Role of thiamine in managing ifosfamide-induced encephalopathy

Encephalopathy is a well known side effect of ifosfamide, developing in approximately 10-30% of patients exposed to the drug. It is generally reversible after discontinuing the therapy; however cases of fatal neurotoxicity have been reported. Methylene blue is commonly used in the treatment and prophylaxis of ifosfamide induced encephalopathy; however its efficacy is moderate at best. We report here the utility of thiamine in both treating and preventing ifosfamide induced neurotoxicity in three patients. With the use of intravenous thiamine encephalopathy resolved in all of our patients within a mean time of 17 hours (range 10-30 hours). In three cycles where thiamine was used as prophylaxis no evidence of ifosfamide induced encephalopathy was seen. Thiamine appears to be a safe and effective treatment for reversing encephalopathy resulting form ifosfamide infusion, without any significant side effects.