What is Cytoxan?
Cytoxan is a brand name for the medication cyclophosphamide. It is used in chemotherapy to suppress the immune system and treat a number of different cancers, including leukemia, lymphoma, Hodgkin’s disease, small cell lung cancer, multiple myeloma, neuroblastoma, retinoblastoma, and cancers of the soft tissues.
It can also be given for severe rheumatoid arthritis or connective tissue diseases. This usually only occurs in severe cases with evidence of effects in the whole body.
Cytoxan can be given as a tablet or as an injection.
How does it work?
Cytoxan belongs to a group of medicines called antineoplastics, which work against cancers. It is in a subgroup of this family of drugs known as alkylating agents. Once the medication is administered, the body converts the drug to active components acrolein and phosphoramide. These active components impact the genetic material, the DNA of the cancer cells, which prevents them from replicating and multiplying. Unfortunately, Cytoxan is not able to tell normal cells from cancer cells. This means that normal, healthy cells are also affected. This can cause serious side effects for anyone using this medication. It also causes the immune system to be suppressed which can make you more prone to infections, including those to which you would not normally be susceptible.
How to use
Cytoxan can be taken as an injection or as a tablet. The injection comes in 500mg, 1g, and 2g vials. This is usually dissolved in a small amount of saline or dextrose and given as an infusion. This is usually administered once or twice per week.
The tablets come as 25mg or 50mg and are taken orally each day.
Dosage
The dose will vary depending on the condition it is prescribed to treat as well as other medicines that you are taking. It also depends on your body weight and the method of administration, as tablets or injection. Your doctor will advise on the best schedule of treatment for you.
As an injection, Cytoxan is administered up to twice a week in a clinical setting. It must be given and supervised by a medical professional in a sterile manner. It is then administered intravenously. It is possible that larger doses may be administered every three to four weeks during the course of treatment.
Tablets are given as a daily dose, much smaller than the injected form, as they are taken daily. As with the injections, larger doses may be given every three to four weeks. Oral tablets are typically taken in the morning with food to reduce gastrointestinal upset. Your doctor will advise as to your dosing schedule.
Doses are usually smaller when used for severe rheumatoid arthritis or connective tissue disease. If using injections, they are usually administered every 2 weeks. If in doubt about the form and dose of your medication, consult your doctor. Tablets are taken orally on a daily basis, but usually at a lower dose than would be used for cancer.
Side Effects
Some people may experience an allergic reaction to Cytoxan. Stop taking medication immediately and seek medical attention if you experience signs of a severe allergic reaction. Typically, this would manifest as hives, difficulty breathing, and/or swelling of the face or throat.
Some people may experience skin reactions when using Cytoxan. Stop taking medication immediately and seek medical attention if you experience signs of a skin reaction. This would include blistering, peeling of skin, or a rash that covers a large area, spreads quickly, or is associated with a fever. Cytoxan can be absorbed through the skin. It is important to wash your hands if you have come into contact with broken tablets or capsules. You should try to avoid inhaling any powder produced by broken tablets or capsules.
Some people may experience seizures when taking Cytoxan. If this occurs, stop taking the medication and seek immediate help from a healthcare professional.
At least 1% of people experience some of the following side effects:
- Fatigue
- Nausea
- Diarrhea
- Headache
- Loss of appetite
- Vomiting
- Temporary hair loss
- Blood and bone marrow disorders
Rare but serious side effects can occur. If you experience any of the following side effects, contact your doctor as soon as possible:
- Blood in your urine
- Burning or pain when urinating
- Confusion
- Dizziness
- Fever or chills accompanied by cough or hoarseness
- Strange sensations in arms or legs, such as tingling, prickling or numbness
- Redness, swelling, or pain at the site of injection
- Anemia – signs to look out for include dizziness, pale skin, unusual tiredness or weakness, shortness of breath
- Heart failure – signs to look out for include shortness of breath, fatigue, swelling of feet, ankles, or legs
- Infection – signs to look out for include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiffness, weight loss, listlessness
- Infertility in both men and women
- Kidney problems – signs to look out for include increased urination at night, decreased urine production, blood in urine, and a change in the color of urine
- Liver problems – signs to look out for include nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or eyes, dark urine, and pale stools
- Inflammation of the lungs – signs to look out for include darkening of lips and fingernails, persistent cough, burning sensation in the chest
- Mouth ulcers and lip sores
- Low blood pressure – symptoms to look out for include fainting, dizziness, light-headedness, blurred vision, increased thirst, nausea
- Low platelets – any cuts or grazes will bleed for longer, and bruises occur frequently after minimal trauma
- Syndrome of inappropriate antidiuretic hormone secretion – SIADH – symptoms to look out for include nausea and vomiting, cramps, tremors, depressed mood, memory impairment, irritability, personality changes, confusion, hallucinations, and seizures
- Vein inflammation from injections
As with many medicines used in cancer treatment, it is possible that the use of Cytoxan can lead to the development of other secondary cancers.
