Holoxan - Precautions | Dosage | Side Effects

This article was medically reviewed by M.Pharm, Marko Tanaskovic on August 12, 2018. To read more about an author, click here.

Holoxan is a medicine that contains an active substance called ifosfamide. It belongs to a group of medicines called cytostatics (drugs used to treat cancer). It is used to treat various forms of cancer, but most commonly for the treatment of testicular cancer, cervical cancer, breast cancer, microcellular and non-microcellular cancer of the bronchi, Hodgkin and Non-Hodgkin lymphoma.

The mechanism of action of the Holoxan is based on the killing of tumor cells.


Holoxan should not be used in patients who have urinary tract obstruction, as studies have shown that this drug has the urotoxic effects (can cause hemorrhagic cystitis). It is recommended that a urinalysis be performed regularly while you are on therapy with this drug, in order to notice the possible urotoxic effects on time. Holoxan is contraindicated in patients with bone marrow suppression and should not be used in patients who have a blood leukocyte count of less than 2000/ microliter or a platelet count of less than 50,000/ microliter.

Leukocyte, platelet, erythrocyte counts and hemoglobin levels should be monitored regularly while on treatment with this medicine.

Reversible neurotoxic effects have also been reported in patients using this drug. Somnolence, hallucination, confusion and even coma may occur. In patients who develop these side effects, the administration of Holoxan should be discontinued until the side effects are resolved.

Holoxan should not be used in patients who have kidney damage, because elimination is aggravated in these patients, and thus the concentration of the drug in the blood may be increased, which consequently leads to increased incidence of side effects.

Holoxan can also cause cardiotoxic effects, such as: ECG changes, arrhythmias, and cardiomyopathy, which can have a fatal outcome.

Holoxan can cause pulmonary fibrosis as well as pulmonary weakness which can also be fatal. Tell your doctor immediately if you notice any changes in breathing.

Use of Holoxan during pregnancy and breastfeeding

The FDA classifies this drug in Category D, meaning that the fetotoxicity of this drug has been confirmed in studies and this drug should therefore not be used during pregnancy. Holoxan has a carcinogenic effect on the fetus, which is another reason why its use during pregnancy is contraindicated.

Holoxan is excreted in breast milk, and breastfeeding should be discontinued while you are taking Holoxan.


More than 400 interactions with other drugs have been reported, of which more than 50 are classified as major interactions.

Holoxan should not be administered concomitantly with the following medicines:

  • Medicines used to treat rheumatoid arthritis, such as: adalimumab, leflunomide, golimumab, etanercept, baricitinib and certolizumab. These drugs can cause bone marrow suppression and significantly weaken the immune system, just like Holoxan, which can lead to life-threatening infections.
  • Medicines used to treat cytomegalovirus, such as cidofovir. Co-administration with this medicine increases the risk of nephrotoxic effects.
  • Medicines used to treat tumors, such as: cladribine. Concomitant use significantly increases the risk of low leukocyte, platelet and erythrocyte counts, which can lead to serious complications.
  • Deferipirone - a medicine used to treat thalassemia. Deferipirone can cause bone marrow suppression and should not be administered concomitantly with Holoxan.
  • Medicines used to treat multiple sclerosis, such as: fingolimod, teriflunomide, and natalizumab. Concomitant use increases the risk of serious infections.

Tell your doctor about any medicines you use.

Avoid alcoholic beverages while being treated with Holoxan, as alcohol may increase the risk of certain side effects (e.g., nausea).


Holoxan is available in the form of injection and is only administered by qualified healthcare professionals, under the supervision of an oncologist experienced in the use of chemotherapy, such as Holoxan.

Holoxan injections can only be administered in healthcare settings. The dose is calculated based on your body surface area, the type of tumor and can be affected if you are using other antineoplastic drugs / radiation.

Health care providers administering this medicine should avoid direct contact because Holoxan can cause mutations and cancer.

Side Effects

Holoxan can cause the following side effects:

  • Hair loss (alopecia)
  • Nausea and vomiting
  • Lethargy and fatigue
  • Confusion
  • Coma
  • Depression
  • Hallucinations
  • Aggressive behavior
  • Dermatitis
  • Diarrhea
  • High or low blood pressure
  • Cardiomyopathy
  • Interstitial pneumonitis
  • Infections
  • Convulsions
  • Weakened immune system
  • Bone marrow suppression
  • Allergic reaction

Tell your doctor if you are experiencing any side effects.


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If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional.