Cyclophosphamide

Generic Details

Generic Name

Cyclophosphamide

Other Names

  • Cytoxan
  • Neosar

Drug Class

  • Alkylating Agent
  • Immunosuppressive Agent

Chemical Formula

C7H15Cl2N2O2P

Molecular Weight

261.1 g/mol

Mechanism of Action

  • Cyclophosphamide is a prodrug that is converted in the liver by cytochrome P450 enzymes to active metabolites that crosslink DNA strands, leading to cell death.

Indications

  • Cancer chemotherapy (e.g., lymphomas, leukemias, multiple myeloma)
  • Autoimmune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus)

Common Dosage Forms

  • Tablet
  • Capsule
  • Powder for Injection

Typical Dosage

  • 50-150 mg per day for cancer chemotherapy
  • 1-5 mg/kg/day for autoimmune diseases

Pediatric Dosage

  • Dosage adjustments may be needed based on the child's weight and condition.

Geriatric Dosage

  • Initial doses may need to be lower due to decreased kidney function in elderly patients.

Side Effects

  • Nausea/vomiting
  • Bone marrow suppression
  • Hair loss
  • Hemorrhagic cystitis
  • Increased risk of infections
  • Secondary malignancies

Contraindications

  • Hypersensitivity to cyclophosphamide
  • Severe bone marrow suppression
  • Urinary tract hemorrhage

Pregnancy Category

  • Category D - Positive evidence of risk

Lactation Safety

  • Limited data available; caution advised

Drug Interactions

  • Allopurinol (increased risk of bone marrow suppression)
  • Live vaccines (decreased efficacy)
  • Warfarin (increased risk of bleeding)

Overdose Symptoms

  • Severe bone marrow suppression
  • Hemorrhagic cystitis

Antidote for Overdose

  • Supportive care, hematopoietic growth factors

Storage Conditions

  • Store at room temperature away from moisture and heat.

Pharmacokinetics

  • Absorption: Well-absorbed orally
  • Distribution: Widely distributed in the body, crosses the blood-brain barrier
  • Metabolism: Hepatic via cytochrome P450 enzymes
  • Excretion: Primarily renally excreted

Precautions

  • Monitor complete blood counts regularly
  • Use with caution in patients with renal impairment
  • Avoid use in patients with active infections

Warnings

  • Increased risk of secondary malignancies
  • Risk of severe bone marrow suppression

Others

  • Cyclophosphamide is often used in combination chemotherapy regimens for cancer treatment.