Male patients who are sexually active with female partners who are or may become pregnant should use a condom during and for at least 4 months after treatment. Affected patients generally resume regular menses within a few months after cessation of therapy. The use of scarves, wigs, hats and hairpieces may help. This medication can interact with a number of medications including: metronidazole . Make sure your pharmacist knows to process this prescription through your Medicare part B and NOT part D. There are a number of things you can do to manage the side effect of cyclophosphamide. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. The presence of other medical problems may affect the use of this medicine. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Tumor cell accumulationIncreased risk of tumor cells entering the bone marrow, due to bone marrow depression from high doses of cyclophosphamide. Descriptions Cyclophosphamide is used to treat cancer of the ovaries, breast, blood and lymph system, and nerves (mainly in children). Your oncology care team can recommend medications to relieve diarrhea. St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Keep your fingernails and toenails clean and dry. 3 and platelets <50,000/mm 3. Before starting treatment, exclude or correct any urinary tract obstructions [see Contraindications (4)]. Oral: Swallow capsules whole; do not open, crush, or chew. Brush with a soft-bristle toothbrush or cotton swab twice a day. Cyclophosphamide is indicated for the treatment of biopsy proven minimal change nephrotic syndrome in pediatrics patients who failed to adequately respond to or are unable to tolerate adrenocorticosteroid therapy. You may wear nail polish, but not fake nails. Hyponatremia associated with increased total body water, acute water intoxication, and a syndrome resembling SIADH (syndrome of inappropriate secretion of antidiuretic hormone), which may be fatal, has been reported. Copyright 2023. OR DIRECT INJECTION USE, Baxter Logo : those who have a cold, fever or cough or live with someone with these symptoms). The doses below can be regarded as general guidelines: This hair loss can be all body hair, including pubic, underarm, legs/arms, eyelashes, and nose hairs. Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib) etc. For Direct Injection Use: Add 100 mL 0.9% Sodium Chloride Injection, USP, and shake vigorously to dissolve the drug. The dosing recommendations provided here are guidelines. Fetal growth retardation and toxic effects manifesting in the newborn, including leukopenia, anemia, pancytopenia, severe bone marrow hypoplasia, and gastroenteritis have been reported after exposure to cyclophosphamide. Please report all side effects to the doctor or nurse. This drug is frequently used in combination with other cytotoxic drugs as part of a chemotherapy regimen. Many other regimens of IV and oral administration of this drug have been reported. Advise female patients of reproductive potential to avoid becoming pregnant and to use highly effective contraception during treatment and for up to 1 year after completion of therapy [see Use in Specific Populations (8.6)]. Let your oncology care team know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums or blood in your urine or stool. Please consult with your healthcare team regarding use of these agents and all over the counter medications/supplements while on therapy. This hair loss can be all body hair, including pubic, underarm, legs/arms, eyelashes, and nose hairs. Pigmentation of the skin and changes in nails can occur. Late onset pneumonitis (greater than 6 months after start of cyclophosphamide) appears to be associated with increased mortality. The risk of bladder cancer may be reduced by prevention of hemorrhagic cystitis. Blenrep, Tecvayli, prednisone, methotrexate, triamcinolone, budesonide, prednisolone, Keytruda, Arimidex, mycophenolate mofetil. Cyclophosphamide can be given by intravenous (IV, into a vein) infusion or taken orally (by mouth) in a pill form. Cyclophosphamide can cause fetal harm when administered to a pregnant woman based on its mechanism of action and published reports of effects in pregnant patients or animals. Avoid smoking and chewing tobacco, drinking alcoholic beverages, and citrus juices. Serious consequences of overdosage include manifestations of dose dependent toxicities such as myelosuppression, urotoxicity, cardiotoxicity (including cardiac failure), veno-occlusive hepatic disease, and stomatitis [see Warnings and Precautions (5.1, 5.2, 5.3 and 5.6)]. Therefore, rapid hemodialysis is indicated when treating any suicidal or accidental overdose or intoxication. This medication may affect your reproductive system, resulting in the menstrual cycle or sperm production becoming irregular or stopping permanently. Hematopoietic system: The risk of cardiotoxicity may be increased with high doses of cyclophosphamide, in patients with advanced age, and in patients with previous radiation treatment to the cardiac region and/or previous or concomitant treatment with other cardiotoxic agents. Get Label RSS Feed, Dosages must be adjusted in accord with evidence of antitumor activity and/or leukopenia. Tablet Powder for solution for injection Indications and dose In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. Skin and Subcutaneous Tissue: toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, palmar-plantar erythrodysesthesia syndrome, radiation recall dermatitis, toxic skin eruption, urticaria, dermatitis, blister, pruritus, erythema, nail disorder, facial swelling, hyperhidrosis. Tell the doctor or nurse right away if you are not urinating as often as you usually do. Anorexia and, less frequently, abdominal discomfort or pain and diarrhea may occur. This may result in increased toxicity [see Clinical Pharmacology (12.3)]. Each vial contains 500 mg cyclophosphamide. IV: The doses below can be regarded as general guidelines: [see Dosage and Administration (2.3)]. