystitis caused by ifosfamide.

Updated 2026-11-01

- Class: [Chemotherapy supportive agents](https://durgical.com/en/pharmacology/classes/chemotherapy-supportive-agents/)
- Target: Acrolein and other urotoxic ifosfamide metabolites (in urine)
- ATC code: V03AF01
- WHO Model List of Essential Medicines

Also called: sodium 2-mercaptoethanesulfonate

## Mechanism of action

Ifosfamide (and cyclophosphamide) release acrolein and 4-hydroxy metabolites that reach the bladder and damage its lining. Mesna is a thiol (SH) compound: in the urine it binds 4-hydroxy-ifosfamide and the double bonds of acrolein, forming harmless products. In the blood it is quickly oxidised to dimesna, and both forms are excreted in the urine.

- Ifosfamide releases acrolein into the urine
- Mesna's thiol group binds acrolein in the bladder
- Harmless products: no haemorrhagic cystitis

## Pharmacokinetics

**Absorption**
Intravenous or oral; food does not change the amount reaching the urine.

**Distribution**
Total body water.

**Metabolism**
Rapidly oxidised to dimesna (mesna disulfide).

**Elimination**
In the urine as mesna and dimesna.

**Half-life**
Very short (well under an hour for mesna), so doses are repeated to cover the whole ifosfamide exposure.

## Indications

- Prevention of ifosfamide-induced haemorrhagic cystitis.
- Also used to protect the bladder in high-dose cyclophosphamide regimens.

## Adverse effects

### Common

- Nausea, vomiting, abdominal pain, diarrhoea or constipation (with ifosfamide)
- Headache, fatigue, drowsiness
- Skin and mucosal reactions: rash, itching, flushing

### Serious (rare, important)

- Systemic hypersensitivity, including anaphylaxis
- Drug rash with eosinophilia (DRESS), Stevens–Johnson syndrome and toxic epidermal necrolysis
- «Gasping syndrome» in premature and low-birth-weight infants from the benzyl alcohol in multi-dose vials

## Contraindications

- Hypersensitivity to mesna or any excipient, including benzyl alcohol

## Key interactions

**Urine ketone dipstick tests (nitroprusside)**
False-positive results.

**Enzymatic CPK tests that use a thiol reagent**
Falsely low CPK values.

**Ifosfamide in the same bag**
Higher ifosfamide concentrations, or the benzyl alcohol in mesna vials, can reduce ifosfamide stability.

## What is monitored

- Urine for blood (microscopic haematuria) before each ifosfamide dose
- Skin reactions and signs of hypersensitivity

## Administration and safety

- Given on a fixed schedule with each ifosfamide dose (at the start and repeated afterwards) because its effect is short.
- If an oral dose is vomited soon after it is taken, it is repeated or replaced by an intravenous dose.
- Multi-dose vials contain benzyl alcohol, which is toxic to premature and low-birth-weight infants.

## Nursing care

- Check the timing of every mesna dose against the ifosfamide schedule; a missed dose leaves the bladder unprotected.
- Test a urine sample for blood before each ifosfamide dose and report any red or pink urine.
- Encourage fluids and frequent voiding unless restricted.
- Teaching: report blood in the urine, rash or mouth sores; tell the laboratory about mesna before urine tests.

## Pregnancy and breastfeeding

Mesna is always given with ifosfamide or other cytotoxics, which can cause fetal harm.

## Memory aid

«MESNA Mops up acrolein»: the thiol sponge for the bladder. Ifosfamide always comes with its mesna.

## Test yourself

Think of the answer, then tap the question to see it.

## Which metabolite causes haemorrhagic cystitis with ifosfamide and cyclophosphamide?

Acrolein (with 4-hydroxy metabolites), excreted in the urine.

## Where does mesna act, and what does it bind?

In the urine and bladder: its thiol group binds acrolein and 4-hydroxy-ifosfamide, forming harmless products.

## Why must mesna doses be repeated during ifosfamide treatment?

Mesna has a very short half-life, while ifosfamide metabolites keep reaching the bladder for hours.

## Which urine test can be falsely positive in a patient on mesna?

The nitroprusside (dipstick) test for urinary ketones.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/mesna/)

## Related drugs

- [Calcium folinate](https://durgical.com/en/pharmacology/calcium-folinate/)
- [Amifostine](https://durgical.com/en/pharmacology/amifostine/)

[← Back to the class: Chemotherapy supportive agents](https://durgical.com/en/pharmacology/classes/chemotherapy-supportive-agents/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - MESNA injection, solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a880160b-fa82-453a-a971-29ab897876a7) (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 70 (McGraw Hill, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=V03AF01) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/pharmacology/mesna/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/mesna/