Chemical formula: C₇H₁₅Cl₂N₂O₂P Molecular mass: 261.086 g/mol PubChem compound: 2907
Cyclophosphamide interacts in the following cases:
Reduced activation of cyclophosphamide may alter the effectiveness of cyclophosphamide treatment.
Sulfonamides delay activation of cyclophosphamide.
Co-administration with CYP3A4 inducers can reduce the efficacy or increase the toxicity of cyclophosphamide.
Reduced activation of cyclophosphamide may alter the effectiveness of cyclophosphamide treatment.
CYP3A4 inhibitors may reduce the efficacy of cyclophosphamide.
In patients with renal impairment, particularly in patients with severe renal impairment, decreased renal excretion may result in increased plasma levels of cyclophosphamide and its metabolites. This may result in increased toxicity and should be considered when determining the dosage in such patients. A dose reduction of 50% for a glomerular filtration rate below 10 mL/minute is recommended.
Cyclophosphamide and its metabolites are dialyzable, although there may be differences in clearance depending upon the dialysis system being used. In patients requiring dialysis, use of a consistent interval between cyclophosphamide administration and dialysis should be considered.
Reduced activation of cyclophosphamide may alter the effectiveness of cyclophosphamide treatment.
CYP2B6 inhibitors may reduce the efficacy of cyclophosphamide.
A reduced antitumor activity was observed in tumour-bearing animals during ethanol (alcohol) consumption and concomitant oral low-dose cyclophosphamide medication. In some patients, alcohol may increase cyclophosphamide-induced vomiting and nausea.
Severe hepatic impairment may be associated with a decreased activation of cyclophosphamide. This may alter the effectiveness of the cyclophosphamide treatment and should be considered when selecting the dose and interpreting response to the dose selected.
The dose must be reduced in patients with severe hepatic impairment. A dose reduction of 25% is recommended in patients with serum bilirubin concentrations of 3.1-5 mg/100 ml (=0.053-0.086 mmol/l).
Both increased and decreased warfarin effects have been reported in patients receiving warfarin and cyclophosphamide.
Increased hematotoxicity and/or immunosuppression may result from a combined effect of cyclophosphamide and thiazide diuretics (e.g. hydrochlorthiazide). An increase of bone marrow suppression was reported.
Increased hematotoxicity and/or immunosuppression may result from a combined effect of cyclophosphamide and ACE inhibitors. ACE inhibitors can cause leukopenia.
Reduced activation of cyclophosphamide may alter the effectiveness of cyclophosphamide treatment.
Azole-antimycotics are known to inhibit cytochrome P450 enzymes. Increased amounts of toxic degradation products of cyclophosphamide have been reported in combination with Itraconazole.
Concomitant use of protease inhibitors may increase the concentration of cytotoxic metabolites. Use of protease inhibitor-based regimens was found to be associated with a higher incidence of infections and neutropenia in patients receiving cyclophosphamide, doxorubicin, and etoposide (CDE) than use of an NNRTI-based regimen. Increased incidence of mucositis is reported in combined therapy of cyclophosphamide (CDE) and saquinavir.
The immunosuppressive effects of cyclophosphamide can be expected to reduce the response to vaccination. Use of live vaccines may lead to vaccine-induced infection.
Increased cardiotoxicity may result from a combined effect of cyclophosphamide and anthracyclines.
Reports suggest an increased risk of pulmonary toxicity in patients treated with cytotoxic chemotherapy that includes cyclophosphamide and G-CSF (granulocyte colony-stimulating factor) or GMCSF (granulocyte macrophage colony-stimulating factor).
Cyclophosphamide treatment causes a marked and persistent inhibition of cholinesterase activity. Prolonged apnoea may occur with concurrent depolarizing muscle relaxants (e.g. succinylcholine, suxamethonium) as a result of a decreased pseudocholinesterase level. If a patient has been treated with cyclophosphamide within 10 days of general anaesthesia, the anaesthesiologist should be alerted.
Cyclophosphamide is genotoxic and mutagenic, both in somatic and in male and female germ cells. Therefore, women should not become pregnant and men should not father a child during therapy with cyclophosphamide.
Women should not become pregnant during the treatment and for a period of 12 months following discontinuation of the therapy.
Men should not father a child during the treatment and for a period of 6 months following discontinuation of the therapy.
Animal data indicate that exposure of oocytes during follicular development may result in a decreased rate of implantations and viable pregnancies, and in an increased risk of malformations. This effect should be considered in case of intended fertilisation or pregnancy after discontinuation of cyclophosphamide therapy. The exact duration of follicular development in humans is not known, but may be longer than 12 months. Sexually active women and men should use effective methods of contraception during these periods of time.
Cyclophosphamide interferes with oogenesis and spermatogenesis. It may cause sterility in both sexes. Men treated with cyclophosphamide should be informed about sperm preservation prior to treatment.
An increase of the concentration of cytotoxic metabolites of cyclophosphamide may occur in co-administration with allopurinol. An increase of bone marrow suppression was reported.
Increased pulmonary toxicity may result from a combined effect of cyclophosphamide and amiodarone.
Increased nephrotoxicity may result from a combined effect of cyclophosphamide and amphotericin B.
Reduced activation of cyclophosphamide may alter the effectiveness of cyclophosphamide treatment.
Aprepitant delays activation of cyclophosphamide.
An increase of the concentration of cytotoxic metabolites of cyclophosphamide may occur in co-administration with azathioprine. An increased risk of hepatotoxicity (liver necrosis) was reported.
Reduced activation of cyclophosphamide may alter the effectiveness of cyclophosphamide treatment.
Bupropion delays activation of cyclophosphamide.
Cyclophosphamide metabolism by CYP2B6 may inhibit bupropion metabolism.
Reduced activation of cyclophosphamide may alter the effectiveness of cyclophosphamide treatment.
Decreased elimination of cyclophosphamide and prolonged half-life has been reported in patients who received high-dose cyclophosphamide less than 24 hours after high-dose busulfan. Increased incidence of hepatic veno-occlusive disease and mucositis has been reported with concomitant administration.
An increase of the concentration of cytotoxic metabolites of cyclophosphamide may occur in co-administration with chloral hydrate.
Reduced activation of cyclophosphamide may alter the effectiveness of cyclophosphamide treatment.
Chloramphenicol delays activation of cyclophosphamide.
Lower serum concentrations of cyclosporine have been observed in patients receiving a combination of cyclophosphamide and cyclosporine than in patients receiving only cyclosporine. This interaction may result in an increased incidence of graft versus host disease (GVHD).
An increase of the concentration of cytotoxic metabolites of cyclophosphamide may occur in co-administration with cimetidine.
Reduced activation of cyclophosphamide may alter the effectiveness of cyclophosphamide treatment.
Ciprofloxacin when administered prior to treatment with cyclophosphamide (used for conditioning prior to bone marrow transplant), ciprofloxacin may cause regression of the underlying disease.
Increased cardiotoxicity may result from a combined effect of cyclophosphamide and cytarabine.
Impaired absorption of digoxin and β-acetyldigoxin tablets have been reported during a concomitant cytotoxic treatment.
An increase of the concentration of cytotoxic metabolites of cyclophosphamide may occur in co-administration with disulfiram.
In patients with Wegener’s granulomatosis, the addition of etanercept to standard treatment, including cyclophosphamide, was associated with a higher incidence of non-cutaneous solid malignancies.
Increased nephrotoxicity may result from a combined effect of cyclophosphamide and indomethacin. Acute water intoxication has been reported with concomitant use of indomethacin.
Acute encephalopathy has been reported in a patient receiving cyclophosphamide and metronidazole. Causal association is unclear.
In an animal study, the combination of cyclophosphamide with metronidazole was associated with increased cyclophosphamide toxicity.
Increased cardiotoxicity may result from a combined effect of cyclophosphamide and mitomycin.
Increased hematotoxicity and/or immunosuppression may result from a combined effect of cyclophosphamide and natalizumab.
