lBREAST FEEDINGDiscontinue breast-feeding.
lHEPATIC IMPAIRMENT
Dose adjustmentsManufacturer advises consider dose
reduction in severe impairment—limited information
available.
lMONITORING REQUIREMENTSMonitor full blood count
regularly throughout treatment.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Chlorambucil for nephrotic
syndromewww.medicinesforchildren.org.uk/chlorambucil-
nephrotic-syndrome- 0
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
▶Chlorambucil (Non-proprietary)
Chlorambucil 2 mgChlorambucil 2 mg tablets| 25 tabletP
£ 42. 87 DT = £ 42. 87
Cyclophosphamide
lINDICATIONS AND DOSE
Acute lymphoblastic leukaemia, non-Hodgkin’s
lymphoma, retinoblastoma, neuroblastoma,
rhabdomyosarcoma, soft-tissue sarcomas, Ewing
tumour, neuroectodermal tumours (including
medulloblastoma), infant brain tumours, ependymona,
high-dose conditioning for bone marrow
transplantation, lupus nephritis
▶BY MOUTH, OR BY INTRAVENOUS INFUSION
▶Child:(consult local protocol)
Steroid-sensitive nephrotic syndrome
▶BY MOUTH
▶Child 3 months–17 years: 2 – 3 mg/kg daily for 8 weeks
▶BY INTRAVENOUS INFUSION
▶Child 3 months–17 years: 500 mg/m^2 once a month for
6 monthslUNLICENSED USENot licensed for use in children.
IMPORTANT SAFETY INFORMATION
RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES
See Cytotoxic drugs p. 531.lCONTRA-INDICATIONSHaemorrhagic cystitis
lCAUTIONSAvoid in Acute porphyrias p. 603 .diabetes
mellitus.previous or concurrent mediastinal irradiation—
risk of cardiotoxicity
lINTERACTIONS→Appendix 1 : alkylating agents
lSIDE-EFFECTS
▶Common or very commonAgranulocytosis.alopecia.
anaemia.asthenia.bone marrow disorders.cystitis.
decreased leucocytes.fever.haemolytic uraemic
syndrome.haemorrhage.hepatic disorders.
immunosuppression.increased risk of infection.mucosal
abnormalities.neutropenia.progressive multifocal
leukoencephalopathy.reactivation of infections.sperm
abnormalities.thrombocytopenia
▶UncommonAppetite decreased.embolism and thrombosis
.flushing.hypersensitivity.ovarian and fallopian tube
disorders.sepsis
▶Rare or very rareBladder disorders.chest pain.confusion
.constipation.diarrhoea.disseminated intravascular
coagulation.dizziness.eye inflammation.fluid imbalance
.headache.hyponatraemia.menstrual cycle irregularities
.nail discolouration.nausea.neoplasms.oral disorders.
pancreatitis acute.renal failure.secondary neoplasm.
seizure.severe cutaneous adverse reactions (SCARs).
SIADH.skin reactions.visual impairment.vomiting
▶Frequency not knownAbdominal pain.altered smell
sensation.arrhythmias.arthralgia.ascites.cardiac
inflammation.cardiogenic shock.cardiomyopathy.cough
.dyspnoea.encephalopathy.excessive tearing.facial
swelling.gastrointestinal disorders.hearing impairment.
heart failure.hyperhidrosis.hypoxia.infertility.
influenza like illness.multi organ failure.muscle
complaints.myelopathy.myocardial infarction.nasal
complaints.nephropathy.nerve disorders.neuralgia.
neurotoxicity.oedema.oropharyngeal pain.palpitations.
pericardial effusion.peripheral ischaemia.pulmonary
hypertension.pulmonary oedema.QT interval
prolongation.radiation injuries.renal tubular disorder.
renal tubular necrosis.respiratory disorders.
rhabdomyolysis.scleroderma.sensation abnormal.
sinusoidal obstruction syndrome.taste altered.testicular
atrophy.tremor.tumour lysis syndrome.vasculitis
SIDE-EFFECTS, FURTHER INFORMATION
Haemorrhagic cystitisA urinary metabolite of
cyclophosphamide, acrolein, can cause haemorrhagic
cystitis; this is a rare but serious complication that may be
prevented by increasingfluid intake for 24 – 48 hours after
intravenous injection, mesna can also help prevent
cystitis.
Secondary malignancyAs with all cytotoxic therapy,
treatment with cyclophosphamide is associated with an
increased incidence of secondary malignancies.
Fluid retentionAlkylating drugs can causefluid retention
with oedema and dilutional hyponatraemia in younger
children; the risk of this complication is higher in thefirst
2 days and also when given with concomitant vinca
alkaloids.
lCONCEPTION AND CONTRACEPTIONManufacturer advises
effective contraception during and for at least 3 months
after treatment in men or women. See alsoPregnancy and
reproductive functionin Cytotoxic drugs p. 531.
lPREGNANCYAvoid. See alsoPregnancy and reproductive
functionin Cytotoxic drugs p. 531.
lBREAST FEEDINGDiscontinue breast-feeding during and
for 36 hours after stopping treatment.
lHEPATIC IMPAIRMENT
Dose adjustmentsReduce dose—consult local treatment
protocol for details.
lRENAL IMPAIRMENT
Dose adjustmentsReduce dose—consult local treatment
protocol for details.
lDIRECTIONS FOR ADMINISTRATIONConsult local
treatment protocol for details.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Cyclophosphamide for nephrotic
syndromewww.medicinesforchildren.org.uk/
cyclophosphamide-nephrotic-syndrome- 0lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: tablet, oral suspension, oral solution,
solution for injection, solution for infusion
Tablet
CAUTIONARY AND ADVISORY LABELS25, 27
▶Cyclophosphamide (Non-proprietary)
Cyclophosphamide (as Cyclophosphamide monohydrate)
50 mgCyclophosphamide 50 mg tablets| 100 tabletP£ 139. 00
DT = £ 139. 00
▶Cytoxan(Imported (United States))
Cyclophosphamide 25 mgCytoxan 25 mg tablets|
100 tabletPs
Powder for solution for injection
▶Cyclophosphamide (Non-proprietary)
Cyclophosphamide (as Cyclophosphamide monohydrate)
500 mgCyclophosphamide 500 mg powder for solution for injection
vials| 1 vialP£ 9. 66 (Hospital only)| 1 vialP£ 9. 66BNFC 2018 – 2019 Cytotoxic responsive malignancy 535
Immune system and malignant disease8