Cyclophosphamide - alkylating agents. Antineoplastic drug.
Structure and Composition of cyclophosphamide
The drug is released in the form of a white crystalline powder for solution for intramuscular or intravenous administration. Each vial contains the active ingredient - 200 mg cyclophosphamide.
According to the instructions Cyclophosphamide is an alkylating cytostatic drug, chemical composition similar to nitrogen mustard analogues.
The mechanism of drug action is the formation of crosslinks between DNA and RNA strands, as well as in the inhibition of protein synthesis.
Indications for use of cyclophosphamide
According to the instructions Cyclophosphamide is shown in the following cases:
- chronic lymphocytic leukemia or acute lymphoblastic leukemia;
- non-Hodgkin's lymphoma;
- Hodgkin's disease;
- breast cancer, ovarian cancer;
- multiple myeloma;
- mycosis fungoides;
Cyclophosphamide is used in combination with other anticancer drugs for the treatment of:
- germ cell tumors;
- cancer of the lung, bladder, cervical, prostate
- soft tissue sarcoma, Ewing's sarcoma;
- Wilms' tumor.
Furthermore, Cyclophosphamide Review effective as immunosuppressive agents in progressive autoimmune diseases (psoriatic arthritis, rheumatoid arthritis, autoimmune hemolytic anemia, collagen diseases, nephrotic syndrome), as well as to suppress graft rejection.
The instructions to cyclophosphamide contain the following contraindications:
- during pregnancy and breastfeeding;
- severe disorders of the bone marrow;
- urinary retention;
- active infection;
In the opinion of Cyclophosphamide should be used with caution in:
- severe liver, heart and kidneys;
- a history of gout;
- bone marrow infiltration by tumor cells;
- suppression of bone marrow function.
Dosing and dosing regimen of cyclophosphamide
According to the instructions Cyclophosphamide is used intramuscularly or intravenously. Cyclophosphamide is an integral component of many treatments of cancer. Dosage and route of administration depends upon the particular indication and patient tolerability.
The average dose of cyclophosphamide for children and adults:
- from 50 to 100 mg per m2 of each day for two to three weeks;
- from 100 to 200 mg per m2 twice or three times a week for three or four weeks;
- from 600 to 750 mg per m2 once every two weeks;
- from 1500 to 2000 mg per m2 once a month up to a total dose of 6-14
In the case of a combination of cyclophosphamide with other anticancer drugs may require dose reduction is not only cyclophosphamide, and other means.
The side effects of cyclophosphamide
In the opinion of Cyclophosphamide causes the following side effects:
- Digestive system: anorexia, nausea, vomiting, discomfort and pain in the abdominal area, stomatitis, constipation or diarrhea. There have been some reviews of cyclophosphamide, indicating the occurrence of jaundice, hemorrhagic colitis.
- Hemopoietic system: neutropenia, anemia, thrombocytopenia, leukopenia. At 7-14 days of treatment may be a slight reduction in the number of platelets and leukocytes.
- Skin: alopecia. Hair grow again after the completion of dosing. Furthermore, during the treatment of the skin rash may appear observed skin pigmentation and nail changes.
- Cardiovascular system: the introduction of high doses of cyclophosphamide for a long period of time can be observed cardiotoxicity. In addition, the observed complex, sometimes fatal, cases of heart failure due to hemorrhagic myocarditis.
- Urinary system: renal tubular necrosis (until the death of the patient), hemorrhagic cystitis or urethritis, bladder fibrosis. The urine may occur epithelial cells of the bladder. In rare reviews Cyclophosphamide at high doses can cause kidney disease, hyperuricemia and renal dysfunction.
- Respiratory system: interstitial pulmonary fibrosis.
- Reproductive system: disruption of spermatogenesis and oogenesis, sterility (sometimes irreversible). Many women develop amenorrhea. After the cessation of treatment regular menstruation usually recovered. Men taking the drug can lead to azoospermia or oligospermia, testicular atrophy varying degrees.
- Allergies: rash, skin rash and itching, anaphylactic reactions.
- Other side effects: rush of blood to the face, flushing of the face, the development of secondary malignancies, increased sweating, headache.
During the period of cyclophosphamide should regularly monitor the level of neutrophils and platelets in the blood and urine tests to pass the number of red blood cells.
Discontinue treatment cyclophosphamide according to the instructions in the following cases:
- If signs of cystitis with macro or microscopic haematuria;
- when the level of 100,000 platelets / microliter or more;
- when the level of white blood cells to 2500 cells / mm or more;
- in the event of severe infections.
While the drug is forbidden to drink alcohol. For the entire period of treatment must use reliable methods of contraception.
Cyclophosphamide is stored at a temperature not exceeding 10 degrees Celsius. Shelf life - 36 months.