Cyclophosphamide

Cyclophosphamide Brand Names- Cytoxan | Neosar

What is Cyclophosphamide

Cyclophosphamide is a bifunctional alkylating agent related to mechlorethamine (nitrogen mustard).

Cyclophosphamide has activity against many neoplastic diseases including Hodgkin lymphoma, non-Hodgkin’s lymphoma, acute lymphocytic leukemia, breast carcinoma, ovarian carcinoma, lung cancers, multiple myeloma, sarcomas, chronic lymphocytic leukemia, mycosis fungoides, neuroblastoma, and retinoblastoma.

The drug has also been used to treat immunologic disorders such as lupus nephritis, nephrotic syndrome, Wegener’s granulomatosis, rheumatoid arthritis, and graft-versus-host disease or graft rejection.

Oral or intermittent intravenous cyclophosphamide has become the standard treatment for diffuse proliferative lupus nephritis; the drug has been shown to prevent progressive scarring within the kidney, preserve renal function, induce renal remission, and reduce the risk of end-stage renal failure requiring dialysis or transplantation.

High-dose cyclophosphamide over 4 days may also have utility for the treatment of aggressive multiple sclerosis.

Indications

  1. acute lymphocytic leukemia (ALL)
  2. acute myelogenous leukemia (AML)
  3. amyloidosis
  4. aplastic anemia
  5. Behcet’s syndrome
  6. breast cancer
  7. Burkitt’s lymphoma
  8. chronic lymphocytic leukemia (CLL)
  9. chronic myelogenous leukemia (CML)
  10. Churg-Strauss syndrome
  11. cutaneous T-cell lymphoma (CTCL)
  12. dermatomyositis
  13. heart transplant rejection
  14. heart transplant rejection prophylaxis
  15. Hodgkin lymphoma
  16. immune thrombocytopenic purpura (ITP)
  17. juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)
  18. kidney transplant rejection
  19. kidney transplant rejection prophylaxis
  20. liver transplant rejection
  21. liver transplant rejection prophylaxis
  22. lung transplant rejection
  23. lupus nephritis
  24. macroglobulinemia
  25. multiple myeloma
  26. mycosis fungoides
  27. nephrotic syndrome
  28. neuroblastoma
  29. non-Hodgkin’s lymphoma (NHL)
  30. osteogenic sarcoma
  31. ovarian cancer
  32. peripheral blood stem cell (PBSC) mobilization
  33. peripheral T-cell lymphoma (PTCL)
  34. pneumonitis
  35. polyarteritis nodosa
  36. polymyositis
  37. pulmonary fibrosis
  38. retinoblastoma
  39. rhabdomyosarcoma
  40. rheumatoid arthritis
  41. scleroderma (systemic sclerosis)
  42. small cell lung cancer (SCLC)
  43. stem cell transplant preparation
  44. systemic anaplastic large-cell lymphoma
  45. systemic lupus erythematosus (SLE)
  46. thymoma
  47. trophoblastic disease
  48. uveitis
  49. Wegener’s granulomatosis

Side Effects

  1. abdominal pain
  2. acute respiratory distress syndrome (ARDS)
  3. alopecia
  4. amenorrhea
  5. anaphylactic shock
  6. anemia
  7. anorexia
  8. arthralgia
  9. ascites
  10. asthenia
  11. azoospermia
  12. bladder spasm
  13. bronchiolitis obliterans
  14. bronchospasm
  15. cardiac tamponade
  16. chills
  17. cholestasis
  18. colitis
  19. confusion
  20. conjunctivitis
  21. constipation
  22. cough
  23. diabetes insipidus
  24. diarrhea
  25. disseminated intravascular coagulation (DIC)
  26. dizziness
  27. dysesthesia
  28. dysgeusia
  29. dyspnea
  30. edema
  31. elevated hepatic enzymes
  32. erythema
  33. erythema multiforme
  34. fatigue
  35. fetal death
  36. fever
  37. fluid retention
  38. flushing
  39. GI bleeding
  40. gonadal suppression
  41. hearing loss
  42. heart failure
  43. hematuria
  44. hemolytic-uremic syndrome
  45. hemorrhagic cystitis
  46. hepatic encephalopathy
  47. hepatic failure
  48. hepatitis
  49. hepatomegaly
  50. hot flashes
  51. hyperbilirubinemia
  52. hyperglycemia
  53. hyperhidrosis
  54. hypertension
  55. hyperuricemia
  56. hypoesthesia
  57. hypoglycemia
  58. hyponatremia
  59. hypotension
  60. hypoxia
  61. immunosuppression
  62. impaired wound healing
  63. infection
  64. infertility
  65. injection site reaction
  66. lacrimation
  67. leukoencephalopathy
  68. leukopenia
  69. malaise
  70. menstrual irregularity
  71. myalgia
  72. myocarditis
  73. nasal congestion
  74. nausea
  75. neutropenia
  76. new primary malignancy
  77. oligospermia
  78. oral ulceration
  79. palmar-plantar erythrodysesthesia (hand and foot syndrome)
  80. pancreatitis
  81. paresthesias
  82. parotitis
  83. pericardial effusion
  84. pericarditis
  85. peripheral neuropathy
  86. phlebitis
  87. pleural effusion
  88. pneumonitis
  89. premature labor
  90. pruritus
  91. pulmonary edema
  92. pulmonary embolism
  93. pulmonary fibrosis
  94. pulmonary hypertension
  95. radiation recall reaction
  96. rash
  97. renal failure (unspecified)
  98. renal tubular necrosis
  99. respiratory arrest
  100. rhabdomyolysis
  101. rhinorrhea
  102. seizures
  103. SIADH
  104. sinusoidal obstruction syndrome (SOS)
  105. skin hyperpigmentation
  106. skin necrosis
  107. Stevens-Johnson syndrome
  108. stomatitis
  109. teratogenesis
  110. testicular atrophy
  111. thrombocytopenia
  112. thromboembolism
  113. thrombosis
  114. thrombotic microangiopathy
  115. tinnitus
  116. toxic epidermal necrolysis
  117. tremor
  118. tumor lysis syndrome (TLS)
  119. typhlitis
  120. urticaria
  121. vasculitis
  122. veno-occlusive disease (VOD)
  123. visual impairment
  124. vomiting

