N-acetylcysteine as a novel prophylactic treatment for ifosfamide-induced nephrotoxicity in children: Translational pharmacokinetics

Lauren N. Hanly, Nancy Chen, Katarina Aleksa, Murray Cutler, Milica Bajcetic, Rasmi Palassery, Osvaldo Regueira, Curtis Turner, Bandar Baw, Becky Malkin, David Freeman, Michael J. Rieder, Tetyana L. Vasylyeva, Gideon Koren

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Ifosfamide (IFO), which is used in the treatment of pediatric solid tumors, causes high rates of nephrotoxicity. N-acetylcysteine (NAC), an antidote for acetaminophen overdose, has been shown to prevent IFO-induced renal cell death and nephrotoxicity in both LLCPK-1 cells and a rat model. To facilitate the use of NAC in preventing IFO-induced nephrotoxicity in children, the authors compared the systemic exposure to NAC in children treated for acetaminophen overdose to the systemic exposure of the therapeutically effective rat model. The mean systemic exposure in the rat model was 18.72 mM•h (range, 9.92-30.02 mM•h), compared to the mean systemic exposure found in treated children (14.48 mM•h; range, 6.22-32.96 mM•h). They also report 2 pediatric cases in which NAC-attenuated acute renal failure associated with IFO when given concurrently with their chemotherapy treatment. Systemic exposure to NAC measured in 1 of these cases was comparable to that in the children treated for acetaminophen overdose. These results corroborate NAC's potential to protect against IFO-induced nephrotoxicity in children when used in its clinically approved dose schedule and supports a clinical trial in children.

Original languageEnglish
Pages (from-to)55-64
Number of pages10
JournalJournal of Clinical Pharmacology
Issue number1
StatePublished - Jan 2012
Externally publishedYes


  • Ifosfamide
  • N-acetylcysteine
  • children
  • nephrotoxicity
  • prevention


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