Pharmacy - Intravenous Cyclophosphamide

Why have I been prescribed intravenous Cyclophosphamide?

Cyclophosphamide is a drug that can be used to treat auto immune conditions. It is used in several specialities including renal, dermatology, rheumatology & neurology. The clinician that prescribes this medicine for you will tell you about your condition and why Cyclophosphamide is being prescribed.

How does it work?

Intravenous Cyclophosphamide works by “damping down” the overactive immune system. The immune system makes antibodies and immune cells, which are in the blood to help your body to fight infections, such as those caused by bacteria and viruses. In certain illnesses the immune system becomes too active and fights the person’s own body instead of helping to protect it.  These kinds of diseases are called auto-immune diseases.

What dose will I be given?

The dose of Cyclophosphamide is dependent on your age, weight and renal function.

Why am I being prescribed intravenous Cyclophosphamide?

Cyclophosphamide is licensed to treat a wide range of cancers, and other auto-immune diseases. Cyclophosphamide can be given as a daily tablet or intravenously (into a vein), called a bolus injection every few weeks.

Intravenous Cyclophosphamide will not be prescribed if:

• You are pregnant or breastfeeding
• You have previously had a bad reaction to Cyclophosphamide

Before your Cyclophosphamide treatment, tell your doctor:

• If you are allergic to Cyclophosphamide
• If you are pregnant, trying for a baby or are likely to want to have a baby in the future
• If you are breastfeeding
• If you have chickenpox, shingles, other infections or are feeling unwell
• If you need any vaccinations in the near future, as some of them should not be given at the same time as Cyclophosphamide

When and how do I receive Cyclophosphamide?

You will be given Cyclophosphamide as an outpatient, by intravenous injection (into a vein), after having fluid via a drip (intravenous). The dose of Cyclophosphamide is calculated taking into account your age, weight and kidney function. You should drink plenty of water throughout the day before and after the treatment. You will need to empty your bladder (go for a wee) more often to avoid bladder irritation or soreness. Occasionally, patients feel sick after the treatment and are offered anti- sickness medicine before treatment. The frequency of the Cyclophosphamide will depend on the infusion schedule set by the doctor.

Can Cyclophosphamide cause side effects?

As with all medication, side effects are possible but will not affect everyone. However, you will be given other medicines to take home to prevent some of the potential side effects of Cyclophosphamide:

• The most common side effect is feeling nauseous and sometimes being sick. This may start 2-3 hours after treatment and last for up to 72 hours. You will be offered effective anti- sickness medication (ondansetron) to take to reduce the chances of feeling sick. If your nausea and/or sickness persists beyond the course of anti-sickness medicines please let one of the team know and we will be able to provide you with a longer course in the future
• Irritation of the bladder can occur with Cyclophosphamide. This is why it is important to drink lots of fluid and empty the bladder often. Tell the doctor or nurse if you find it painful or difficult when passing urine after having your treatment. You will be given a medication (mesna) to protect your bladder from the effects of the Cyclophosphamide
• The bone marrow (the spongy part in the middle of bones) makes blood cells. These cells fight infections and also carry oxygen round our body. Cyclophosphamide can stop the bone marrow making these cells. It is very important that you have your blood count checked (by a blood test) when you are asked to. Tell your doctor if you notice any unusual bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums. You may become anaemic (low red blood cells), which may make you feel breathless and tired. Let your doctor know if you suffer from any of these symptoms
• Cyclophosphamide can affect the way that your liver works. This usually goes back to normal when your treatment is finished. This is very unlikely to cause you any harm, but your doctor will check this carefully by taking blood tests
• Mouth sores can occur. Use soft toothbrushes, look after your mouth and make sure you have regular six monthly dental check-ups
• You may suffer with headaches
• Your hair may get thinner, but this is rare. This usually starts 2-4 weeks after the first dose of Cyclophosphamide, although it may occur earlier. Usually, your hair will start to grow again within a few weeks at the end of treatment. Perms or hair dyes may make hair weaker for the first few months after treatment, so wait a few months if you can
• After taking the drug for many years, there is a very small risk of developing cancer, however, giving the drug intravenously greatly reduces this risk as a smaller dose is given. To reduce this risk, avoid sunbathing and when you go out in the sun, always use a sun block (at least SPF30) to reduce the risk of skin cancers. Women should go for regular smear tests. Following the usual screening programmes for breast and prostrate cancer is recommended

Is it ok to have Cyclophosphamide during pregnancy and breastfeeding?

