cyclophosphamide

ROUTE	ONSET	PEAK	DURATION
PO, IV	7 days	7–15 days	21 days

Monitor vital signs frequently during administration. Report significant changes.
Monitor urinary output frequently during therapy. To ↓ the risk of hemorrhagic cystitis and to promote excretion of uric acid, fluid intake should be ≥3000 mL/day for adults and ≥1000–2000 mL/day for children. May be administered with mesna. Alkalinization of the urine may be used to help prevent uric acid nephropathy.
Monitor for bone marrow depression. Assess for bleeding (bleeding gums; bruising; petechiae; guaiac stools, urine, and emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for ↑ fatigue, dyspnea, and orthostatic hypotension.
Assess nausea, vomiting, and appetite. Weigh weekly. Antiemetics may be given 30 min before administration of medication to minimize GI effects. Anorexia and weight loss can be minimized by feeding frequent light meals.
Assess cardiac and respiratory status for dyspnea, rales/crackles, cough, weight gain, or edema. Pulmonary toxicity may occur after prolonged therapy. Cardiotoxicity may occur early in therapy and is characterized by symptoms of HF.

Lab Test Considerations:

Monitor CBC with differential before and periodically during therapy. The nadir of leukopenia occurs in 7–12 days (recovery in 17–21 days). Leukocytes should be maintained at 2500–4000/mm³. May also cause thrombocytopenia (nadir 10–15 days) and rarely causes anemia.
- Monitor BUN, serum creatinine, and uric acid before and frequently during therapy to detect nephrotoxicity.
- Monitor ALT, AST, LDH, and serum bilirubin before and frequently during therapy to detect hepatotoxicity.
- Urinalysis should be evaluated before initiating therapy and frequently during therapy to detect hematuria or change in specific gravity indicative of SIADH.
- May suppress positive reactions to skin tests for Candida, mumps, Trichophyton, and tuberculin purified-protein derivative. May also produce false-positive results in Papanicolaou smears.

Implementation

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High Alert: Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double-check single, daily, and course-of-therapy dose limits; have second practitioner independently double-check original order, calculations, and infusion pump settings.
Do not confuse cyclophosphamide with cyclosporine or cycloserine.
Administer antiemetics before dosing with cyclophosphamide.
PO: Administer in the morning. DNC: Swallow tablets whole; do not crush, break, or chew.

IV Administration:

