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Mesna: Drug information

Mesna: Drug information
(For additional information see "Mesna: Patient drug information" and see "Mesna: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Mesnex
Brand Names: Canada
  • Uromitexan
Pharmacologic Category
  • Antidote;
  • Chemoprotective Agent
Dosing: Adult

Note: Mesna dosing schedule should be repeated each day ifosfamide is administered. If the ifosfamide dose is adjusted (decreased or increased), the mesna dose should also be modified to maintain the mesna-to-ifosfamide ratio. Patients should receive adequate hydration during treatment. Mesna may not prevent hemorrhagic cystitis in all patients; examine urine specimen for hematuria prior to ifosfamide (or cyclophosphamide) treatment; if hematuria >50 RBC/HPF develops, reduce the ifosfamide/cyclophosphamide dose or discontinue.

Prevention of ifosfamide-induced hemorrhagic cystitis

Prevention of ifosfamide-induced hemorrhagic cystitis:

Standard-dose ifosfamide (Ref): IV: Each mesna dose is equal to 20% of the daily ifosfamide dose given for 3 doses: With the ifosfamide dose (hour 0), hour 4, and at hour 8 after the ifosfamide dose (total daily mesna dose is 60% of the daily ifosfamide dose).

Oral mesna (following IV mesna; for ifosfamide doses ≤2 g/m2/day): Mesna dose (IV) is equal to 20% of the daily ifosfamide dose at hour 0, followed by 2 mesna doses (orally), each equal to 40% of the daily ifosfamide dose given 2 and 6 hours after the ifosfamide dose (total daily mesna dose is 100% of the daily ifosfamide dose). Note: If the oral mesna dose is vomited within 2 hours of administration, repeat the oral mesna dose or administer IV mesna.

Short infusion standard-dose ifosfamide (<2.5 g/m2/day): IV: Total mesna dose is equal to 60% of the ifosfamide dose, in 3 divided doses (each mesna dose as 20% of daily ifosfamide dose), given 15 minutes before the ifosfamide dose, and 4 and 8 hours after each dose of ifosfamide (Ref).

Continuous infusion standard-dose ifosfamide (<2.5 g/m2/day): IV: Mesna dose (as a bolus) is equal to 20% of the daily ifosfamide dose, followed by a continuous infusion of mesna at 40% of the daily ifosfamide dose; continue mesna infusion for 12 to 24 hours after completion of ifosfamide infusion (Ref).

High-dose ifosfamide (>2.5 g/m2/day): Evidence for use is inadequate; more frequent and prolonged mesna administration regimens may be required (Ref).

Other dosing strategies used in combination with ifosfamide (off-label dosing):

Mesna continuous infusion: IV: 1.8 g/m2/day to 5 g/m2/day as a continuous infusion (100% of the ifosfamide dose), repeated each day ifosfamide is received; see protocols for specific details (Ref).

Mesna bolus followed by continuous infusion: IV: 1 g/m2 1 hour prior to ifosfamide on day 1, followed by 3 g/m2/day continuous infusion (continuous infusion is 100% of the daily ifosfamide dose) on days 1, 2, and 3 (with sufficient hydration) every 3 weeks for 6 courses (Ref)

Prevention of cyclophosphamide-induced hemorrhagic cystitis in patients with cancer

Prevention of cyclophosphamide-induced hemorrhagic cystitis in patients with cancer (off-label use):

HDCAV/IE regimen for Ewing sarcoma: Adults <40 years of age:

Cycles 1, 2, 3, and 6 (cyclophosphamide-containing regimen): IV: 2.1 g/m2/day continuous infusion (mesna dose is equivalent to the daily cyclophosphamide dose) for 2 days with cyclophosphamide infusion during cycles 1, 2, 3, and 6 (Ref).

Cycles 4, 5, and 7 (ifosfamide-containing regimen): IV: 1.8 g/m2/day continuous infusion (mesna dose is equivalent to the daily ifosfamide dose) for 5 days with ifosfamide infusion during cycles 4, 5, and 7 (Ref).

