Parenteral Manual

Cyclophosphamide

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
CYTOXAN, PROCYTOX
Classification: 
Antineoplastic, Alkylator/Immunosuppressive - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
March 2023
Indications: 
  • Many pediatric and adult cancers

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 

  • Available as 500 mg, 1000 mg and 2000 mg vials of powder injection. Store vials at room temperature. Temperature fluctuations can lead to melting of the active ingredient. Vials with melting may have a clear to yellow liquid which may appear as droplets. Do NOT use vials with signs of melting.

  • After reconstitution with 0.9% Normal saline (25 mL for 500 mg vial, 50 mL for 1 g vial, 100 mL for 2 g vial), shake well. Drug may take up to 1 hour to completely dissolve. Reconstituted solution is 20 mg/mL and should be a clear and colourless.
  • Infusions in 0.45% or 0.9% NaCl are stable for 24 hours at room temperature or 72 hours refrigerated.

  • Infusions in D5W or D5W-0.9%NaCl solutions are stable for 24 hours at room temperature or 36 hours refrigerated.

Compatibility: 

- Solutions Compatible: D5W, saline solutions, D5W-0.9%NaCl

- Additives/Above Cassette  Compatible: KCl, mesna

- Y-site Compatible: ampicillin, allopurinol, cefazolin, cefotaxime, cisplatin, clindamycin, cotrimoxazole, dexamethasone, doxorubicin, erythromycin, fluorouracil, furosemide, gentamicin, heparin, hydromorphone, idarubicin, leucovorin, lorazepam, methotrexate, methylprednisolone, metoclopramide, metronidazole, morphine, ondansetron, piperacillin, piperacillin-tazobactam, ranitidine, sodium bicarbonate, ticarcillin, vancomycin, vincristine

- Incompatible: no information

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO
IV Intermittent Infusion

YES
Doses < 1000 mg may be given undiluted by syringe pump

Usual dilution: in 50-250 mL of IV fluid
Infusion time: 30-60 minutes
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • 1-2.5 g/m2 Q 3-4 weeks
  • 150 - 300 mg/m2 x 3-5 days Q 3-4 weeks
  • High Dose: 4.5 g/m2 over 2 days (i.e: 2.25g/m2/day x 2 days)
  • For children <0.6 m2 convert mg/m2 dose to mg/kg/dose by dividing by 30

- Mesna must be administered at equivalent dose for doses > 1000 mg/m2

** Great variance in dosage, depending on indication and protocol

Dosage adjustment in renal impairment 

  • If CrCl <10 mL/minute, give 75% of dose
Potential hazards of parenteral administration: 

Immediate (within a few minutes to hours):

  • Nausea and/or vomiting especially with high doses (onset 6-12 hours post dose), anorexia, diarrhea
  • Headache, dizziness; nasal stuffiness
  • SIADH-like effect with hyponatremia, inappropriately concentrated urine; onset 6-12 hours after administration (caution: acute water intoxication - seizures)
  • Hemorrhagic cystitis
  • Taste alterations
  • Hyperkalemia, hyperuricemia (usually with first dose in lymphoma/leukemia with large tumor burden-tumor lysis syndrome)
  • If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.

Delayed (within a few weeks or months):

  • Alopecia
  • Myelosuppression, leukocyte nadir 8-15 days
  • Sterile hemorrhagic cystitis especially with high doses if inadequate hydration
  • Interstitial pneumonitis, pulmonary fibrosis (with prolonged, high-dose administration)
  • Sterility
  • Amenorrhea
  • Cardiomyopathy, pericardial effusion in extremely high doses (greater than 120 mg/kg)
  • Secondary malignancies
  • Mucositis, rash
  • Non vesicant

- Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

Notes: 
  • Monitor hematological status, renal function, and electrolytes
  • Ensure adequate hydration, maintain specific gravity <1.010, and frequent voiding (follow pre-printed orders)
  • Increased sensitivity to neuromuscular blocking drugs such as succinylcholine; the dose of succinylcholine should be reduced when administered concomitantly with cyclophosphamide
  • Administer as early in the day as possible to decrease amount of drug remaining in bladder overnight
  • Exerts immunosuppressive action, especially when on steroid concomitantly
  • Moderately dialyzable (20-50%)

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