Reduced activation of cyclophosphamide may alter the effectiveness of cyclophosphamide treatment.
There have been reports of a pharmacokinetic interaction between ondansetron and high-dose cyclophosphamide resulting in decreased cyclophosphamide AUC.
Increased hematotoxicity and/or immunosuppression may result from a combined effect of cyclophosphamide and paclitaxel. Increased hematotoxicity has been reported when cyclophosphamide was administered after paclitaxel infusion.
Increased cardiotoxicity may result from a combined effect of cyclophosphamide and pentostatin.
Reduced activation of cyclophosphamide may alter the effectiveness of cyclophosphamide treatment.
Prasugrel delays activation of cyclophosphamide.
The potential for hepatic and extrahepatic microsomal enzyme induction must be considered in case of prior or concomitant treatment of cyclophosphamide with substances known to induce an increased activity of such enzymes such as rifampin, phenobarbital, carbamazepine, phenytoin, St. John’s wort, benzodiazepines and corticosteroids.
Concomitant use of tamoxifen and chemotherapy may increase the risk of thromboembolic complications.
Reduced activation of cyclophosphamide may alter the effectiveness of cyclophosphamide treatment.
Thiotepa a strong inhibition of cyclophosphamide bioactivation by thiotepa in high-dose chemotherapy regimens has been reported when thiotepa was administered 1 hour prior to cyclophosphamide.
Increased cardiotoxicity may result from a combined effect of cyclophosphamide and trastuzumab.
Impaired intestinal absorption of orally administered verapamil has been reported in co-administration with cyclophosphamide.
Increased hematotoxicity and/or immunosuppression may result from a combined effect of cyclophosphamide and zidovudine.
Cyclophosphamide and its metabolites are dialyzable, although there may be differences in clearance depending upon the dialysis system being used. In patients requiring dialysis, use of a consistent interval between cyclophosphamide administration and dialysis should be considered.
Patients with adrenal insufficiency may require an increase in corticoid substitution dose when exposed to stress from toxicity due to cytostatics, including cyclophosphamide.
Myocarditis and myopericarditis, which may be accompanied by significant pericardial effusion and cardiac tamponade, have been reported with cyclophosphamide therapy and have led to severe, sometimes fatal congestive heart failure. Histopathologic examination has primarily shown hemorrhagic myocarditis. Haemopericardium has been reported secondary to hemorrhagic myocarditis and myocardial necrosis. Acute cardiac toxicity has been reported with single doses as low as 20 mg/kg of cyclophosphamide.
Following exposure to treatment regimens that included cyclophosphamide, supraventricular arrhythmias (including atrial fibrillation and flutter) as well as ventricular arrhythmias (including severe QT prolongation associated with ventricular tachyarrhythmia) have been reported in patients with and without other signs of cardiotoxicity.
The risk of cyclophosphamide cardiotoxicity as a result of treatment with cyclophosphamide may, for example, be increased following high doses of cyclophosphamide, in patients with advanced age, and in patients with previous radiation treatment of the cardiac region and/or previous or concomitant treatment with other cardiotoxic agents.
Particular caution is required in patients with risk factors for cardiotoxicity and in patients with a pre-existing cardiac disease.
Treatment with cyclophosphamide may cause myelosuppression (anaemia, leukopenia, neutropenia and thrombocytopenia) and significant suppression of immune responses, which may result in severe, sometimes fatal, infections, sepsis and septic shock. Infections reported with cyclophosphamide include pneumonias, as well as other bacterial, fungal, viral, protozoal, and parasitic infections.
Latent infections can be reactivated. Reactivation has been reported for various bacterial, fungal, viral, protozoal, and parasitic infections.
Infections occurring during treatment with cyclophosphamide, including neutropenic fever, must be treated appropriately. Antimicrobial prophylaxis may be indicated in certain cases of neutropenia (at the discretion of the managing physician). In case of neutropenic fever, antibiotics and/or antimycotics must be given. Cyclophosphamide must be administered with the necessary caution (or not at all) in patients with severe functional impairment of bone marrow and patients with severe immunosuppression.
