Cyclophosphamide

Cyclophosphamide (pronounced sigh-clo-fos-fa-mide) is a chemotherapy drug that is given as a treatment for many types of cancer. It is most commonly used to treat lymphomas; cancers of the ovary, breast and bladder; and a type of leukaemia known as chronic lymphocytic leukaemia. This information describes cyclophosphamide, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

• What cyclophosphamide looks like
• How it is given
• Possible side effects
• Less common side effects
• Additional information
• Things to remember about cyclophosphamide tablets

What cyclophosphamide looks like

Cyclophosphamide is a colourless fluid after being dissolved from powder. It is also available as pink or white tablets of 50mg.

How it is given

Cyclophosphamide is given:

• as an injection into the vein (intravenously) through a fine tube (cannula) inserted into the vein. It may be given through a central line which is inserted under the skin into a vein near the collarbone, or into a PICC line which is inserted into a vein in the crook of the arm
• by drip (intravenous infusion) through a cannula or line
• as tablets, which should be swallowed whole.

Possible side effects

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given cyclophosphamide, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common and less common side effects, so you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you do notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Cyclophosphamide can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next course of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• Your temperature goes above 38ºC (100.5ºF)
• You suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Cyclophosphamide can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with cyclophosphamide you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Feeling sick (nausea) and vomiting If you do feel sick it may begin a couple of hours after the treatment is given and last for up to 24 hours (or a few days if high-dose treatment is given). Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice and tips on boosting appetite, coping with eating difficulties and maintaining weight.

Irritation of the bladder lining It is important to drink plenty of fluids to help prevent any irritation. If you notice any blood in your urine, tell your doctor. With high-dose cyclophosphamide, fluids are given into the vein, along with a drug called mesna (Uromitexan®), which can help to prevent bladder irritation.

Hair loss Hair may be lost completely or may just thin. This usually starts 2–4 weeks after the first dose of cyclophosphamide, although it may occur earlier. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and all your hair will start to regrow within a few weeks of the end of treatment. To help reduce hair loss, scalp cooling may be suitable for some people.

Less common side effects

Your liver may be temporarily affected Cyclophosphamide may cause changes in the way that your liver works, but your liver will return to normal when the treatment is finished. This is very unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver is working properly.

Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help reduce the risk of these effects. If you do have them, tell your nurse or doctor, who can give you special mouthwashes and medicines to prevent or clear any mouth infection.

Taste changes You may notice that your food tastes different. Normal taste will come back after the treatment finishes.

Diarrhoea This can usually be easily controlled with medicine but tell your doctor if it is severe or persistent. It is important to drink plenty of fluids if you have diarrhoea.

Changes in nails Your nails may become darker, or ridged. These changes grow out over a few months once the treatment has finished.

Skin changes Your skin may darken, due to excess production of pigment, but this is rare.

Changes to the lungs Cyclophosphamide may cause some changes to lung tissue. Tell your doctor if you notice any coughing or breathlessness.

Second cancer With long-term use of this drug there is a very small risk of developing a second cancer after many years. Your doctor or nurses can discuss this risk with you further.

Changes in the way your heart works This is very rare with standard doses but may occasionally occur with high-dose treatment. The muscle of the heart may be affected, usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given, and occasionally before each treatment.

Additional information

Some people have hot flushes, dizziness, a strange taste and a feeling of having a blocked nose when the drug is being given. If you have any of these symptoms ask the doctor or nurse to slow down the drip to reduce the feeling.

Cyclophosphamide may be prescribed for conditions other than cancer. The drug dosage will then be much lower and therefore these side effects will probably not occur.

Other medicines Some medicines can be harmful to take when you are having chemotherapy. Tell your doctor about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking cyclophosphamide, as the developing foetus may be harmed. It is necessary to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Things to remember about cyclophosphamide tablets

• It is important to take your tablets at the right times. You must take them as directed by your doctor.
• Keep the tablets in the original packaging and store them at room temperature, away from heat and direct sunlight.
• Keep the tablets in a safe place where children cannot reach them, as cyclophosphamide could harm them.
• If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
• If you are sick just after taking the tablet tell your doctor as you may need to take another dose. Do not take another tablet without first telling your doctor.
• If you forget to take a tablet do not take a double dose. Let your doctor know and keep to your regular dose schedule.