Indications & Uses
Cytcloph 1 g is indicated for:
Pharmacology
Cyclophosphamide is converted mainly in the liver into active alkylating metabolites through a mixed function microsomal oxidase system. These metabolites interfere with the growth of susceptible, rapidly proliferating malignant cells. Its mechanism of action is thought to involve cross-linking of tumor cell DNA. Cyclophosphamide is well absorbed after oral administration, with a bioavailability greater than 75%. The unchanged drug has an elimination half-life of 3 to 12 hours. It is eliminated mainly as metabolites, though 5% to 25% of the dose is excreted in urine as unchanged drug. Several cytotoxic and noncytotoxic metabolites have been identified in urine and in plasma. Metabolite concentrations in plasma reach a peak 2 to 3 hours after an intravenous dose. Plasma protein binding of the unchanged drug is low, but some metabolites are bound to a greater extent, more than 60%. No single metabolite has been shown to be responsible for either the therapeutic or the toxic effects of cyclophosphamide. Although elevated metabolite levels have been observed in patients with renal failure, increased clinical toxicity in such patients has not been demonstrated.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
Treatment of malignant diseases (adults and children): When cyclophosphamide is used as the only oncolytic drug, the initial course for patients with no hematologic deficiency usually consists of 40 to 50 mg/kg given intravenously in divided doses over 2 to 5 days. Other intravenous regimens include 10 to 15 mg/kg given every 7 to 10 days, or 3 to 5 mg/kg twice weekly. Oral cyclophosphamide is usually given in the range of 1 to 5 mg/kg/day for both initial and maintenance dosing. Many other intravenous and oral cyclophosphamide regimens have been reported. Doses must be adjusted according to evidence of antitumor activity and/or leukopenia. The total leukocyte count is a good, objective guide for regulating the dose. A transient fall in the total white blood cell count to 2000 cells/mm3 (following short courses), or a more persistent reduction to 3000 cells/mm3 (with continuing therapy), is tolerated without serious risk of infection provided there is no marked granulocytopenia. When cyclophosphamide is included in combined cytotoxic regimens, it may be necessary to reduce the dose of cyclophosphamide as well as that of the other drugs. Cyclophosphamide and its metabolites are dialyzable, although there are probably quantitative differences depending on the dialysis system used. Patients with compromised renal function may show some measurable changes in the pharmacokinetic parameters of cyclophosphamide metabolism, but there is no consistent evidence that the cyclophosphamide dose needs to be modified in patients with renal function impairment.
Treatment of nonmalignant diseases. Biopsy proven "minimal change" nephrotic syndrome in children: An oral dose of 2.5 to 3 mg/kg daily for 60 to 90 days is recommended. In males, the incidence of oligospermia and azoospermia increases if cyclophosphamide treatment lasts longer than 60 days. Treatment beyond 90 days increases the probability of sterility. Adrenocorticosteroid therapy may be tapered and discontinued during the course of cyclophosphamide therapy.
Side Effects
Side effects of Neoclomide are grouped below by the body system affected or the type of reaction, and within each group they are listed from most to least common. Digestive system: Nausea and vomiting are common during Neoclomide therapy. Loss of appetite (anorexia) may occur, and less often abdominal discomfort or pain and diarrhea. There have been isolated reports of hemorrhagic colitis, ulceration of the mouth lining and jaundice during treatment. These effects generally settle once Neoclomide is stopped. Skin and its structures: Hair loss (alopecia) is common in patients treated with Neoclomide. The hair can be expected to grow back after treatment, or even while treatment continues, although it may differ in texture or color. Skin rash occurs occasionally. Skin pigmentation and nail changes can occur. Very rare reports of Stevens-Johnson syndrome and toxic epidermal necrolysis have been received during post-marketing surveillance; because these were spontaneous reports, a definite causal link to cyclophosphamide has not been established. Hematopoietic system: Leukopenia (a low white blood cell count) occurs in patients treated with Neoclomide. It is related to the dose and can be used as a guide to dosing. Leukopenia below 2000 cells/mm3 develops commonly in patients given an initial loading dose, and less often in patients maintained on smaller doses. The degree of neutropenia is particularly important because it goes hand in hand with reduced resistance to infection. Fever without a documented infection has been reported in neutropenic patients. Thrombocytopenia (low platelets) or anemia develops occasionally. These blood effects can usually be reversed by lowering the dose or interrupting treatment. Recovery from leukopenia usually begins 7 to 10 days after therapy is stopped. Urinary system: Hemorrhagic ureteritis and renal tubular necrosis have been reported in patients treated with Neoclomide. Such lesions usually resolve once therapy is stopped. Respiratory system: Interstitial pneumonitis has been reported in post-marketing experience. Interstitial pulmonary fibrosis has been reported in patients receiving high doses of Neoclomide over a prolonged period. Other: Anaphylactic reactions have been reported, and death has also been reported in association with this event. Possible cross-sensitivity with other alkylating agents has been reported. SIADH (syndrome of inappropriate ADH secretion) has been reported with the use of Neoclomide. Malaise and asthenia (weakness) have been reported in post-marketing experience.
