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

Images: Related links to external sites (from Bing)

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

Ontology: Cyclophosphamide (C0010583)

Definition (MSH) Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the LIVER to form the active aldophosphamide. It has been used in the treatment of LYMPHOMA and LEUKEMIA. Its side effect, ALOPECIA, has been used for defleecing sheep. Cyclophosphamide may also cause sterility, birth defects, mutations, and cancer.
Definition (NCI) A synthetic alkylating agent chemically related to the nitrogen mustards with antineoplastic and immunosuppressive activities. In the liver, cyclophosphamide is converted to the active metabolites aldophosphamide and phosphoramide mustard, which bind to DNA, thereby inhibiting DNA replication and initiating cell death.
Definition (NCI_NCI-GLOSS) A drug that is used to treat many types of cancer and is being studied in the treatment of other types of cancer. It is also used to treat some types of kidney disease in children. Cyclophosphamide attaches to DNA in cells and may kill cancer cells. It is a type of alkylating agent.
Definition (CSP) precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent; used in the treatment of lymphomas, leukemias and other cancers, and as an immunosupressive agent to prevent transplant rejection; its side effect, alopecia, has been used for defleecing sheep; may also cause sterility, birth defects, mutations, and cancer.
Definition (PDQ) A synthetic alkylating agent chemically related to the nitrogen mustards with antineoplastic and immunosuppressive activities. In the liver, cyclophosphamide is converted to the active metabolites aldophosphamide and phosphoramide mustard, which bind to DNA, thereby inhibiting DNA replication and initiating cell death. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39748&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39748&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C405" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organophosphorus Compound (T115)
MSH D003520
SnomedCT 74470007, 387420009
LNC LP70366-7, MTHU029970
English Cyclophosphamide, Cyclophosphane, cyclophosphamide, N,N-Bis(2-chloroethyl)tetrahydro-2H-1,3,2-oxazaphosphorin-2-amine 2-Oxide, Ciclofosfamide, Zytoxan, Cyclophosphan, Cyclophosphanum, Mitoxan, Claphene, 2H-1,3,2-oxazaphosphorin-2-amine, N,N-is(2-chloroethyl)tetrahydro-,2-oxide, Cyclophospham, Cyclophosphamidum, Ciclofosfamida, Syklofosfamid, cyclophosphamide (medication), CYCLOPHOSPHAMIDE, Cyclophosphamide [Chemical/Ingredient], cyts, cyclophosphane, cyt, CPM - cyclophosphamide, CYT - cyclophosphamide, CTX - cyclophosphamide, Cytophosphane, (-)-Cyclophosphamide, CPM, CTX, CYT, Cyclophosphamide (product), Cyclophosphamide (substance)
Swedish Cyklofosfamid
Czech cyklofosfamid
Finnish Syklofosfamidi
Russian TSIKLOFOSFAMID, ЦИКЛОФОСФАМИД
Japanese シクロフォスファミド, シクロホスファミド, サイクロフォスファミド
Italian Ciclofosfano, Ciclofosfamide
Croatian CIKLOFOSFAMID
Polish Cyklofosfamid, Endoksan
Spanish CFM, ciclofosfamida (producto), ciclofosfamida (sustancia), ciclofosfamida, Ciclofosfamida
French Cyclophosphamide
German Cyclophosphamid
Portuguese Ciclofosfamida

Ontology: Cytoxan (C0699319)

Concepts Pharmacologic Substance (T121) , Organophosphorus Compound (T115)
MSH D003520
LNC LA14335-6
English cytoxan, and cytoxan, Cytoxan®, Cytoxan