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Last updated: Acute Kidney Injury…
on 10 Apr 2017

Cyclophosphamide



Indication

Alkylating agent used for:

  • Immunosuppression of autoimmune diseases eg vasculitis, lupus
  • Treatment of malignant disease
Preparations
  • Tablets - 50mg
  • Injection - slow IV bolus or in 100mls sodium chloride 0.9%
Contraindications
  • Hypersensitivity and haemorrhagic cystitis.
  • Pregnancy should be avoided during cyclophosphamide therapy and for three months thereafter
Cautions
  • Cyclophosphamide should be withheld in the presence of severe bone marrow depression and reduced doses should be used in the presence of lesser degrees of bone marrow depression. Regular blood counts should be performed in patients receiving cyclophosphamide
  • It should not normally be given to patients with severe infections and should be withdrawn if such infections become life threatening
Side-effects
  • Leucopenia, hair loss, rash, haematuria, bladder cancer. Amenorrhoea and azoospermia often occur during treatment with cyclophosphamide; but in most cases these are reversible
  • A high fluid intake should be maintained with frequent emptying of the bladder to reduce the risk of haematuria
Dose
  • Oral: 1-2.5mg/kg/day
  • IV: 15mg/kg/pulse. Give pulses every 2-3 weeks for 3-6 months to induce remission

The CYCLOPS (2012) study showed that there was no difference in time to relapse or mortality with daily oral vs pulsed iv, but there was less cyclophosphamide given cumulatively with pulsed iv dosing

Dose in renal impairment
Age (years) Creatinine (mmol/L) Creatinine (mmol/L)
  <300 >300
<60 15mg / kg / pulse 12.5mg / kg / pulse
≥ 60 12.5mg / kg / pulse 10mg / kg / pulse
≥ 70 10mg / kg / pulse 7.5mg / kg / pulse

 

Interactions
  • Increased risk of agranulocytosis with clozapine
  • Give preventative therapies such as co-trimoxazole and nystatin (or fluconazole) to prevent opportunistic infections
How to Prescribe View Details
Patient comment
  • Encourage patient to drink plenty of fluid
  • Cyclophosphamide and its metabolites are eliminated during dialysis
  • Mesna may be given to prevent urethral toxicity
  • Young male patients may wish to undertake sperm banking prior to therapy. Women may wish to have concomitant therapy to protect their ovaries, eg triptorelin to prevent ovulation

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