Cyclophosphamide

WHY is this medicine prescribed?

Cyclophosphamide is used alone or in combination with other medications to treat Hodgkin's lymphoma (Hodgkin's disease) and non-Hodgkin's lymphoma (types of cancer that begin in a type of white blood cells that normally fights infection); cutaneous T-cell lymphoma (CTCL, a group of cancers of the immune system that first appear as skin rashes); multiple myeloma (a type of cancer of the bone marrow); and certain types of leukemia (cancer of the white blood cells), including chronic lymphocytic leukemia (CLL), chronic myelogenous leukemia (CML), acute myeloid leukemia (AML, ANLL), and acute lymphoblastic leukemia (ALL). It is also used to treat retinoblastoma (cancer in the eye), neuroblastoma (a cancer that begins in nerve cells and occurs mainly in children), ovarian cancer (cancer that begins in the female reproductive organs where eggs are formed), and breast cancer. Cyclophosphamide is also used to treat nephrotic syndrome (a disease that is caused by damage to the kidneys) in children whose disease has not improved, has gotten worse, or has come back after taking other medications or in children who experienced intolerable side effects with other medications. Cyclophosphamide is in a class of medications called alkylating agents. When cyclophosphamide is used to treat cancer, it works by slowing or stopping the growth of cancer cells in your body. When cyclophosphamide is used to treat nephrotic syndrome, it works by suppressing your body's immune system.

Are there OTHER USES for this medicine?

Cyclophosphamide is also sometimes used to treat a certain type of lung cancer (small cell lung cancer; SCLC). It is also used to treat rhabdomyosarcoma (a type of cancer of the muscles) and Ewing's sarcoma (a type of bone cancer) in children. Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Cyclophosphamide comes as a tablet to take by mouth once a day. The length of treatment depends on the types of drugs you are taking, how well your body responds to them, and the type of cancer or condition you have. Take cyclophosphamide at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take cyclophosphamide exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the tablets whole; do not split, chew, or crush them.

Your doctor may need to delay your treatment or adjust your dose of cyclophosphamide depending on your response to treatment and any side effects that you experience. Talk to your doctor about how you are feeling during your treatment. Do not stop taking cyclophosphamide without talking to your doctor.

What SPECIAL PRECAUTIONS should I follow?

Before taking cyclophosphamide,

• tell your doctor and pharmacist if you are allergic to cyclophosphamide, other alkylating agents such as bendamustine (Treanda^®), busulfan (Myerlan^®, Busulfex^®), carmustine (BiCNU^®, Gliadel^® Wafer), chlorambucil (Leukeran^®), ifosfamide (Ifex^®), lomustine (CeeNU^®), melphalan (Alkeran^®), procarbazine (Mutalane^®), or temozolomide (Temodar^®), any other medications, or any of the ingredients in cyclophosphamide tablets. Ask your pharmacist for a list of the ingredients.

• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: allopurinol (Zyloprim^®), cortisone acetate, doxorubicin (Adriamycin^®, Doxil^®), hydrocortisone (Cortef^®), or phenobarbital (Luminal^® Sodium). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with cyclophosphamide, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.

• tell your doctor if you have previously received treatment with other chemotherapy medications or if you have had x-rays recently. Also tell your doctor if you have or have ever had kidney or liver disease.

• you should know that cyclophosphamide may interfere with the normal menstrual cycle (period) in women and may stop sperm production in men. Cyclophosphamide may cause permanent infertility (difficulty becoming pregnant); however, you should not assume that you cannot get pregnant or that you cannot get someone else pregnant. Women who are pregnant or breast-feeding should tell their doctors before they begin taking this drug. You should not plan to have children while receiving chemotherapy or for a while after treatments. (Talk to your doctor for further details.) Use a reliable method of birth control to prevent pregnancy. Cyclophosphamide may harm the fetus.

What SPECIAL DIETARY instructions should I follow?

Drink plenty of fluids while you are using this medication.

What should I do IF I FORGET to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Cyclophosphamide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• loss of appetite or weight
• abdominal pain
• diarrhea
• hair loss
• sores on the mouth or tongue
• changes in skin color
• changes in color or growth of finger or toe nails

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• sore throat, fever, chills, or other signs of infection
• poor or slow wound healing
• unusual bruising or bleeding
• black, tarry stools
• painful urination or red urine
• rash
• hives
• itching
• difficulty breathing or swallowing
• shortness of breath
• cough
• swelling in the legs, ankles, or feet
• chest pain
• yellowing of the skin or eyes

Cyclophosphamide may increase the risk that you will develop other cancers. Talk to your doctor about the risks of taking cyclophosphamide.

Cyclophosphamide may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• black, tarry stools
• red urine
• unusual bruising or bleeding
• unusual tiredness or weakness
• sore throat, cough, fever, or other signs of infection
• swelling in the legs, ankles, or feet
• chest pain

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to cyclophosphamide.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

^¶ This branded product is no longer on the market. Generic alternatives may be available.