Coronavirus and cancer

We know it’s a worrying time for people with cancer, we have information to help. If you have symptoms of cancer contact your doctor.

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Cyclophosphamide

Cyclophosphamide (pronounced sigh-clo-fos-fah-mide) is a type of chemotherapy. It is a treatment for a number of different types of cancer.

You can have cyclophosphamide on its own, or in combination with other chemotherapy drugs.

How cyclophosphamide works

Cyclophosphamide works by damaging the DNA of cancer cells. The DNA is the genetic material of cells.

How you have cyclophosphamide

You have cyclophosphamide as a drip into your bloodstream (intravenously) or as tablets that you swallow whole with plenty of water.

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Taking your tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have cyclophosphamide

You have cyclophosphamide as cycles of treatment. Your plan depends on the type of cancer you have. And whether you’re having cyclophosphamide on its own or with other chemotherapy drugs.

Your doctor or nurse will tell you how often you’ll have it.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Inflammation of the bladder

Inflammation of the bladder (cystitis) can cause pain and occasionally blood when passing urine. 

Contact your advice line straight away if you see blood in your urine.

You should drink 8 to 12 cups of fluid a day to try to prevent this.

Depending on the dose of cyclophosphamide you have, you might have extra fluids through a drip to prevent bladder irritation. Or you might have a drug called mesna to protect your bladder.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • liver changes that are usually mild – you have regular blood tests to check this
  • a sore mouth
  • low sperm count in men
  • chills
  • lack of energy and strength

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • an allergic reaction causing a skin rash, itching, swelling of the lips, face or throat, or breathing difficulties
  • heart problems such as changes to the heart muscle or rhythm
  • nerve pain or changes that can cause a lack of sensation and strength in the hands and feet
  • loss of appetite
  • hearing loss
  • second cancers such as acute leukaemia or bladder cancer
  • lung changes that can cause a cough or shortness of breath
  • blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung. Contact your advice line or doctor straight away if you have any of these symptoms
  • eye problems causing vision changes and discomfort
  • skin and nail problems including a rash and colour changes
  • irregular or no periods

Other side effects

There isn’t enough information to work out how often these side effects might happen. You might have one or more of them. They include:

  • ringing in the ears (tinnitus)
  • changes in blood sugar levels
  • feeling confused
  • inflammation of the lining of the large bowel (colitis)

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Grapefruit and grapefruit juice

You should not eat grapefruit or drink grapefruit juice when you are taking this drug because it may increase the side effects.

Alcohol

Your doctor may tell you not to drink alcohol while having cyclophosphamide as a tablet. Alcohol might change the way this drug works and may increase feeling or being sick (nausea and vomiting).

Pregnancy and contraception

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

Women must not become pregnant for at least a year after the end of treatment. Men should not father a child for at least 6 months after treatment. 

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 might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help