Close haematological monitoring is required for all patients during treatment. Haematological parameters must be checked prior to each administration and regularly during treatment. More frequent monitoring may be required if leukocyte counts drop below 3000 cells/microlitre (cells/mm³). Dose adjustment due to myelosuppression is recommended.
Unless essential, cyclophosphamide should not be administered to patients with a leukocyte count below 2500 cells/microlitre (cells/mm³) and/or a platelet count below 50,000 cells/microlitre (cells/mm³).
In principle, the fall in the peripheral blood cell and thrombocyte count and the time taken to recover may increase with increasing doses of cyclophosphamide.
The nadirs of the reduction in leukocyte count and thrombocyte count are usually reached in weeks 1 and 2 of treatment. The bone marrow recovers relatively quickly, and the levels of peripheral blood cell counts normalise, as a rule, after approximately 20 days.
Cyclophosphamide treatment may not be indicated, or should be interrupted, or the dose reduced, in patients who have or who develop a serious infection.
Severe myelosuppression must be expected particularly in patients pre-treated with and/or receiving concomitant chemotherapy and/or radiation therapy.
A leukocyte and platelet count should be regularly performed during treatment with cyclophosphamide. It is recommended to adjust the dose, if required, if signs of myelosuppression become evident.
Please refer to the table below. Urinary sediment should also be checked regularly for the presence of erythrocytes.
| Leukocyte count/μl | Platelet count/μl | Dosage |
|---|---|---|
| >4000 | >100 000 | 100% of the planned dose |
| 2500–4000 | 50 000–100 000 | 50% of the planned dose |
| <2500 | <50 000 | Omit until values normalise or decide individually |
In combination therapy further dose reductions may have to be considered.
Hemorrhagic cystitis, pyelitis, ureteritis, and haematuria have been reported with cyclophosphamide therapy. Bladder ulceration/necrosis, fibrosis/contracture and secondary cancer may develop. Urotoxicity may mandate interruption of treatment. Cases of urotoxicity with fatal outcomes have been reported.
Urotoxicity can occur with short-term and long-term use of cyclophosphamide. Hemorrhagic cystitis after single doses of cyclophosphamide has been reported. Cystectomy may become necessary due to fibrosis, bleeding, or secondary malignancy. Past or concomitant radiation or busulfan treatment may increase the risk for cyclophosphamide-induced hemorrhagic cystitis. Cystitis is, in general, initially abacterial. Secondary bacterial colonisation may follow.
Before starting treatment, it is necessary to exclude or correct any urinary tract obstructions. Urinary sediment should be checked regularly for the presence of erythrocytes and other signs of uro/nephrotoxicity. Adequate treatment with mesna and/or strong hydration to force diuresis can markedly reduce the frequency and severity of bladder toxicity. It is important to ensure that patients empty the bladder at regular intervals. Haematuria usually resolves in a few days after cyclophosphamide treatment is stopped, but it may persist. Severe hemorrhagic cystitis usually requires a discontinuation of the treatment with cyclophosphamide.
Cyclophosphamide has also been associated with nephrotoxicity, including renal tubular necrosis.
Pneumonitis and pulmonary fibrosis have been reported during and following treatment with cyclophosphamide. Pulmonary veno-occlusive disease and other forms of pulmonary toxicity have also been reported.
Pulmonary toxicity leading to respiratory failure has been reported.
While the incidence of cyclophosphamide-associated pulmonary toxicity is low, prognosis for affected patients is poor.
Late onset of pneumonitis (greater than 6 months after start of cyclophosphamide) appears to be associated with a particularly high mortality. Pneumonitis may develop even years after treatment with cyclophosphamide.
Acute pulmonary toxicity has been reported after a single cyclophosphamide dose.
Administration of cyclophosphamide may cause stomatitis (oral mucositis). Current guidelines on measures for prevention and amelioration of stomatitis should be considered.
