The drug should be used only under constant supervision by experienced physicians because concomitant therapy with other antineoplastic agents may cause potential risks and fatal complication.
The drug is used for continuous reduction or reduction induction of disease.
Induction Dosage: The initial course of cyclophosphamide for patients with no hematologic deficiency usually consists of 40 to 50 mg/kg given intravenously in divided doses over a period of 2 to 5 days.
For the treatment of patients who were previously under X-ray therapy or anti-neoplastic agents which can decrease bone marrow function like cytotoxic drugs, and patients whose bone marrow are infiltrated tumor, the recommended dose is 1/2-1/3 of the initial dose.
Although leukopenia, related to the above dosage, may occur, generally it will disappear 7-10 days after the administration. White blood cell count should be monitored in the induction duration.
Maintenance Dosage: The recommended dose for delay or suppression of tumor growth is the following: 10 to 15 mg/kg/day given every 7 to 10 days intravenously.
3 to 5 mg/kg/day twice a week intravenously.
It is generally advisable to administer the largest maintenance dose that reasonably can be tolerated by the patient, unless the disease is unusually sensitive to cyclophosphamide.
Measure of total white blood cell count is a good objective guide for maintenance dosage control. If decreases in the total white blood cell count to 3000-4000 cells/mm3 develop commonly in patients, the drug can be used without risk of serious infection or other complication.
Preparation and Handling of Solutions: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to medication, whenever solution and container permit.
Cyclophosphamide Injection should be prepared for parenteral use by adding Sterile Water for Injection to the vial. Use the quantity of diluent shown below to reconstitute the product (see Table).
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Solutions of Cyclophosphamide Injection may be injected intravenously, intramuscularly, intraperitoneally, or intrapleurally or they may be infused intravenously in the following diluent: Dextrose Injection (5% dextrose), Dextrose and Sodium Chloride Injection (5% dextrose and 0.9% sodium chloride), 5% Dextrose and Ringer's Injection, Sodium Chloride Injection (0.45% sodium chloride), Sodium Lactate Injection (1/6 molar sodium lactate).
Reconstituted Cyclophosphamide Injection does not contain any antimicrobial preservative and thus care must be taken to assure the sterility of prepared solutions.
The reconstituted solution should be used immediately, not exceeding 6 hours.
Extemporaneous liquid preparations of Cyclophosphamide for oral administration may be prepared by dissolving Cyclophosphamide Injection in Aromatic Elixir. The concentration of the solution is 1-5 mg of cyclophosphamide per mL. Such preparations should be stored under refrigeration and used within 14 days.