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Cyclophosphamide

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Cyclophosphamide, Cytoxan

  • See Also
  1. Ifosfamide
  2. Chemotherapy
  3. Alkylating Agent
  • Indications
  1. FDA Approved
    1. Breast Cancer
    2. Leukemia
    3. Lymphoma
    4. Multiple Myeloma
    5. Mycosis Fungoides
    6. Neuroblastoma (metastatic)
    7. Nephrotic Syndrome (Minimal Change Disease, children)
    8. Ovarian Adenocarcinoma
    9. Retinoblastoma
  2. Off-Label
    1. Gestational Trophoblastic Disease (e.g. Hydatidiform Mole)
    2. Genitourinary Cancers (e.g. Bladder Cancer, Testicular Cancer, Ovarian Cancer germ cell tumor)
    3. Granulomatosis with Polyangiitis (Wegener's Granulomatosis)
    4. Hemolytic Anemia (autoimmune)
    5. Idiopathic Thrombocytopenic Purpura (ITP)
    6. Multiple Sclerosis
    7. Myasthenia Gravis
    8. Pheochromocytoma
    9. Polyarteritis Nodosa
    10. Rheumatoid Arthritis or Juvenile Idiopathic Arthritis (severe, progressive, refractory)
    11. Sarcoma
    12. Small Cell Lung Cancer
    13. Hematopoietic Stem Cell Transplant
    14. Systemic Lupus Erythematosus
    15. Uveitis
    16. Vasculitis (steroid resistant)
    17. Waldenstrom's Macroglobulinemia
    18. Wilms Tumor (rare renal Cancer in Children)
  • Mechanism
  1. See Alkylating Agent
  2. Synthetic alkylating Antineoplastic Agent
  3. Prodrug precursor of nitrogen mustards, metabolized in the liver to aldophosphamide and phosphoramide
  4. As with other Alkylating Agents, cross-binds DNA, blocking cell replication and other cellular functions
    1. Inhibits B Cell proliferation more than T Cells
  • Medications
  1. Oral: 25 and 50 mg tablets and capsules
  2. IV: 500 mg, 1 g, 2 g vials
  • Dosing
  1. See other references for disease specific dosing protocols
  2. Stay hydrated while taking Cyclophosphamide to prevent hemorrhagic cystitis
  • Adverse Effects
  1. Alopecia
  2. Cardiotoxicity
  3. Gastrointestinal upset
  4. Hemorrhagic Cystitis
    1. Maximize hydration near drug administration
    2. Consider concurrent Mesna administration when high dose Cyclophosphamide is administered
  5. Hypersensitivity
  6. Impaired future fertility
  7. Leukopenia
  8. Secondary Malignancy
  • Safety
  1. Avoid in Lactation
  2. Avoid in Pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count
    2. Urinalysis
      1. Observe for Microscopic Hematuria
  • Drug Interactions
  1. Drugs that prolong Leukopenia or myelosuppression
    1. Allopurinol
    2. Thiazides
  2. Cyclophosphamide may decrease other drug levels and activity
    1. Digoxin
    2. Fluoroquinolones
  • Resources
  1. Cyclophosphamide Powder for Injection Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=6bae5c14-9e87-4fb6-ae9c-4d875c1ecffe
  2. Cyclophosphamide Capsule (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=8135b917-882f-4b4c-99b7-fa8ea54af4bf
  3. Ogino and Tadi (2023) Cyclophosphamide, Stat Pearls, Treasure Island, FL, accessed 2/14/2024
    1. https://www.ncbi.nlm.nih.gov/books/NBK553087/
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia