Cyclophosphamide

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Administration

  • Type: Antineoplastic/immune modulating agent
  • Dosage Forms:
  • Routes of Administration: IV, oral
  • Common Trade Names:

Adult Dosing

  • Vasculitis: 2 mg/kg PO daily OR 15mg/kg IV q2 weeks x3 then q3 weeks. Adjust dose to avoid severe leukopenia
  • Lupus nephritis: 1g/m(2) IV monthly
  • Neuropsychiatric lupus: 0.75 g/m(2) IV q1mo x 1 year, then q3mo x 3 years
  • Oncologic uses: Typically much higher doses (e.g. 40 to 50 mg/kg IV over several days)

Pediatric Dosing

Special Populations

Contraindications

  • Allergy to class/drug
  • Urinary outflow obstruction

Adverse Reactions

Serious

  • Malignancy: leukemia, bladder, renal pelvis, dermis, angiosarcoma
  • Pericardial effusion, cardiac tamponade
  • Cardiac toxicity, CHF
  • SJS/TEN
  • Interstitial pneumonia, pulmonary fibrosis
  • Infection/sepsis
  • Bladder fibrosis/contracture, hemorrhagic cystitis,
  • Azoospermia

Common

  • Alopecia, skin pigmentation changes, rash, nail damage
  • Nausea/vomiting, diarrhea, anorexia
  • Leukopenia, neutropenia
  • Amenorrhea

Pharmacology

  • Half-life: 3-12h
  • Metabolism: Hepatic
  • Excretion: Renal

Mechanism of Action

  • Alkylating agent, cross-links strands of DNA and RNA, inhibits protein synthesis

Comments

See Also

References

  • Amant F, Deckers S, Van Calsteren K, et al. Breast cancer in pregnancy: recommendations of an international consensus meeting. Eur J Cancer. 2010;46(18):3158-3168. [PubMed 20932740]
  • Anderson JE, Appelbaum FR, Schoch G, et al, “Allogeneic Marrow Transplantation for Myelodysplastic Syndrome With Advanced Disease Morphology: A Phase II Study of Busulfan, Cyclophosphamide, and Total Body-Irradiation and Analysis of Prognostic Factors,” J Clin Oncol, 1996, 14(1):220-6. [PubMed 8558201]
  • Arndt C, Hawkins, D, Anderson JR, et al. Age is a Risk Factor for Chemotherapy-Induced Hepatopathy With Vincristine, Dactinomycin and Cyclophosphamide. J Clin Oncol. 2004;22(10):1894-1901. [PubMed 15143082]
  • Arndt CA, Stoner JA, Hawkins DS, et al. Vincristine, actinomycin, and cyclophosphamide compared with vincristine, actinomycin, and cyclophosphamide alternating with vincristine, topotecan, and cyclophosphamide for intermediate-risk rhabdomyosarcoma: children's oncology group study D9803. J Clin Oncol. 2009;27(31):5182-5188. doi: 10.1200/JCO.2009.22.3768. [PubMed 19770373]
  • Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed. Philadelphia, PA: American College of Physicians; 2007, p 97, 170.