III. Mechanism

  1. See Alkylating Agent
  2. Synthetic alkylating Antineoplastic Agent
  3. Prodrug precursor of nitrogen mustards, metabolized in the liver to aldophosphamide and phosphoramide
  4. As with other Alkylating Agents, cross-binds DNA, blocking cell replication and other cellular functions
    1. Inhibits B Cell proliferation more than T Cells

IV. Medications

  1. Oral: 25 and 50 mg tablets and capsules
  2. IV: 500 mg, 1 g, 2 g vials

V. Dosing

  1. See other references for disease specific dosing protocols
  2. Stay hydrated while taking Cyclophosphamide to prevent hemorrhagic cystitis

VI. Adverse Effects

  1. Alopecia
  2. Cardiotoxicity
  3. Gastrointestinal upset
  4. Hemorrhagic Cystitis
    1. Maximize hydration near drug administration
    2. Consider concurrent Mesna administration when high dose Cyclophosphamide is administered
  5. Hypersensitivity
  6. Impaired future fertility
  7. Leukopenia
  8. Secondary Malignancy

VII. Safety

  1. Avoid in Lactation
  2. Avoid in Pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count
    2. Urinalysis
      1. Observe for Microscopic Hematuria

VIII. Drug Interactions

  1. Drugs that prolong Leukopenia or myelosuppression
    1. Allopurinol
    2. Thiazides
  2. Cyclophosphamide may decrease other drug levels and activity
    1. Digoxin
    2. Fluoroquinolones

IX. Resources

  1. Cyclophosphamide Powder for Injection Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=6bae5c14-9e87-4fb6-ae9c-4d875c1ecffe
  2. Cyclophosphamide Capsule (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=8135b917-882f-4b4c-99b7-fa8ea54af4bf
  3. Ogino and Tadi (2023) Cyclophosphamide, Stat Pearls, Treasure Island, FL, accessed 2/14/2024
    1. https://www.ncbi.nlm.nih.gov/books/NBK553087/

X. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

cyclophosphamide (on 7/19/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
CYCLOPHOSPHAMIDE 50 MG CAPSULE Generic $4.07 each