Hyper-CVAD regimen for acute lymphocytic leukemia: IV: 600 mg/m2/day continuous infusion (mesna continuous infusion is same total daily dose as cyclophosphamide) on days 1, 2, and 3, beginning with cyclophosphamide and ending 6 hours after the last cyclophosphamide dose during odd-numbered cycles (cycles 1, 3, 5, 7) of an 8-cycle phase (Ref).

Prevention of cyclophosphamide-induced hemorrhagic cystitis in patients with rheumatic or autoimmune disorders

Prevention of cyclophosphamide-induced hemorrhagic cystitis in patients with rheumatic or autoimmune disorders (off-label use; based on limited data): IV: Each mesna dose is equal to 20% of the daily cyclophosphamide dose given for 3 doses, 15 to 30 minutes prior to cyclophosphamide (hour 0), and 4 and 8 hours after cyclophosphamide (if administering mesna orally, each oral mesna dose is equal to 40% of the daily cyclophosphamide dose, with the first dose administered 2 hours prior to cyclophosphamide, and 4 and 8 hours after cyclophosphamide) (Ref) or each mesna dose is equal to 20% of the daily cyclophosphamide dose given for 3 doses at 3, 6, and 8 hours following cyclophosphamide each day for 4 days (Ref).

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied)

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied)

Dosing: Adjustment for Toxicity: Adult

Dermatologic toxicity, severe: Discontinue mesna and manage with supportive care.

Hypersensitivity: Discontinue mesna and manage with supportive care.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Mesna: Pediatric drug information")

Note: Dose, frequency, number of doses, and start date may vary by protocol and treatment phase. Refer to individual protocols.

Prevention of ifosfamide-induced hemorrhagic cystitis

Prevention of ifosfamide-induced hemorrhagic cystitis: Mesna dosing schedule should be repeated each day ifosfamide is received according to protocol. If ifosfamide dose is adjusted (decreased or increased), the mesna dose should also be modified to maintain the mesna-to-ifosfamide ratio.

Infants, Children, and Adolescents:

Standard-dose ifosfamide: Note: ASCO defines standard-dose ifosfamide IV as <2500 mg/m2/day (Ref); other pediatric oncology experts suggest ≤2000 mg/m2/day in protocols. ASCO defines standard-dose ifosfamide oral as ≤2000 mg/m2/day (Ref).

Manufacturer's labeling: IV: Mesna dose is equal to 20% of the ifosfamide dose given for 3 doses: With the ifosfamide dose (hour 0), at hour 4, and at hour 8 after the ifosfamide dose (total daily mesna dose is 60% of the ifosfamide dose). Note: Safety and efficacy not established for ifosfamide doses >2000 mg/m2/day.

Alternate dosing: Limited data available:

IV:

Short IV infusion (intermittent): ASCO guidelines: Mesna dose equal to 60% of the ifosfamide dose given in 3 divided doses (20% each) 15 minutes before the ifosfamide dose and at 4 and 8 hours after the start of ifosfamide (Ref).

Continuous IV infusion: Dosing regimens variable: ASCO guidelines: Mesna dose (as an IV bolus) equal to 20% of the ifosfamide dose, followed by a continuous IV infusion of mesna at 40% of the ifosfamide dose; continue mesna infusion for 12 to 24 hours after completion of ifosfamide infusion (Ref). Some centers have used a mesna dose equal to 60% to 100% of the ifosfamide dose as a continuous IV infusion beginning 15 to 30 minutes before the first ifosfamide dose and completed at least 8 hours after the end of the ifosfamide infusion (Ref).

Oral: ASCO guidelines: Total mesna dose equal to 100% of the ifosfamide dose, begin with IV dose equal to 20% for initial dose followed by oral dose at 40% of the ifosfamide dose at 2 and 6 hours after start of ifosfamide (Ref); Note: Typically, oral doses of mesna are twice the IV dose.