Cyclophosphamide is known to be damaging to an unborn child and must not be given during pregnancy unless there are exceptional conditions. Pregnancy is not recommended for 12 months after finishing Cyclophosphamide treatment, and some form of contraception must be used to prevent this. Men should use contraception for 6 months after finishing a course of Cyclophosphamide. Cyclophosphamide is excreted in human breast milk. Therefore, breastfeeding is not advised in mothers receiving Cyclophosphamide.

Do I need any special checks while on Cyclophosphamide?

You will have a physical examination and blood tests before starting the first treatment and then more blood tests after each dose (usually 10 days after a dose). The kidney team will review your results.

Can I take other medicines along with Cyclophosphamide?

You should discuss any new medications with your kidney doctor before starting them, and you should also tell any other doctor treating you that you are taking Cyclophosphamide.

Do not take any ‘over the counter’ medicines or herbal remedies without first discussing it with your kidney doctor or pharmacist.

If you are taking phenytoin for epilepsy, Cyclophosphamide may possibly reduce its absorption, which could lead to reduced control of fits.

If you take a drug called Clozapine, tell your doctor - this may give you more side effects if you have the two drugs.

Some tablets taken to control blood sugars in diabetes may work more effectively with Cyclophosphamide, which may increase the risk of suffering from low blood sugars.

Can I drink alcohol while taking Cyclophosphamide?

It is safe to drink alcohol in moderation while taking Cyclophosphamide but you are recommended to have alcohol free days without saving units up to drink all in one go.

What if I am thinking of having a baby?

Effects on fertility

Women treated with Cyclophosphamide may develop infertility and an early menopause, although this risk increases with increasing age of the patient as well as total treatment dose.  Generally, patients older than 30-35 years at the time of treatment are more likely to develop an early menopause than younger patients. Menstruation (periods) usually returns within one year of stopping Cyclophosphamide treatment. If you haven’t finished your family you can have an injection once a month to try to prevent you from stopping your periods.

In men, a reduced sperm count develops in relation to the total dose of Cyclophosphamide administered. In other words, the more Cyclophosphamide you have the more likely you are to have a low sperm count. In many cases this is reversible within one year of completion of the therapy. Occasionally, however, particularly after high doses of Cyclophosphamide, sterility is permanent. As a result, sperm banking prior to therapy can be considered. Cyclophosphamide can also result in some foetal (baby in the womb) abnormalities if you conceive during treatment. Males are therefore advised to take contraceptive precautions throughout treatment and for 6 months after and women are advised to use at least 2 forms of effective contraception whilst receiving Cyclophosphamide and for at least 12 months after.

Vaccinations

Whilst taking Cyclophosphamide, you must not have any live vaccines. Your immune system is dampened down whilst taking Cyclophosphamide, which increases your risk of infection. Other types of vaccines are safe for you to have. Ensure you discuss any vaccinations you need with the clinic.

We strongly advise that all patients who have a reduced immune system have the flu vaccination each year and follow the recommended COVID vaccination schedule – your clinical team will advise you. If your GP or Practice Nurse needs advice about vaccinations, they can contact the clinic.

Tips to reduce your risk of infection

• Try to avoid close contact with people you know have an active infection
• Wash your hands regularly and carry round a small bottle of antibacterial gel to use
• Keep your mouth clean by brushing your teeth regularly
• Make sure your food is stored and prepared properly
• Try to keep your house clean and hygienic, especially the kitchen, bathrooms and toilets
• Ensure your annual vaccines are up to date

Contact details

Medicines information: 0161 206 5223