Suspected ifosfamide-induced neurotoxicity

Ifosfamide is an antineoplastic agent that requires hepatic activation to t he cytotoxic active metabolite ifosforamide mustard. During metabolism, the byproduct, chloroacetaldehyde, which is structurally similar to both chlor al hydrate and acetaldehyde, is produced. Secondary to its ability to cross the blood-brain barrier, this metabolite may be responsible for the neurot oxicity observed with ifosfamide. Any case of suspected ifosfamide-induced neurotoxicity, together with a decision to treat, must be determined on an individual patient basis. The differential diagnosis should include infecti on, laboratory abnormalities, and concomitant drugs. At this time, literatu re to support treatment modalities such as intravenous albumin and methylen e blue is minimal.