Classes
DEA Class; Rx
Common Brand Names; Cytoxan
- Antineoplastics, Alkylating;
- DMARDs, Immunomodulators
Description
Alkylating agent; has activity as both an antineoplastic and immunosuppressant
Used for the treatment of a variety of solid tumors, NHL, Hodgkin lymphoma, and ALL; oral cyclophosphamide used for nephrotic syndrome in pediatric patients; several off-label uses
Contraindicated in patients with urinary outflow obstruction
Indications
Indicated for the treatment of acute lymphocytic leukemia (ALL).
Contraindications
Severe myelosuppression
Hypersensitivity
Urinary outflow obstruction
Adverse Effects
- Neutropenia
- Fever
- Nausea
- Vomiting
- Anorexia
- Abdominal discomfort or pain
- Diarrhea
- Hemorrhagic colitis
- Oral mucosal ulceration
- Jaundice
- Alopecia
- Skin rash
- Pigmentation of skin and changes in nails
Warnings
Use with caution in patients with hepatic or renal impairment, leukopenia, thrombocytopenia, recent radiation therapy or chemotherapy
Pelvic irradiation potentiates hemorrhagic cystitis
Potential for radiation recall when used in conjunction with radiation therapy
Risk of potentially fatal and irreversible interstitial pulmonary fibrosis if given over prolonged periods
May cause infertility in male patients who received high doses as children
Monitor for secondary malignancies
Heart Failure risk
- Acute heart failure, often occurring within 1 to 10 days of treatment, has been reported
- Subclinical decreases in LVEF in up to 50% of cases have also been seen
- The onset of HF usually resolves over 3 to 4 weeks; However, fatalities caused by HF have been reported
- Large individual doses (greater than 120–170 mg/kg or 1.55 mg/m 2 per day), old age, mediastinal radiation, and anthracycline use have been identified as risk factors
Pregnancy and Lactation
Based on mechanism of action and published reports of effects in pregnant patients or animals, drug can cause fetal harm when administered to pregnant woman; exposure to cyclophosphamide during pregnancy may cause fetal malformations, miscarriage, fetal growth retardation, and toxic effects in the newborn; drug is teratogenic and embryo-fetal toxic in mice, rats, rabbits and monkeys; advise pregnant women and females of reproductive potential of the potential risk to the fetus
Drug is present in breast milk; neutropenia, thrombocytopenia, low hemoglobin, and diarrhea have been reported in infants breast fed by women treated with cyclophosphamide; because of potential for serious adverse reactions in a breastfed child from therapy, advise lactating women not to breastfeed during treatment and for 1 week after last dose
Maximum Dosage
The suggested maximum tolerated dose (MTD) for cyclophosphamide is dependent on the disease state, performance status, and other chemotherapy agents or radiation therapy given in combination.
In conjunction with bone marrow transplantation, 240 mg/kg IV over a 4 day period (60 mg/kg/day IV) or 7 g/m2 (240 mg/kg) IV as a 96-hour continuous infusion have been reported as the MTD with acceptable myelosuppression and dose-limiting cardiotoxicity. Orally, 50 mg/m2/day PO for 14 days has been reported as the MTD.
In conjunction with bone marrow transplantation, 240 mg/kg IV over a 4 day period (60 mg/kg/day IV) or 7 g/m2 (240 mg/kg) IV as a 96-hour continuous infusion have been reported as the MTD with acceptable myelosuppression and dose-limiting cardiotoxicity. Orally, 50 mg/m2/day PO for 14 days has been reported as the MTD.
50 mg/kg IV in divided doses over a period of 2—5 days; 5 mg/kg/day PO.
50 mg/kg IV in divided doses over a period of 2—5 days; 5 mg/kg/day PO.
How supplied
Cyclophosphamide
powder for injection
- 500mg
- 1g
- 2g
tablet
- 25mg
- 50mg