High-dose ifosfamide: Note: ASCO defines high dose as ifosfamide dosage ≥2500 mg/m2/day (Ref); other pediatric oncology experts suggest ≥2000 mg/m2/day in protocols: Limited data available; dosing regimens variable: IV: ASCO considers evidence for use inadequate and dosing recommendations are not established; more frequent and prolonged mesna administration regimens may be required (Ref). Some centers have used a mesna dose equal to 100% of the ifosfamide dose as a short IV infusions 5 divided doses (0, 3, 6, 9 and 12) hours after the start of ifosfamide) (Ref) or as a continuous IV infusion beginning 15 to 30 minutes before the first ifosfamide dose and completed at least 12 hours after the end of the ifosfamide infusion.

Other dosing strategies have been used in combination with ifosfamide for specific regimens/protocols: Limited data available:

Mesna continuous IV infusion: Children and Adolescents: IV: 1800 mg/m2/day to 5000 mg/m2/day as a continuous infusion (100% of the ifosfamide dose), repeated each day ifosfamide is received; see protocols for specific details (Ref).

Mesna IV bolus followed by continuous IV infusion: Children and Adolescents: IV: 1000 mg/m2 1 hour prior to ifosfamide on day 1, followed by 3000 mg/m2/day continuous infusion (continuous infusion is 100% of the ifosfamide dose) on days 1, 2, and 3 (with sufficient hydration); administer with subsequent ifosfamide doses (Ref).

Mesna (20% higher than ifosfamide) continuous IV infusion: Children and Adolescents: IV: 3600 mg/m2/day continuous infusion for 4 days (mesna dose is 20% higher than ifosfamide), with hydration, administer with subsequent ifosfamide doses (Ref).

Prevention of cyclophosphamide-induced hemorrhagic cystitis

Prevention of cyclophosphamide-induced hemorrhagic cystitis: Limited data available: Note: Specific protocols should be consulted for combination regimens with cyclophosphamide. Mesna dosing schedule is typically repeated with each day cyclophosphamide is received; mesna dosing should be adjusted if cyclophosphamide dose is adjusted (decreased or increased) to maintain the mesna-to-cyclophosphamide ratio for the protocol.

Infants, Children, and Adolescents:

Standard (low)-dose cyclophosphamide: Note: Some pediatric oncology experts have defined as cyclophosphamide dose <1800 mg/m2/day in protocols.

IV: Reported regimens variable: Mesna doses equivalent usually 60% to 100% of the cyclophosphamide daily dose although some protocols have used up to 160%.

Short IV infusion (intermittent): Mesna dose equal to 60% of the cyclophosphamide dose given in 3 divided doses (0, 4, and 8 hours after the start of cyclophosphamide) has been used by some centers; others have used a mesna dose equal to 100% of the cyclophosphamide dose as short IV infusions in 5 divided doses (0, 3, 6, 9, and 12 hours after the start of cyclophosphamide) (Ref).

Continuous IV infusion: Some centers have used a mesna dose equal to 60% of the cyclophosphamide dose as a continuous IV infusion beginning 15 to 30 minutes before the first cyclophosphamide dose and completed at least 8 hours after the end of the cyclophosphamide infusion.

Oral: Some centers have used a total mesna dose equal to 100% of the cyclophosphamide dose, begin with IV dose equal to 20% for initial dose followed by oral dose at 40% of the cyclophosphamide dose at 2 and 6 hours after start of cyclophosphamide; Note: Typically, oral doses of mesna are twice the IV dose.

High-dose cyclophosphamide: Note: Some pediatric oncology experts have defined cyclophosphamide dose ≥1800 mg/m2/day in protocols: IV: Some centers have used a mesna dose equal to 100% of the cyclophosphamide dose as short IV infusions in 5 divided doses (0, 3, 6, 9, and 12 hours after the start of) (Ref) or as a continuous IV infusion beginning 15 to 30 minutes before the first cyclophosphamide dose.

