Disclaimer: This information is intended to help you understand your treatment. Always discuss your health and treatment plan with your doctor or nurse, who can answer your specific questions.
At a Glance: Quick Facts about Cyclophosphamide
- Generic Name: cyclophosphamide
- Brand Name(s): The original formulation of cyclophosphamide is Cytoxan® and Endoxan®. Cyclophosphamide is available as a generic. You can ask your healthcare provider for more information.
- Type of Drug: Alkylating Agent (a type of chemotherapy)
- How It’s Given: As an infusion into a vein (intravenous or IV) or as tablets to be taken by mouth (orally).
- Common Cancers Treated: A very wide range of cancers including breast cancer, ovarian cancer, leukaemias, lymphomas, multiple myeloma, and retinoblastoma. It is also used to treat certain autoimmune disorders.
About Cyclophosphamide
- What It Is and What It’s Used For: Cyclophosphamide is a classic and versatile chemotherapy drug that has been used for many years to treat a wide variety of cancers. It is an “alkylating agent,” which means it works by damaging the DNA of cancer cells. It is often given as part of a combination chemotherapy regimen.
- How It Works: Cyclophosphamide is inactive when it first enters the body. It travels to the liver, where it is broken down (“activated”) into its cancer-killing forms. These active chemicals then travel through the bloodstream and work by attaching to and damaging the DNA inside cancer cells. This damage is so severe that the cancer cells cannot repair themselves or divide, which causes them to die.
How You Will Receive This Drug
- Your Dosing Schedule: Your dose and schedule will vary greatly depending on whether you are receiving it as an IV infusion or as oral tablets.
- IV infusions are often given in cycles, for example, once every 2 to 4 weeks.
- Oral tablets are typically taken daily for a set period. Your doctor will determine the right dose, schedule, and number of cycles for you based on your specific condition.
- How It’s Given:
- Intravenous (IV): You will receive this at a hospital or clinic. A nurse will give it as an infusion into a vein, which can take from 30 to 60 minutes.
- Oral Tablets: If you are prescribed tablets, you should swallow them whole with a large glass of water. Do not crush or chew them. It is best to take them in the morning.
- Important Instructions: Cyclophosphamide can irritate the lining of the bladder. To prevent this, it is extremely important to drink plenty of fluids (at least 2-3 litres per day) throughout your treatment. You may also be given a protective drug called mesna with your IV infusion to help protect your bladder. Emptying your bladder frequently, including before you go to bed, is also crucial.
Possible Side Effects
This drug can cause many side effects, some of which are serious. Your healthcare team will monitor you closely. It’s very important to report any new or worsening symptoms to them right away.
- Most Common Side Effects:
- Nausea and Vomiting: Your doctor will prescribe anti-nausea medicine. Take it as directed to help prevent this.
- Low Blood Counts: This is a very common side effect. Cyclophosphamide can significantly lower your white blood cells (increasing your risk of serious infection), red blood cells (causing fatigue and weakness), and platelets (increasing your risk of bruising and bleeding). Your blood counts usually reach their lowest point about 7-14 days after treatment.
- Hair Loss: Hair thinning or complete hair loss is common. This is usually temporary, and your hair will grow back after treatment is finished.
- Loss of Appetite.
- Infertility: This drug can affect your ability to have children in the future. Discuss fertility preservation options with your doctor before starting treatment if this is a concern.
- Less Common but SERIOUS Side Effects:
- Bladder Problems (Hemorrhagic Cystitis): Cyclophosphamide can cause irritation and bleeding of the bladder lining. This is a serious side effect. Staying well-hydrated is the most important way to prevent this.
- Heart Problems: In high doses, cyclophosphamide can affect the heart muscle.
- Lung Problems: In rare cases, it can cause inflammation and scarring of the lungs.
- Secondary Cancers: Treatment can increase the risk of developing a secondary cancer, such as bladder cancer or leukaemia, months or years later.
- When to Contact Your Doctor Immediately: Call your doctor or go to an emergency room right away if you experience any of the following:
- Signs of Bladder Problems: Pain or burning when you urinate, needing to urinate more often, or seeing blood in your urine (pink, red, or dark-coloured urine).
- Signs of Infection: Fever over 38°C (100.4°F), chills, sore throat, a new cough, or shortness of breath.
- Signs of Serious Bleeding: Unusual bleeding or bruising, black or tarry stools, or blood in your vomit.
- Signs of Heart or Lung Problems: Sudden chest pain, new or worsening shortness of breath, or a rapid heartbeat.
Important Information to Discuss with Your Doctor
- Before You Start Treatment: It is crucial that you tell your doctor your full medical history. Be sure to mention if you:
- Have any bladder or kidney problems.
- Have any heart conditions.
- Have any liver problems.
- Are pregnant, planning to become pregnant, or are breastfeeding. Cyclophosphamide can cause serious harm to an unborn baby.
- Pregnancy and Contraception:
- Women: You must not become pregnant during this treatment. You must use effective birth control during treatment and for at least 1 year after your final dose.
- Men: You must not father a child during this treatment. You must use effective birth control during treatment and for at least 4 months after your final dose.
- Drug and Food Interactions: Tell your doctor and pharmacist about everything you take, including all prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. Do not eat grapefruit or drink grapefruit juice while taking cyclophosphamide tablets, as it can affect how the drug works.
Practical Tips While Taking Cyclophosphamide
- What to Do If You Miss a Dose (Oral Tablets): If you miss a dose of your tablets, contact your doctor or nurse for advice. Do not take a double dose to make up for the missed one.
- Storage (Oral Tablets): Store your tablets at room temperature, away from moisture and direct sunlight. Keep them safely out of the reach of children and pets.
- Follow-Up and Monitoring: You will have regular appointments and frequent blood tests to check your blood counts and monitor the function of your kidneys and liver.
Questions to Ask Your Healthcare Team
Don’t hesitate to ask questions. It helps you to be an active partner in your care.
- What is the main goal of this treatment for my cancer?
- What are the signs of bladder problems I need to watch for?
- How much fluid should I be drinking each day?
- Which of my side effects should I report to you immediately?
- What is the number to call if I have a problem at night or on the weekend?
- If I am concerned about fertility, what are my options?