Veno-occlusive liver disease (VOLD) has been reported in patients receiving cyclophosphamide, mainly in patients receiving a cytoreductive regimen in preparation for bone marrow transplantation in combination with whole-body irradiation, busulfan, or other agents. After cytoreductive therapy, the clinical syndrome typically develops 1 to 2 weeks after transplantation and is characterized by sudden weight gain, painful hepatomegaly, ascites, and hyperbilirubinemia/jaundice. However, VOLD has also been reported to develop gradually in patients receiving long-term low-dose immunosuppressive doses of cyclophosphamide.
As a complication of VOLD, hepatorenal syndrome and multiorgan failure may develop. Fatal outcome of cyclophosphamide-associated VOLD has been reported. Risk factors predisposing a patient to the development of VOLD include pre-existing disturbances of hepatic function, previous radiation therapy of the abdomen, and a low performance score.
VOLD incidence has been reported to reduce, if a time interval of at least 24 hours is observed between the last administration of busulfan and the first administration of cyclophosphamide.
Increased cardiotoxicity may result from a combined effect of cyclophosphamide and radiation therapy of the cardiac region.
Caution is also advised in is patients with diabetes mellitus, since cyclophosphamide may interact with insulin and other hypoglycaemic agents.
An increase of the concentration of cytotoxic metabolites of cyclophosphamide may occur in co-administration with glyceraldehyde.
Cyclophosphamide is contraindicated in pregnancy. Cyclophosphamide crosses the placental barrier. Treatment with cyclophosphamide has a genotoxic effect and may cause foetal damage when administered to pregnant women. Both women and men should wait at least 6 to 12 months after stopping cyclophosphamide before attempting to conceive or father a child.
Malformations have been reported in children born to mothers treated with cyclophosphamide during the first trimester of pregnancy. However, there are also reports of children without malformations born to women exposed during the first trimester.
Exposure to cyclophosphamide in utero may cause miscarriage, foetal growth retardation, and foetotoxic effects manifesting in the newborn, including leukopenia, anaemia, pancytopenia, severe bone marrow hypoplasia, and gastroenteritis.
Animal data suggest that an increased risk of failed pregnancy and malformations may persist after discontinuation of cyclophosphamide as long as oocytes/follicles exist that were exposed to cyclophosphamide during any of their maturation phases.
If cyclophosphamide is used during pregnancy, or if the patient becomes pregnant while taking this drug or after treatment, the patient should be apprised of the potential hazard to a foetus.
Cyclophosphamide is passed into the breast milk. Neutropenia, thrombocytopenia, low hemoglobin, and diarrhoea have been reported in children breast fed by women treated with cyclophosphamide. Women must not breastfeed during treatment with cyclophosphamide.
Girls treated with cyclophosphamide during pre-pubescence generally develop secondary sexual characteristics normally and have regular menses.
Girls treated with cyclophosphamide during pre-pubescence subsequently have conceived.
Girls treated with cyclophosphamide who have retained ovarian function after completing treatment are at increased risk of developing premature menopause (cessation of menses before age of 40 years).
Women should not become pregnant during the treatment and for a period of 12 months following discontinuation of the therapy.
Men should not father a child during the treatment and for a period of 6 months following discontinuation of the therapy.
Sexually active women and men should use effective methods of contraception during these periods of time.
Cyclophosphamide interferes with oogenesis and spermatogenesis. It may cause sterility in both sexes.
Development of sterility appears to depend on the dose of cyclophosphamide, duration of therapy, and the state of gonadal function at the time of treatment.
Cyclophosphamide-induced sterility may be irreversible in some patients.
Sexually active women and men should use effective methods of contraception during these periods of time.
Amenorrhea, transient or permanent, associated with decreased oestrogen and increased gonadotrophin secretion develops in a significant proportion of women treated with cyclophosphamide.
For older women, in particular, amenorrhea may be permanent.
Oligomenorrhea has also been reported in association with cyclophosphamide treatment.
Girls treated with cyclophosphamide during prepubescence generally develop secondary sexual characteristics normally and have regular menses.
Girls treated with cyclophosphamide during prepubescence subsequently have conceived.
