Patients who vomit within two hours of taking oral mesna should repeat the dose or receive intravenous mesna.
2.3 Monitoring for HematuriaMaintain adequate hydration and sufficient urinary output, as required for ifosfamide treatment, and monitor urine for the presence of hematuria. If severe hematuria develops when mesna is given according to the recommended dosage schedule, dosage reductions or discontinuation of ifosfamide therapy may be required.
2.4 Preparation for Intravenous Administration and StabilityPreparation
Determine the volume of mesna injection for the intended dose.
Dilute the volume of mesna injection for the dose in any of the following fluids to obtain a final concentration of 20 mg/mL:
  5% Dextrose Injection, USP
  5% Dextrose and 0.2% Sodium Chloride Injection, USP
  5% Dextrose and 0.33% Sodium Chloride Injection, USP
  5% Dextrose and 0.45% Sodium Chloride Injection, USP
  0.9% Sodium Chloride Injection, USP
  Lactated Ringer's Injection, USP
Stability
The mesna injection multidose vials may be stored and used for up to 8 days after initial puncture.
Store diluted solutions at 25°C (77°F). Use diluted solutions within 24 hours.
Do not mix mesna injection with epirubicin, cyclophosphamide, cisplatin, carboplatin, and nitrogen mustard.
The benzyl alcohol contained in mesna injection vials can reduce the stability of ifosfamide. Ifosfamide and mesna may be mixed in the same bag provided the final concentration of ifosfamide does not exceed 50 mg/mL. Higher concentrations of ifosfamide may not be compatible with mesna and may reduce the stability of ifosfamide.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Any solutions which are discolored, hazy, or contain visible particulate matter should not be used.
3. DOSAGE FORMS AND STRENGTHS
Mesna injection: 1 g Multidose Vial, 100 mg/mL 
4. CONTRAINDICATIONS
Mesna is contraindicated in patients known to be hypersensitive to Mesna or to any of the excipients [See Warnings and Precautions (5.1)].
5. WARNINGS AND PRECAUTIONS
5.1 Hypersensitivity ReactionsMesna may cause systemic hypersensitivity reactions, including anaphylaxis. These reactions may include fever, cardiovascular symptoms (hypotension, tachycardia), acute renal impairment, hypoxia, respiratory distress, urticaria, angioedema, laboratory signs of disseminated intravascular coagulation, hematological abnormalities, increased liver enzymes, nausea, vomiting, arthralgia, and myalgia. These reactions may occur with the first exposure or after several months of exposure. Monitor for signs or symptoms. Discontinue mesna and provide supportive care.
5.2 Dermatologic ToxicityDrug rash with eosinophilia and systemic symptoms and bullous and ulcerative skin and mucosal reactions, consistent with Stevens-Johnson syndrome or toxic epidermal necrolysis have occurred. Mesna may cause skin and mucosal reactions charact