Provide adequate fluids (PO or IV) during or immediately after IV administration to force diuresis and ↓ risk of urinary tract toxicity.
IV: Wear gloves, gown, and mask while handling medication. If powder or solution comes in contact with skin or mucosa, wash thoroughly with soap and water. Discard equipment in specially designated containers.
IV Push: Reconstitution: Reconstitute each vial of lyophilized powder for injection with 25 mL (500 mg vial), 50 mL (1000 mg vial), or 100 mL (2000 mg vial) of 0.9% NaCl. Do not reconstitute with sterile water for injection; results in a hypotonic solution not suitable for IV push. Solution is clear, colorless to slight yellow; do not administer solutions that are cloudy, discolored, or contain particulate matter. Reconstituted solution can be stored at room temperature for up to 24 hr or in the refrigerator for up to 6 days. Concentration: 20 mg/mL.
Rate: Inject very slowly. Monitor IV site; may be an irritant.
Intermittent Infusion: Reconstitution: Reconstitute each vial of lyophilized powder for injection with 25 mL (500 mg vial), 50 mL (1000 mg vial), or 100 mL (2000 mg vial) of 0.9% NaCl. Reconstituted solution can be stored at room temperature for up to 24 hr or in the refrigerator for up to 6 days. Concentration: 20 mg/mL. Diluent: Withdraw prescribed dose from vial and dilute with D5/0.9% NaCl, 0.45% NaCl, or D5W. Swirl gently to dissolve. Solutions diluted with 0.45% NaCl may be stored at room temperature for 24 hr or if refrigerated for 6 days. Solutions diluted with D5W or D5/0.9% NaCl are stable up to 24 hr at room temperature or 36 hr if refrigerated. Concentration: 2 mg/mL.
Y-Site Compatibility:
- acyclovir
- alemtuzumab
- allopurinol
- amifostine
- amikacin
- aminocaproic acid
- aminophylline
- amiodarone
- amphotericin B lipid complex
- amphotericin B liposomal
- ampicillin/sulbactam
- anidulafungin
- argatroban
- arsenic trioxide
- atracurium
- atropine
- azithromycin
- aztreonam
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- carboplatin
- carmustine
- caspofungin
- cefazolin
- cefepime
- cefotaxime
- cefotetan
- cefoxitin
- ceftazidime
- ceftriaxone
- cefuroxime
- chloramphenicol
- chlorpromazine
- chlorothiazide
- ciprofloxacin
- cisatracurium
- cisplatin
- cladribine
- clindamycin
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daptomycin
- daunorubicin
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- foscarnet
- fosphenytoin
- furosemide
- ganciclovir
- gemcitabine
- gentamicin
- granisetron
- haloperidol
- heparin
- hetastarch
- hydralazine
- hydrocortisone
- hydromorphone
- idarubicin
- imipenem/cilastatin
- insulin, regular
- irinotecan
- isoproterenol
- ketorolac
- labetalol
- leucovorin calcium
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methadone
- methotrexate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- minocycline
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- nafcillin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxacillin
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- pantoprazole
- pemetrexed
- penicillin G
- pentamidine
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- potassium phosphates
- procainamide
- prochlorperazine
- promethazine
- propofol
- propranolol
- remifentanil
- rituximab
- rocuronium
- sargramostim
- sodium acetate
- sodium bicarbonate
- sodium phosphates
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiopental
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- trimethoprim/sulfamethoxazole
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B deoxycholate
- diazepam
- gemtuzumab ozogamicin
- phenytoin

Patient/Family Teaching

⬆ ⬇

Instruct patient to take dose in early morning. Emphasize need for adequate fluid intake for 72 hr after therapy. Patient should void frequently to ↓ bladder irritation from metabolites excreted by the kidneys. Report hematuria immediately. If a dose is missed, contact health care professional. Advise caregivers to use gloves when handling capsules. If capsule opens, wash hands thoroughly.
Instruct patient to notify health care professional promptly if fever; sore throat; signs of infection; lower back or side pain; difficult or painful urination; sores in the mouth or on the lips; yellow discoloration of skin or eyes; bleeding gums; bruising; petechiae; blood in urine, stool, or emesis; unusual swelling of ankles or legs; joint pain; shortness of breath; cough; palpitations; weight gain >5 lb in 24 hr; dizziness; loss of consciousness; or confusion occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to avoid falls. Patient should also be cautioned not to drink alcoholic beverages or to take products containing aspirin or NSAIDs; may precipitate GI hemorrhage.
Discuss with patient the possibility of hair loss. Explore methods of coping. May also cause darkening of skin and fingernails.
Instruct patient not to receive any vaccinations without advice of health care professional.
Rep: May cause fetal harm. Advise women of reproductive potential to use highly effective contraceptive measures for up to 1 yr after last dose and to avoid breastfeeding during and for 1–6 wk after last dose. Advise men with female partners of reproductive potential to wear condoms during and for ≥4 mo after last dose of therapy. Advise patient or notify health care professional if pregnancy is planned or suspected. Patients treated for rheumatic and musculoskeletal diseases should consider discontinuing cyclophosphamide 3–6 mo prior to conception to allow for disease monitoring and potential change to another immunosuppressant. Discontinue cyclophosphamide 12 wk before attempting conception in patients with rheumatic and musculoskeletal diseases who are planning to father a child. Inform patient that this medication may cause sterility and menstrual irregularities or cessation of menses.

Evaluation/Desired Outcomes

⬆ ⬇

Decrease in size or spread of malignant tumors.
Improvement of hematologic status in patients with leukemia. Maintenance therapy is instituted if leukocyte count remains between 2500 and 4000/mm³ and if patient does not demonstrate serious side effects.
Management of minimal change nephrotic syndrome in children.

