Cyclophosphamide
A nitrogen mustard alkylating prodrug for lymphomas, leukemias, breast and ovarian cancer and myeloma, and for nephrotic syndrome in children.
Drug card
- Class
- Alkylating agent
- How it works
- Cross-linking DNA strands with alkyl groups so cells cannot divide
- Used for
- Hodgkin and non-Hodgkin lymphoma
- Leukemias, including ALL, AML and CLL
- Breast cancer
- Ovarian cancer
- Known for
- Bone marrow suppression and neutropenic fever
- Hemorrhagic cystitis
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does cyclophosphamide work?
A prodrug that the liver converts, through 4-hydroxycyclophosphamide and aldophosphamide, into phosphoramide mustard, which cross-links DNA, and acrolein. Acrolein passes into the urine and injures the bladder lining; mesna binds and inactivates it there. Cyclophosphamide also suppresses the immune system.
Uses
What is cyclophosphamide used for?
- Hodgkin and non-Hodgkin lymphoma
- Leukemias, including ALL, AML and CLL
- Breast cancer
- Ovarian cancer
- Multiple myeloma
- Minimal change nephrotic syndrome in children
Side effects
Side effects of cyclophosphamide
- Bone marrow suppression and neutropenic feverKnown forSerious
- Hemorrhagic cystitisKnown forSerious
- Serious infections, including reactivated onesSerious
- Nausea and vomiting
- Hair loss
- Infertility, possibly permanentSerious
- Bladder cancer, leukemia and other second cancersSerious
- Heart damage: myocarditis, heart failure, arrhythmiasSerious
- Pneumonitis and lung fibrosisSerious
- Low sodium from water retention (SIADH-like)Serious
- Veno-occlusive liver diseaseSerious
- Harm to an unborn babySerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Contraindicated with urinary outflow obstruction; hydration, frequent voiding and mesna reduce bladder toxicity.
- Check blood counts; do not give it when neutrophils or platelets are too low.
- It strongly inhibits cholinesterase: suxamethonium within 10 days of a dose can cause prolonged apnea.
- Protease inhibitors raise its toxic metabolites; monitor INR closely with warfarin.
Remember it
A way to remember it
Acrolein attacks the bladder; mesna mops it up.
Acrolein, a urinary metabolite of cyclophosphamide, injures the bladder lining and causes hemorrhagic cystitis; mesna binds and inactivates it, and good hydration helps too.
Written for biofideX
Its class
Alkylating agents
Alkylating agents, or the metabolites they form in the body, attach alkyl groups to DNA. The bonds cross-link the strands, so the DNA cannot be copied and the cell cannot divide, and it dies. Their damage falls hardest on fast-dividing tissue, which is why bone marrow, the gut lining, hair follicles and the gonads bear their main toxicities.
Easily mixed up with platinum compounds and antimetabolites.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Cyclophosphamide for injection: label (DailyMed)
- Cyclophosphamide (NCI Thesaurus)
- Cyclophosphamide (NCI)
- Mesna (NCI Thesaurus)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Cancer chemotherapy
Cyclophosphamide is one of 9 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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