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Medline ® Abstract for Reference 249

of 'Overview of neurologic complications of non-platinum cancer chemotherapy'

Prophylaxis and reversal of ifosfamide encephalopathy with methylene-blue.
Küpfer A, Aeschlimann C, Wermuth B, Cerny T
Lancet. 1994;343(8900):763.
The antineoplastic ifosfamide produces dose-dependent signs of neurotoxicity. After ifosfamide overdose in a patient, we found excessive urinary excretion of glutaric acid and sarcosine, which is compatible with glutaric aciduria type II, a defect in mitochondrial fatty acid oxidation that results from defective electron transfer to flavoproteins. We therefore used the electron-accepting drug methylene-blue as an antidote for ifosfamide encephalopathy. In one patient, ifosfamide neurotoxicity was rapidly reversed by methylene-blue 50 mg intravenously. In another patient with previous episodes of ifosfamide encephalopathy, methylene-blue was administered orally prophylactically. No symptoms of neurotoxicity were noted.
Department of Clinical Pharmacology, University of Berne, Switzerland.