Decision to take Cytoxan should be made in conjunction with your doctor. All benefits and risks, including side effects, should be discussed and a fully informed decision should be made.
You may experience side effects other than those listed above. Always check with your doctor if you are concerned.
Warnings & Precautions
It is important to let all of your healthcare providers know all of the medications that you are taking, all of the conditions that you have been diagnosed with, and any allergies that you may have. Remember to include any over-the-counter medications, vitamins, supplements, herbal medicines, and recreational drugs.
Cytoxan should be avoided in those with acute porphyrias or diabetes mellitus. Also, avoid use in those with hemorrhagic cystitis and those receiving mediastinal irradiation.
If there is impairment in liver or kidney function, doses may need to be reduced. This should be discussed with your doctor. If there is severe liver or kidney dysfunction it may not be possible to safely take this medicine. Cytoxan is metabolised by the liver and can cause bladder toxicity, particularly if urine is kept there for a prolonged period. Drinking lots of fluids and frequent urination can help to reduce this risk. It is recommended that you take the advice of your doctor.
Interactions
Medications known to interact with Cytoxan:
- Adalimumab
- Alemtuzumab
- Allopurinol
- Amiodarone
- Amphotericin B
- Azathioprine
- Bacillus Calmette-Guerin (BCG)
- Belimumab
- Carbamazepine
- Ciprofloxacin
- Clozapine
- Colchicine
- Cyclosporin
- Dabrafenib
- Deferiprone
- Denosumab
- Digoxin
- Echinacea
- Efavirenz
- Etanercept
- Filgrastim
- Fingolimod
- Grapefruit juice
- HIV protease inhibitors
- Indomethacin
- Leflunomide
- Lumacaftor
- Mifepristone
- Natalizumab
- Nevirapine
- Other cancer medications
- Pentostatin
- Phenobarbital
- Phenytoin
- Pimecrolimus
- Rifampin
- Roflumilast
- Tacrolimus
- Thiazide diuretics
- Tofacitinib
- Vaccines
- Warfarin
If you are on any of the medications mentioned above, consult with your doctor or your pharmacist. It may be necessary to stop taking one of the medications, change one of the medications to an alternative, or change how or when you take one or both medications. However, your healthcare professional may also decide it is best to leave all medicines as they are.
The list above is not exhaustive and may not contain all medications known to interact with Cytoxan. It is important that you inform your doctor of all medications, herbal medicines, supplements, over-the-counter medication, and recreational drugs that you are taking.
Contraindications
Cytoxan should not be used if there is a known allergy to cyclophosphamide.
Do not use in those who are pregnant or breastfeeding.
Do not use if you have severe bladder problems.
Do not use if you have severe liver or kidney problems.
Do not use if you have low platelets or white cell count.
Do not use if you have an active infection.
Inform your doctor if any of the contraindications mentioned above apply to you.
Frequently Asked Questions
Disclaimer
Pharma Giant provides medical information to help you better understand medications and medical conditions.This content is for informational use only and does not replace advice from a licensed medical practitioner. Consult your doctor or pharmacist before starting or changing any medication. All our partners follow strict safety standards set by their country’s health authorities to make sure you receive safe and high-quality medications.
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