Cytoxan   (Cyclophosphamide, Neosar )

Brand name: Cytoxan®, Neosar®  

Generic name: Cyclophosphamide  

Other names: CTX 

Therapeutic Class: alkylating agent 

Manufacturer / Distributor: Viatris  

Availability: Cytoxan is available by prescription only  

Dosage form: Cytoxan can be taken by mouth in tablet form or by injection into a vein 

Indications: Cytoxan is used in the treatment of a variety of cancers; mainly:  

• 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).  

Cytoxan is sometimes used to treat non cancerous medical conditions; talk to your physician or pharmacist to have more information on Cytoxan  

Dosage:   The recommended dose of Cytoxan varies deepening the type of cancer being treated. Your age and body surface area (BSA) play a major role in the dosage. If you are treated with other chemotherapy medications, you will likely receive a lower dose of Cytoxan. In general, Cytoxan is taken by infusion into a vein or by mouth in tablet form. Your doctor will prescribe you the method most appropriate to your condition. 

If your doctor thinks it will be better that you take the drug in tablet form, you will be recommended to take the medication every day in small doses. In some cases, Cytoxan can be taken in large doses for a few days at a time, at intervals of two to four weeks between doses. If the intravenous form is chosen, the medication will be administered twice a week or larger doses every three or four weeks, depending on your health and condition being treated.  

In general, the injection of Cytoxan is done in a hospital or a center equipped for its preparation. The drug must be prepared and administered by specialists in oncology or hematology, or nurses who have experience in administering chemotherapy drugs.  

It is important that you drink plenty of fluids during the treatment. Drink at least 8 ounce glasses of fluid every day to help you urinate frequently; this prevents the drug from damaging your kidneys and other organs in your body. 

Storage: Keep Cytoxan 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 Cytoxan 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  Cytoxan 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. Cytoxan 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 Cytoxan, contact a poison control center or go to an emergency as soon as possible.     

Missing dose: When Cytoxan is given by injection, it is administered in hospital; missing dose is very difficult. If for some reasons you cannot be present at the hospital for the treatment, contact your health care provider before the appointment. If you are recommended to take Cytoxan by mouth in tablet form, 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. 

Contraindication: Cytoxan is contraindicated or should be used with precaution in the following conditions:  

• allergic to cyclophosphamide or any of its ingredients  
• pregnancy or breastfeeding  
• reduced white blood cell count  
• low platelet count (thrombocytopenia)  
• chronic liver dysfunction
• Chronic kidney dysfunction.

 Mechanism of action (MOA): Cytoxan is an immunosuppressant; it slows or stops the growth of cancer cells in your body by attacking the genetic material (DNA) they need to multiply.  

Interactions: Cytoxan should be taken exactly as recommended by your doctor or pharmacist. Cytoxan is often recommended to be taken in the morning to reduce the risk of bladder disorder. In addition, avoid taking the drug with food; it can cause stomach upset.  

Cytoxan may interact with certain substances; talk to your doctor before taking these products:  

• 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, Cytoxan can also affect normal cells, which can cause various adverse effects in some patients. Some Cytoxan 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 
• shortness of breath or difficulty breathing  
• unusual bruising or bleeding 
• swelling of the feet or ankles 
• Painful urination  
• Bloody or red urine.