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Cyclophosphamide Treatment: Uses, Dosage, and Side Effects Guide
Summary or Key Points
Cyclophosphamide is a prescription medication used to treat various cancers, autoimmune diseases, and other serious conditions. It works by suppressing the immune system and slowing the growth of abnormal cells. Available in both oral and intravenous forms, it is essential to follow your healthcare provider’s instructions and promptly report any side effects. If you have questions, our telemedicine providers are available to assist you.
Names of Medication
US Brand Name: Cytoxan
Generic Name: Cyclophosphamide
The generic name refers to the active ingredient in the medication, which is listed in parentheses after the brand name.
Pharmacologic Category
Alkylating Agent
Antineoplastic Agent
Immunosuppressant
Cyclophosphamide Dosage
Cyclophosphamide is prescribed for a variety of conditions, with the dosage tailored to the specific illness being treated. Always follow your doctor’s instructions carefully, and never adjust your dose without consulting your healthcare provider. Our telemedicine team is available for guidance if needed.
Cyclophosphamide for Cancer Treatment
Dosage: 1-5 mg/kg/day, taken orally or intravenously, depending on the type of cancer and the treatment plan. The duration of treatment varies based on the cancer type and the patient’s response to therapy.
Cyclophosphamide for Lymphoma
Dosage: 600-750 mg/m² intravenously every 3-4 weeks, often in combination with other chemotherapy drugs. The length of treatment depends on the type of lymphoma and the patient’s response.
Cyclophosphamide for Leukemia
Dosage: 1-3 mg/kg/day, administered orally or intravenously. Treatment typically lasts several months, depending on the type of leukemia.
Cyclophosphamide for Multiple Sclerosis (MS)
Dosage: 500-1000 mg/m² intravenously every 4-8 weeks. Cyclophosphamide is used in severe, relapsing cases of MS that have not responded to other treatments.
Cyclophosphamide for Nephrotic Syndrome
Dosage: 2-3 mg/kg/day orally for 8-12 weeks. Cyclophosphamide is prescribed for patients with steroid-resistant nephrotic syndrome.
Cyclophosphamide for Rheumatoid Arthritis
Dosage: 1-2 mg/kg/day orally. Treatment is typically short-term and reserved for severe cases that have not responded to other therapies.
Cyclophosphamide for Systemic Lupus Erythematosus (SLE)
Dosage: 500-1000 mg/m² intravenously every month for 6 months, followed by every 3 months for 2 years. Cyclophosphamide is often used in severe lupus cases, particularly when the kidneys or other organs are affected.
Cyclophosphamide for Granulomatosis with Polyangiitis
Dosage: 2 mg/kg/day, taken orally or intravenously. The duration of treatment depends on the severity of the disease and the patient’s response to therapy.
Cyclophosphamide for Scleroderma
Dosage: 500-1000 mg/m² intravenously every 4-8 weeks. Cyclophosphamide is used in patients with severe lung involvement due to scleroderma.
Cyclophosphamide for Thrombotic Thrombocytopenic Purpura (TTP)
Dosage: 1-2 mg/kg/day, administered orally or intravenously. Treatment is typically short-term and used in conjunction with other therapies.
Dosage Forms and Strengths
Oral Tablets: 25 mg, 50 mg
Intravenous (IV) Injection: 100 mg, 200 mg, 500 mg, 1 g, 2 g vials
Contraindications for Cyclophosphamide
Contraindications are specific situations where a medication should not be used due to the potential for harm. Cyclophosphamide has several contraindications, meaning it should not be taken by certain individuals or under specific conditions. Below are the primary contraindications for Cyclophosphamide and the reasons it is not recommended in these cases:
Allergy to Cyclophosphamide: If you have a known allergy to Cyclophosphamide or any of its components, taking this medication could trigger a severe allergic reaction, which may include symptoms such as rash, swelling, or difficulty breathing.
Severe Bone Marrow Suppression: Cyclophosphamide can further suppress bone marrow function, leading to dangerously low blood cell levels. If you already have severe bone marrow suppression, this medication could worsen your condition.
Active Infections: Since Cyclophosphamide weakens the immune system, taking it during an active infection could impair your body’s ability to fight the infection, potentially leading to serious complications.
Urinary Outflow Obstruction: Cyclophosphamide can irritate the bladder and increase the risk of urinary complications. If you have a condition that obstructs urine flow, this medication could exacerbate your symptoms.
Drug to Drug Interactions with Cyclophosphamide
Cyclophosphamide can interact with other medications, increasing the risk of side effects or reducing the effectiveness of either drug. Always inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements. Below are some medications that may interact with Cyclophosphamide:
Allopurinol (Zyloprim): May increase the risk of bone marrow suppression when taken with Cyclophosphamide.
Warfarin (Coumadin): Cyclophosphamide may enhance the effects of warfarin, increasing the risk of bleeding.
