Cyclophosphamide

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Cyclophosphamide
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Last Editorial Review: 1/16/2000

GENERIC NAME: Cyclophosphamide
BRAND NAME: Cytoxan

DRUG CLASS AND MECHANISM: Cyclophosphamide is a drug that is used primarily for treating several types of cancer. In order to work, cyclophosphamide first is converted by the liver into two chemicals, acrolein and phosphoramide. Acrolein and phosphoramide are the active compounds, and they slow the growth of cancer cells by interfering with the actions of deoxyribonucleic acid (DNA) within the cancerous cells. It is, therefore, referred to as a cytotoxic drug. Unfortunately, normal cells also are affected, and this results in serious side effects. Cytoxan also suppresses the immune system and is also referred to as immunosuppressive.

GENERIC AVAILABLE: Yes

PRESCRIPTION: Yes

PREPARATIONS: Powder for intravenous injection (100 mg), tablets of 25 and 50 mg.

STORAGE: Powder and tablets should be stored at room temperature, 15-30°C (59-86°F). Solutions prepared with bacteriostatic water are usable up to 24 hours if stored at room temperature and up to 6 days if stored in the refrigerator.

PRESCRIBED FOR: Cyclophosphamide is used for the treatment of several types of cancers and often in combination with other drugs to treat breast cancer, leukemia and ovarian cancer. It also is approved for treating nephrotic syndrome (a disease of the kidneys) in children. Unapproved uses include the treatment of Wegener's granulomatosis, severe rheumatoid arthritis, lupus erythematosus, advanced mycosis fungoides, and a number of forms of vasculitis.

DOSING: The usual initial dose for adults and children is 40-50 mg/kg administered intravenously over 3-5 days in divided doses. The usual oral dose is 1-5 mg/kg daily. Subsequent maintenance doses are adjusted based on the response of the tumor to treatment and the side effects.

DRUG INTERACTIONS: Allopurinol (Zyloprim) enhances the ability of cyclophosphamide to reduce production of blood cells from the bone marrow. (See below.)

Cyclophosphamide increases the occurrence of heart failure that is caused by doxorubicin (Adriamycin), increases the action of blood thinners such as coumarin (Coumadin), and decreases the effects of quinolone antibiotics (Cipro).

PREGNANCY: Use of cyclophosphamide during pregnancy may affect the fetus. Fetuses exposed to cyclophosphamide may be born with missing fingers, toes and a poorly-developed heart. Exposure in the second or third trimester may be less risky.

NURSING MOTHERS: Cyclophosphamide is excreted in breast milk and could cause serious problems in the nursing infant.

SIDE EFFECTS: Side effects of cyclophosphamide include hair loss, vomiting, diarrhea, mouth sores, sterility and jaundice.

Cyclophosphamide causes kidney failure, and it also may affect the heart and lungs. Cyclophosphamide suppresses production of blood cells from the bone marrow, including white blood cells (leukopenia), red blood cells (anemia) and platelets (thrombocytopenia). Leukopenia reduces the ability of the body to fight infection, thrombocytopenia impairs the ability of blood to clot, and anemia reduces the ability of blood to carry oxygen.

Cyclophosphamide also may cause inflammation of the urinary bladder with bleeding (hemorrhagic cystitis). This can result in lower abdominal pain from the bladder, problems urinating due to blood clots, and anemia due to loss of blood.

Last Editorial Review: 3/2/2005

GENERIC NAME: CYCLOPHOSPHAMIDE - ORAL, INJECTION (sye-klo-FOSS-fuh-mide)
BRAND NAME(S): Cytoxan, Neosar

USES: Cyclophosphamide is used to treat different types of cancer.

OTHER USES: This medication may also be used to treat a variety of rheumatoid diseases including rheumatoid arthritis and lupus, and has other uses as determined by your doctor.

HOW TO USE: This is a powerful medication. Use it exactly as prescribed. While you are using this medication, you must drink more fluid than usual and pass urine frequently. This helps your kidneys to remove the drug from your body and avoid some of the side effects. Ask your doctor how much you should drink and how often to empty your bladder each day and follow these instructions carefully. Do not stop using this medication, even if you feel nauseated or experience vomiting. If you vomit shortly after a dose, or if you miss a dose, contact your doctor.

SIDE EFFECTS: Nausea, vomiting, loss of appetite, diarrhea, rash, hives, itch, stomach pain, darkening of skin/nails, headache, flushing or red face, sweating, or swollen lips are common side effects. Using the medication on an empty stomach with a full glass of water may help relieve vomiting. Changes in diet such as eating several small meals or limited activity may help lessen some of these effects. Temporary hair loss is another common side effect; normal hair growth should return after treatment has ended. Notify your doctor immediately if you develop: pink or bloody urine. An allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Tell your doctor your medical history, especially of: blood disorders, liver disease, kidney disease, allergies (especially drug allergies). Avoid touching your eyes or inside your nose without first washing your hands for the duration of this treatment. Use caution with sharp objects like safety razors or nail cutters and avoid activities such as contact sports in order to lower the chance of getting cut, bruised or injured. Do not have immunizations/vaccinations without consent of your doctor and avoid contact with people who have recently received oral polio vaccine. This medication can lower your body's ability to fight an infection. Notify your doctor if you develop any signs of an infection such as fever, sore throat, rash, or chills. Cyclophosphamide is not recommended for use during pregnancy. Consult your doctor before using this drug. This drug is excreted into breast milk and should not be used while breast-feeding. Because this medication can affect the production of sperm in men, a reliable form of birth control is recommended while using this medication.

DRUG INTERACTIONS: Tell your doctor of all over-the-counter or prescription medication you may use, including: allopurinol, chloramphenicol, phenothiazines, chloroquine, succinylcholine, St John's wort. Do not start or stop any medicine without doctor or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include red or bloody urine, back or stomach pain, weakness, and fast heartbeat.

NOTES: Regular doctor visits are important. Frequent blood and urine tests will be done to monitor therapy and prevent side effects.

MISSED DOSE: For optimal benefits, it is important to receive each scheduled dose of this medication as directed. If you miss a dose, inform your doctor. Do not "double-up" the dose to catch up.

STORAGE: Store tablets between 36 and 77 degrees F (between 2.2 and 25 degrees C) away from moisture and sunlight. Store the powder for injection below 77 degrees F (below 25 degrees C). Refrigerate but do not freeze the oral solution.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).

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