Cyclophosphamide

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)

Special Populations

• Pregnancy Rating: D
• Lactation risk: Infant risk has been demonstrated
• Renal dosing:
• Hepatic dosing:

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

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.