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Cyclophosphamide is chemotherapy that is given as a treatment for many types of cancer. It is most commonly used to treat lymphomas, cancers of the ovary, breast and bladder, and a type of leukaemia known as chronic lymphocytic leukaemia. This section describes cyclophosphamide, how it is given and some of its possible side effects. It should ideally be read with CancerBACUP's general information on chemotherapy, which gives more information and advice.
You will see your doctor regularly while you have this treatment so that he or she can monitor the effects of the chemotherapy. This section should help you to discuss any queries about your treatment and its side effects with your doctor or chemotherapy nurse, as they are in the best position to help and advise you. You may also want to discuss it with one of CancerBACUP's Cancer Support Service nurses.
Cyclophosphamide is a clear fluid after being dissolved from powder. It is also available as pink or white tablets of 50mg.
Each person's reaction to chemotherapy is unique. Some people have very few side effects, while others may experience more. The side effects described here will not affect everyone who is given cyclophosphamide, and may be different if you are having more than one chemotherapy drug.
We have outlined the most common and the less common side effects, so you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you do notice any effects which you think may be due to the drug, but which are not listed here, please discuss them with your doctor or chemotherapy nurse.
Temporary reduction in the production of blood cells by the bone marrow This can result in anaemia leading to tiredness; an increased risk of bruising or bleeding and an increased risk of infection.
This effect can begin seven days after the treatment has been given and the number of blood cells is usually at its lowest point at 10-14 days after the chemotherapy. Your blood count will then increase steadily and will usually have returned to normal within 21 days.
The extent to which the number of blood cells is reduced depends on the dose of chemotherapy you have and which other chemotherapy drugs, if any, are given in combination. Your doctor can advise you how likely it is that your blood cells will be lowered by the chemotherapy. Your blood will be checked regularly to see how well your bone marrow is working.
If your temperature goes above 38°C (100.5°F), or you have any unexplained bruising or bleeding, or you suddenly feel unwell, even if you have a normal temperature, contact your doctor or the hospital straight away.
Nausea (feeling sick) and vomiting There are now very effective anti-sickness drugs to prevent or greatly reduce nausea and vomiting. If you do feel sick it may begin a couple of hours after the treatment is given and last for up to 24 hours (or a few days if high-dose treatment is given). If the sickness is not controlled, or continues, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.
Loss of appetite A dietitian or specialist nurse at your hospital can give advice. CancerBACUP's section on diet and the cancer patient has tips on boosting appetite, coping with eating difficulties and maintaining weight.
Irritation of the bladder lining It is important to drink plenty of fluids to help prevent any irritation. If you notice any blood in your urine, tell your doctor. With high-dose cyclophosphamide, fluids are given into the vein, along with a drug called mesna, which can help to prevent bladder irritation.
Hair loss This usually starts 3-4 weeks after the first dose of cyclophosphamide, although it may occur earlier. Hair may be lost completely or may just thin. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and the hair will start to regrow once the treatment ends.
Your liver may be temporarily affected Cyclophosphamide may cause changes in the way that your liver works, but it will return to normal when the treatment is finished. This is very unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver function.
Sore mouth and taste change Your mouth may become sore, or you may notice small ulcers, during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help reduce the risk of these effects. If you do have them, tell your doctor, who can prescribe special mouthwashes and medicines to prevent or clear any mouth infection.
You may notice that your food tastes different. Normal taste will come back after the treatment finishes.
Diarrhoea This can usually be easily controlled with medicine but tell your doctor if it is severe or persistent. It is important to drink plenty of fluids if you have diarrhoea.
Changes in nails Your nails may become darker, or ridged. These changes grow out over a few months once the treatment has finished.
Skin changes Your skin may darken, due to excess production of pigment, but this is rare.
Changes to the lungs Cyclophosphamide may cause some changes to lung tissue. Tell your doctor if you notice any cough or breathlessness.
Second cancer With long-term use of this drug there is a very small risk of developing a second cancer after many years. Your doctor or nurses can discuss this risk with you further.
Changes in the way your heart works This is very uncommon with standard doses but may occasionally occur with high-dose treatment. The muscle of the heart may be affected, usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given, and occasionally before each treatment.
Some people have hot flushes, dizziness, a strange taste and a feeling of having a blocked nose when the drug is being given. If you have any of these symptoms ask the doctor or nurse to slow down the drip to reduce the feeling.
Cyclophosphamide may be prescribed for conditions other than cancer. The drug dosage will then be much lower and therefore these side effects will probably not occur.
Some medicines can be harmful to take when you are having chemotherapy. Always tell your doctor about any medicine you are taking.
Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while taking cyclophosphamide as it may harm the developing foetus. It is necessary to use effective contraception whilst taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.
This section has been compiled using information from a number of reliable sources including;
For futher references, please see general bibliography.