Adult: Low dose regimen: 2-6 mg/kg wkly as a single dose; moderate dose regimen: 10-15 mg/kg wkly as a single dose; high dose regimen: 20-40 mg/kg as a single dose every 10-20 days. Alternatively, 80-300 mg/m2 daily as a single dose, or 300-600 mg/m2 wkly as a single dose, or 600-1,500 mg/m2 as a single dose or short infusion at 10- to 20-day intervals.
Oral Nephrotic syndrome
Child: 2 mg/kg daily for 8-12 wk. Max cumulative dose: 168 mg/kg. Max duration: 90 days.
Adult: Low dose regimen: 2-6 mg/kg wkly in divided dose. Alternatively, 100-300 mg daily in divided doses, or 50-250 mg/m2 daily or 80-300 mg/m2 daily in divided doses.
Should be taken on an empty stomach. Preferably taken on an empty stomach, but may be taken w/ meals to minimise GI irritation. Ensure adequate fluid intake. Swallow whole.
Reconstitute w/ 25 mL for a 500 mg vial, 50 mL for a 1,000 mg vial or 100 mL for a 2,000 mg vial to a concentration of 20 mg/mL using NaCl 0.9% for direct IV push, or NaCl 0.9% or sterile water for inj for IV infusion. Gently swirl to mix. For IV infusion, dilute further w/ dextrose 5% in water, NaCl 0.45% or dextrose 5% and NaCl 0.9% inj to a minimum concentration of 2 mg/mL.
Y-site: Incompatible w/ amphotericin B cholesteryl sulfate complex.
Patient w/ bone marrow aplasia, urinary outflow obstruction, UTI, acute infection, drug- or radiation-induced urothelial toxicity. Pregnancy.
Patient w/ DM, severe immunosuppression, acute porphyria, pre-existing CV disease or those at risk for cardiotoxicity. Renal and hepatic impairment. Lactation.
Alopecia, skin and nails hyperpigmentation, nausea and vomiting, mucositis, inappropriate antidiuretic hormone secretion, carbohydrate metabolism disturbances, gonadal suppression, interstitial pulmonary fibrosis. Potentially Fatal: Anaphylactic reactions, bone marrow failure, severe immunosuppression, urotoxicity, cardiotoxicity, hyponatraemia, haemorrhagic cystitis.
Patient Counseling Information
This drug may cause visual impairment and dizziness, if affected, do not drive or operate machinery.
Monitor CBC w/ differential and platelets, serum electrolytes and creatinine, BUN, urinalysis. Monitor for signs/symptoms of haemorrhagic cystitis or other urinary/renal toxicity, cardiac, pulmonary and/or hepatic toxicity.
Symptoms: Urotoxicity, myelosuppression, cardiotoxicity (including cardiac failure), stomatitis, veno-occlusive hepatic disease. Management: Supportive treatment. May consider haemodialysis. Cystitis prophylaxis w/ mesna may be useful for urotoxicity.
Increased risk of cardiotoxicity w/ doxorubicin or other cardiotoxic drugs. May increase incidence of mucositis w/ protease inhibitors. May increase haematotoxicity and/or immunosuppression w/ ACE inhibitors, natalizumab, paclitaxel, thiazide diuretics, zidovudine. May increase pulmonary toxicity w/ amiodarone. May increase nephrotoxicity w/ amphotericin B. May result to acute water intoxication w/ indometacin. May increase risk of hepatotoxicity w/ azathioprine. May increase incidence of hepatic veno-occlusive disease and mucositis w/ busulfan. May increase risk of haemorrhagic cystitis w/ previous or concomitant radiotherapy. May result to acute encephalopathy w/ metronidazole. May increase risk of thromboembolic complications. May alter the effect of warfarin. May increase immunosuppressive effect of ciclosporin. May result to prolonged apnoea w/ depolarising muscle relaxants (e.g. suxamethonium).
Description: Cyclophosphamide is a prodrug which is converted in the body to the active metabolites. It acts at any stage of the cell cycle. It prevents cell division by cross-linking deoxyribonucleic acid (DNA) strands and reducing DNA synthesis. It also exerts a potent immunosuppressive effect. Pharmacokinetics: Absorption: Well absorbed from the GI tract. Bioavailability: >75%. Time to peak plasma concentration: Approx 1 hr (oral); 2-3 hr (IV as metabolites). Distribution: Widely distributed in the tissues, crosses the blood-brain barrier and placenta; enters breast milk. Volume of distribution: 30-50 L. Plasma protein binding: Approx 20%; >60% (some metabolites). Metabolism: Undergoes hepatic metabolism and converted to active metabolites acrolein, 4-aldophosphamide, 4-hydroperoxycyclophosphamide and nor-nitrogen mustard. Excretion: Via urine (10-20% as unchanged drug); faeces (4%). Mean half-life: 4-8 hr.
L01AA01 - cyclophosphamide ; Belongs to the class of alkylating agents, nitrogen mustard analogues. Used in the treatment of cancer.
Anon. Cyclophosphamide. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 12/01/2016.Buckingham R (ed). Cyclophosphamide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 12/01/2016.Cyclophosphamide Capsule (Roxane Laboratories, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 12/01/2016.Cyclophosphamide Injection, Powder for Solution (Sandoz Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 12/01/2016.Joint Formulary Committee. Cyclophosphamide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 12/01/2016.McEvoy GK, Snow EK, Miller J et al (eds). Cyclophosphamide. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 12/01/2016.