Chemotherapy Patient Resource Area

Cyclophosphamide/Cytoxan^®

Drug
Cyclophosphamide (generic name) is manufactured as Cytoxan^® (trade name) (Mead Johnson Oncology, a Bristol-Myers Squibb Company, Princeton, NJ).

Action
Cyclophosphamide is an anticancer drug that stops cell growth and division. It is a type of drug called an alkylating agent. Oral cyclophosphamide is used to treat breast cancer and may be used to treat other types of cancer.

What does the drug look like?
Cyclophosphamide is supplied as white tablets with blue speckles in 25-mg and 50-mg dose strengths.

How long will I take the drug?
The length of treatment varies and depends on your diagnosis and how well your body responds to treatment.

How do I take the drug?
Cyclophosphamide is taken by mouth once a day. The dose of cyclophosphamide is based on your body size and is determined by your doctor. Your doctor and pharmacist will tell you how many tablets to take each day. Be sure to read the label on your medicine closely so that you take the dose you need. Because this drug can cause bladder irritation, it generally is taken in the morning to make emptying your bladder often more convenient. Drink at least 2-3 quarts (8-10 cups) of water each day while you are taking this medicine. Swallow each tablet whole; do not chew them. If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. If you accidentally take too many pills or someone else accidentally takes your medicine, contact your doctor or the nearest emergency room immediately.

Storage
Store this medicine at room temperature, away from excess heat and moisture (do not store on a windowsill or in a bathroom). Keep this medicine in its original container, out of the reach of children or pets. Do not keep outdated medication that you no longer need. Ask your nurse or pharmacist how you should dispose of any medicine you do not use.

• Cyclophosphamide can irritate the bladder and may cause bleeding in the bladder. This usually is avoided by drinking large amounts of fluid (at least 8-10 cups per day) and frequently urinating. Empty your bladder often, at the first feeling of the need to urinate. Continue to drink plenty of fluids after treatment has finished. If you experience painful urination or notice bloody urine, contact your doctor immediately.
• Cyclophosphamide temporarily lowers the number of white blood cells in your blood, increasing your chance of getting an infection. Avoid crowds and people who have infections. Call your doctor immediately if you develop a temperature higher than 100.5^oF or have chills, a cough, or painful urination.
• Cyclophosphamide also lowers the number of platelets in your blood, which are necessary for proper blood clotting. Call your doctor immediately if you notice unusual bleeding or bruising, have black or tar-like stools, see blood in your urine, or develop pinpoint red spots on your skin. Use a soft toothbrush, and use care when flossing. Your healthcare providers may give you suggestions on how to care for your mouth, and these directions should be followed carefully.
• Cyclophosphamide causes mild to moderate nausea and vomiting. It generally occurs within 3-12 hours of taking the medicine and may last 8-12 hours. Eat small frequent meals and bland foods, and report moderate to severe vomiting to your doctor. Medications for nausea can be prescribed to help with this side effect.
• Some hair loss (mostly thinning) may occur during cyclophosphamide therapy. Hair on the head and body will grow back once treatment is completed.
• Cyclophosphamide may cause mouth sores. Avoid spicy foods and do not use mouthwash, because it may contain alcohol and worsen mouth pain. Your healthcare providers may give you suggestions on how to care for your mouth or manage mouth sores, and these directions should be followed carefully.
• Cyclophosphamide causes delayed wound healing. Keep all wounds (such as cuts, scrapes, and insect bites) clean and dry. Notify your doctor if redness or drainage occurs.
• Cyclophosphamide may cause your skin to darken slightly, and ridges may form on fingernails and toenails.
• If you are taking cyclophosphamide or have taken this drug within the 10-day period prior to undergoing surgery, be sure to tell your surgeon and anesthesiologist because cyclophosphamide treatment affects general anesthesia.
• Cyclophosphamide may interfere with the normal menstrual cycle (period) in women and may stop sperm production in men. However, you must use a reliable birth control method and not assume that you cannot get pregnant or get someone else pregnant. Women who are pregnant or would like to become pregnant need to discuss this with their doctors before taking this drug.

Let your doctor know what medications you are taking. Also, if you are taking vitamins, herbs, or nutritional supplements, be sure to let your doctor know.

• Temperature (fever) higher than 100.5^oF
• Any signs of infection, such as chills and cough
• Painful urination
• Blood-tinged urine
• Moderate to severe nausea and vomiting
• Moderate to severe mouth sores or blistering
• Any bleeding, such as from your nose or gums or in your urine
• Dark-colored (black or tar-like) stools
• Unusual bruising
• Pinpoint red spots on your skin