Cyclophosphamide

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Sections available in full article Name, Class of drug, Description, Uses, Administration, Routes of administration, Dosage, Pharmocokinetics, Pathological variations, Precautions, Contra-indications, Use with care, Interactions, Adverse reactions, Sources, Publications,
Contributors Dr William Brewer Jr DVM DiplACVIM Oncology and Internal Medicine

Name

  • Cyclophosphamide.

Class of drug

  • Nitrogen mustard group.

Uses

Action

  • Anti-neoplastic cytotoxic immunosuppressive alkylating agent Chemotherapy: general principles.

Indications

  • Lymphoproliferative disease Lymphoproliferative disease.
  • Myeloproliferative disease Myeloproliferative tumor.
  • Sarcoma OsteosarcomaSoft tissue sarcomaHemangiosarcoma , carcinoma Skin: squamous cell carcinomaAdenoma adenocarcinomaSkin: basal cell tumor.
  • Immune-mediated disease Immune-mediated thrombocytopeniaAnemia: immune mediated hemolyticArthritis: immune-mediated.

Adverse reactions

Other reported reactions

  • Myelosuppression, with nadir 7-14 days after the start of therapy.
  • Hemorrhagic cystitis.
  • Vomiting.
  • Diarrhea.
  • Decreased hair growth rate.

Treatment

Myelosuppression

  • Regular monitoring of neutrophil is recommended, adjust dose as necessary.
  • Prophylactic antibiotics when neutrophil count <1,000.

Hemorrhagic cystitis

Prophylaxis

  • Increase water consumption and induce polyuria, ensuring adequate urine flow.
  • Administer in morning to allow animal to urinate out of bladder, evening dosing increases dwell time of toxic metabolite (acrolein) in bladder as animal sleeps.
  • Administer furosemide Furosemide concurrently to increase urine production and therefore dilution and excretion of the toxic metabolite.

Treatment

  • Discontinue cyclophosphamide.
  • Treat concurrent UTI.
  • Increase fluid intake possibly with use of furosemide.
  • Possible use of anti-inflammatory doses of corticosteroids.
  • Intracavitary instillation of formalin or DMSO in cases that do not respond to above therapies after 2-3 months.

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