Cyclomid

Indications

Cyclophosphamide is used by specialists, often with other medicines, to treat:

• cancers such as lymphoma, some leukaemias, multiple myeloma, and cancers of the breast and ovary, and several childhood cancers;
• severe autoimmune diseases, such as lupus affecting the kidneys or inflammation of the blood vessels (vasculitis);
• some kidney conditions in children (nephrotic syndrome) that do not respond to steroids.

It is also used to prepare the body for a bone marrow or stem cell transplant.

How It Works

Cyclophosphamide is an alkylating agent. Once the liver activates it, it damages the DNA of cells that divide quickly, such as cancer cells, so they cannot grow. It also calms an overactive immune system.

Dosage and Administration

The dose depends on the condition, body size, blood counts and other treatment, and is given only as prescribed by a specialist.

Injection or drip: given in hospital by a doctor or trained nurse.

Tablets: swallow whole, usually in the morning. Do not break or chew them.

Drink plenty of fluids on treatment days and for a day or two after, and pass urine often, to protect the bladder. A medicine called Mesna may also be given to protect the bladder.

Interactions

• Other cancer medicines and radiotherapy: side effects may add up.
• Allopurinol: may increase effects on the bone marrow.
• Live vaccines (such as oral polio, measles or yellow fever): must be avoided during and for some time after treatment.
• Medicines that can affect the heart, such as Doxorubicin: higher risk of heart problems.
• Medicines that change liver enzymes, such as Rifampicin, Carbamazepine or Phenytoin, can change its effect.

Tell your specialist about every medicine and herbal product you take.

Contraindications

• Severe bone marrow failure
• Active urinary tract infection, blockage of urine flow or bladder inflammation
• Pregnancy and breastfeeding
• Allergy to Cyclophosphamide

Side Effects

Common: nausea and vomiting, hair loss, loss of appetite, mouth sores, tiredness, low blood counts (infections, bleeding, anaemia), blood in the urine or bladder irritation, and missed periods or reduced fertility.

Less common or later: heart and lung problems, liver problems and, years later, a small risk of a second cancer.

Get medical help at once for fever of 38°C or higher, chills or sore throat; blood in the urine or pain on passing urine; unusual bruising or bleeding; breathlessness, chest pain or swollen legs; yellowing of the skin or eyes; or vomiting so severe you cannot keep fluids down.

Pregnancy and Lactation

Cyclophosphamide can seriously harm an unborn baby. Women must avoid pregnancy during treatment and for up to a year after; men should use condoms during treatment and for several months after, as the doctor advises. It can cause lasting infertility, so ask about storing eggs or sperm before starting. Do not breastfeed during treatment.

Precautions and Warnings

• Regular blood tests are needed.
• Take extra care in kidney or liver disease.
• Avoid people with infections, and wash hands often.
• Wounds may heal more slowly.
• Carers should wear gloves if handling broken tablets or body fluids for 2 days after a dose.

Overdose

Overdose is serious. Go to hospital immediately. Treatment is supportive, with protection of the bladder and care for low blood counts.

Therapeutic Class

Anticancer medicine (alkylating agent) and immunosuppressant.

Storage

Store as stated on the pack, usually below 25°C, in a dry place away from light and out of the reach of children. Mixed solutions are prepared and stored by hospital staff.