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. This information is about the IV formulation. Dexamethasone 40 mg PO days 1,8 and 15. Immune: immunosuppression, anaphylactic shock and hypersensitivity reaction. Reconstitution of Cyclophosphamide:Reconstitute Cyclophosphamide using 0.9% Sodium Chloride Injection, USP or Sterile Water for Injection, USP with the volume of diluent listed below in Table 2. These highlights do not include all the information needed to use CYCLOPHOSPHAMIDE safely and effectively. How does AC (Adriamycin and Cytoxan [cyclophosphamide]) work for Breast Cancer? They should avoid touching the pills. Cyclophosphamide can pose a health hazard to caregivers. We comply with the HONcode standard for trustworthy health information. Keep containers out of reach of children and pets. Cyclophosphamide is a pro-drug that is activated by cytochrome P450s [see Clinical Pharmacology (12.3)]. Severe myelosuppression may be expected particularly in patients pretreated with and/or receiving concomitant chemotherapy and/or radiation therapy. being able to get an erection, but not having it last long enough for sex. You may notice dry skin or changes in the color or tone of your skin. You may use nail polish, but do not wear fake nails. Aldophosphamide can undergo -elimination to form active metabolites phosphoramide mustard and acrolein. If mouth sores become painful, your doctor or nurse can recommend a pain reliever. STOP TAKING CYCLOPHOSPHAMIDE AND SEE YOUR DOCTOR OR GET EMERGENCY HELP IMMEDIATELY IF YOU HAVE: Signs of an infection such as fever (over 100F or 38C by an oral thermometer); Patients who received an overdose should be closely monitored for the development of toxicities, and hematologic toxicity in particular. Prolonged apnea may occur with concurrent depolarizing muscle relaxants (e.g., succinylcholine). . Keep your fingernails and toenails clean and dry. Urinary sediment should be checked regularly for the presence of erythrocytes and other signs of urotoxicity and/or nephrotoxicity. Male and female reproductive function and fertility may be impaired in patients being treated with cyclophosphamide. Avoid the sun between 10-2pm, when it is strongest. It also can be given as a clear liquid into a vein (IV). lenalidomide 10 mg PO days 1-21. During that 48-hour period, caregivers should follow safety guidelines when handling the patients vomit, blood, urine, and bowel movements, including diapers. Shower or bath daily and perform frequent. The results demonstrated that the systemic exposure to cyclophosphamide increased as the renal function decreased. Possible Cyclophosphamide Side Effects. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. It may be given to you for other reasons. During or immediately after the administration, adequate amounts of fluid should be ingested or infused to force diuresis to reduce the risk of urinary tract toxicity; therefore, administration should be in the morning. Primary and secondary prophylaxis with G-CSF should be considered in patients considered to be at increased risk for neutropenia complications. Medically reviewed by Drugs.com. Aggressive hydration with forced diuresis and frequent bladder emptying can reduce the frequency and severity of bladder toxicity. MAINTENANCE (28-day alternating cycles until stopped for toxicity, relapse or death): Odd cycles (9, 11, 13, etc.) Each oral syringe holds one (1) dose. Oral doses should be taken whole (not crushed, chewed, or broken) and with food in order to decrease nausea. They can help you decide what will work best for you. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. It is used to treat nephrotic syndrome . Shower or bath daily and perform frequent. If the liquid form is used, each dose will be measured in advance by the pharmacy and put in an oral syringe. Depolarizing muscle relaxants: Cyclophosphamide treatment causes a marked and persistent inhibition of cholinesterase activity. Administration of cyclophosphamide to pregnant mice, rats, rabbits and monkeys during the period of organogenesis at doses at or below the dose in patients based on body surface area resulted in various malformations, which included neural tube defects, limb and digit defects and other skeletal anomalies, cleft lip and palate, and reduced skeletal ossification. