Cyclophosphamide

What is cyclophosphamide?

Cyclophosphamide is a medicine that is used to kill cancer cells. It is also used to prepare children for bone marrow or stem cell transplant and to treat conditions that may affect the immune system. You may hear cyclophosphamide called "cyclo" or by its brand names, Cytoxan or Procytox. Cyclophosphamide comes in tablet, liquid, and injection forms.

Before giving cyclophosphamide to your child

Tell your doctor if your child has ever reacted badly to cyclophosphamide or any other drug product.

Talk with your doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medication if your child has:

• infection or recent exposure to infection (such as chickenpox)
• kidney or liver problems
• low blood counts
• had previous chemotherapy or radiation therapy

How should you give your child cyclophosphamide?

Cyclophosphamide is most commonly given into a vein (intravenously or IV). It is a clear liquid that will be given by a nurse while in hospital or clinic.

In some cases or conditions, cyclophosphamide may be given by mouth. Although tablets are available, the injection form of cyclophosphamide (a liquid) may also be used by mouth for children who cannot take tablets. If your child is taking cyclophosphamide by mouth, you should follow these instructions when giving your child cyclophosphamide:

• Give your child cyclophosphamide at the same time every day. Pick a time that is easy for you so that you do not miss doses. It is best to give cyclophosphamide in the morning. This reduces the chance of bladder problems.
• Give this medicine for as long as your doctor or pharmacist tells you, even if your child seems completely well. Talk to your child's doctor before you stop giving cyclophosphamide for any reason.
• Give cyclophosphamide without food if possible. If this medicine upsets your child's stomach, try giving it with some food.
• If you must split or crush the cyclophosphamide tablets, ask your pharmacist about how to do this safely.
• If your child is taking liquid cyclophosphamide, give your child cyclophosphamide with the special spoon or syringe that the pharmacist gave you.
• You may mix the liquid cyclophosphamide with some juice just before giving it to your child. Do not give grapefruit or grapefruit juice while your child is taking cyclophosphamide.
• If your child throws up within 20 minutes after taking cyclophosphamide by mouth, repeat the dose. If it has been longer or you are not sure what to do, call your child's doctor or main nurse (called the contact nurse). Ask them if you should give the cyclophosphamide again.
• Have your child drink lots of fluid on the days before they take cyclophosphamide and 2 days after. Ask your child's doctor how much fluid your child should drink each day.
• Try to get your child to empty the bladder every 2 hours while awake and at bedtime. The doctor may also want your child to get up to empty the bladder in the night. This helps prevent problems with the bladder.

What should you do if your child misses a dose of cyclophosphamide?

• Give the missed dose as soon as you remember.
• If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
• Do not give your child two doses to make up for one missed dose.

What are the possible side effects of cyclophosphamide?

Your child may have some of these side effects while they take cyclophosphamide. Check with your child's doctor if your child continues to have any of these side effects and they do not go away or they bother your child:

• upset stomach, throwing up
• flushing, which is the face turning red and warm
• darkening of the skin and fingernails
• stuffy nose, headache, pain across the cheekbones

Call your child's doctor during office hours if your child has any of these side effects:

• unusual tiredness or weakness
• yellow eyes or skin
• skin changes, especially if your child also received radiation
• sores on the lips, tongue, mouth, or throat
• dizziness or confusion

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to the Emergency Department if your child has any of these side effects:

• fever or chills
• cough or sore throat
• unusual bleeding or bruising
• black, tarry bowel movements (stools)
• pain in the lower back or side
• blood in the urine or stools
• urinating more often
• a burning feeling or pain when your child urinates
• swelling in the ankles, feet, or lower legs
• trouble breathing or shortness of breath
• a heartbeat that seems fast

After your child stops getting cyclophosphamide, it may still cause side effects. Check with your child's doctor right away if your child has blood in their urine, even after they have stopped getting cyclophosphamide.

What safety measures should you take when your child is using cyclophosphamide?

Cyclophosphamide can lower the number of white blood cells in the blood temporarily, which increases your child's chances of getting an infection.

Your child can take the following precautions to prevent infections, especially when the blood count is low:

• Avoid people with infections, such as a cold or the flu.
• Avoid places that are very crowded with large groups of people.
• Be careful when brushing or flossing your child's teeth. Your doctor, nurse, or dentist may suggest different ways to clean your child's mouth and teeth.
• You/your child shouldn't touch your child's eyes or inside their nose without washing you/your child's hands first.
• Your child's nurse will review with you what to do in case of fever.

Cyclophosphamide can lower the number of platelets in the blood, which increases your child's risk of bleeding. You can take the following precautions:

• Be careful not to cut your child when using a razor, fingernail scissors, or toenail clippers.
• Your child should avoid contact sports where bruising or injury could occur.
• Before your child has surgery, including dental surgery, inform the doctor or dentist that your child is taking cyclophosphamide.

Your child should not receive any immunizations (vaccines) without your child's doctor's approval. Your child or anyone else in your household should not get oral polio vaccine while your child is being treated with cyclophosphamide. Tell your child's doctor if anyone in your household has recently received oral polio vaccine. Your child should avoid contact with anyone who has recently received this vaccine. Other live vaccines that your child should not get include measles, mumps and rubella (MMR), and chicken pox vaccine.

Cyclophosphamide may cause sores in the mouth. Rinse your child's mouth with a mouthwash made from baking soda to help keep it clean. Your nurse or pharmacist can tell you how to make this. Do not use store bought mouthwash as it may sting and cause a dry mouth.

Check with your child's doctor or pharmacist before giving your child any other medicines (prescription, non-prescription, herbal, or natural products).

What other important information should you know about cyclophosphamide?

• Tell your doctor and dentist that your child is getting cyclophosphamide before your child has any operation, even on teeth, or an emergency treatment.
• Keep a list of all medications your child is on and show the list to the doctor or pharmacist.
• Do not share your child's medicine with others and do not give anyone else's medicine to your child.
• Cyclophosphamide given in a vein may cause an upset stomach and throwing up. Your child will get medicine to prevent these problems.
• Your child may lose their hair. It will grow back when your child stops getting cyclophosphamide. The colour and feel of your child's hair may change when it grows back. Use a gentle shampoo and a soft brush on your child's hair.
• Cyclophosphamide may cause girls who have starting menstruating to miss their monthly menses (period). Speak to your doctor or nurse about what this may mean for your child.
• There is a chance that cyclophosphamide may cause birth defects if it is taken at the time of conception or if it is taken during pregnancy. If your child is sexually active, it is best that they use some kind of birth control while receiving cyclophosphamide. Tell the doctor right away if your child may be pregnant.
• After receiving cyclophosphamide, your child may not be able to have children or have more difficulty having children. Your child's doctor will discuss this in more detail with you or your child.
• If your child is taking cyclophosphamide by mouth, make sure you always have enough cyclophosphamide to last through weekends, holidays, and vacations. Call your pharmacy at least 2 days before your child runs out of medicine to order refills.
• Keep cyclophosphamide tablets at room temperature in a cool, dry place away from sunlight. Do not store it in the bathroom or kitchen.
• Keep cyclophosphamide liquid in the refrigerator. Do not freeze this medicine.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Keep cyclophosphamide out of your child’s sight and reach and locked up in a safe place. If your child takes too much cyclophosphamide, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.