Cytoxan

The active ingredient in Cytoxan is cyclophosphamide. It is converted in the body into active metabolites that attach to DNA inside rapidly dividing cells. This prevents cancer cells and immune system cells from growing and dividing.

Follow all directions given to you by your doctor and read all documents provided, including the full Prescribing Information, FDA-Approved Product Labeling, Instructions for Use, and Medication Guide before using Cytoxan. However, the following is a synopsis of the general guidelines for the use of Cytoxan:

• Cytoxan may be given as an oral tablet or as an intravenous injection, depending on the treatment regimen.
• Oral cyclophosphamide should be swallowed with a full glass of water unless instructed otherwise.
• Doses vary depending on the type of cancer, body weight, treatment schedule, blood cell counts, and whether other chemotherapy drugs are being used.
• Drink plenty of fluids to help protect the bladder from toxic effects.
• If you miss a dose of oral cyclophosphamide, take it as soon as you remember, unless it is close to the next scheduled dose. Skip the missed dose if necessary. Do not double the next dose.

Some mild or common side effects of Cytoxan seen in clinical trials as compared to placebo include:

• Hair loss.
• Loss of appetite.
• Nausea or vomiting.
• Mouth sores.
• Skin rash.
• Low white blood cell counts increase the risk of infection.

Some individuals may experience serious side effects while using Cytoxan. These side effects may require immediate medical attention. If you experience any of the following, contact your healthcare provider or seek emergency medical help:

• Shortness of breath or difficulty breathing.
• Blood in the urine, painful urination, or bladder problems.
• Severe drop in blood cell counts, which may cause fever, infection, bleeding, or life-threatening complications.
• Heart failure or chest pain, particularly at high doses.
• Allergic reaction, such as rash, hives, swelling, or trouble breathing.
• Yellowing of the skin or eyes may indicate liver disease.
• Irregular menstrual periods, early menopause, or fertility changes.
• Fluid retention or sudden weight gain.

These are not all of the possible side effects of Cytoxan. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Before starting Cytoxan, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including if you have:

• Low blood cell counts or bone marrow problems.
• Liver disease or impaired kidney function.
• Bladder inflammation or difficulty with urination.
• Heart disease or a history of heart failure.
• Any ongoing infections.
• Plans for pregnancy or potential for pregnancy, since cyclophosphamide can cause birth defects.
• Breastfeeding, since cyclophosphamide may pass into breast milk.
• Recent or planned vaccines, especially live vaccines, because the drug suppresses the immune system.

Have a known allergy to cyclophosphamide or any of its components.

Have urinary outflow obstruction.

Have severe bone marrow suppression, unless the benefit outweighs the risk as determined by the treating physician.

For most cancers, improvement depends on the treatment regimen and may take several weeks or months.

When Cytoxan is taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking to avoid any negative drug interactions, including:

• Other immunosuppressive drugs can increase toxic effects on the bone marrow and immune system.
• Warfarin, with the possibility of an altered anticoagulant effect.
• Cyclosporine may increase toxic effects or alter immune suppression.
• High-dose regimens of other chemotherapy drugs.
• Live vaccines, due to reduced immune response and increased infection risk.

Oral tablets are available in 25 mg and 50 mg strengths. Powder for injection is supplied as lyophilized cyclophosphamide for reconstitution.

It should be stored at room temperature, away from the reach of children or pets.

Cytoxan is manufactured and distributed in Canada by Bristol-Myers Squibb Canada Inc.

Yes, it is available from many manufacturers of generic drugs.

Do not stop Cytoxan unless your healthcare provider tells you to. Discontinuation must be supervised, especially during a chemotherapy regimen. If you miss a tablet dose, contact your healthcare provider for instructions. Do not double the next dose.

Cyclophosphamide can cause birth defects and should not be used during pregnancy. Patients who could become pregnant should use effective birth control during treatment and for an appropriate period afterward. Talk to your doctor if you are already pregnant or if you have any plans to become pregnant. They will know or recommend what is best for you.

Breastfeeding is not recommended during treatment with cyclophosphamide due to the potential for harm to the infant. Talk to your doctor if you are already breastfeeding or if you have any plans to breastfeed. They will know or recommend what is best for you.