What is Cyclophosphamide?
Cyclophosphamide is a medication that is classed as a DMARD- a disease modifying anti-rheumatic drug. This means it acts on the disease itself to reduce the effects of the immune system.
The immune system causes inflammation that protects the body from infections and injury. In certain diseases however, the immune system is over active and this can target healthy tissues such as joints and blood vessels. This results in pain, swelling and tenderness and eventually permanent damage.
Cyclophosphamide works to suppress the over activity of the immune system and prevent the inflammation from occurring, reducing the long-term risk of permanent damage.
What is Cyclophosphamide used for?
Cyclophosphamide is used in very serious cases of inflammation where there is a high risk of complications such as permanent organ damage.
It is used in severe cases of vasculitis, systemic lupus erythematosus, myositis and other autoimmune diseases.
How is it taken?
As cyclophosphamide is used when serious complications have arisen, it is usually given as an intravenous drip first (through a vein), before the course being completed as tablets.
The drip through a vein is carried out in the hospital, either as an inpatient or in the rheumatology day unit. The dose is calculated base on your weight, age and kidney function. The drip is given every 21 days for 3 cycles.
Once the drip cycles are completed, the medication is then given as a tablet split over 2 days every 28 days for a further 3 cycles.
In some circumstances the entire 6 cycles are given as drips.
As there are a few side effects listed below, other medications are given alongside the cyclophosphamide to reduce these, they include:
- Mesna- tablets to prevent bleeding in the bladder
- Steroids- either as a drip (methylprednisolone) or tablets (prednisolone)
- Granisetron- an anti-sickness medication
It can take up to a few weeks to have an effect and your doctor will monitor you closely.
Whilst taking cyclophosphamide, your bloods will be monitored for your blood counts, liver and kidney function. Your doctor will advise you how often these need to be taken.
There are a few possible side effects to be aware of, these include:
- Feeling sick, vomiting
- Hair loss
- Mouth ulcers
- Bleeding from the bladder causing red or pink urine
- Medications called mesna will be prescribed to prevent this from happening
- You should stay well hydrated, drinking 8-10 glasses of fluids during treatment
- Rarely, an increased risk of cancers, particularly of the bladder has been noted. The doctors will only use cyclophosphamide if the benefits outweigh the risks.
As the immune system is targeted by cyclophosphamide, it is important to monitor for signs of infection. Should you develop, stop taking your cyclophosphamide and speak to your GP as you may require antibiotics. Once you are feeling better and have completed any antibiotics you can restart taking your tablets.
Cyclophosphamide can also affect the blood cell counts, liver and kidneys. If you notice any yellow discoloration to your skin or eyes, bruising and bleeding you should let your doctor know.
If you develop, or come into contact with anyone with shingles or chickenpox, you should speak to your doctor as you may need treatment and stop taking your medication during this.
Cautions of use
Interactions with other medications
- Cyclophosphamide can cause low numbers of blood cells, therefore you doctor will check if you are on any other medications that could also cause this.
Contraindications with other conditions
- Cyclophosphamide should be avoided if you have previously been diagnosed with cancer that required radiation of the heart and lungs and in previous bleeding from the bladder (haemorrhagic cystitis).
- If any operations are planned, these should be discussed with your doctor.
During pregnancy and breastfeeding
- As cyclophosphamide can cause abnormalities in babies, it is not safe to take whilst trying to conceive or during pregnancy.
- Pregnancy should be avoided for at least 3 months in females and males following completion of the medication course.
- Breastfeeding is not safe whilst taking cyclophosphamide.
- As cyclophosphamide and alcohol can affect the liver it is advised that you do not consume over the recommended 14 units of alcohol weekly.
- It is safe to receive the flu and pneumonia vaccine whilst taking cyclophosphamide
- Live vaccines such as shingles and yellow fever are not safe.
Versus Arthritis: http://www.versusarthritis.org