Cyclophosphamide is a chemotherapy drug usually given to treat lymphomas, leukaemias, lung cancer and breast cancer. It may also be used to treat many other types of cancer.
What cyclophosphamide looks like
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Cyclophosphamide is a powder that dissolves to form a colourlesss fluid. It's also available as 50mg pink or white tablets.
Cyclophosphamide is given in one of the following ways:
by injection into a vein (intravenously) through a fine tube inserted into a vein, usually in the back of your hand
through a fine, plastic tube inserted under the skin and into a vein near your collarbone (central line)
into a fine tube inserted into a vein in the crook of your arm (PICC line)
by drip (intravenous infusion) through a cannula or line
as tablets that should be swallowed whole on an empty stomach.
Chemotherapy is usually given as a course of several sessions (cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer you're being treated for. Your nurse or doctor will discuss your treatment plan with you.
Some people have high-dose cyclophosphamide. This treatment is given before a stem cell transplant. You'll have this treatment while staying in hospital, usually over a period of about 4 days.
Before you begin your treatment your doctor will arrange for you to have blood tests. You'll usually be given anti-sickness drugs before and/or during your treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone who is given cyclophosphamide and may be different if you're having more than one type of chemotherapy drug.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that are not listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Cyclophosphamide can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38ºC (100.4ºF)
you suddenly feel unwell, even with a normal temperature.
You'll have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (blood count) is still low.
Bruising or bleeding
Cyclophosphamide can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low
Cyclophosphamide can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms.
You may need to have a blood transfusion if the number of red blood cells becomes too low.
Cyclophosphamide may irritate your bladder. It’s important to drink as much fluid as you can (at least two litres) during the 24 hours following chemotherapy to help prevent this. Let your doctor know if you have any discomfort when you pass urine, or if you notice any blood in it.
If you're having high-dose cyclophosphamide, you'll be given fluids through a drip(infusion), along with a drug called mesna (Uromitexan® ), to help prevent bladder irritation.
Feeling sick (nausea) or being sick (vomiting)
This may begin soon after the treatment is given and can last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Loss of appetite
Some people lose their appetite while having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give advice on improving your appetite and keeping to a healthy weight.
Your hair may thin or fall out completely. This usually starts 2–4 weeks after starting treatment, although it may occur earlier. You may also have thinning and loss of eyelashes, eyebrows and hair in other areas of the body. Hair loss is temporary, and your hair will grow back once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Scalp cooling is a method of reducing hair loss that may be helpful for some people. You can ask your doctor or nurse if it's available at your hospital.
Less common side effects
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Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicines to prevent or clear mouth infections.
Your nails may become darker or ridged. They usually return to normal within a few months of finishing the treatment.
This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished. During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun but should wear a suncream with a high sun protection factor (SPF), and cover up with clothing and a hat.
Sometimes areas of skin that have been treated with radiotherapy may become red and sore. Tell your doctor if this happens.
Treatment with cyclophosphamide may cause changes in the way your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor will take regular blood samples to check your liver is working properly.
Cyclophosphamide may cause some changes to lung tissue. Tell your doctor if you smoke or if you notice any coughing or breathlessness.
With long-term use of this drug there's a very small risk of developing a second cancer many years later. Your doctor or nurses can discuss this with you.
Changes in the way your heart works
This is very rare with standard doses but may occasionally occur with high-dose treatment. The muscle of the heart may be affected; usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given; sometimes before each treatment.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Conditions other than cancer
Cyclophosphamide may be prescribed for conditions other than cancer. The drug dosage will be much lower and so the side effects mentioned in this fact sheet will probably not occur.
Effects when treatment is given
Some people have hot flushes, dizziness, a strange taste, and a feeling of having a blocked nose when the drug is being given. If you have any of these symptoms, ask the doctor or nurse to slow down the drip, as this should reduce these effects.
Risk of developing a blood clot
Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it's important to tell your doctor straight away if you have any of these symptoms. Most clots can be treated with drugs to thin the blood. Your doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by taking this drug. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while taking cyclophosphamide, as it may harm the developing baby. It's necessary to use effective contraception while taking this drug and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
Things to remember about cyclophosphamide tablets
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It's important to take your tablets at the right times as directed by your doctor.
Swallow your tablets whole with a glass of water.
If you’re asked by your doctor or pharmacist to break your tablet in half, don't inhale any tablet powder. Wash your hands afterwards.
Always tell any doctors treating you for non-cancerous conditions that you're taking a course of chemotherapy tablets that should not be stopped or restarted without your cancer specialist's advice.
Keep the tablets in their original packaging, and store them at room temperature.
Keep the tablets in a safe place and out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Don't flush them down the toilet or throw them away.
If you're sick just after taking the tablet tell your doctor as you may need to take another dose. Don't take another tablet without telling your doctor first.
If you forget to take a tablet, don't take a double dose. Let your doctor know and keep to your regular dose schedule.
This section is based on our Cyclophosphamide factsheet which has been compiled using information from a number of reliable sources, including:
Sweetman, et al. Martindale: The Complete Drug Reference 37th edition 2011. Pharmaceutical Press.
electronic Medicines Compendium. (accessed October 2011).
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.