Girls treated with cyclophosphamide who have retained ovarian function after completing treatment are at increased risk of developing premature menopause (cessation of menses before age of 40 years).
Men treated with cyclophosphamide may develop oligospermia or azoospermia, which are normally associated with increased gonadotrophin but normal testosterone secretion.
Sexual potency and libido generally are unimpaired in these patients.
Boys treated with cyclophosphamide during prepubescence may develop secondary sexual characteristics normally, but may have oligospermia or azoospermia.
Some degree of testicular atrophy may occur.
Cyclophosphamide-induced azoospermia is reversible in some patients, though the reversibility may not occur for several years after cessation of therapy.
Patients undergoing treatment with cyclophosphamide may experience undesirable effects (including nausea, vomiting, dizziness, blurred vision, visual impairment) which could affect the ability to drive or use machines. The decision to drive or operate machinery should be made on an individual basis.
The frequency of adverse reactions reported in the table below are derived from clinical trials and from post marketing experience and are defined using the following convention: very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000) not known.
Common: Infections1
Uncommon: Pneumonia2, Sepsis1
Rare: Acute leukaemia3, Myelodysplastic syndrome, Secondary malignancies, Bladder cancer, Ureteric cancer
Very rare: Tumour lysis syndrome
Not known: Non-Hodgkin’s lymphoma, Sarcoma, Renal cell carcinoma, Renal pelvis cancer, Thyroid cancer
Very common: Myelosuppression4, Leukopenia, Neutropenia
Common: Febrile neutropenia
Uncommon: Thrombocytopenia, Anaemia
Very rare: Disseminated intravascular coagulation, Haemolytic uremic syndrome
Not known: Agranulocytosis, Lymphopenia, Haemoglobin decreased
Very common: Immunosuppression
Uncommon: Anaphylactic/Anaphylactoid reaction, Hypersensitivity reaction
Very rare: Anaphylactic shock
Rare: SIADH (syndrome of inappropriate antidiuretic hormone secretion)
Uncommon: Anorexia
Rare: Dehydration
Very rare: Hyponatremia
Not known: Blood glucose increased, Blood glucose decreased
Very rare: Confusional state
Uncommon: Peripheral neuropathy, Polyneuropathy, Neuralgia
Rare: Convulsion, Dizziness
Very rare: Dysgeusia, Hypogeusia, Paresthesia
Not known: Neurotoxicity5, Reversible posterior leukoencephalopathy Syndrome6, Encephalopathy
Rare: Blurred vision, Visual impairment
Very rare: Conjunctivitis, Eye oedema7
Not known: Lacrimation increased
Uncommon: Deafness
Not known: Tinnitus
Uncommon: Cardiomyopathy, Myocarditis, Heart failure8, Tachycardia
Rare: Ventricular arrhythmia, Supraventricular arrhythmia
Very rare: Ventricular fibrillation, Angina, Myocardial infarction, Pericarditis, Atrial fibrillation
Not known: Ventricular tachycardia, Cardiogenic shock, Pericardial effusion, Bradycardia, Palpitations, Electrocardiogram QT prolonged
Uncommon: Flushing
Rare: Haemorrhage
Very rare: Thromboembolism, Hypertension, Hypotension
Not known: Pulmonary embolism, Venous thrombosis, Vasculitis, Peripheral ischemia
Very rare: Acute respiratory distress syndrome (ARDS) Chronic pulmonary interstitial fibrosis, Pulmonary oedema, Bronchospasm, Dyspnoea, Hypoxia, Cough
Not known: Nasal congestion, Oropharyngeal pain, Rhino rhea, Sneezing, Pulmonary veno-occlusive disease, Obliterative bronchiolitis, Alveolitis allergic, Pneumonitis, Pleural effusion
Common: Mucosal inflammation
Very rare: Enterocolitis haemorrhagic, Acute pancreatitis, Ascites, Stomatitis, Diarrhoea, Vomiting, Constipation, Nausea
