{"id":3868,"date":"2025-03-31T18:11:51","date_gmt":"2025-03-31T18:11:51","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/cyclophosphamide-txt\/"},"modified":"2025-03-31T18:11:51","modified_gmt":"2025-03-31T18:11:51","slug":"cyclophosphamide-txt","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/cyclophosphamide-txt\/","title":{"rendered":"Cyclophosphamide.txt"},"content":{"rendered":"

Cyclophosphamide<\/h1>\n

CLINICAL USE <\/H3>
\nAlkylating agent:Immunosuppression of autoimmune diseases including rheumatoid arthritisTreatment of malignant disease

DOSE IN NORMAL RENAL FUNCTION <\/H3>Autoimmune disease: Oral: 1\u20132.5 mg\/kg\/day \u2014IV: Usually 0.5\u20131 g\/m \u20142 or 10\u201315 mg\/kg repeated at intervals, e.g. monthly (pulse therapy)Malignant disease: Oral: 50\u2013250 mg\/m \u20142 daily or according to local protocol

PHARMACOKINETICS <\/H3>
  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :279.1<\/li>\n
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Parent drug 0\u201310: alkylating metabolites >60<\/li>\n
  • %Excreted unchanged in urine &nbsp &nbsp : 5\u201325<\/li>\n

  • Volume of distribution (L\/kg) &nbsp &nbsp &nbsp :0.78<\/li>\n

  • half-life \u2013 normal\/ESRD (hrs)&nbsp &nbsp &nbsp :3\u201312\/10

    DOSE IN RENAL IMPAIRMENT <\/H3>

    GFR (mL\/MIN)<\/H4>
  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : 75\u2013100% of normal dose depending on clinical indication and local protocol
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : 50\u2013100% of normal dose depending on clinical indication and local protocol

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES <\/H3>
  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Dialysed. Dose as in GFR
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL\/min. Following dose, do not perform
  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp: exchange for 12 hours<\/p>\n
  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Dialysed. Dose as in GFR
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL\/min. Dose at minimum of 12 hours before\n
  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : session
  • HDF\/high flux &nbsp :Dialysed. Dose as in GFR
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL\/min. Dose at minimum of 12 hours before HDF session
  • CAV\/VVHD &nbsp &nbsp &nbsp:Dialysed. Dose as in GFR=10\u201320 mL\/min

    IMPORTANT DRUG INTERACTIONS <\/H3>Potentially hazardous interactions with other drugsAntipsychotics: avoid concomitant use with clozapine, increased risk of agranulocytosisCytotoxics: increased toxicity with high- dose cyclophosphamide and pentostatin \u2013 avoid concomitant use

    ADMINISTRATION <\/H3>

    Reconstition<\/H4>Add 5 mL water for injection to each 100 mg (sodium chloride 0.9% for Endoxana)

    Route <\/H4>Oral, IV

    Rate of Administration <\/H4>Directly into vein over 2\u20133 minutes, OR directly into tubing of fast running IV infusion with patient supine

    Comments<\/H4>IV route occasionally used for pulse therapy. Can be administered as an IV infusionInjection can be administered orally down an NG tube

    OTHER INFORMATION <\/H4>Prodrug \u2013 converted by hepatic microsomal enzymes to alkylating metabolites (great inter-patient variability in metabolism). Excretion primarily renal. Reduce IV dose to 75% of oral dose, bioavailability is 75%Cyclophosphamide and its alkylating metabolites can be eliminated by dialysisPatients receiving chronic indefinite therapy may be at increased risk of developing urothelial carcinomaIf patient is anuric and on dialysis, neither cyclophosphamide or its metabolites, nor Mesna should appear in the urinary tract. The use of Mesna may therefore be unnecessary, although this would be a clinical decisionIf the patient is still passing urine, Mesna should be given to prevent urothelial toxicity
    \n","protected":false},"excerpt":{"rendered":"

    Cyclophosphamide CLINICAL USE Alkylating agent:Immunosuppression of autoimmune diseases including rheumatoid<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-3868","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/3868","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=3868"}],"version-history":[{"count":0,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/3868\/revisions"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=3868"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=3868"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=3868"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}