& Clophosphamide

[Guest guest]

Hello Steve, I found an article on the internet about Cyclophosphamide and hope it shall answer some of your questions. I believe it takes approximately 6 weeks before you begin to feel the effects of this drug, but read on to get the full facts. Hope this helps, Marilyn

Why am I being prescribed clophosphamide?

Cyclophosphamide is used for several different types of rheumatic disease, including systemic lupus erythematosus (SLE), diseases which inflame the walls of blood vessels (e.g. polyarteritis nodosa), and sometimes for rheumatoid arthritis. It is a very powerful drug and may have effects on the immune system (the body’s own defence system). One of its actions is to reduce the activity of the immune system, and it is only prescribed under very close supervision. Cyclophosphamide is often prescribed along with steroid tablets.

When do I take cyclophosphamide, and what dose will I be prescribed?

There are several different ways in which cyclophosphamide can be prescribed. Your doctor will decide which is best for you and discuss this with you. The dose will depend on your body weight and may change depending on how you respond to the cyclophosphamide. The three main ways are as follows:

low doses of tablets (usually taken once a day)

high doses of tablets taken less often (e.g. once every 2 weeks)Tablets should be taken with or after food (preferably in the morning or early afternoon). They should be taken with plenty of water and swallowed whole (not chewed).

by injection into a vein (intravenous injection). Your doctor will decide how frequently you should have these injections. The injections need to be given in hospital.

How long will cyclophosphamide take to work?

Cyclophosphamide does not work immediately. It may take 6 weeks or more to produce an effect, depending on the illness for which it is being given.

What are the possible side-effects?

A common side-effect is nausea (feeling sick). Your doctor may prescribe medicine to reduce the sickness.

One very important side-effect of cyclophosphamide is inflammation and bleeding of the bladder wall (haemorrhagic cystitis). If this occurs you may notice blood in your urine and you must report to your doctor immediately. To reduce the risk of this happening, you should increase the number of non-alcoholic drinks each day to the equivalent of 8–10 glasses of water. Some doctors prescribe a drug called MESNA along with cyclophosphamide to try and reduce the risk of cystitis.

There is a slightly increased risk of certain types of cancer with cyclophosphamide. Discuss this with your doctor.

Cyclophosphamide can also affect the blood count (one of the effects is that fewer blood cells are made). Taking cyclophosphamide can make you more likely to develop infections. If this happens, or if you have a fever, unexplained bruising or bleeding, you must tell your doctor immediately.

Other possible side-effects are loss of hair, mouth ulcers, and irregular menstrual periods. If you develop these or any other new symptoms after starting cyclophosphamide, you should tell your doctor or rheumatology nurse as soon as possible.

Because cyclophosphamide can make you more prone to infections, if you have not had chickenpox but come into contact with someone who has chickenpox or shingles, or if you develop chickenpox or shingles, you should go to your doctor immediately as you may need special treatment.

Do I need any special checks while on cyclophosphamide?

Because cyclophosphamide can affect the blood and the bladder, your doctor will arrange for you to have a blood and urine test before you start treatment and then regular blood and urine checks while on cyclophosphamide. You may be asked to keep a record booklet with your blood and urine test results. Bring this with you when you visit your general practitioner or the hospital. You must not take cyclophosphamide unless you are having regular checks.

Can I take other medicines along with cyclophosphamide?

Cyclophosphamide may be prescribed along with other drugs in treating your condition. Some drugs interact with cyclophosphamide, so you should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are taking cyclophosphamide.

Cyclophosphamide is not a painkiller. So if you are on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you may continue to take these as well as cyclophosphamide, unless your doctor advises otherwise.

Do not take ‘over-the-counter’ preparations without discussing this first with your doctor, nurse or pharmacist.

Can I have vaccinations while on cyclophosphamide?

It is recommended that you should not be immunised using any of the ‘live’ vaccines such as polio, rubella (German measles) and yellow fever.

An ‘inactivated’ polio vaccine can be given instead of the ‘live’ polio vaccine, and the ‘inactivated’ version should also be given to people you are in close contact with, such as members of your household.

If you are on cyclophosphamide you should avoid contact with children or adults who have been given the ‘live’ polio vaccine, for 4–6 weeks after vaccination.

Yearly flu vaccines and pneumovax are safe and recommended.

May I drink alcohol while taking cyclophosphamide?

There is no particular reason for you to avoid alcohol while taking cyclophosphamide.

Does cyclophosphamide affect fertility or pregnancy?

Cyclophosphamide can reduce fertility in both men and women and so, for young patients, it is used only with caution. The effect may be reversible if you stop taking cyclophosphamide.

Cyclophosphamide should not be used by pregnant women. While taking cyclophosphamide, and for 6 months after treatment is stopped, both women and men must take contraceptive precautions. If you are planning a family or if you become pregnant while taking cyclophosphamide, you should discuss this with your doctor as soon as possible.

And what about breastfeeding?

You should not breastfeed if you are taking cyclophosphamide.

Where can I obtain further information?

If you would like any further information about cyclophosphamide, or if you have any concerns about your treatment, you should discuss this with your doctor, nurse or pharmacist.

Remember to keep all medicines out of reach of children.

PLEASE NOTE: this information sheet does not list all the side-effects these types of drugs can cause. For the full details, please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to side-effects which may be relevant in your particular case.

© Arthritis Research Campaign 2003

6244/D-CYP/03-1

A team of people contributed to this publication. The original text was written by an expert in the subject. It was assessed at draft stage by doctors, allied health professionals, an education specialist and people with arthritis. A non-medical editor rewrote the text to make it easy to understand and an arc medical editor is responsible for the content overall.

----Original Message Follows----

From: " "

I've had 1 injection of a drug called clophosphamide and I have 9 more

over the next 9 weeks. I will then have it once a month.

My doc says this is a chemotherapy drug and I'm just hoping to God that it

works. I am however questionning how long it will take before the drug takes

effect. I think the dose I am having via IV is 500ml / 25 mg.

Steve

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