cyclophosphamide monohydrate at a glance
Medicine class
Alkylating cytotoxic and immunosuppressive agent.
Main roles
Treating several blood and solid cancers; selected injectable products also cover severe lupus nephritis and granulomatosis with polyangiitis.
How it is given
Oral tablets or a powder prepared for injection or infusion by trained staff.
Important checks
Regular blood counts and checks for infection and urinary toxicity are essential.
What is cyclophosphamide monohydrate used for?
Licensed uses represented by the selected products include:
Blood cancers including acute or chronic lymphocytic leukaemia, Hodgkin lymphoma, non-Hodgkin lymphoma and multiple myeloma.
Conditioning before bone-marrow transplantation for specified leukaemias.
Breast and ovarian carcinoma, Ewing sarcoma, small-cell lung cancer and advanced or metastatic neuroblastoma.
Life-threatening severe progressive lupus nephritis and granulomatosis with polyangiitis for the selected injectable product.
Other inflammatory or autoimmune uses may be unlicensed for a particular product and require specialist justification.
How does cyclophosphamide monohydrate work?
Cyclophosphamide is a prodrug activated mainly in the liver. Its active metabolites attach alkyl groups to DNA, disrupting replication and preferentially damaging rapidly dividing cells. Suppression of B cells and T cells explains its effect in severe autoimmune disease. A separate metabolite, acrolein, contributes to bladder toxicity.
cyclophosphamide monohydrate preparations and strengths
Tablet
Route: Oral
Strengths: 50 mg
Injection
Route: Parenteral
Strengths: 500 mg, 1000 mg, 2000 mg, 1 g
How to take cyclophosphamide monohydrate
Follow the schedule supplied by the specialist team; treatment is individualised and requires monitoring.
Swallow tablets with sufficient fluid without chewing, dividing or crushing them.
Injectable preparations are reconstituted and administered by trained healthcare professionals, usually through a vein.
Maintain fluid intake and empty your bladder regularly as instructed to reduce urinary toxicity. Mesna may also be prescribed for bladder protection.
Do not handle damaged tablets. Pregnant or breastfeeding people should not handle cyclophosphamide preparations.
cyclophosphamide monohydrate side effects
Common or expected effects
- Reduced blood-cell production, increasing infection risk and sometimes causing tiredness, bruising or bleeding
- Feeling sick or vomiting
- Hair thinning or loss, which is usually reversible
- Bladder irritation, including discomfort or blood in the urine
- Tiredness, appetite or taste changes
- Sore mouth or mouth ulcers
Get urgent medical advice
- Fever, chills or other signs of serious infection
- Unexplained bleeding, extensive bruising or marked pallor
- Blood in the urine, painful urination or substantially reduced urine output
- Severe allergic reaction with wheezing, swelling or collapse
- New or worsening breathlessness, chest symptoms or persistent cough
- Jaundice, sudden weight gain or painful liver enlargement
- Severe skin blistering, peeling or widespread painful rash
cyclophosphamide monohydrate in pregnancy
Cyclophosphamide can harm a developing baby and is contraindicated or not recommended during pregnancy under the selected product information, particularly in the first trimester. Discuss pregnancy plans, contraception and fertility preservation before treatment. Contact the specialist team promptly if pregnancy occurs.
cyclophosphamide monohydrate while breastfeeding
Breastfeeding is contraindicated during cyclophosphamide treatment. It enters breast milk and may suppress an infant's blood-cell production or cause other harm; specialist advice is needed about feeding alternatives.
cyclophosphamide monohydrate interactions
Check all prescribed, over-the-counter and herbal products with the specialist team. Important examples include:
Live vaccines
Immunosuppression can cause vaccine-related infection, while responses to other vaccines may be reduced.
Clozapine and other marrow-suppressing treatments
Combined use may increase leukopenia, infection or other blood toxicity.
Allopurinol
Bone-marrow suppression may be increased.
Common questions about cyclophosphamide monohydrate
Answers are fully visible for fast scanning and source review.
Is cyclophosphamide chemotherapy?
Yes. It is an alkylating cytotoxic treatment used for cancer, and its immune-suppressing action is also useful in selected severe autoimmune diseases.
Why is mesna given with cyclophosphamide?
Mesna helps protect the bladder from toxic metabolites that can cause inflammation and bleeding, although monitoring and hydration remain important.
Can cyclophosphamide tablets be crushed or split?
No. Swallow them without chewing, dividing or crushing; the coating reduces direct exposure to this cytotoxic substance.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.