II. Indications
- FDA Approved
- Breast Cancer
- Leukemia
- Lymphoma
- Multiple Myeloma
- Mycosis Fungoides
- Neuroblastoma (metastatic)
- Nephrotic Syndrome (Minimal Change Disease, children)
- Ovarian Adenocarcinoma
- Retinoblastoma
- Off-Label
- Gestational Trophoblastic Disease (e.g. Hydatidiform Mole)
- Genitourinary Cancers (e.g. Bladder Cancer, Testicular Cancer, Ovarian Cancer germ cell tumor)
- Granulomatosis with Polyangiitis (Wegener's Granulomatosis)
- Hemolytic Anemia (autoimmune)
- Idiopathic Thrombocytopenic Purpura (ITP)
- Multiple Sclerosis
- Myasthenia Gravis
- Pheochromocytoma
- Polyarteritis Nodosa
- Rheumatoid Arthritis or Juvenile Idiopathic Arthritis (severe, progressive, refractory)
- Sarcoma
- Small Cell Lung Cancer
- Hematopoietic Stem Cell Transplant
- Systemic Lupus Erythematosus
- Uveitis
- Vasculitis (steroid resistant)
- Waldenstrom's Macroglobulinemia
- Wilms Tumor (rare renal Cancer in Children)
III. Mechanism
- See Alkylating Agent
- Synthetic alkylating Antineoplastic Agent
- Prodrug precursor of nitrogen mustards, metabolized in the liver to aldophosphamide and phosphoramide
- As with other Alkylating Agents, cross-binds DNA, blocking cell replication and other cellular functions
- Inhibits B Cell proliferation more than T Cells
IV. Medications
- Oral: 25 and 50 mg tablets and capsules
- IV: 500 mg, 1 g, 2 g vials
V. Dosing
- See other references for disease specific dosing protocols
- Stay hydrated while taking Cyclophosphamide to prevent hemorrhagic cystitis
VI. Adverse Effects
- Alopecia
- Cardiotoxicity
- Gastrointestinal upset
- Hemorrhagic Cystitis
- Maximize hydration near drug administration
- Consider concurrent Mesna administration when high dose Cyclophosphamide is administered
- Hypersensitivity
- Impaired future fertility
- Leukopenia
- Secondary Malignancy
VII. Safety
- Avoid in Lactation
- Avoid in Pregnancy (all trimesters)
- Use reliable Contraception
- Monitoring
VIII. Drug Interactions
- Drugs that prolong Leukopenia or myelosuppression
- Cyclophosphamide may decrease other drug levels and activity
IX. Resources
- Cyclophosphamide Powder for Injection Solution (DailyMed)
- Cyclophosphamide Capsule (DailyMed)
- Ogino and Tadi (2023) Cyclophosphamide, Stat Pearls, Treasure Island, FL, accessed 2/14/2024
X. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
| cyclophosphamide (on 7/19/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| CYCLOPHOSPHAMIDE 50 MG CAPSULE | Generic | $4.07 each |