Monitoring Parameters

  • CBC with differential

Contraindications

  • anemia
  • bladder obstruction
  • bone marrow suppression
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • cardiac tamponade
  • children
  • dialysis
  • geriatric
  • heart failure
  • hematuria
  • hemorrhagic cystitis
  • hepatic disease
  • herpes infection
  • hyponatremia
  • infection
  • infertility
  • leukopenia
  • male-mediated teratogenicity
  • myocarditis
  • neutropenia
  • new primary malignancy
  • pericardial effusion
  • pericarditis
  • pneumonitis
  • pregnancy
  • pulmonary fibrosis
  • QT prolongation
  • radiation therapy
  • renal impairment
  • surgery
  • thrombocytopenia
  • tumor lysis syndrome (TLS)
  • urinary tract infection (UTI)
  • urinary tract obstruction
  • vaccination
  • varicella
  • ventricular arrhythmias
  • viral infection

Interactions

  • Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
  • Abatacept
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Adalimumab
  • Alefacept
  • Amiodarone
  • Amlodipine; Benazepril
  • Amobarbital
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Angiotensin-converting enzyme inhibitors
  • Anthracyclines
  • Antithymocyte Globulin
  • Articaine; Epinephrine
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Atracurium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Azathioprine
  • Bacillus Calmette-Guerin Vaccine, BCG
  • Barbiturates
  • Basiliximab
  • Belimumab
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Benazepril
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bupivacaine
  • Bupivacaine Liposomal
  • Bupivacaine; Lidocaine
  • Busulfan
  • Butabarbital
  • Captopril
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbamazepine
  • Certolizumab pegol
  • Chloroprocaine
  • Ciprofloxacin
  • Cisatracurium
  • Clopidogrel
  • Clozapine
  • Cytarabine, ARA-C
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Daunorubicin Liposomal
  • Daunorubicin Liposomal; Cytarabine Liposomal
  • Doxacurium
  • Doxorubicin Liposomal
  • Echinacea
  • Efalizumab
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Enalapril, Enalaprilat
  • Enalapril; Felodipine
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Etanercept
  • Ethotoin
  • Febuxostat
  • Filgrastim, G-CSF
  • Fosinopril
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Golimumab
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Imatinib
  • Indomethacin
  • Influenza Virus Vaccine
  • Intranasal Influenza Vaccine
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Lamivudine, 3TC; Zidovudine, ZDV
  • Lidocaine
  • Lisinopril
  • Live Vaccines
  • Lopinavir; Ritonavir
  • Luliconazole
  • Lumacaftor; Ivacaftor
  • Lumacaftor; Ivacaftor
  • Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
  • Measles/Mumps/Rubella Vaccines, MMR
  • Mephobarbital
  • Mepivacaine
  • Mepivacaine; Levonordefrin
  • Methohexital
  • Metronidazole
  • Mifepristone
  • Mitotane
  • Mivacurium
  • Modafinil
  • Moexipril
  • Nafcillin
  • Natalizumab
  • Nefazodone
  • Nelfinavir
  • Netupitant, Fosnetupitant; Palonosetron
  • Neuromuscular blockers
  • Nevirapine
  • Nicardipine
  • Octreotide
  • Ombitasvir; Paritaprevir; Ritonavir
  • Omeprazole; Amoxicillin; Rifabutin
  • Ondansetron
  • Orphenadrine
  • Paclitaxel
  • Palifermin
  • Pancuronium
  • Pegfilgrastim
  • Penicillamine
  • Penicillin G Benzathine; Penicillin G Procaine
  • Penicillin G Procaine
  • Pentobarbital
  • Pentostatin
  • Perindopril
  • Perindopril; Amlodipine
  • Phenobarbital
  • Phenytoin
  • Posaconazole
  • Prilocaine
  • Prilocaine; Epinephrine
  • Primidone
  • Quinapril
  • Ramipril
  • Rapacuronium
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Rifaximin
  • Rilonacept
  • Ritonavir
  • Rituximab
  • Rituximab; Hyaluronidase
  • Rocuronium
  • Ropivacaine
  • Rotavirus Vaccine
  • Rubella Virus Vaccine Live
  • Saquinavir
  • Secobarbital
  • Simeprevir
  • Smallpox and Monkeypox Vaccine, Live, Nonreplicating
  • Smallpox Vaccine, Vaccinia Vaccine
  • St. John’s Wort, Hypericum perforatum
  • Succinylcholine
  • Tbo-Filgrastim
  • Telithromycin
  • Telotristat Ethyl
  • Temozolomide
  • Tetracaine
  • Thiazide diuretics
  • Thiopental
  • Thiotepa
  • Ticlopidine
  • Tipranavir
  • Tocilizumab
  • Trandolapril
  • Trandolapril; Verapamil
  • Tuberculin Purified Protein Derivative, PPD
  • Tubocurarine
  • Typhoid Vaccine
  • Valproic Acid, Divalproex Sodium
  • Varicella-Zoster Virus Vaccine, Live
  • Vasopressin, ADH
  • Vecuronium
  • Verapamil
  • Voriconazole
  • Warfarin
  • Yellow Fever Vaccine, Live
  • Zidovudine, ZDV
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