Not known: Abdominal pain, Parotid gland inflammation, Gastrointestinal haemorrhage, Cecitis, Colitis, Enteritis
Common: Hepatic function abnormal
Rare: Hepatitis
Very rare: Veno-occlusive liver disease, Hepatomegaly, Jaundice
Not known: Cholestatic hepatitis, Hepatotoxicity10
Very common: Alopecia11
Rare: Rash, Dermatitis, Nail discolouration, Skin discolouration12
Very rare: Stevens-Johnson syndrome, Toxic epidermal necrolysis, Radiation erythaema, Pruritus (including itching due to inflammation)
Not known: Erythaema multiforme, Palmar-plantar erythrodysesthesia syndrome (hand-foot syndrome), Urticaria, Erythaema, Facial swelling, Hyperhidrosis
Very rare: Rhabdomyolysis, Cramps
Not known: Scleroderma, Muscle spasms, Myalgia, Arthralgia
Very common: Cystitis, Microhaematuria
__Common:__Haemorrhagic cystitis, Macrohematuria
Very rare: Suburethral haemorrhage, Bladder wall oedema, Bladder fibrosis and sclerosis, Renal impairment, Blood creatinine increased, Renal tubular necrosis
Not known: Renal tubular disorder, Nephropathy toxic, Hemorrhagic ureteritis, Bladder contracture, Nephrogenic diabetes insipidus, Atypical urinary bladder epithelial cells, Blood urea nitrogen increased
Not known: Premature labour
Common: Impairment of spermatogenesis
Uncommon: Ovulation disorder (rarely irreversible)
Rare: Amenorrhea13, Azoospermia/asperima13, Oligospermia13
Not known: Infertility, Ovarian failure, Oligomenorrhoe, Testicular atrophy
Not known: Intra-uterine death, Foetal malformation, Foetal growth retardation, Foetal damage, Carcinogenic effect on offspring
Very common: Fever
Common: Chills, Asthenia, Malaise
Rare: Chest pain
Very rare Headache, Multiorgan failure, Injection/infusion site reactions (thrombosis, necrosis, phlebitis, inflammation, pain, swelling, erythaema)
Uncommon: Blood lactate dehydrogenase increased, C-reactive protein increased, ECG changes, Decreased LVEF, Lower levels of female sex hormones
Very rare: Weight gain
Not known: Blood oestrogen level decreased, Blood gonadotropin level increased
1 An increased risk for and severity of pneumonias (including fatal outcomes), other bacterial, fungal, viral, protozoal, and parasitic infections; reactivation of latent infections, including viral hepatitis, tuberculosis, JC virus with progressive multifocal leukoencephalopathy (including fatal outcomes), pneumocystis jiroveci, herpes zoster, strongyloides, sepsis and septic shock (including fatal outcomes).
2 including fatal outcomes
3 including acute myeloid leukemia, acute promyelocytic leukemia
4 manifested as Bone marrow failure, Pancytopenia, Neutropaenia, Agranulocytosis, Granulocytopenia, Thrombocytopaenia (complicated by bleeding), Leukopenia, Anaemia
5 manifested as myelopathy, peripheral neuropathy, polyneuropathy,neuralgia, dysesthesia, hypoesthesia, paresthesia, tremor, dysgeusia, hypogeusia,parosmia.
6 manifested as headache, altered mental functioning, seizures and abnormal vision from blurriness to vision loss
7 Observed in connection with an allergic reaction
8 Including fatal outcomes
9 While the incidence of cyclophosphamide-associated pulmonary toxicity is low, prognosis for affected patients is poor.
10 Hepatic failure, Hepatic encephalopathy, Ascites, Hepatomegaly, Jaundice, Blood bilirubin increased, Hepatic enzymes increased (ASAT, ALAT, ALP, gamma-GT)
11 May progress to baldness
12 Of the palms and heels
13 Persistent
Certain complication such as thromboembolisms, disseminated intravascular coagulation, and haemolytic uremic syndrome may occur as a result of the underlying disorders, but the frequency of these complications may increase due to chemotherapy with cyclophosphamide.
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