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Cyclophosphamide (Cytoxan) -- Cell-cycle phase-nonspecific antineoplastic
agent and immunosuppressant that acts as alkylating agent.
Adult Dose 1-2 mg/kg/d PO or monthly pulse IV; dosing based on body size used;
usually a 6-mo treatment period used; dose adjusted to reduce WBC count to
2000-3000/mL; reports describe high-dose ablative therapy (which reduces WBC
counts to 0) having efficacy in patients with otherwise severe and refractory
disease
Pediatric Dose Not established
Contraindications Absolute: Breastfeeding; dehydration; infection
Relative: Documented hypersensitivity; bone marrow suppression; dental work;
gout; hyperuricemia; hemorrhagic cystitis; pregnancy; radiation treatment;
vaccinations
Interactions Other immunosuppressive agents can worsen marrow suppression;
thrombolytic agent or anticoagulant can increase risk of bleeding; has additive
GI effect with salicylates and NSAIDs; enzyme inducers such as phenytoin and
barbiturates can increase toxic effects; multiple medications, including
prednisone, can alter efficacy; can alter efficacy of vaccines
Pregnancy D - Unsafe in pregnancy
Precautions Hemorrhagic cystitis is serious complication, and vigorous hydration
has to be instituted in all patients; can lead to various GI symptoms and ulcer
formation with delayed healing (use with prophylactic agent); can lead to
leukopenia, anemia, and thrombocytopenia (monitor blood counts); as immune
suppressant, places patients at risk for infections
Teratogenic—use in pregnancy should be greatly discouraged, particularly in
first trimester
Variety of other adverse effects must be monitored, and patients must be aware
of them, including alopecia, allergic reactions, infertility, myocarditis and
pericarditis, nephrolithiasis, and secondary malignancy
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