cyclophosphamide at a glance
Medicine class
Alkylating cytotoxic and immunosuppressive agent
Important protection
Hydration, regular bladder emptying and sometimes mesna help reduce bladder toxicity
Routine checks
Blood counts, urine, kidney and liver function, and clinical assessments
What is cyclophosphamide used for?
The selected product is licensed for these conditions, alone or with other treatments:
Acute lymphocytic or lymphoblastic leukaemia and chronic lymphocytic leukaemia
Hodgkin lymphoma, non-Hodgkin lymphoma and multiple myeloma
Metastatic ovarian or breast cancer, and adjuvant treatment of breast cancer
Ewing sarcoma, small-cell lung cancer and advanced or metastatic neuroblastoma
Conditioning before bone-marrow transplantation for specified leukaemias
Life-threatening severe progressive lupus nephritis
Life-threatening severe granulomatosis with polyangiitis
How does cyclophosphamide work?
Liver enzymes convert cyclophosphamide into active metabolites that attach alkyl groups to DNA, disrupting cell replication. This affects rapidly dividing cancer cells and suppresses B cells and T cells involved in harmful immune responses. Another metabolite, acrolein, contributes to bladder toxicity.
cyclophosphamide preparations and strengths
Injection
Route: Parenteral
Strengths: 500 mg, 1000 mg, 2000 mg
How to take cyclophosphamide
This formulation is prepared and given into a vein by trained healthcare professionals, preferably as an infusion. Follow instructions about fluids, bladder emptying, mesna and anti-sickness treatment. Tell the team beforehand about infection symptoms, urinary problems or difficulty maintaining hydration.
Do not prepare or administer the vial yourself.
Tell the team about all prescribed, non-prescription and herbal products.
Do not ignore the urge to pass urine after treatment.
cyclophosphamide side effects
Common or expected effects
- Reduced white cells, red cells or platelets, increasing infection, tiredness, bruising or bleeding risks
- Hair loss
- Bladder irritation or blood in the urine
- Fever, chills, weakness or malaise
- Mouth inflammation
- Nausea or vomiting
Get urgent medical advice
- Fever, shivering or other infection symptoms
- Visible blood in urine, painful urination or difficulty passing urine
- Unexpected bleeding, marked bruising or pinpoint red-purple skin spots
- New breathlessness, persistent cough or chest pain
- Palpitations, fainting or swelling suggesting heart problems
- Severe confusion, seizure, severe headache or visual disturbance
- Yellow skin or eyes, painful abdominal swelling or sudden unexplained weight gain
- Facial or throat swelling, wheeze, collapse or another severe allergic reaction
cyclophosphamide in pregnancy
Cyclophosphamide can harm an unborn baby and is not recommended during pregnancy, particularly in the first trimester, unless a specialist decides the potential benefit outweighs the fetal risk. Discuss pregnancy plans or suspected pregnancy promptly. Effective contraception is advised during treatment and afterwards for the product-specified periods.
cyclophosphamide while breastfeeding
Breastfeeding is contraindicated because cyclophosphamide enters breast milk and may cause serious blood-cell effects and diarrhoea in the infant. Discuss feeding alternatives with the specialist team.
cyclophosphamide interactions
Interaction checks should cover prescriptions, non-prescription products, supplements and planned vaccines. Important examples include:
Live vaccines
Immunosuppression can allow vaccine-related infection; vaccination may also produce a weaker response.
Allopurinol
May increase bone-marrow suppression.
Clozapine and other marrow-suppressing treatments
Combined use may further lower blood-cell counts and increase infection risk.
Common questions about cyclophosphamide
Answers are fully visible for fast scanning and source review.
Is cyclophosphamide used for autoimmune disease?
Yes. The selected product is licensed for life-threatening severe progressive lupus nephritis and granulomatosis with polyangiitis. Use for non-malignant disease is restricted to life-threatening situations.
Why is mesna sometimes given?
Mesna binds harmful urinary metabolites and can reduce bladder toxicity.
Why are fluids important?
Adequate hydration increases urine flow, helping clear urinary metabolites and reduce bladder toxicity. Follow your treatment team's instructions, especially if you have heart or kidney problems.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.