β οΈ Warning: Cyclophosphamide is a highly toxic alkylating agent. It must only be prescribed by experienced specialists under close supervision.
π‘ Famous for causing haemorrhagic cystitis β prevention is essential.
π About
Always check the BNF link here before use.
- π Alkylating agent with profound bone marrow suppression.
- β¬οΈ Immunity β high risk of infection, bleeding, and secondary malignancy.
- π« Potent teratogen β contraindicated in pregnancy and breastfeeding.
βοΈ Mode of Action
- Prodrug activated by hepatic cytochrome P450 to 4-hydroxy-cyclophosphamide.
- Metabolites crosslink DNA β inhibit DNA replication & cell division.
- β±οΈ Effects may be delayed (up to 6 weeks in rheumatology indications).
π©Έ Malignant Indications
- Hodgkinβs disease & non-Hodgkinβs lymphomas (incl. Burkittβs lymphoma).
- Leukaemias (CLL, CML, AML, ALL in children).
- Multiple myeloma, mycosis fungoides, neuroblastoma.
- Breast carcinoma, ovarian adenocarcinoma, retinoblastoma.
𧬠Non-Malignant / Autoimmune Indications
- Severe, refractory rheumatoid arthritis.
- Systemic lupus erythematosus (esp. nephritis), myositis, systemic sclerosis, vasculitis.
- Steroid-resistant nephrotic syndrome, progressive IgA nephropathy.
- Life- or organ-threatening autoimmune disease when other therapies fail.
π Dose (Specialist Protocols)
β οΈ Always follow local oncology/rheumatology protocols. Below are typical regimens:
- Rheumatology: 1β1.5 mg/kg/day PO for systemic disease.
- IV pulses: 0.5β1 g every 2 weeks β then monthly (depending on response).
- Cancer: protocols vary (see oncology guidelines).
- Course length: often 3β6 months to induce remission.
π Interactions
- β Avoid live vaccines (e.g. yellow fever, varicella).
- π Additive marrow suppression with other cytotoxics or radiotherapy.
- Possible increased cardiotoxicity with anthracyclines.
β οΈ Contraindications
- π« Pregnancy or breastfeeding.
- π« Severe bone marrow suppression.
- π« Active severe infection.
β οΈ Side Effects
- π€’ Nausea, vomiting, mucositis.
- π©Έ Myelosuppression β neutropenia, infections, bleeding; later risk of AML/MDS.
- π« Pulmonary fibrosis, π cardiac toxicity (high doses).
- π‘ Haemorrhagic cystitis β prevent with vigorous hydration + MESNA.
- β¬οΈ Long-term risk: bladder carcinoma, skin cancers, lymphomas.
- β οΈ Infertility (permanent risk, esp. in young patients).
- π§β𦲠Hair loss, menstrual irregularity, mouth ulcers.
- π§ͺ Immunosuppression β seek medical help if sore throat, fever, or exposure to chickenpox/shingles.
π References