Cyclophosphamide (Cytoxan)

Article Translations: (Spanish)

How does this medicine work?

Cyclophosphamide (sy-kloh-fos-fuh-mide) destroys cancer cells in all phases of cell life. It is also used to treat inflammatory diseases such as rheumatoid arthritis, hepatitis (a liver condition), and other medical problems.

How is it given?

Cyclophosphamide is usually given into the vein (IV). It may be given in the hospital, clinic, or short stay unit.

Cyclophosphamide can also be given by mouth as a tablet. Give it at a regular time to keep a steady level in the bloodstream. Your child should be awake and alert when taking any medicine.

___ For children who cannot swallow pills:

1. Put on gloves.
2. Crush the tablet in a tablet crusher or between 2 spoons inside a clear plastic bag.
3. Mix the powder with a very small amount (about 1 teaspoon) of soft food such as applesauce, yogurt, ice cream, jelly, or chocolate syrup. Make sure your child takes all of the mixture.
4. Wash spoons and container right after use. Discard the plastic bag and gloves.

The pharmacy may be able to make an oral solution if needed. Wear gloves when drawing up a dose.

Are there any precautions about food or other medicines?

Cyclophosphamide may be taken with food to prevent stomach upset.

Important: Cyclophosphamide is removed from the body through the kidneys. A high fluid intake will help prevent bladder irritation. Encourage your child to drink twice the normal amount of fluids for 24 hours after cyclophosphamide is given.

Check with the doctor, nurse practitioner, or pharmacist before giving any other prescription or non-prescription medicines, herbs, or vitamins.

What should I do if a dose is missed?

If a dose is missed, give it as soon as you remember that day. Never give a double dose.

If your child throws up within 30 minutes after receiving a dose, give it again. If your child vomits after 30 minutes, do not repeat the dose. Call the oncology clinic or your doctor if more than one dose is missed or vomited.

What are the side effects?

Common

• low blood cell counts
• nausea, vomiting
• metallic taste at time of infusion
• irritation of the vein when given by peripheral IV
• loss of appetite
• hair loss

Occasional

• diarrhea
• irritation of the bladder
• darkened areas of skin or fingernails
• fluid retention

Rare

• lung irritation
• congestive heart failure
• secondary cancer
• infertility, depending on age and dose

Medicines may be given to help reduce nausea and vomiting.

With higher doses of cyclophosphamide, a medicine called mesna (Mesnex®) may be given to protect the bladder, and IV fluids may be given to flush the cyclophosphamide out of the bladder.

When should I call the doctor?

• pain when urinating
• blood in the urine
• unusual bleeding or bruising
• fever, chills
• sore throat, cough
• shortness of breath
• stomach or joint pain
• mouth sores
• continued vomiting

What else do I need to know?

All caregivers should wear gloves when handling urine, stool, and vomit while your child is receiving the chemotherapy and for 48 hours afterward. Urine, stool, and vomit can be safely disposed of in septic tanks and the sewer system.

Any clothing or bed linens that are contaminated with urine, stool, or vomit should be washed separately from other laundry in hot water and detergent. Anyone handling the contaminated laundry should wear gloves.

Blood counts are lowest 1 to 2 weeks after starting this medication.

This medication will make your child more susceptible to infection. Avoid unnecessary exposure to crowds or individuals with infections.

Encourage your child to urinate often.

It may be helpful to suck on hard candy while receiving cyclophosphamide to reduce any unpleasant taste.

You and your child should know the names of all the medicines he or she is taking. Share this information with anyone involved in your child's care.

If cyclophosphamide is given at home, always make sure you have enough medicine on hand. Each time you refill your prescriptions, check to see how many refills are left. If no refills are left, the pharmacist will need 2 or 3 days to contact the doctor to renew the prescription.

Check the label for the expiration date. Bring outdated or extra medicines back to the clinic or pharmacy for disposal. Do not flush them down the toilet or throw them in the garbage.

Store all medicines in their original container and away from direct sunlight or heat. Do not store pills in humid places such as the bathroom. Keep it out of children's reach, locked up if possible.

If too much or the wrong kind of chemotherapy medicine is taken, call the oncology clinic right away. If your child is unconscious or has a seizure, call 911.

Questions?

This is not specific to your child but provides general information. If you have any questions, please call the oncology clinic or pharmacy.

Last reviewed by Children's pharmacy 8/2015

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