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Cyclophosphamide (Endoxan, Cytoxan, Neosar, Procytox, Revimmune)   

 

Warning: Although very rare, second cancers can develop in some patients treated with cyclophosphamideused alone or in association with other cancer chemotherapy drugs. Be sure to inform your physician of any allergies you might have with this drug.  Patients must be careful not to conceive during the treatment period and some weeks after.

 

Indications:  Cyclophosphamide is a drug used to combat cancer by slowing or completely stopping the growth of cancerous cells in patients.  Besides being a part of chemotherapy, it is also effective in treating a certain form of child kidney disease.  This drug has other applications as well, including treatment of rheumatoid arthritis and lupus.  It can be administered to transplant patients to prevent organ rejection

In general, Cyclophosphamide is, most of the times, used to treat the following cancers:

  • breast cancer  
  • testicular cancer 
  • endometrial cancer 
  • ovarian cancer 
  • lung cancers 
  • Ewing's sarcoma 
  • multiple myeloma
  • mycosis fungoides
  • neuroblastoma ..................... 
  • retinoblastoma 
  • rhabdomyosarcoma 
  • retinoblastoma
  • Lymphomas: Hodgkin’s lymphomas and non-Hodgkin's lymphomas 
  • Leukemias: chronic lymphocytic leukemia (CLL), chronic myelocytic leukemia (CML), acute myelocytic leukemia (AML), acute lymphocytic leukemia (ALL). 

Dosage:  Cyclophosphamide is doctor prescribed according to the conditions of the individual patient.  The medication can be taken by mouth in tablet form or by injection into a vein. When a health care professional does not administer the doses, the patient must strictly follow the instructions provided by his physician. The patient should also take care to wash hands after any handling.

Cyclophosphamide, also known by its generic form Cytoxan, should be taken under very careful control by children or the elderly, who can be more susceptible to its effects. 

Storage:  Keep Cyclophosphamide out of children reach. Store the medication at room temperature below 25 degrees Celsius (77 degrees Fahrenheit), and strictly away from temperatures exceeding 30 degrees Celsius. Always store Cyclophosphamide away from moisture and heat. Discard any unused doses after the expiration date. Talk to your pharmacist about the proper disposal of the medication. 

Overdose:  when  Cyclophosphamide is given in hospital by professionals, the risk of overdose is virtually nonexistent. When the drug is taken by mouth chance of overdose increases; either voluntary or involuntary, it may happen that some patients take higher dose. Cyclophosphamide overdose can cause severe and even fatal health problems. An accidental overdose in elderly and especially among young children can lead to death.  If you think you have taken an overdose of Cyclophosphamide, contact a poison control center or go to an emergency as soon as possible.     

Missing dose:  If you are recommended to take Cyclophosphamide by mouth in tablet form at home, you can easily forget to take it. If you forgot to take the drug for less than 12 hours, take the usual dose. Beyond 12 hours, it is better to wait for the next dose to continue taking the medication as usual; do not double. 

Interactions: Cyclophosphamide has significant interactions with specific drugs.  It can be used with Allopurinol (Zyloprim), to enhance the ability of the drug to control and lesson the production of blood cell that is produced in the bone marrow.

This medication should not be taken in conjunction with Doxorubicin (Adriamycin), which can increase chances of heart failure.  Blood thinners such as Coumarin (Coumadin) may perform their job too well in the presence of this drug.  Drugs like Cipro and other Quinolone antibiotics will be less effect in patients taking this drug.

Contraindications: It is important for patients to understand that they cannot plan to have children or actually be pregnant during the time of treatment with this medication.  Further, there is a period of time after delivery that a mother must postpone treatment in order to avoid transmission to her newborn, primarily through mother’s milk.  This drug can also affect family planning in other ways.  Though postponing the drug indefinitely may not be an option, couples need to be aware that this medication can cause temporary sterility for some time, and in some cases the sterility becomes permanent.

Although often not a consideration for a life-saving drug, appearance can be affected drastically by the drug and may be an issue for those whose occupation depends on a healthy, robust appearance.  In some cases, patients experience temporary hair loss, darkening of the nails, and yellowing of the eyes.  It can also cause abdominal pains, muscle spasms, and general weakness.  Time should be allowed during and after treatment to deal with these possible side effects.

It is possible that Cyclophosphamide interacts with the following substances:

  • vaccins
  • acetaminophen
  • aspirin
  • ibuprofen
  • ketoprofen 
  • naproxen
  • doxorubicin
  • etanercept
  • St. John's wort 
  • Phenobarbital
  • succinylcholine chloride
  • trastuzumab
  • Pain Killers
  • Anti anemia drugs such as filgrastim and pegfilgrastim

Side effects:  In addition to attacking cancer cells, Cyclophosphamide can also affect normal cells, which can cause various adverse effects in some patients. Some Cyclophosphamide side effects include:  

  • fatigue
  • hair loss
  • dizziness
  • nausea and vomiting
  • mouth sores
  • darkened and thickened skin
  • blistering skin or acne
  • decreased appetite
  • weight loss
  • Absence of menstrual bleeding (amenorrhea).

If the side effects above become severe or persist for long, contact your oncologist. In addition, contact your doctor immediately if you experience any of these symptoms:  

  • fever  
  • persistent coughing  
  • black, tarry stools  
  • persistent constipation or diarrhea   
  • sore throat
  • severe depression  
  • shortness of breath or difficulty breathing   
  • unusual bruising or bleeding  
  • swelling of the feet or ankles  
  • Painful urination   
  • Bloody or red urine.