Cautions & Contraindications
Warnings & Precautions
Take particular care to watch for toxicity in patients being treated with Neoclomide if any of these conditions are present: leukopenia, thrombocytopenia, tumor cell infiltration of bone marrow, previous X-ray therapy, previous therapy with other cytotoxic agents, impaired hepatic function, impaired renal function.
Contraindications
Cyclophosphamide should not be continued in patients whose bone marrow function is severely depressed. It must not be given to anyone who has previously shown hypersensitivity to the drug.
Pregnancy & Breastfeeding
Pregnancy Category D. Cyclophosphamide passes into breast milk. Because of the potential for serious adverse reactions in a nursing infant, along with evidence in humans that the drug may pose a tumor risk, the mother and her doctor should decide together whether to stop breastfeeding or stop the medicine, weighing how important the drug is for her treatment.
⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
Use in Special Populations
Pediatric use: The safety profile of Cyclophosphamide in children is similar to what is seen in adults.
Geriatric use: For patients aged 65 years and older, there isn't enough clinical study data on Cyclophosphamide to say whether they respond differently from younger patients. This applies to malignant lymphoma, multiple myeloma, leukemia, mycosis fungoides, neuroblastoma, retinoblastoma and breast carcinoma. In two clinical trials, Cyclophosphamide was compared with paclitaxel, each given together with cisplatin, for advanced ovarian carcinoma. Of the 552 patients who received Cyclophosphamide plus cisplatin, 154 (28%) were 65 years or older. Subset analyses (65 years) from these trials, published reports of trials of Cyclophosphamide-containing regimens in breast cancer and non-Hodgkin's lymphoma, and post marketing experience all suggest that elderly patients may be more susceptible to the toxicities of Cyclophosphamide. In general, dose selection for an elderly patient should be cautious. The usual approach is to start at the low end of the dosing range and adjust as necessary based on how the patient responds.
Overdose
There's no known specific antidote for Cyclophosphamide. If someone takes too much, the overdose is managed with supportive care. That includes proper treatment of any infection, myelosuppression or cardiac toxicity that develops.
⚠️ In an emergency call 999 or go to the nearest hospital emergency department.
Storage
Store at a temperature not exceeding 25°C in a dry place. Protect from light and moisture. Do not freeze.
Drug Interactions
Common questions about Cytcloph 1 g 1000 mg
What is Cytcloph 1 g 1000 mg Injection?
Cytcloph 1 g 1000 mg Injection is a medicine that contains Cyclophosphamide. It is made by Eskayef Pharmaceuticals Ltd., Narayanganj. It belongs to the Cytotoxic Chemotherapy group of medicines.
What is Cytcloph 1 g used for?
Cytcloph 1 g is used for: Cancer.
What are the side effects of Cytcloph 1 g?
Side effects of Neoclomide are grouped below by the body system affected or the type of reaction, and within each group they are listed from most to least common. Digestive system: Nausea and vomiting are common during Neoclomide therapy.
Can I take Cytcloph 1 g during pregnancy or while breastfeeding?
Pregnancy Category D. Cyclophosphamide passes into breast milk. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
What happens if I take too much Cytcloph 1 g?
There's no known specific antidote for Cyclophosphamide. If someone takes too much, the overdose is managed with supportive care. In an emergency call 999 or go to the nearest hospital emergency department.
How should I store Cytcloph 1 g?
Store at a temperature not exceeding 25°C in a dry place. Protect from light and moisture.
Can I take other medicines with Cytcloph 1 g?
Some medicines can interact with Cyclophosphamide, for example: Chlorthalidone, Glimepiride, Palonosetron, Phenobarbital, Daunorubicin, Glipizide. Tell your doctor or pharmacist about every medicine you take.
Do I need a prescription for Cytcloph 1 g?
Cytcloph 1 g is a prescription (Rx) medicine. Take it as your doctor advises.