Cytox and Mesna

[Sangye]

A quick Google search of "oral ctx and mesna" got me this brief article from May 2010 on the use of mesna with IV ctx and oral ctx.
http://www.medscape.com/viewarticle/721688

It seems that the cost is prohibitive for daily use. A typical dose of oral ctx is 150mg. Using info from the article, mesna is $100 for 100 mg and is dosed at 40% of the ctx dose. It would cost $60 per day or $1800 per month.

I thought it was interesting that the article said neither mesna for IV ctx nor hydration (drinking tons of water) for oral ctx have much evidence to support their use. Amazing, since ctx has been used for decades.

[Thakator]

Hi Sangye,
Thanks for the cite, I'm going to keep it for future reference. Please note though that it speaks of Mesna in terms of mg (pill form). And that would equate to a daily cost in excess of $100 for someone such as me on 150mg of oral cyto per day. However, the article does not mention the use of the injectable solution - - at least it doesn't refer to using mls at home and makes no mention of the suggested ratio of ml to mg of cyto (wish that it did). So, perhaps one is an apple and one is an orange. I don't know; I simply know that I take it in milliliters and not in milligrams. Whether I am taking enough is another question which is why I wish the article disussed this aspect of it (sounds like more research for me). Either way, I do know that the liquid route is not cost prohibitive at the level for which I have been prescribed. Maybe that's why my rheumie did it this way; looking out for the patient, you know.

[Sangye]

Yeah, we really need more info.

[Thakator]

Okay, I've done some searching and some math; also studied the spec sheet that came with my Rx. Since we are talking mgs and mls here, the critical number is the manufacturer's ratio of mg Mesna per ml of injecftable (ie: drinkable fluid). Turns out that the formulation I use gives me nearly 75 mg of the stuff per day. At your article's mentioned ratio of 40%, this means I would need 60 mg since I am doing 150mg of the cyto - - - so, looks like I'm actually getting very nearly a full 50% ratio of Mesna to cyto as far as the mgs are concerned. At the aforementioned price.
Pills=expensive; liquid, not so much. Don't know what else I can say regarding this. Sure would like to know why other docs aren't recommending it but sure am glad that mine is and that she has figured out how to make it a practical Rx for the patient. I can't find any particularly bad side effects listed for it (especially considering what we are used to with our other meds) and I've only found positive comments regarding it's success rates, especially as regards the hemorrhagic cystitis. Have found nothing to indicate that drinking it versus shooting it would make any difference.

[Sangye]

Very good info, Thakator! I think the price thing is similar to mtx? I think someone recently said mtx injections are way less expensive than the pills. I was on injections very briefly and they only cost about $20 a month.

[me2]

Good home work Thakator. Thank you. I was under the weather a bit and tried to find some info but didn't. This is just like school, if I wait long enough someone else will finish the homework before me.
I will definately ask my doc and pharmacist about doing liquid instead of pill.

[Thakator]

You're quite welcome, M, hope that it works out well for you and any other of our brother/sister weggies who raise the subject with their docs - - we've enough to contend with as it is and don't need to destroy our bladders along the way. Take care, Ron

[dunkie2202]

Hey Ron, I was put on the IV solution from the start of dx. Cytoxin & Mesna each in a 500ml bag, once a mth for six mths. My pred was at a max of 75 mg but now down to 10mg daily.
Just finished the last dose of Cytoxin and will be going onto Imuran tablets 150mg daily as at 5th Feb. Never had any bladder problems with it as I always drank heaps of water.
My hair is still falling out and I was sick for the first three days after each treatment but other wise feeling well.

[me2]

Me2 - - checked with my pharmacist; a month's supply of Mesna (daily doseage of 0.75ml) in this injectable format costs only $120 even if an insurance company wouldn't cover it. Mine does so I'm lucky. Fortunate also that my rheumie is sharp enough to have got me on it and to have done it in this way. Again, thank you so much for the positive feedback regarding its effectiveness. Also, taking it with something sweet kills the taste of it if you don't exhale for a few seconds after downing it.

I've no idea why this extra step of precaution is so unheard of given how many of us are on oral cytox and how good its reputation seems to be (perhaps Sangye's DR Seo will render his opinion to her on the matter). Either way, this appears to be another question that many of our forum members might wish to raise during their next Dr. visit. Hope that this proves to be helpful to at least one of you (my whole point for bringing the subject to light herein). And, Sangye, I shall get me some more answers on the 90mg pred issue. As always, my sincere appreciation for your looking out for us in these issues - - you have this calling to go with your others, so please don't let up.

I am trying to figure this out still. Ron, you take 0.75ml daily. This would be 22.5 ml per month. You say your pharmacy charges $120 for that amount. I called my pharmacy and they said it would cost me $60 for 4ml (400mg). By my math you pay $5.33 per ml and my pharmacy is asking $15 per ml . This IS way cheaper than what they have been charging me for the 400 mg pill but still three times what you are apparently paying. Could you check my math and with your pharmacy to see if I have described things correctly?

I wonder why they have been letting me buy the pill for $118 when I could have gotten the liquid for $60? Why hasn't the liquid become common practice and put the pill out of business? (convenience?) I will be digging deeper on this. Thanks for the help. Already I'm going to save some money.

[Thakator]

Hi Dunkie - - Glad to hear that you are feeling better, but sorry about the hair loss.
Seems like Mesna is used commonly enough with the IV cyto but not with the daily oral. I'd still like to know why; I halfway expect someone to come on here and say their doc says it's harmful to drink. Yet, I've found no such indication in my ressearch (perhaps they don't think there'd be anybody silly enough to drink it). Or sharp enough - - as in my rheumie - - to think about it. Don't know, but until otherwise contraindicated, I'm going to keep at it.

Hi me2 - - I've rechecked my math, my Rx's formulation and my costs. They are as stated before; I am getting 75mg of the Mesna itself per 0.75 ml of the solution. $120/month if the insurance didn't cover, but it does and we didn't have to do any persuading. Your figures are correct about the total mls/month I take. I can only attribute the 3x cost for yours versus mine to either or both of the pricing structures of your pharmacist or its supplier. Too bad, for sure - - but much better than that old $118/pill business. And, you only get one guess as to why someone making a profit off of your need to medicate may not have voluntarily pointed this out to you in the past.
Even so, why haven't the docs? Could it simply be that they are creatures of habit like most of us and so they keep prescibing what they have in the past? Could it be that the idea is simply too new to have made the rounds? Don't know but it sure does strike me as odd that I appear to be the only one on here who's gone this route with the oral cyto. Will let you know if my stomache decides to blow up or something else odd happens as a consequence - - of course, given the fact that I am nowhere near remission from the old Wegs, who'd know the difference. I mean, what with all the other blow ups and oddities that one encounters along this route. So very glad to have made a suggestion that may prove to have been of help to you. Take care, Ron