Other dosing strategies have been used in combination with cyclophosphamide for specific regimens/protocols: Limited data available: HDCAV/IE regimen for Ewing sarcoma: Children and Adolescents: IV: 2100 mg/m2/day continuous infusion (mesna dose is equivalent to the cyclophosphamide dose) for 2 days with cyclophosphamide infusion during cycles 1, 2, 3, and 6 (Ref).

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Mesna alone (frequency not defined):

Cardiovascular: Flushing

Central nervous system: Dizziness, drowsiness, headache, hyperesthesia, rigors

Dermatologic: Skin rash

Gastrointestinal: Anorexia, constipation, diarrhea, dysgeusia (with oral administration), flatulence, nausea, unpleasant taste (with oral administration), vomiting

Local: Injection site reaction

Neuromuscular & skeletal: Arthralgia, back pain

Ophthalmic: Conjunctivitis

Respiratory: Cough, flu-like symptoms, pharyngitis, rhinitis

Miscellaneous: Fever

<1%, postmarketing and/or case reports (mesna alone or in combination): Anaphylaxis, erythema at injection site, hypersensitivity reaction, hypertension, hypotension, increased serum transaminases, increased ST segment on ECG, limb pain, malaise, myalgia, pain at injection site, tachycardia, tachypnea, thrombocytopenia

Contraindications

Known hypersensitivity to mesna or any component of the formulation.

Warnings/Precautions

Concerns related to adverse effects:

• Dermatologic toxicity: Drug rash with eosinophilia and systemic symptoms and bullous/ulcerative skin and mucosal reactions consistent with Stevens-Johnson syndrome or toxic epidermal necrolysis have been reported. The skin and mucosal reactions may be characterized by rash, pruritus, urticaria, erythema, burning sensation, angioedema, periorbital edema, flushing, and stomatitis. Reactions may occur with the first mesna exposure, or after several months of treatment.

• Hematuria: Monitor urine for hematuria. Severe hematuria despite utilization of mesna may require ifosfamide (or cyclophosphamide) dose reduction or discontinuation. Examine urine specimen for hematuria prior to ifosfamide (or cyclophosphamide) treatment; if hematuria (>50 RBC/HPF) develops, reduce the ifosfamide/cyclophosphamide dose or discontinue; mesna may not prevent hemorrhagic cystitis in all patients. Patients should receive adequate hydration during treatment.

• Hypersensitivity: Hypersensitivity reactions (including anaphylaxis) have been reported. Reactions may also include fever, hypotension, tachycardia, acute renal impairment, hypoxia, respiratory distress, urticaria, angioedema, signs of disseminated intravascular coagulation, hematologic abnormalities, increased liver enzymes, nausea, vomiting, arthralgia, and myalgia. Reactions may occur with the first mesna exposure, or after several months of treatment. Mesna is a thiol compound; it is unknown if the risk for reaction is increased in patients who have had a reaction to other thiol compounds (eg, amifostine).

• Ifosfamide/cyclophosphamide toxicities: Mesna is intended for the prevention of hemorrhagic cystitis and will not prevent or alleviate other toxicities associated with ifosfamide or cyclophosphamide.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer’s labeling.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Mesnex: 100 mg/mL (10 mL) [contains benzyl alcohol, edetate (edta) disodium]

Generic: 100 mg/mL (10 mL)

Tablet, Oral:

Mesnex: 400 mg [scored]

Generic Equivalent Available: US

May be product dependent

Pricing: US

Solution (Mesna Intravenous)

100 mg/mL (per mL): $2.40 - $7.96

Solution (Mesnex Intravenous)

100 mg/mL (per mL): $3.00

Tablets (Mesnex Oral)

400 mg (per each): $94.31

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Uromitexan: 100 mg/mL (4 mL, 10 mL, 50 mL) [contains benzyl alcohol, edetate (edta) disodium]

Generic: 100 mg/mL (10 mL)

Administration: Adult

Maintain adequate hydration and urinary output during ifosfamide (or cyclophosphamide) treatment.

