Posted on April 28th, 2009 by
Generic Name: Cyclophosphamide (sigh-kloe-FOSS-fah-mide)
Trade Name: Cytoxan®, Neosar®
For which conditions is this drug approved? Cyclophosphamide is commonly used for the treatment of several cancers, including lymphomas, multiple myeloma, leukemias, advanced mycosis fungoides, advanced neuroblastoma, ovarian cancer, retinoblastoma and breast cancer. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Cyclophosphamide belongs to a group of drugs referred to as alkylating drugs. Cyclophosphamide produces anti-cancer effects by causing a chemical reaction that damages the DNA in a cell. This DNA damage results in cellular death.
How is cyclophosphamide typically given (administered)? Cyclophosphamide may be given in several different ways, depending upon the condition being treated and the dose of drug being used. Cyclophosphamide may be administered intravenously (into a vein), intramuscularly (into a muscle), intraperitoneally (into the lining of the abdomen), intrapleurally (into the lining of the lung), or orally. The prescribed dose of cyclophosphamide depends upon the patient’s weight, height and general health, as well as the particular regimen being used, the method of administration, and the type of condition being treated.
Patients may experience side effects during administration of cyclophosphamide. These side effects may include hot flushes, dizziness, a strange taste, runny eyes and a feeling of having a blocked nose. Patients should tell their healthcare provider if they experience any of these symptoms during administration of cyclophosphamide. Once cyclophosphamide is administered, it is eliminated from the body through the kidneys.
How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with cyclophosphamide. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.
What are the common (occur in 30% or more of patients) side effects of treatment with cyclophosphamide?
• Low white blood cell levels – increases the risk of infection
• Low red blood cell levels – increases the risk of anemia and blood transfusions
• Low platelet levels – increases the risk of bleeding
• Loss of hair – temporary
• Nausea and vomiting
• Loss of appetite
• Sterility – inability to conceive a child
• Nail disorders
• Skin reactions – discoloration
What are the less common (occur in 10% to 29% of patients) side effects of treatment with cyclophosphamide?
• Irritation of the bladder, may be severe
• Mouth sores or ulcers
What are the rare (occur in less than 10% of patients) side effects of treatment with cyclophosphamide?
• Damage to the lung with shortness of breath and cough
• Heart changes may occur with higher doses
• Changes in liver function tests
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What are possible late side effects of treatment with cyclophosphamide? With the use of this drug, there is risk of developing side effects months or years after treatment has been completed. In rare instances, a secondary malignancy may occur as a result of receiving this drug. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy. Patients should ask their physician about the possibility of developing a secondary malignancy as a result of their treatment.
What can I do to help alleviate or prevent discomfort and side effects?
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.
• Patients should empty their bladder frequently.
• Patients should take the oral form during the daytime.
• Eat small meals frequently to help alleviate nausea.
• If an oral dose is missed, do not double up on doses. Patients should contact their physician in this event.
• Keep tablets out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.
Are there any special precautions patients should be aware of before starting treatment?
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
When should patients notify their physician?
• Shortness of breath, difficulty breathing, persistant cough
• Chest pain, noticeable change in heart rate or rhythm
• Signs of infection – fever, chills, cough, sore throat, redness, tenderness
• Unusual bleeding or bruising (nosebleeds, blood in urine or stool, black, tarry stool, etc)
• Blood in the urine or painful urination
• Continued nausea or vomiting
• Severe or persistant diarrhea
• Extreme or persistant fatigue
• Ulcers in the mouth
• Skin rash
• Yellowing of eyes or skin
What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
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