US Brand Names

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Canadian Brand Names

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Code

⬆

NDC Code

0054- West-Ward Pharmaceuticals Corp.
- 0054-0382- Cyclophosphamide
  - 0054-0382-25- 100 CAPSULE in 1 BOTTLE (0054-0382-25)

0054- West-Ward Pharmaceuticals Corp.
- 0054-0383- Cyclophosphamide
  - 0054-0383-25- 100 CAPSULE in 1 BOTTLE (0054-0383-25)

0781- Sandoz Inc.
- 0781-3233- Cyclophosphamide
  - 0781-3233-94- 1 VIAL, SINGLE-DOSE in 1 CARTON (0781-3233-94) > 25 mL in 1 VIAL, SINGLE-DOSE

0781- Sandoz Inc.
- 0781-3244- Cyclophosphamide
  - 0781-3244-94- 1 VIAL, SINGLE-DOSE in 1 CARTON (0781-3244-94) > 50 mL in 1 VIAL, SINGLE-DOSE

0781- Sandoz Inc.
- 0781-3255- Cyclophosphamide
  - 0781-3255-94- 1 VIAL, SINGLE-DOSE in 1 CARTON (0781-3255-94) > 100 mL in 1 VIAL, SINGLE-DOSE

10019- Baxter Healthcare Corporation
- 10019-935- CYCLOPHOSPHAMIDE
  - 10019-935-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-935-01) > 25 mL in 1 VIAL, SINGLE-DOSE (10019-935-25)

10019- Baxter Healthcare Corporation
- 10019-936- CYCLOPHOSPHAMIDE
  - 10019-936-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-936-01) > 50 mL in 1 VIAL, SINGLE-DOSE (10019-936-50)

10019- Baxter Healthcare Corporation
- 10019-937- CYCLOPHOSPHAMIDE
  - 10019-937-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-937-01) > 100 mL in 1 VIAL, SINGLE-DOSE (10019-937-10)

10019- Baxter Healthcare Corporation
- 10019-938- CYCLOPHOSPHAMIDE
  - 10019-938-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-938-01) > 25 mL in 1 VIAL, SINGLE-DOSE (10019-938-25)

10019- Baxter Healthcare Corporation
- 10019-939- CYCLOPHOSPHAMIDE
  - 10019-939-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-939-01) > 50 mL in 1 VIAL, SINGLE-DOSE (10019-939-50)

10019- Baxter Healthcare Corporation
- 10019-942- CYCLOPHOSPHAMIDE
  - 10019-942-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-942-01) > 100 mL in 1 VIAL, SINGLE-DOSE (10019-942-10)

10019- Baxter Healthcare Corporation
- 10019-943- CYCLOPHOSPHAMIDE
  - 10019-943-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-943-01) > 25 mL in 1 VIAL, SINGLE-DOSE (10019-943-25)

10019- Baxter Healthcare Corporation
- 10019-944- CYCLOPHOSPHAMIDE
  - 10019-944-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-944-01) > 50 mL in 1 VIAL, SINGLE-DOSE (10019-944-50)

10019- Baxter Healthcare Corporation
- 10019-945- CYCLOPHOSPHAMIDE
  - 10019-945-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-945-01) > 100 mL in 1 VIAL, SINGLE-DOSE (10019-945-10)

10019- Baxter Healthcare Corporation
- 10019-955- Cyclophosphamide
  - 10019-955-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-955-01) > 25 mL in 1 VIAL, SINGLE-DOSE (10019-955-50)

10019- Baxter Healthcare Corporation
- 10019-956- Cyclophosphamide
  - 10019-956-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-956-01) > 50 mL in 1 VIAL, SINGLE-DOSE (10019-956-16)

10019- Baxter Healthcare Corporation
- 10019-957- Cyclophosphamide
  - 10019-957-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (10019-957-01) > 100 mL in 1 VIAL, SINGLE-DOSE (10019-957-11)

16714- NorthStar Rx LLC
- 16714-857- Cyclophosphamide
  - 16714-857-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (16714-857-01) > 50 mL in 1 VIAL, SINGLE-DOSE

