cytoxan

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Cyclophosphamide (Cytoxan)

Introduction:Cyclophosphamide is a chemotherapy drug—a drug sometimes used to treat cancer. Also, it may be recommended as a treatment for serious autoimmune connective tissue diseases (“arthritis” diseases)—such as lupus, Wegener's granulomatosis and vasculitis. Although cyclophosphamide is accepted as “standard” therapy for serious manifestations of these diseases, it is still considered "experimental" since it has not been officially approved by the Food and Drug Administration ("FDA") for the treatment of lupus or other “arthritis” diseases.Cyclophosphamide suppresses the immune system, which is the system in your body responsible for protecting against infection and abnormal cells. On occasion, diseases occur when the immune system attacks your own body. This can threaten vital organs such as the kidneys or brain or may even be life-threatening. Scientific studies have shown that cyclophosphamide has the potential of reducing the injury caused by those diseases.Cyclophosphamide may be administered by pill or by injecting it into the vein. When injected into the vein, it is usually injected once monthly for 6 months and if necessary, less often after the initial 6 months. The cyclophosphamide injection usually takes 30 to 60 minutes. The dose of cyclophosphamide varies from patient to patient and is partially dependent upon the height and weight of the patient and the status of various blood tests (for example, whether your blood counts are high or low). Many physicians believe that taking cyclophosphamide by injection leads to fewer side-effects than taking it by mouth, and the doses used to treat “arthritis” diseases are usually much lower than those used to treat cancer. None-the-less, whether injected into the vein or given in pill form, serious side effects can occur. These side effects are described below. If you have questions or do not understand, ask your doctor. Possible Side-effects:It is impossible to predict who will get side effects or how serious they might be. In addition, it is impossible to predict the results of future research of the effectiveness and safety of cyclophosphamide. There may be side effects that will become apparent during future research that are currently unknown and unsuspected. Also, there can be no guarantee that cyclophosphamide or any therapy will successfully treat any illness. Cyclophosphamide decreases the production of blood cells in the bone marrow and also inhibits their functioning once they are in the blood stream. This can include the red blood cells, white blood cells and platelet cells. The decrease in blood counts may be particularly prominent within the first 3 weeks after treatment. If the number of blood cells decreases enough, serious (potentially life-threatening) side-effects can occur. These include serious infection (if the white blood cell count is significantly decreased), serious bleeding (if the platelet count is significantly decreased) or serious anemia (if the red blood cell count is significantly decreased). Shingles (an infection caused by the virus Herpes zoster) may occur as a complication of cyclophosphamide treatment. Other serious bacterial, virus or fungus infections can occur. Decreased blood cell counts may be so severe that transfusion is required. Thinning or loss of hair often occurs after cyclophosphamide treatment. The loss of hair is usually reversible but the color or texture of the hair may be different when it re-grows. The healing of wounds may be delayed during treatment with cyclophosphamide. Mouth sores and irritation of the vein where the cyclophosphamide is injected can occur. Rarely, a person can be allergic to cyclophosphamide. Serious allergic reactions can be fatal and require prompt treatment.There have been very rare reports of damage to the heart, liver, lungs or intestines due to cyclophosphamide, but this usually has been with large, cancer-treating doses.Nausea and vomiting are common with cyclophosphamide. Medication is prescribed to decrease these side effects, but sometimes nausea and vomiting occur despite the use of preventive medications.Cyclophosphamide should not be used during pregnancy, since it is likely to cause birth defects or death to the fetus (unborn baby). Cyclophosphamide should not be taken by men or women capable of having children, unless adequate precautions are taken to prevent pregnancy. Men often have permanently decreased sperm production and fertility after taking cyclophosphamide. Women can have permanent changes in their menstrual periods, permanently decreased fertility (be unable to bear children) or premature menopause ("change of life").Cyclophosphamide can damage the kidneys or bladder. This includes scarring, serious bleeding or tumor formation.Cyclophosphamide makes cancer formation more likely during a person’s lifetime. The precise risk is unknown but perhaps as many as 5 to 10% of people taking cyclophosphamide eventually will develop cancer. Cancer of the urinary tract (including kidneys or bladder) or cancer of other areas can occur. The increased risk of cancer persists even years after the cyclophosphamide is stopped. Therefore, follow-up blood and urine tests are required.Taking extra fluids may decrease the risk of irritation to the kidneys and bladder. Also, as indicated above, using the cyclophosphamide by injecting it in the vein monthly—rather than taking it as a pill every day—may decrease the risk of side-effects, including cancer formation and bleeding from the bladder. However, this is not certain.Potential Benefits:Lupus, Wegener’s granulomatosis and vasculitis can damage vital organs, including the kidneys and brain. If vital organs become damaged, serious sickness or death can result. Kidney damage can be severe enough to require dialysis (treatment with a "kidney machine") or a kidney transplant. Cyclophosphamide is recommended when less aggressive treatments—including cortisone ("steroids," "corticosteroids," "glucocorticoids") are not likely to be adequate therapy. Names of cortisone medications include: prednisone, Deltasone, methylprednisolone and Medrol. Cyclophosphamide may allow the use of lower doses of cortisone, and thus decrease the risk of cortisone side effects.