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What cyclophosphamide is

Cyclophosphamide is a chemotherapy drug. It is pronounced sigh-clo-fos-fah-mide. It is used to treat some types of cancer, including

It is often combined with other types of cancer drug treatment.

 

How cyclophosphamide works

Cyclophosphamide belongs to a group of drugs called alkylating agents. It works by sticking to one of the cancer cell's DNA strands. DNA is the genetic code that is in the heart of all animal and plant cells. It controls everything the cell does. The cell cannot then divide into 2 new cells.

 

How you have cyclophosphamide

You usually have cyclophosphamide as an injection into a vein (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. The tube stays in place as long as you need it.

Cyclophosphamide also comes as tablets that you swallow, ideally on an empty stomach. It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for cyclophosphamide depends on which type of cancer you have. We have detailed information about planning chemotherapy.

The side effects associated with cyclophosphamide are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link, look in our cancer drugs side effects section or use the search box at the top of the page.

 

Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
  • Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Nausea and vomiting – this is usually mild and well controlled with anti sickness medicines
  • Loss of appetite
  • Hair loss or hair thinning usually starts about 3 to 4 weeks after your first dose. A cold cap may help to stop you losing your hair, but you need to talk to your doctor about how advisable this is with your type of cancer
  • Women may stop having periods (amenorrhoea) but this may only be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Diarrhoea – you should drink plenty of fluids. If your diarrhoea is severe or continues you could become dehydrated so let your doctor or nurse know
  • Your nails may darken or become ridged
  • Your skin may darken
  • Mouth ulcers
  • Inflammation of the bladder (cystitis) can cause pain and occasionally blood when passing urine. If you see blood in your urine contact your doctor or nurse straight away. You should drink 8 to 12 cups of fluid a day. If you are having cyclophosphamide through a drip you will have extra fluids through the drip too
 

Rare side effects

Fewer than 1 in 100 people have these.

  • An increased risk of getting a second cancer some years after cyclophosphamide treatment
  • Damage to heart muscle – this is usually temporary and only occurs with high dose treatment. But for a small number of people it may be permanent. You will have tests to check your heart before and after your treatment
  • Changes in lung tissue may lead to a cough or breathlessness
  • Fluid build up, leading to swollen hands or ankles
 

Important points to remember

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Do not breastfeed during this treatment because the drug may come through in the breast milk.

 

Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information about cyclophosphamide

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 25 July 2014