Cyclophosphamide

Cyclophosphamide is a type of drug known as a disease-modifying anti-rheumatic drug, or DMARD. These drugs have the effect of dampening down the underlying disease process, rather than simply treating symptoms. Cyclophosphamide is a very powerful drug. One of its effects is to reduce the activity of the immune system (the body’s own defence system), and it is only prescribed under very close supervision.

Why is cyclophosphamide prescribed?

Cyclophosphamide is used for several different types of rheumatic disease, including systemic lupus erythematosus (SLE), diseases such as polyarteritis nodosa which inflame the walls of blood vessels, and sometimes for rheumatoid arthritis.

Cyclophosphamide is often prescribed along with steroid tablets.

When and how do I take cyclophosphamide?

There are several different ways in which cyclophosphamide can be prescribed. Your doctor will discuss the options with you. The dose will depend on your body weight and may change depending on how you respond to the cyclophosphamide.

The three main ways of taking cyclophosphamide are:

• low doses of tablets (usually taken once a day)
• high doses of tablets taken less often (e.g. once every 2 weeks)
• intravenous injection (injection into a vein).

Cyclophosphamide tablets should be taken with or after food (preferably in the morning or early afternoon). They should be taken with plenty of water and swallowed whole (not chewed). Intravenous injections need to be given in hospital and your doctor will tell you how often you need to have them.

How long does cyclophosphamide take to work?

Cyclophosphamide does not work immediately. It may take 6 weeks or more to produce an effect, depending on the illness for which it is being given.

What are the possible risks or side-effects?

A common side-effect of cyclophosphamide is nausea (feeling sick). Your doctor may prescribe medicine to control this.

One very important side-effect of cyclophosphamide is inflammation and bleeding of the bladder wall (haemorrhagic cystitis). If this occurs you may notice blood in your urine and you must see your doctor immediately. To reduce the risk of this happening, you should drink 8–10 glasses (i.e. 2–3 litres) of non-alcoholic drinks or water each day. Some doctors prescribe a drug called mesna along with cyclophosphamide to try to reduce the risk of cystitis.

Cyclophosphamide can also affect the blood count (one of the effects is that fewer blood cells are made). Taking cyclophosphamide can make you more likely to develop infections. You should tell your doctor or rheumatology nurse specialist straight away if you develop any of the following after starting cyclophosphamide:

• a sore throat

• a fever

• any other symptoms of infection

• unexplained bruising or bleeding

• any other new symptoms or anything else that concerns you.

You should stop cyclophosphamide and see your doctor immediately if:

• any of the symptoms listed above are severe
• you have not had chickenpox and you come into contact with someone who has chickenpox or shingles
• you develop chickenpox or shingles.

Chickenpox and shingles can be severe in people on treatments such as cyclophosphamide which affect the immune system. Therefore you may need antiviral treatment, which your doctor will be able to prescribe.

Sometimes cyclophosphamide can cause hair loss, mouth ulcers and irregular menstrual periods.

There is a slightly increased risk of certain types of cancer with cyclophosphamide. Discuss this with your doctor.

What other treatments could be used instead of cyclophosphamide?

A number of other drugs are used in the treatment of rheumatoid arthritis and related conditions. Your doctor will discuss these other options with you.

Will I need any special checks while on cyclophosphamide?

Because cyclophosphamide can affect the blood and the bladder, your doctor will arrange for you to have a blood and urine test before you start treatment and then regular blood and urine checks while on cyclophosphamide. You may be asked to keep a record booklet with your blood and urine test results, and you should bring this with you when you visit your GP or the hospital. You must not take cyclophosphamide unless you are having regular checks.

Can I take other medicines along with cyclophosphamide?

Cyclophosphamide may be prescribed along with other drugs in treating your condition. Some drugs interact with cyclophosphamide, so you should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are on cyclophosphamide.

Cyclophosphamide is not a painkiller. If you are already on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you can carry on taking these as well as cyclophosphamide, unless your doctor advises otherwise.

Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.

What about immunisations?

If you are on cyclophosphamide it is recommended that you should not be immunised with ‘live’ vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella immunisation in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the immunisation with you.

Pneumovax (which gives protection against the commonest cause of pneumonia) and yearly flu vaccines are safe and recommended.

Can I drink alcohol while on cyclophosphamide?

There is no particular reason to avoid alcohol while on cyclophosphamide.

Does cyclophosphamide affect fertility or pregnancy?

Cyclophosphamide can reduce fertility in both men and women and so, for young patients, it is used only with caution. The effect may be reversible if the cyclophosphamide treatment is stopped. You should discuss this with your doctor.

Cyclophosphamide should not be used by pregnant women. While taking cyclophosphamide, and for at least 3 months after treatment is stopped, both women and men must take contraceptive precautions. If you are planning a family or if you become pregnant while taking cyclophosphamide, you should discuss this with your doctor as soon as possible.

What about breastfeeding?

You should not breastfeed if you are on cyclophosphamide. The drug may pass into the breast milk and could be harmful to your baby.

Where can I obtain further information?

If you would like any further information about cyclophosphamide, or if you have any concerns about your treatment, you should discuss this with your doctor, rheumatology nurse or pharmacist.

 

Remember to keep all medicines out of reach of children.

PLEASE NOTE: We have made every effort to ensure that this content is correct at time of publication, but remember that information about drugs may change. This page is for general education only and does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet that comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects that may be relevant in your particular case.

Our drug information is revised annually and published at the start of the year.