Anticancer drug also used in RA, produces acrolein in urine that leads to hemorrhagic cystitis

Cyclophosphamide IMPOANT POINTS ON HEMORRHAGIC CYSTITIS: Drugs causing: Cyclophosphamide Ifosfamide Metabolite responsible: Acrolein - In Cyclophosphamide Chloracetaldehyde - In Ifosfamide Treatment: Mesna. Nitrogen mustards: 1. Cyclophosphamide: Powerful vesicant Prodrug - Activated by hepatic biotransformation to aldophosphamide. Acrolein - One of its degradation products. Responsible for hemorrhagic cystitis - Characteristic adverse effect. Use: DOC for Wegener's granulomatosis. Adverse effects: Hemorrhagic cystitis (Characteristic) - Treated by mercapto ethane sulfonic acid (mesna). May cause cardiac dysfunction, pulmonary toxicity & syndrome of inappropriate ADH secretion. 2. Ifosfamide: Produces chloracetaldehyde & acrolein as metabolites. Adverse effects: HIGHER risk of neurotoxicity & hemorrhagic cystitis. Chloracetaldehyde - Responsible for nephrotoxic.