Drug reference

Cyclophosphamide

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 967, 968

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Rheumatoid arthritis with severe systemic manifestations ▶BY MOUTH ▶Adult: 1–1.5 mg/kg daily Severe systemic rheumatoid arthritis | Other connective tissue diseases (especially with active vasculitis) ▶BY INTRAVENOUS INJECTION ▶Adult: 0.5–1 g every 2 weeks, then reduced to 0.5–1 g every month, frequency adjusted according to clinical response and haematological monitoring. To be given Immune system and malignant disease with prophylactic mesna Used, mainly in combination with other agents for treating a wide range of malignancies, including some leukaemias, lymphomas, and solid tumours ▶BY MOUTH, OR BY INTRAVENOUS INFUSION ▶Adult: (consult local protocol) l UNLICENSED USE Not licensed for rheumatoid arthritis with severe systemic manifestations.

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Cautions

Avoid in Acute porphyrias p. 1120. diabetes mellitus. haemorrhagic cystitis. previous or concurrent mediastinal irradiation—risk of cardiotoxicity

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Safety

Important Safety Information

RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.

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Interactions

→Appendix 1: alkylating agents

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Side Effects

GENERAL SIDE-EFFECTS ▶Common or very common Agranulocytosis. alopecia. anaemia. asthenia. bone marrow disorders. cystitis. decreased leucocytes. fever. haemolytic uraemic syndrome. haemorrhage. hepatic disorders. immunosuppression. increased risk of infection. mucosal abnormalities. neutropenia. progressive multifocal leukoencephalopathy (PML). reactivation of infections. sperm abnormalities. thrombocytopenia ▶Uncommon Appetite decreased. embolism and thrombosis . ﬂushing. hypersensitivity. ovarian and fallopian tube disorders. sepsis ▶Rare or very rare Bladder disorders. chest pain. confusion . constipation. diarrhoea. disseminated intravascular coagulation. dizziness. eye inﬂammation. ﬂuid imbalance . headache. hyponatraemia. menstrual cycle irregularities . nail discolouration. nausea. neoplasms. oral disorders. pancreatitis acute. renal failure. secondary neoplasm. seizure. severe cutaneous adverse reactions (SCARs). SIADH. skin reactions. visual impairment. vomiting ▶Frequency not known Abdominal pain. altered smell sensation. arrhythmias. arthralgia. ascites. cardiac inﬂammation. cardiogenic shock. cardiomyopathy. cough . deafness. dyspnoea. encephalopathy. excessive tearing. facial swelling. gastrointestinal disorders. heart failure. hyperhidrosis. hypoxia. infertility. inﬂuenza like illness. multi organ failure. muscle complaints. myelopathy. myocardial infarction. nasal complaints. nephropathy. nerve disorders. neuralgia. neurotoxicity. oedema. oropharyngeal pain. palpitations. pericardial effusion. peripheral ischaemia. pulmonary hypertension. pulmonary oedema. QT interval prolongation. radiation injuries. renal tubular disorder. renal tubular necrosis. respiratory disorders. rhabdomyolysis. scleroderma. sensation abnormal. sinusoidal obstruction syndrome. taste altered. testicular atrophy. tinnitus. tremor. tumour lysis syndrome. vasculitis SPECIFIC SIDE-EFFECTS ▶With intravenous use Infusion site necrosis. injection site necrosis SIDE-EFFECTS, FURTHER INFORMATION Haemorrhagic cystitis A urinary metabolite of cyclophosphamide, acrolein, can cause haemorrhagic cystitis; this is a rare but serious complication that may be prevented by increasing ﬂuid intake for 24–48 hours after intravenous injection. Mesna can also help prevent cystitis when high-dose therapy (e.g. more than 2 g intravenously) is used or when the patient is considered to be at high risk of cystitis (e.g. because of pelvic irradiation). Secondary malignancy As with all cytotoxic therapy, treatment with cyclophosphamide is associated with an increased incidence of secondary malignancies. Immune system and malignant disease

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Conception And Contraception

Manufacturer advises effective contraception during and for at least 3 months after treatment in men or women. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.

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Pregnancy

Avoid. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.

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Breast Feeding

Discontinue breast-feeding during and for 36 hours after stopping treatment.

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Hepatic Impairment

Manufacturer advises caution (risk of decreased cyclophosphamide activation and increased risk of veno-occlusive liver disease). Dose adjustments Manufacturer advises consider dose adjustment in severe impairment—consult product literature.

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Renal Impairment

Dose adjustments Reduce dose if serum creatinine concentration greater than 120 micromol/litre.

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Dose and formulations

Directions For Administration

▶With intravenous use For intravenous infusion (cyclophosphamide injection; Baxter) give via drip tubing in Glucose 5% or Sodium chloride 0.9%; reconstitute 500 mg with 25 mL sodium chloride 0.9%; reconstitute 1 g with 50 mL sodium chloride 0.9%.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: tablet, oral suspension, oral solution, solution for injection, solution for infusion Tablet CAUTIONARY AND ADVISORY LABELS 25, 27 ▶Cyclophosphamide (Non-proprietary) Cyclophosphamide (as Cyclophosphamide monohydrate) 50 mg Cyclophosphamide 50mg tablets | 100 tablet P £139.00 DT = £139.00 ▶Cytoxan (Imported (United States)) Cyclophosphamide 25 mg Cytoxan 25mg tablets | 100 tablet P s Powder for solution for injection ▶Cyclophosphamide (Non-proprietary) Cyclophosphamide (as Cyclophosphamide monohydrate) 500 mg Cyclophosphamide 500mg powder for solution for injection vials | 1 vial P £9.20 (Hospital only) | 1 vial P £9.66 Cyclophosphamide (as Cyclophosphamide monohydrate) 1 gram Cyclophosphamide 1g powder for solution for injection vials | 1 vial P £10.66 (Hospital only) | 1 vial P £17.91 Cyclophosphamide (as Cyclophosphamide monohydrate) 2 gram Cyclophosphamide 2g powder for solution for injection vials | 1 vial P £31.64 (Hospital only)

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Dose text by age group

Adult

1–1.5 mg/kg daily

First-line fragment. Read the complete Indications and Dose section above.

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Adult

0.5–1 g every 2 weeks, then reduced to 0.5–1 g

First-line fragment. Read the complete Indications and Dose section above.

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Adult

(consult local protocol)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 967

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Cyclophosphamide

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 967, 968

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 967

Cautions

Avoid in Acute porphyrias p. 1120. diabetes mellitus. haemorrhagic cystitis. previous or concurrent mediastinal irradiation—risk of cardiotoxicity

PDF page 967

Safety

Important Safety Information

RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.

PDF page 967

Interactions

→Appendix 1: alkylating agents

PDF page 967

Side Effects

PDF pages 967, 968

Conception And Contraception

Manufacturer advises effective contraception during and for at least 3 months after treatment in men or women. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.

PDF page 968

Pregnancy

Avoid. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.

PDF page 968

Breast Feeding

Discontinue breast-feeding during and for 36 hours after stopping treatment.

PDF page 968

Hepatic Impairment

PDF page 968

Renal Impairment

Dose adjustments Reduce dose if serum creatinine concentration greater than 120 micromol/litre.

PDF page 968

Dose and formulations

Directions For Administration

PDF page 968

Medicinal Forms

PDF page 968

Dose text by age group

Adult

1–1.5 mg/kg daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 967

Adult

0.5–1 g every 2 weeks, then reduced to 0.5–1 g

First-line fragment. Read the complete Indications and Dose section above.

PDF page 967

Adult

(consult local protocol)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 967

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.