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
- acute lymphocytic leukemia (ALL)
- acute myelogenous leukemia (AML)
- amyloidosis
- aplastic anemia
- Behcet’s syndrome
- breast cancer
- Burkitt’s lymphoma
- chronic lymphocytic leukemia (CLL)
- chronic myelogenous leukemia (CML)
- Churg-Strauss syndrome
- cutaneous T-cell lymphoma (CTCL)
- dermatomyositis
- heart transplant rejection
- heart transplant rejection prophylaxis
- Hodgkin lymphoma
- immune thrombocytopenic purpura (ITP)
- juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)
- kidney transplant rejection
- kidney transplant rejection prophylaxis
- liver transplant rejection
- liver transplant rejection prophylaxis
- lung transplant rejection
- lupus nephritis
- macroglobulinemia
- multiple myeloma
- mycosis fungoides
- nephrotic syndrome
- neuroblastoma
- non-Hodgkin’s lymphoma (NHL)
- osteogenic sarcoma
- ovarian cancer
- peripheral blood stem cell (PBSC) mobilization
- peripheral T-cell lymphoma (PTCL)
- pneumonitis
- polyarteritis nodosa
- polymyositis
- pulmonary fibrosis
- retinoblastoma
- rhabdomyosarcoma
- rheumatoid arthritis
- scleroderma (systemic sclerosis)
- small cell lung cancer (SCLC)
- stem cell transplant preparation
- systemic anaplastic large-cell lymphoma
- systemic lupus erythematosus (SLE)
- thymoma
- trophoblastic disease
- uveitis
- Wegener’s granulomatosis
Side Effects
- abdominal pain
- acute respiratory distress syndrome (ARDS)
- alopecia
- amenorrhea
- anaphylactic shock
- anemia
- anorexia
- arthralgia
- ascites
- asthenia
- azoospermia
- bladder spasm
- bronchiolitis obliterans
- bronchospasm
- cardiac tamponade
- chills
- cholestasis
- colitis
- confusion
- conjunctivitis
- constipation
- cough
- diabetes insipidus
- diarrhea
- disseminated intravascular coagulation (DIC)
- dizziness
- dysesthesia
- dysgeusia
- dyspnea
- edema
- elevated hepatic enzymes
- erythema
- erythema multiforme
- fatigue
- fetal death
- fever
- fluid retention
- flushing
- GI bleeding
- gonadal suppression
- hearing loss
- heart failure
- hematuria
- hemolytic-uremic syndrome
- hemorrhagic cystitis
- hepatic encephalopathy
- hepatic failure
- hepatitis
- hepatomegaly
- hot flashes
- hyperbilirubinemia
- hyperglycemia
- hyperhidrosis
- hypertension
- hyperuricemia
- hypoesthesia
- hypoglycemia
- hyponatremia
- hypotension
- hypoxia
- immunosuppression
- impaired wound healing
- infection
- infertility
- injection site reaction
- lacrimation
- leukoencephalopathy
- leukopenia
- malaise
- menstrual irregularity
- myalgia
- myocarditis
- nasal congestion
- nausea
- neutropenia
- new primary malignancy
- oligospermia
- oral ulceration
- palmar-plantar erythrodysesthesia (hand and foot syndrome)
- pancreatitis
- paresthesias
- parotitis
- pericardial effusion
- pericarditis
- peripheral neuropathy
- phlebitis
- pleural effusion
- pneumonitis
- premature labor
- pruritus
- pulmonary edema
- pulmonary embolism
- pulmonary fibrosis
- pulmonary hypertension
- radiation recall reaction
- rash
- renal failure (unspecified)
- renal tubular necrosis
- respiratory arrest
- rhabdomyolysis
- rhinorrhea
- seizures
- SIADH
- sinusoidal obstruction syndrome (SOS)
- skin hyperpigmentation
- skin necrosis
- Stevens-Johnson syndrome
- stomatitis
- teratogenesis
- testicular atrophy
- thrombocytopenia
- thromboembolism
- thrombosis
- thrombotic microangiopathy
- tinnitus
- toxic epidermal necrolysis
- tremor
- tumor lysis syndrome (TLS)
- typhlitis
- urticaria
- vasculitis
- veno-occlusive disease (VOD)
- visual impairment
- 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
