Cyclophosphamide Injection

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 injection 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 injection comes as a powder to be added to fluid and injected intravenously (into a vein) by a doctor or nurse in a medical office or hospital outpatient clinic. It may also be injected intramuscularly (into a muscle), intraperitoneally (into the abdominal cavity), or intrapleurally (into the chest cavity). 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.

Your doctor may need to delay your treatment or adjust your dose if you experience certain side effects. It is important for you to tell your doctor how you are feeling during your treatment with cyclophosphamide injection.

What SPECIAL PRECAUTIONS should I follow?

Before receiving cyclophosphamide injection,

• tell your doctor and pharmacist if you are allergic to cyclophosphamide, other alkylating agents such as bendamustine (Treanda^®), busulfan (Myerlan^®), Busulfex^®), carumustine (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 injection. 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 receiving 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 receiving this medication.

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 receiving cyclophosphamide injection.

Cyclophosphamide may cause other side effects. Call your doctor if you have any unusual problems while receiving 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?

This medication will be stored in the hospital or medical facility where you receive each dose.

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.

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.