Administration: Intravenous infusion

Dose: Dose and dose frequency varies depending on condition being treated.

Time to response: Up to 6 weeks

Indications:

• Vasculitis.
• Severe Systemic Lupus Erythematosis and Other Connective Tissue Diseases.

Contraindications:

• Pregnancy & breast feeding.
• Active infection.
• Haemorrhagic cystitis.

Cautions: Impaired liver function & moderate/severe renal impairment.

Monitoring:

• FBC, U&E, LFT, ESR, CRP will be checked prior to infusion.
• Please check FBC 10 days post infusion.

Vaccinations:

• Avoid live attenuated vaccines.
• Offer annual influenza vaccination.
• In those who are biologic naïve pneumococcal vaccination and Sars-Cov-2 vaccination should ideally be performed at least 2 weeks before commencing biologic treatment.
• Assuming no contraindications before starting treatment:
  • Patients >50 should undergo vaccination against HZV.
  • Those who are varicella zoster negative should be offered varicella vaccination.

Ensure:

• Adequate contraception whilst on CYCLOPHOSPHAMIDE and for 3 months after stopping it.
• Young patients are aware of infertility risk.

In the event of:

• Nausea – give anti-emetics.
• Sore throat/fever/bruising/pallor – check FBC.
• Infection – CYCLOPHOSPHAMIDE infusion will be withheld.
• New haematuria unrelated to underlying rheumatic disease – discuss with urology.
• Increasing dyspnoea –arrange CXR.

Please inform the rheumatology department if:

• WBC < 3.5 x10⁹/L
• Neutrophils < 2.0 x 10⁹/l
• Platelets < 100 x 10⁹/l