16714- NorthStar Rx LLC
- 16714-858- Cyclophosphamide
  - 16714-858-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (16714-858-01) > 100 mL in 1 VIAL, SINGLE-DOSE

16714- NorthStar Rx LLC
- 16714-859- Cyclophosphamide
  - 16714-859-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (16714-859-01) > 25 mL in 1 VIAL, SINGLE-DOSE

43975- Amerigen Pharmaceuticals Inc.
- 43975-307- CYCLOPHOSPHAMIDE
  - 43975-307-10- 100 CAPSULE in 1 BOTTLE (43975-307-10)

43975- Amerigen Pharmaceuticals Inc.
- 43975-308- CYCLOPHOSPHAMIDE
  - 43975-308-10- 100 CAPSULE in 1 BOTTLE (43975-308-10)

54879- STI Pharma LLC
- 54879-021- CYCLOPHOSPHAMIDE
  - 54879-021-01- 100 CAPSULE in 1 BOTTLE (54879-021-01)

54879- STI Pharma LLC
- 54879-022- CYCLOPHOSPHAMIDE
  - 54879-022-01- 100 CAPSULE in 1 BOTTLE (54879-022-01)

68001- BluePoint Laboratories
- 68001-370- Cyclophosphamide
  - 68001-370-27- 1 VIAL, SINGLE-DOSE in 1 CARTON (68001-370-27) > 25 mL in 1 VIAL, SINGLE-DOSE (68001-370-24)

68001- BluePoint Laboratories
- 68001-371- Cyclophosphamide
  - 68001-371-32- 1 VIAL, SINGLE-DOSE in 1 CARTON (68001-371-32) > 50 mL in 1 VIAL, SINGLE-DOSE (68001-371-33)

68001- BluePoint Laboratories
- 68001-372- Cyclophosphamide
  - 68001-372-32- 1 VIAL, SINGLE-DOSE in 1 CARTON (68001-372-32) > 100 mL in 1 VIAL, SINGLE-DOSE (68001-372-33)

69097- Cipla USA Inc.
- 69097-516- Cyclophosphamide
  - 69097-516-07- 100 CAPSULE in 1 BOTTLE (69097-516-07)

69097- Cipla USA Inc.
- 69097-517- Cyclophosphamide
  - 69097-517-07- 100 CAPSULE in 1 BOTTLE (69097-517-07)

70121- Amneal Pharmaceuticals LLC
- 70121-1238- Cyclophosphamide
  - 70121-1238-1- 1 VIAL, SINGLE-DOSE in 1 CARTON (70121-1238-1) > 25 mL in 1 VIAL, SINGLE-DOSE

70121- Amneal Pharmaceuticals LLC
- 70121-1239- Cyclophosphamide
  - 70121-1239-1- 1 VIAL, SINGLE-DOSE in 1 CARTON (70121-1239-1) > 50 mL in 1 VIAL, SINGLE-DOSE

70121- Amneal Pharmaceuticals LLC
- 70121-1240- Cyclophosphamide
  - 70121-1240-1- 1 VIAL, SINGLE-DOSE in 1 CARTON (70121-1240-1) > 100 mL in 1 VIAL, SINGLE-DOSE

72603- NorthStar RxLLC
- 72603-104- Cyclophosphamide
  - 72603-104-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (72603-104-01) > 25 mL in 1 VIAL, SINGLE-DOSE

72603- NorthStar RxLLC
- 72603-326- Cyclophosphamide
  - 72603-326-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (72603-326-01) > 50 mL in 1 VIAL, SINGLE-DOSE

72603- NorthStar RxLLC
- 72603-411- Cyclophosphamide
  - 72603-411-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (72603-411-01) > 100 mL in 1 VIAL, SINGLE-DOSE

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Canadian Brand Names ⬆ ⬇

Code ⬆

Pronunciation

Classifications

Indications

Action

Pharmacokinetics

Time/Action Profile

Contraind./Precautions

Adv. Reactions/Side Effects

Interactions

Route/Dosage

Availability

Assessment

Implementation

Patient/Family Teaching

Evaluation/Desired Outcomes

US Brand Names

Canadian Brand Names

Code