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Generic name: Cyclophosphamide
Brand names: Cytoxan

Why is Cyclophosphamide prescribed?

Cytoxan, an anticancer drug, works by interfering with the growth of malignant cells. It may be used alone but is often given with other anticancer medications.

Cytoxan is used in the treatment of the following types of cancer:

Breast cancer
Leukemias (cancers affecting the white blood cells)
Malignant lymphomas (Hodgkin's disease or cancer of the lymph nodes)
Multiple myeloma (a malignant condition or cancer of the plasma cells)
Advanced mycosis fungoides (cancer of the skin and lymph nodes)
Neuroblastoma (a malignant tumor of the adrenal gland or sympathetic nervous system)
Ovarian cancer (adenocarcinoma)
Retinoblastoma (a malignant tumor of the retina)

In addition, Cytoxan may sometimes be given to children who have "minimal change" nephrotic syndrome (kidney damage resulting in loss of protein in the urine) and who have not responded well to treatment with steroid medications.

Most important fact about Cyclophosphamide

Cytoxan may cause bladder damage, probably from toxic byproducts of the drug that are excreted in the urine. Potential problems include bladder infection with bleeding and fibrosis of the bladder.

While you are being treated with Cytoxan, drink 3 or 4 liters of fluid a day to help prevent bladder problems. The extra fluid will dilute your urine and make you urinate frequently, thus minimizing the Cytoxan byproducts' contact with your bladder.

How should you take Cyclophosphamide?

Take Cytoxan exactly as prescribed. You will undergo frequent blood tests, and the doctor will adjust your dosage depending on your white blood cell count; a dosage reduction is necessary if the count drops below a certain level. You will also have frequent urine tests to check for blood in the urine, a sign of bladder damage.

Take Cytoxan on an empty stomach. If you have severe stomach upset, then you may take it with food.

If you are unable to swallow the tablet form, you may be given an oral solution made from the injectable form of Cytoxan and Aromatic Elixir. This solution should be used within 14 days.

--If you miss a dose...

Do not take the dose you missed. Go back to your regular schedule and contact your doctor. Do not take 2 doses at once.

--Storage instructions...

Store tablets at room temperature. Store the oral solution in the refrigerator.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor immediately. Only your doctor can determine if it is safe for you to continue using Cytoxan.

One possible Cytoxan side effect is the development of a secondary cancer, typically of the bladder, lymph nodes, or bone marrow. A secondary cancer may occur up to several years after the drug is given.

Cytoxan can lower the activity of your immune system, making you more vulnerable to infection.

Noncancerous bladder problems may occur during Cytoxan therapy (see "Most important fact about Cyclophosphamide" section, above).

• More common side effects may include:
  Loss of appetite, nausea and vomiting, temporary hair loss

Why should Cyclophosphamide not be prescribed?

Do not take Cyclophosphamide if you have ever had an allergic reaction to it.

Also, tell your doctor if you have ever had an allergic reaction to another anticancer drug such as Alkeran, CeeNU, Emcyt, Leukeran, Myleran, or Zanosar.

In adults, Cytoxan should not be given for "minimal change" nephrotic syndrome or any other kidney disease.

Also, Cytoxan should not be given to anyone who is unable to produce normal blood cells because the bone marrow--where blood cells are made--is not functioning well.

Special warnings about Cyclophosphamide

You are at increased risk for toxic side effects from Cytoxan if you have any of the following conditions:

Blood disorder (low white blood cell or platelet count)
Bone marrow tumors
Kidney disorder
Liver disorder
Past anticancer therapy
Past X-ray therapy

Possible food and drug interactions when taking Cyclophosphamide

If Cytoxan is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Cytoxan with the following:

Anticancer drugs such as Adriamycin
Allopurinol (the gout medicine Zyloprim)
Phenobarbital

If you take adrenal steroid hormones because you have had your adrenal glands removed, you are at increased risk for toxic effects from Cytoxan; your dosage of both the steroids and Cytoxan may need to be modified.

Special information if you are pregnant or breastfeeding

If you are pregnant or plan to become pregnant, inform your doctor immediately. When taken during pregnancy, Cytoxan can cause defects in the unborn baby. Women taking Cytoxan should use effective contraception. Cytoxan does appear in breast milk. A new mother will need to choose between taking Cyclophosphamide and nursing her baby.

Recommended dosage

ADULTS AND CHILDREN

Malignant Diseases

Your doctor will tailor your dosage according to your condition and other drugs taken with Cytoxan.

The recommended oral dosage range is 1 to 5 milligrams per 2.2 pounds of body weight per day.

CHILDREN

"Minimal Change" Nephrotic Syndrome

The recommended oral dosage is 2.5 to 3 milligrams per 2.2 pounds of body weight per day for a period of 60 to 90 days.

Overdosage

Although there is no specific information on Cytoxan overdose, any medication taken in excess can have serious consequences. If you suspect an overdose of Cytoxan, seek medical attention immediately.