IV: Administer as an IV bolus (per manufacturer); may also be administered by short infusion or continuous infusion (maintain continuous infusion for 12 to 24 hours after completion of ifosfamide infusion) (Ref); refer to specific protocol for administration rate/details.

Oral: Administer orally in tablet formulation; patients who vomit within 2 hours after taking oral mesna should repeat the dose or receive IV mesna. A solution may be prepared from solution for injection by dilution in syrup, juice, carbonate beverages, or milk (Ref); see Extemporaneously Prepared section.

Administration: Pediatric

Oral: Administer orally in tablet form or dilute mesna injection solution for oral use before oral administration to decrease sulfur odor; see Extemporaneous Preparations section. Patients who vomit within 2 hours after taking oral mesna should repeat the dose or receive IV mesna.

Parenteral: Administer as an IV bolus (per manufacturer); current guidelines suggest administration by short IV infusion over 15 to 30 minutes, or by continuous IV infusion (maintain continuous infusion for 12 to 24 after completion of ifosfamide infusion) (Ref); in some trials, a shorter duration (eg, 8 hours) has been reported (Ref); refer to specific protocol for administration rate and details.

Use: Labeled Indications

Prevention of ifosfamide-induced hemorrhagic cystitis: Preventive agent to reduce the incidence of ifosfamide-induced hemorrhagic cystitis

Limitations of use: Mesna is not indicated to reduce the risk of hematuria due to other conditions such as thrombocytopenia

Use: Off-Label: Adult

Prevention of cyclophosphamide-induced hemorrhagic cystitis (with high-dose cyclophosphamide); Prevention of cyclophosphamide-induced hemorrhagic cystitis in patients with rheumatic or autoimmune disorders

Metabolism/Transport Effects

None known.

Drug Interactions

There are no known significant interactions.

Reproductive Considerations

Verify pregnancy status prior to treatment initiation in patients who could become pregnant. Patients who could become pregnant should use effective contraception during mesna/ifosfamide treatment and for 6 months after the final dose. Patients with partners who could become pregnant should use effective contraception during treatment and for 3 months after the final mesna/ifosfamide dose.

Pregnancy Considerations

Use of mesna to reduce ifosfamide-induced hemorrhagic cystitis in pregnancy has been reported (Lam 2006; Merimsky 1999; Mir 2012).

Mesna injection contains benzyl alcohol as a preservative; exposure to the fetus is expected to be unlikely due to rapid maternal metabolism.

Mesna is administered in combination with cytotoxic agents that may cause fetal harm (refer to specific monographs for additional information).

Breastfeeding Considerations

It is not known if mesna is present in breast milk.

Benzyl alcohol is a component in some formulations. The manufacturer notes exposure to the breastfeeding infant is expected to be unlikely due to rapid maternal metabolism; however, because adverse events have been observed in premature neonates and low birth weight infants administered benzyl alcohol IV, breastfeeding is not recommended during therapy and for at least 1 week after the last mesna injection.

Mesna is administered in combination with cytotoxic agents that may cause harm to a breastfed infant (refer to specific monographs for additional information).

Monitoring Parameters

Monitor urine for signs of hematuria; examine urine specimen for hematuria prior to ifosfamide (or cyclophosphamide) treatment (ifosfamide/cyclophosphamide dose reduction or discontinuation may be necessary if hematuria >50 RBC/HPF develops). Monitor urine output and hydration status. Verify pregnancy status prior to treatment initiation in patients who could become pregnant. Monitor for signs/symptoms of hypersensitivity or dermatologic toxicity.

Mechanism of Action

Mesna is oxidized to dimesna in blood, which in turn is reduced in the kidney back to mesna, supplying a free thiol group which binds to and inactivates acrolein, the urotoxic metabolite of ifosfamide and cyclophosphamide

Pharmacokinetics (Adult Data Unless Noted)

Distribution: 0.65 ± 0.24 L/kg; distributed to total body water.

