Cyclophosphamide

Cyclophosphamide is a prescription medicine used alone, or in combination with other medications to treat several types of cancer including lymphoma, leukemia, ovarian, and breast cancer. It has also been used to treat "minimal change" nephrotic syndrome, a kidney disease, when other treatments have failed. 

Cyclophosphamide is a prescription cancer medication used alone, or in combination with other cancer medications, for the treatment of several types of cancer including:

• Malignant lymphomas (Stages III and IV of the Ann Arbor staging system), Hodgkin’s disease, lyphocytic lymphoma (nodular or diffuse), mixed-cell type lymphoma, histiocytic lymphoma, Burkitt’s lymphoma
• Multiple myeloma (a type of cancer of the bone marrow)
• Leukemias (cancer of the white blood cells): Chronic lymphocytic leukemia, chronic granulocytic leukemia (it is usually ineffective in acute blastic crisis), acute myelogenous and monocytic leukemia; acute lymphoblastic (stem-cell) leukemia in children (cyclophosphamide given during remission is effective in prolonging its duration)
• Mycosis fungoides (advanced disease)
• Neuroblastoma (cancer that begins in the nerve cells and occurs mainly in children)
• Ovarian cancer
• Retinoblastoma (cancer in the eye)
• Breast cancer

Cyclophosphamide is also approved to treat "minimal change" nephrotic syndrome in children (a kidney disorder) when other treatments have produced intolerable side effects or have failed.

Cyclophosphamide may be found in some form under the following brand names:

• Cytoxan

• Neosar

Serious side effects can occur with cyclophosphamide use. See "Drug Precautions" section.

Other less serious, more common side effects include:

• nausea
• vomiting
• loss of appetite
• weight loss
• stomach pain
• diarrhea
• temporary hair loss
• mouth sores
• changes in skin or nail color
• menstrual changes
• temporary or permanent sterility

Talk to your doctor about any side effect that is bothersome or does not go away.

This is not a complete list of cyclophosphamide side effects. Ask your doctor or pharmacist for more information.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• allopurinol (Zyloprim)
• cortisone acetate
• doxorubicin (Adriamycin, Doxil)
• hydrocortisone (Cortef)
• phenobarbital (Luminal)

Do not receive "live" vaccines while taking cyclophosphamide.

This is not a complete list of cyclophosphamide drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have occurred with cyclophosphamide use including:

• allergic reactions
• decreased bone marrow function and lower blood cell counts
• increased risk of developing certain cancers (sometimes years after taking cyclophosphamide)
• decreased fertility in both men and women (sometimes reversible)
• damage to the bladder
• increased risk of infection

If you experience any of the following symptoms, tell your doctor right away.

• rash
• hives
• itching
• difficulty breathing or swallowing
• shortness of breath
• sore throat, fever, chills, or other signs of infection
• poor or slow wound healing
• unusual bruising or bleeding
• black, tarry stools
• painful urination or red urine
• cough
• swelling in the legs, ankles, or feet
• chest pain
• yellowing of the skin or eyes

Do not take cyclophospamide if you are allergic to any active or inactive components of the medication.

Talk to your doctor about the risks associated with cyclophosphamide therapy.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of cyclophosphamide there are no specific foods that you must exclude from your diet when receiving cyclophosphamide.
 

Before receiving cyclophosphamide, tell your doctor about all of your medical conditions including if you:

• have low levels of white blood cells (a condition known as neutropenia)
• have low levels of platelets (thrombocytopenia)
• have bone marrow tumors
• have previously been treated with other chemotherapy medicines or x-ray therapy
• have liver or kidney disease
• are allergic to cyclophosphamide or any other medication
• have an infection or have recently been vaccinated
• are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category D. Pregnancy should be avoided during cyclophosphamide treatment. Cyclophosphamide has been shown to be harmful to the unborn baby when taken by pregnant women. Tell your doctor if you are pregnant or plan to become pregnant while receiving cyclophosphamide. If you become pregnant during your treatments, tell your doctor right away.

This medication may also affect fertility in both men and women, by reducing sperm and egg production.

Cyclophosphamide is excreted in breast milk. Because of the potential for serious harm to the nursing baby, do not take cyclophosphamide without talking to your doctor if you are breastfeeding.

This medication comes as a tablet and capsule to be taken by mouth.

Take cyclophosphamide tablets exactly as prescribed and ask your doctor if you don't understand the instructions or treatment schedule.

Oral cyclophosphamide tablets are best if taken on an empty stomach, although, if it causes severe stomach upset, you may take it with food. If vomiting occurs soon after taking a dose of cyclophosphamide, your doctor may want you to take another dose. Always check with your doctor first.

Whether you are taking cyclophosphamide tablets or the injectable form, it is important that you drink plenty of fluids during treatment, to avoid bladder damage. To lower the risk of bladder damage take cyclophosphamide oral tablets in the morning.

Do not stop taking this medication without first talking with your doctor.

If you forget a dose, take the missed oral dose as soon as you remember. If it is almost time for the next dose, skip the dose you missed and take the next regularly scheduled dose as directed. Do not take a double dose of this medication.

Contact your doctor if you miss a dose of cyclophosphamide injection.

During your treatments, your doctor will order certain lab tests to monitor progress and side effects. Keep all laboratory appointments. Your treatments may be delayed or your dose adjusted if you experience certain side effects.

The length of treatment depends on the types of drugs you are taking, how well your body responds to them, and the type of cancer or condition you have.

The cyclophosphamide dosage is highly individualized. Your doctor will determine your dose based on the type of cancer you have as well as:

• your height and weight
• your age
• other medications you are taking
• other medical conditions you have
• if you are taking cyclophosphamide oral tablets or injection

Oral:

• Tablets:
  • Treatment of Malignant Disease
    • Adults and Children - Cyclophosphamide dosing is usually in the range of 1 to 5 mg/kg/day for both starting and maintenance dosing.
  • Treatment of Nonmalignant Diseases
    • A dose of 2.5 to 3 mg/kg daily for a period of 60 to 90 days is recommended.
• Capsules
  • Treatment of Malignant Disease
    • Usually 1 mg/kg per day to 5 mg/kg per day for both starting and maintenance dosing.
  • Treatment of Nonmalignant Diseases
    • Usually 2 mg/kg daily for 8 to 12 weeks (maximum cumulative dose 168 mg/kg).

Injectable:

• Treatment of Malignant Disease
  • Starting dose of 40 mg/kg to 50 mg/kg in divided doses over 2 to 5 days. Other options include 10 mg/kg to 15 mg/kg given every 7 to 10 days or 3 mg/kg to 5 mg/kg twice weekly.

If you take too much cyclophosphamide call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If cyclophosphamide is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Store tablets at or below 77°F (25°C).
• Store capsules at 20°C to 25°C (68°F to 77°F).
• Keep this and all medicines out of the reach of children.
• Keep all doctor and laboratory appointments.