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833). Other risk factors predisposing to the development of VOD include preexisting disturbances of hepatic function, previous radiation therapy of the abdomen, and a low performance status. If oral cyclophosphamide is used, the dose is typically 1 to 1.5 mg/kg per day, titrating up by 0.5 mg/kg per day every week up to 2 mg/kg per day (maximum dose 150 mg) if needed based on response, and continued for two to four months. For IV Infusion Use: Add 25 mL SterileWater for Injection, USP, and shakevigorously to dissolve the drug. The nadirs of the reduction in leukocyte count and thrombocyte count are usually reached in weeks 1 and 2 of treatment. View NDC Code(s)NEW! Written by Cerner Multum. 5833-278-866-1 ( : 1040-595-901-1). Hydration and frequent bladder emptying is recommended; however, if the patient is receiving mesna, frequent bladder emptying should be avoided. Store unused drug at controlled room temperature. Mayo Clinic on Incontinence - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Cyclophosphamide (Oral Route, Intravenous Route), Bacillus of Calmette and Guerin Vaccine, Live, Chickenpox (including recent exposure) or. Because cyclophosphamide may cause birth defects, do not take this medicine if you are pregnant. Cyclophosphamide does not contain any antimicrobial preservative and thus care must be taken to assure the sterility of prepared solutions. Neoplasms: acute leukemia, myelodysplastic syndrome, lymphoma, sarcomas, renal cell carcinoma, renal pelvis cancer, bladder cancer, ureteric cancer, thyroid cancer. For the liquid, use each oral syringe only one (1) time and then discard it in the trash. Dosages of this drug may depend upon the specific indication for its use and whether other medications are coadministered. Cyclophosphamide (also called "cyclo", Cytoxan) is an anticancer medicine. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration. (77F) [see USP Controlled Room Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. Cyclophosphamide is primarily excreted as metabolites. There are a number of things you can do to manage the side effect of cyclophosphamide. Approximately 20% of cyclophosphamide is protein bound, with no dose dependent changes. An oral dose of 2 mg per kg daily for 8 to 12 weeks (maximum cumulative dose 168 mg per kg) is recommended. Urotoxicity (bladder ulceration, necrosis, fibrosis, contracture and secondary cancer) may require interruption of cyclophosphamide treatment or cystectomy. This is a decision you and your doctor will make. Patients treated with cyclophosphamide received maintenance treatment with . All content 2023 Trustees of the University of Pennsylvania. Do not flush down the toilet or throw it in the trash. Get Pain Relief With the Most Common Arthritis Medications. There are some of the most common or important side effects: This medication can cause life threatening infections, with or without a decrease in white blood cell counts. The following adverse reactions have been identified from clinical trials or post-marketing surveillance. Cyclophosphamide should not be administered to patients with neutrophils 1,500/mm. Cyclophosphamide should not be administered to patients with neutrophils 1,500/mm3 and platelets < 50,000/mm3. For men, effective birth control is necessary during treatment and for at least 4 months after treatment. The nadirs of the reduction in leukocyte count and thrombocyte count are usually reached in weeks 1 and 2 of therapy. Please call the, It may be easier for you to get infections while you are receiving cyclophosphamide. Baxter Healthcare Corporation Dosages should be adjusted in accord with evidence of antitumor activity and/or leukopenia. Liver diseaseThe effect of cyclophosphamide may be decreased. In this study, 326 patients were included, and 87 patients were treated with cyclophosphamide, either as intravenous monthly pulses with a minimum dose of 500 mg/m 2 for 6-12 months or oral with a dosage of 1-2 mg/kg/day with a recommended duration of 12 months. Should not be prescribed without thorough knowledge of dose, indications and toxicity as contained in accompanying literature. To minimize the risk of dermal exposure, always wear gloves when handling vials containing Cyclophosphamide for Injection, USP. Using this medicine with any of the following medicines is not recommended. Cyclophosphamide is genotoxic in male and female germ cells. Take cyclophosphamide capsules on an empty stomach with a full glass of water. Malformations of the skeleton, palate, limbs and eyes as well as miscarriage have been reported after exposure to cyclophosphamide in the first trimester. They can help you decide what will work best for you. Severe renal impairment (CrCl 10 to 24 mL/min): Monitor these patients for toxicity. Bone marrow failure has been reported. Discuss these options with your oncology team. Hepatic: veno-occlusive liver disease, cholestatic hepatitis, cytolytic hepatitis, hepatitis, cholestasis; hepatotoxicity with hepatic failure, hepatic encephalopathy, ascites, hepatomegaly, blood bilirubin increased, hepatic function abnormal, hepatic enzymes increased. Advise patients on the potential risks for infertility [see Use in Specific Populations (8.4 and 8.6)]. FDA Safety Recalls, Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. Uses Warnings Before taking Side effects Interactions Dosage FAQ What is cyclophosphamide? 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