Protein binding: 69% to 75%.

Metabolism: Rapidly oxidized to mesna disulfide (dimesna) in the intravascular compartment. Mesna and dimesna do not undergo hepatic metabolism.

Bioavailability: Oral: Free mesna: 58% (range: 45% to 71%); not affected by food.

Half-life elimination: Mesna: ~22 minutes; Dimesna: ~70 minutes.

Time to peak, plasma: Oral: Free mesna: 1.5 to 4 hours; Total mesna: 3 to 7 hours.

Excretion: Urine (32% as mesna; 33% as dimesna).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Uromitexan;
  • (AR) Argentina: Fada mesna | Mesna delta farma | Mesna Filaxis | Mesna Gobbi | Mesna microsules | Mesna Norgreen | Mesnex | Mestian | Neper | Uromitexan;
  • (AT) Austria: Uromitexan;
  • (AU) Australia: Uromitexan;
  • (BG) Bulgaria: Uromitexan;
  • (BR) Brazil: Mitexan | Tevamesna;
  • (CH) Switzerland: Uromitexan;
  • (CL) Chile: Uromitexan;
  • (CO) Colombia: Novacarel | Uromitexan | Uroprot;
  • (CZ) Czech Republic: Uromitexan;
  • (DE) Germany: Uromitexan;
  • (DO) Dominican Republic: Mesna delta farma;
  • (EC) Ecuador: Mesnil | Uromitexan;
  • (EE) Estonia: Uromitexan;
  • (EG) Egypt: Uromes | Uromitexan;
  • (ES) Spain: Mesna g.e.s | Uromitexan;
  • (FI) Finland: Uromitexan;
  • (FR) France: Mesna EG | Uromitexan;
  • (GB) United Kingdom: Uromitexan;
  • (HK) Hong Kong: Mesna stada | Uromitexan;
  • (HR) Croatia: Uromitexan;
  • (HU) Hungary: Mesna pharmacenter | Uromitexan;
  • (IE) Ireland: Uromitexan;
  • (IN) India: Cancena | Uromitexan;
  • (IT) Italy: Uromitexan;
  • (JO) Jordan: Uromitexan;
  • (JP) Japan: Uromitexan;
  • (KR) Korea, Republic of: Uromes | Uromitexan;
  • (KW) Kuwait: Uromitexan;
  • (LB) Lebanon: Uromitexan;
  • (LT) Lithuania: MESNA-cell | Uromitexan;
  • (LV) Latvia: Uromitexan;
  • (MX) Mexico: Medaltec | Mesna gi kendrick | Mesna Tecnofarma | Mesnil | Mesodal | Novacarel | Uromes | Uromitexan | Uroprot;
  • (MY) Malaysia: Uromes | Uromitexan;
  • (NL) Netherlands: Uromitexan;
  • (NO) Norway: Uromitexan;
  • (NZ) New Zealand: Uromitexan;
  • (PH) Philippines: Uromes;
  • (PK) Pakistan: Uromitexan;
  • (PL) Poland: Anti uron | Uromitexan;
  • (PR) Puerto Rico: Mesnex;
  • (PY) Paraguay: Mesnil;
  • (QA) Qatar: Uromitexan;
  • (RO) Romania: Uromitexan;
  • (RU) Russian Federation: Mesna lens | Uromitexan;
  • (SA) Saudi Arabia: Uromitexan;
  • (SE) Sweden: Uromitexan;
  • (SG) Singapore: Uromitexan;
  • (SK) Slovakia: Uromitexan;
  • (TH) Thailand: Uromitexan;
  • (TN) Tunisia: Uromitexan;
  • (TR) Turkey: Uromitexan;
  • (TW) Taiwan: Uromitexan | Urona;
  • (UY) Uruguay: Mesna delta farma | Mesna Filaxis | Uromitexan | Uronamid;
  • (ZA) South Africa: Uromitexan
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