Chemotherapeutic Agents

Warning

CYCLOPHOSPHAMIDE

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

Editorial Information

Last reviewed: 16/11/2021

Next review date: 16/11/2024

Author(s): Dr Karen Donaldson (lead author), Dr Elizabeth Murphy, Professor Robin Munro, Dr Sanjiv Nandwani, Dr Saira Batool, Dr Georgiana Young, (other contributors to documents included in guideline).

Version: V1

Approved By: Dr Karen Donaldson Rheumatology Clinical Lead; Rheumatology Consultants

Reviewer name(s): Karen Donaldson.