Composition
lnj 100 mg/200 mg/500 mg/1 gm: Cyclophospha-mide 100 mg/200 mg/500 mg/1 gm, vial. Tab 50 mg: Cyclophosphamide 50 mg.
Indications & Dosage
Rheumatoid arthritis with severe systemic manifestations: ORAL: Adult: 1-1.5 mg/kg daily. Severe systemic rheumatoid arthritis, Other connective tissue diseases (especially with active vasculitis): BY IV INJ: Adult: 0.5-1g every 2 weeks, then reduced to 0.5-1g, with prophylactic mesna, every month, frequency adjusted according to clinical response and haematological monitoring. In combination with other agents for treatment of a wide range of malignancies, including leukaemias, lymphomas, multiple myeloma, mycosis fungoides, neuroblastoma, ovary adenocarcinoma, retinoblastoma, breast carcinoma and solid tumours: BY IV INJ: Adults & Children: 40-50 mg/kg in divided doses over 2-5 days, or 10-15 mg/kg for 7-10 days, or 3-5 mg/kg. ORAL: Adults & Children: 1-5 mg/kg/day.
Administration
May be administered IP, intrapleurally, IVPB, or continuous intravenous infusion, may also be ad-ministered slow IVP in doses <1 gm. IV infusions may be administered over 1-24 hours. Doses >500 mg to approximately 2 g may be administered over 20-30 min. To minimize bladder toxicity, increase normal fluid intake during and for 1-2 days after cyclophosphamide dose. Patients will require a fluid intake of at least 2 litre/day. High-dose regimens should be accompanied by vigorous hydration with or without mesna therapy. Reconstitute vials with SWI, NS, or D5W to a concentration of 20 mg/ml.
Compatibility
Stable in D5LR, D5W, D5NS, LR, IhNS, NS.
Stability
Store at or below 25C (77F). Do not use cyclo-phosphamide if there are signs of melting. Solutions for injection are stable for 24 hours at room temperature or up to 6 days under refrigeration. However, reconstituted solutions are preservative free and should be used within 24 hours,
Contraindications
Bladder haemorrhage, acute UTI, myelo-suppression, Haemorrhagic cystitis
Precautions
Avoid in acute porphyrias, diabetes mellitus, previous or concurrent mediastinal irradiation; risk of cardiotoxicity, elderly, debilitated.
Interactions
Radiotherapy, doxorubicin, sulphonylureas.
Pregnancy
Positive evidence of risk: Avoid
Lactation
Contraindicated. Discontinue breast-feeding.
Side Effects
Anorexia, cardiotoxicity at high doses, disturbances of carbohydrate metabolism, inappropriate secretion of anti-diuretic hormone, interstitial pulmonary fibrosis, pancreatitis, pigmentation of nails, and soles, urothelial toxicity, alopecia, bone-marrow suppression, haemorrhagic cystitis, hyperuricaemia, male sterility, nausea, oral mucositis, premature menopause, secondary malignancy, thromboembolism, tumourlysis syndrome, vomiting. Rare: Hepatotoxicity, renal dysfunction