Phenobarbital (Luminal): May reduce Cyclophosphamide’s effectiveness by speeding up its breakdown in the liver.
Rifampin (Rifadin): Can decrease Cyclophosphamide’s effectiveness by increasing its metabolism in the liver.
Live Vaccines: Cyclophosphamide suppresses the immune system, and taking live vaccines (such as MMR or varicella) can increase the risk of developing the disease the vaccine is intended to prevent.
Cyclophosphamide in Pregnancy
Is it safe to take Cyclophosphamide when pregnant?
No, Cyclophosphamide is not considered safe during pregnancy. It can cause harm to the developing fetus, potentially leading to birth defects or miscarriage. If you are pregnant or planning to become pregnant, it is crucial to discuss alternative treatments with your healthcare provider. If you are currently taking Cyclophosphamide and discover you are pregnant, contact your healthcare provider immediately to discuss the risks and explore your options.
Cyclophosphamide while Breastfeeding
Is it safe to take Cyclophosphamide while breastfeeding?
No, Cyclophosphamide is not recommended while breastfeeding. The medication can pass into breast milk and may pose risks to your baby, including immune suppression or other serious side effects. If you are breastfeeding or planning to breastfeed, speak with your healthcare provider about alternative treatments or consider discontinuing breastfeeding while taking Cyclophosphamide.
Estimated Cost of Cyclophosphamide Medication
The cost of a 30-day supply of Cyclophosphamide without insurance can vary depending on the dosage and the pharmacy. With a GoodRx coupon, the price for a 30-day supply of Cyclophosphamide (50 mg tablets) typically ranges from $40 to $80. Prices may fluctuate, so it’s a good idea to check with your pharmacy or use a coupon service like GoodRx to find the best available price.
Possible Alternatives to Cyclophosphamide Treatment
If Cyclophosphamide is not suitable for you, there are alternative treatments available for the conditions it commonly treats. Below are some potential alternatives, but always consult your healthcare provider before making any changes to your treatment plan. You can also seek personalized advice from one of our providers via telemedicine.
Cancer
Alternatives may include other chemotherapy agents such as methotrexate or targeted therapies like imatinib (Gleevec). Depending on the type and stage of cancer, radiation therapy or surgery may also be viable options.
Lymphoma
Other chemotherapy drugs, such as rituximab (Rituxan), or targeted therapies like brentuximab (Adcetris) may be considered. Immunotherapy and stem cell transplants are also potential alternatives.
Leukemia
Treatment options may include other chemotherapy agents like cytarabine (Cytosar) or targeted therapies such as dasatinib (Sprycel). Bone marrow transplants may also be an option depending on the specific type of leukemia.
Multiple Sclerosis
Alternatives include disease-modifying therapies such as interferon beta (Avonex) or glatiramer acetate (Copaxone). In addition, lifestyle changes, including regular exercise and stress management, can help manage symptoms and improve quality of life.
Nephrotic Syndrome
Steroids like prednisone or immunosuppressants such as mycophenolate mofetil (CellCept) may be used as alternatives. Dietary adjustments, such as reducing salt intake, can also help manage symptoms and improve kidney function.
Rheumatoid Arthritis
Alternatives include disease-modifying antirheumatic drugs (DMARDs) like methotrexate or biologics such as adalimumab (Humira). Physical therapy and lifestyle modifications, including regular exercise, can also play a significant role in managing symptoms.
Systemic Lupus Erythematosus
Other immunosuppressants, such as azathioprine (Imuran), or biologics like belimumab (Benlysta) may be considered. Lifestyle changes, including sun protection and a balanced diet, can also help manage symptoms and reduce flare-ups.
Granulomatosis with Polyangiitis
Alternatives include other immunosuppressants like rituximab (Rituxan) or corticosteroids such as prednisone. Regular monitoring and lifestyle adjustments may also be necessary to manage the condition effectively.
Scleroderma
Immunosuppressants like mycophenolate mofetil (CellCept) or biologics such as tocilizumab (Actemra) may be considered. Physical therapy and skin care routines can also help manage symptoms and improve quality of life.
Thrombotic Thrombocytopenic Purpura
Plasma exchange and immunosuppressants like rituximab (Rituxan) are common alternatives. In some cases, corticosteroids or other treatments may be recommended based on the severity of the condition.
Recent Updates on Cyclophosphamide Research
Recent studies have focused on optimizing Cyclophosphamide dosing to minimize side effects while maintaining its effectiveness. Researchers are also exploring its use in combination with newer immunotherapies for cancer treatment, including checkpoint inhibitors. Additionally, ongoing studies are investigating Cyclophosphamide’s role in treating autoimmune diseases like lupus and multiple sclerosis, with the goal of improving long-term outcomes and reducing the need for prolonged immunosuppression. Always consult your healthcare provider for the most up-to-date information regarding your treatment options.
