Cyclophosphamide (Non-Cancer)

You may experience the following side effects while on Cyclophosphamide. Tell your doctor if you encounter any of them so that adjustments to your therapy may be made to reduce the occurrence of these side effects where possible. These include:

• Hair thinning
• Nausea and vomiting

Please inform your doctor if you experience any other side effects or if the side effects become severe and bothersome.

There are some potentially serious but rare side effects that may be experienced when you are using Cyclophosphamide. These include:

• Bone marrow suppression, manifested as sore throats, mouth ulcers, unexplained bruising/bleeding, unusual tiredness, infection or persistent fever
• Blood in the urine 
• Newly appeared moles, discolouration of skin, swollen lymph nodes

Stop using Cyclophosphamide and inform your doctor immediately if you experience any of the potentially serious side effects.

Do not give your child or yourself any other medications or herbal products without consulting your doctor or pharmacist. Some medication or food may reduce its efficacy, or increase incidence of side effects where close monitoring is required. These include:

1. Blood-thinning medications such as Warfarin
2. Some antibiotics such as Rifampicin, Ciprofloxacin, Erythromycin and Clarithromycin
3. Anti-HIV medications
4. Anti-fungal medications such as Ketoconazole and Voriconazole
5. Anti-epileptic medications such as Carbamazepine and Phenytoin
6. Live vaccines such as BCG, MMR and some forms of polio or influenza vaccines
7. Grapefruit or Pomelo
8. St John’s Wort
9. Echinacea

Disclaimer: The list is not exhaustive, if in doubt, do inform your doctor or pharmacist especially if you are on any other medication or supplements when you are prescribed Methotrexate.

Cyclophosphamide should preferably be taken in the morning when the bladder is voided more frequently. It should not be taken before going to bed.

Cyclophosphamide is available in tablet form.

It is usually taken orally ONCE daily on empty stomach, either 1 hour before or 2 hours after food. It may be taken with or after food if gastric discomfort occurs. However, please inform your pharmacist or doctor if you are doing so.

As Cyclophosphamide may inflame the lining of the bladder, it is important to drink plenty of water to flush the bladder. (8 -10 glasses of water a day is recommended for adults)

Do not stop taking Cyclophosphamide unless you are told to do so by your doctor. Do not take more or less than required unless instructed.

If you forget a dose, take it as soon as you remember. If it is nearer to the time of your next dose or close to bedtime, skip the missed dose. Do not take two doses at the same time.

To minimise drug exposure to other members of the family, the following methods of administration are recommended:

1. Place tablets onto a spoon dedicated for use with Cyclophosphamide and administer directly into the mouth. Avoid contact with fingers if possible and wash hands and the spoon thoroughly after taking Cyclophosphamide.
2. Pregnant or breastfeeding women are advised to wear gloves as extra precaution where possible.
3. For patients who are unable to swallow tablets whole, it is advised to soak the tablets in water for a few minutes before grinding them to minimise the inhalation of medication powder.

Keep away from children;#Keep in a cool, dry place, away from direct sunlight;#Protect from light;#

Store below 25°C.

You are advised to bring Cyclophosphamide to the pharmacy for proper disposal if you are to stop the drug permanently.

Compliance to follow up visits

While taking Cyclophosphamide, you should be seeing your specialist doctor regularly to ensure that your treatment is optimized and to address any concerns relating to your treatment.

Regular laboratory tests may be conducted as directed by your doctor.

Supply of Drugs

You are advised not to purchase more Cyclophosphamide than required before your next visit in case of dose changes or discontinuation of therapy.

Caregiver advice

If you are pregnant or breastfeeding, extra precaution should be taken when handling Cyclophosphamide as it may cause harm to the developing foetus or baby.

Do not give Cyclophosphamide to anyone else. It has been prescribed for a specific condition, may not be the correct treatment for another person, and would be dangerous if the other person is pregnant or breastfeeding.