☠️ Warning: Cyclophosphamide is a highly toxic alkylating agent. It must only be prescribed by experienced specialists under close supervision. 💡 Famous for causing haemorrhagic cystitis – prevention is essential.

📖 About

Always check the BNF link here before use.

💊 Alkylating agent with profound bone marrow suppression.
⬇️ Immunity → high risk of infection, bleeding, and secondary malignancy.
🚫 Potent teratogen – contraindicated in pregnancy and breastfeeding.

⚙️ Mode of Action

Prodrug activated by hepatic cytochrome P450 to 4-hydroxy-cyclophosphamide.
Metabolites crosslink DNA → inhibit DNA replication & cell division.
⏱️ Effects may be delayed (up to 6 weeks in rheumatology indications).

🩸 Malignant Indications

Hodgkin’s disease & non-Hodgkin’s lymphomas (incl. Burkitt’s lymphoma).
Leukaemias (CLL, CML, AML, ALL in children).
Multiple myeloma, mycosis fungoides, neuroblastoma.
Breast carcinoma, ovarian adenocarcinoma, retinoblastoma.

🧬 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.

💊 Dose (Specialist Protocols)

⚠️ Always follow local oncology/rheumatology protocols. Below are typical regimens:

Rheumatology: 1–1.5 mg/kg/day PO for systemic disease.
IV pulses: 0.5–1 g every 2 weeks → then monthly (depending on response).
Cancer: protocols vary (see oncology guidelines).
Course length: often 3–6 months to induce remission.

🔄 Interactions

❌ Avoid live vaccines (e.g. yellow fever, varicella).
💊 Additive marrow suppression with other cytotoxics or radiotherapy.
Possible increased cardiotoxicity with anthracyclines.

⚠️ Contraindications

🚫 Pregnancy or breastfeeding.
🚫 Severe bone marrow suppression.
🚫 Active severe infection.

⚠️ Side Effects

🤢 Nausea, vomiting, mucositis.
🩸 Myelosuppression → neutropenia, infections, bleeding; later risk of AML/MDS.
🫁 Pulmonary fibrosis, 💔 cardiac toxicity (high doses).
💡 Haemorrhagic cystitis – prevent with vigorous hydration + MESNA.
⬆️ Long-term risk: bladder carcinoma, skin cancers, lymphomas.
⚠️ Infertility (permanent risk, esp. in young patients).
🧑‍🦲 Hair loss, menstrual irregularity, mouth ulcers.
🧪 Immunosuppression – seek medical help if sore throat, fever, or exposure to chickenpox/shingles.

📚 References

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Cyclophosphamide