Cyclophosphamide

Uses	Carcinoma and Certain Immune System Conditions
Therapy	Drugs For Nephrotic Syndrome, Anti-Neoplastic
Side Effects	Fever, Nausea, Vomiting, Alopecia

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Molecule Description

Cyclophosphamide is used to treat and prevent cancers in the body and also to suppress the immune system. It belongs to a class of medicines called ‘alkylating agents’

Uses

Treatment of cancer of certain type of white blood cells (acute and chronic
lymphocytic leukemia)
As conditioning for bone marrow transplantation, in certain cancers of white blood
cells that start in the bone marrow (acute lymphoblastic, acute and chronic
myelogenous leukemia)
Cancer of immune white blood cells (plasma cells, a condition called multiple
myeloma), and cancer of the lymph nodes (glands of the immune system, conditions
called as hodgkin’s and non-hodgkin’s lymphoma)
Advanced cancers of the breast and the ovary (that are spreading)
‘Add-on’ treatment to other medicines for treatment of breast cancer (that is not
spreading)
A type of cancer of the soft tissues (muscles, tendons, ligaments etc) or the bones
(ewing’s sarcoma)
A type of lung cancer (small cell lung cancer)
Advanced cancer of immature nerve cells (neuroblastoma)
Life-threatening diseases of the immune system (lupus nephritis that affects the
kidney, a condition called wegener’s granulomatosis that affects the blood vessels)

Contraindications

When should one not use Cyclophosphamide

Allergy to cyclophosphamide or to any of the components
Any acute infections
Bone marrow depression or aplasia (severely reduced cells of the bone marrow)
Urinary tract infections, urinary outflow obstruction
Damage to the lining of the lower urinary tract (damaged urothelium of the urinary
tube between the kidney and outlet)
Cyclophosphamide should not be used for any conditions other than cancer except
for suppression of the immune system in life-threatening situations

Side effects

Common side effects of this drug are:

Decreased activity of the bone marrow causing (myelosuppression)
Decreased production of white blood cells (leucopenia, neutropenia)
Hair loss
Burning sensation and increased frequency of passing urine (cystitis)
Fever
Suppression of the immune system (increase in infections due to reduced resistance)
Irritation of lining of some organs (mucositis)
Blood in the urine (microhematuria)
Feeling unwell, weakness
Liver problems
Chills
Infertility in men
Low red blood cells and platelet counts (anemia and thrombocytopenia)
Lung infections (pneumonia), sepsis (wide spread infection), allergic reactions, chest
pain, fast heart beats, redness of skin, numbness, nerve pain, decreased hunger,
deafness, infertility in females (uncommon)
Allergic reactions with difficulty in breathing, high heart rate, low blood pressure,
tiredness, swelling of face and lips, rashes and itching (Anaphylactic reactions – rare,
but serious)

Precautions and Warnings

Pregnancy

Do not use Cyclophosphamide if you are pregnant Cyclophosphamide might affect the unborn baby. Follow contraceptive measures while you are on this medicine. Inform your doctor if you are pregnant or planning pregnancy

Breast Feeding

Do not take cyclophosphamide if you are breastfeeding, as it appears in human milk in toxic amounts and can harm the baby. Please consult before taking this medicine if you are breastfeeding

Driving

Caution is recommended as Cyclophosphamide can cause side effects such as dizziness, vision problem after taking this medicine. Do not drive if you experience any of these symptoms

Alcohol

Cyclophosphamide causes nausea and vomiting, if you drink alcohol while on this treatment increase the risk of nausea and vomiting It is important to note that alcohol delays healing in conditions like cancer

Other General Warnings

Talk to your doctor if

Low blood cell counts
Severe infections
Liver or kidney problems
Your adrenal glands (hormone releasing glands present on top of the kidney) have
been removed
Received treatment for cancer by radiation (radiotherapy) or by medicines
(chemotherapy)
Heart problems or radiation treatment in your chest area
Diabetes
Weak, elder or have poor oral health
Had recent surgery (less than 10 days ago)

Mode of Action

How Does It Work?

Cyclophosphamide acts by killing the cancer cells in the body after being activated in the liver. At lower doses, it suppresses certain regulatory (T-cells) cells of the immune system and causes immunosuppression

Interactions

Interactions with other medicines

Medicines used to treat HIV/ AIDS (zidovudine, ritonavir, nelfinavir)
Medicines used to treat high blood pressure (ACE inhibitors – ramipril, enalapril,
lisinopril; diuretics – furosemide, torsemide)
Medicines used to treat immune disorders (natalizumab, azathioprine, cyclosporine,
etanercept)
Certain anti-cancer medicines (paclitaxel, anthracyclines, cytarabine, pentostatin,
trastuzumab, tamoxifen, radiation treatment of the chest region)
Medicines that increase the number of blood cells (CSF-colony stimulating factors)
Medicines used to treat heart disease (amiodarone)
Metronidazole (an antibiotic)
Muscle relaxants (succinyl choline etc)

Interactions with food items

No known food interaction with this medicine

Dosage

Overdose

Overdose leads to life threatening situations at very high doses You are advised to take this injection or infusion (slow drip into the veins) in a hospital setting under supervision This will minimize any chances of overdosing But if you experience any serious symptoms like heart problems, altered consciousness, urinary or liver problems, inform your doctor immediately and seek medical care without any delay

Missed a Dose

Take the missed dose as soon as you remember If the missed dose falls at the time of you next scheduled dose then skip it Do not take a double dose to make up for the missed dose

Frequently Asked Questions (FAQs)

Females should not try for pregnancy up to 12 months after discontinuing treatment with Cyclophosphamide Males on Cyclophosphamide should use birth control up to 6 months after stopping the treatment If you are of reproductive age, it may be advisable to preserve your sperms or eggs as Cyclophosphamide may irreversibly affect your fertility Cyclophosphamide interferes with wound healing Exercise caution and reduce the incidence of any cuts, injuries, burns etc and give immediate attention Cyclophosphamide can cause mouth ulcers and sore gums You are advised to maintain good oral health

White blood cell and platelet count need to be done regularly while on treatment with Cyclophosphamide If the medicine is given by infusion (slow drip) or by direct injection (through the veins), it has to be done by trained personnel You are advised not to do it on your own Infusion (slow drip into the veins) should be done over a period of 30 minutes to 2 hours