Cyclophosphamide

1. PRESENTATION
ON
CYCLOPHOSPHAMIDE
Prepared by:
Aasha Budhathoki
Roll no. 1
BNS 3rd year, MNC
Adult Health Nursing Major

2. Introduction
• Cyclophosphamide is a synthetic antineoplastic drug also known as
cytophosphane, a nitrogen mustard alkylating agent from the
oxazophorines group.
• It is a prodrug, converted in the liver to active forms that have
chemotherapeutic activity.
• Soluble in water, saline and ethanol.

3. Introduction (cont’d…)
• Classification: Antineoplastic; alkylating agent
• Availability: 25 mg, 50 mg tablets
• 100 mg, 200 mg, 500 mg, 1 gram, 2 gram vials
• Storage: Room temperature (20 to 25 degree celsius), protect from
sunlight and do not freeze.

5. Pharmacokinetics
• Absorption: Readily absorbed from GI tract and Peak: 1 h PO.
• Distribution: Widely distributed, including brain, breast milk; crosses
placenta
• Metabolism: Metabolized in liver
• Elimination: Excreted in urine as active metabolites and unchanged
drug
• Half-Life: 4–6 h.

6. Mechanism of action
• Alter DNA structure by misreading DNA code, initiating breaks in the
DNA molecule.
• Alkylating metabolites (Phosphoramide mustard) interfere with the
growth of susceptible rapidly proliferating malignant cells and forms
cross linking of DNA strands of tumor cell thereby blocking synthesis
of DNA, RNA, and protein.

7. Indications
• Malignant lymphoma
• Multiple myeloma
• Leukemia
• Mycosis fungoides (advanced disease)
• Neuroblastoma
• Retinoblastoma

8. Indications (cont’d…)
• Adenocarcinoma of ovary
• Carcinoma of breast
• Malignant neoplasms of lung
• Rheumatoid arthritis

9. Contraindications
• Severely depressed bone marrow
• Leukopenia and thrombocytopenia
• Pregnancy and lactation women

10. Adverse effects
• Gastrointestinal: Nausea, vomiting, mucositis, anorexia,
hepatotoxicity, diarrhea.
• Hematologic: Leukopenia, neutropenia, acute myeloid leukemia,
anemia, thrombophlebitis, interference with normal healing.
• Metabolic: Severe hyperkalemia, hyponatremia, weight gain (but
without edema) or weight loss

11. Adverse effects (cont’d…)
• Skin: Alopecia (reversible), transverse ridging of nails, pigmentation
of nail beds and skin (reversible), nonspecific dermatitis.
• Urogenital: hemorrhagic and non-hemorrhagic cystitis, bladder
fibrosis, nephrotoxicity.

12. Preparation
Pre medication
• Inj. Normal saline 100 ml/ 250 ml pre-flush
• Inj. ondem 8 mg bolus or Tab ondem 4 mg TDS/ BD for 2 days.
Inj. Cyclophosphamide (15 mg/kg or 0.5-1 gram/m2) in 500 ml
Normal saline for rheumatology.
Inj. Cyclophosphamide 40-50 mg/kg in Neoplasm.
• In nephro and rheumatology case infuse over 3-4 hours.

13. Preparation (cont’d…)
• In nephro and rheumatology case infuse over 3-4 hours.
• In hematology case over 1 hours.
• In oncology over half an hour over 100 ml Normal saline.
• Then post flush with 100 ml Normal saline.

14. Nursing implications
• Assess the lab reports such as total and differential leukocyte count,
platelet count, and Hematocrit , baseline liver and kidney function ,
serum electrolytes initially and at least 2 times per week during
maintenance period.
• Thrombocytopenia is rare, but if it occurs (count of 100,000/mm3 or
lower), assess for signs of unexplained bleeding or easy bruising. If
platelet count indicates thrombocytopenia (100,000/mm3), drug will
be discontinued.
• Monitor body weight twice a week.

15. Nursing implications (cont’d…)
• During severe leukopenic period, protect patient from potential source
of infection and trauma and from visitors.
• Monitor temperature and report immediately if onset of unexplained
chills, sore throat, tachycardia, fever. Fever in a neutropenic patient
(granulocyte count <1000) is a medical emergency because sepsis can
develop quickly in these patients.
• Monitor Intake output and increased per oral and iv fluid to help
prevent renal irritation and hemorrhagic cystitis.

16. Patient & Family Education
• Adhere to dosage regimen and do not omit, increase, decrease, or
delay doses. If for any reason drug cannot be taken, notify physician.
• Alopecia occurs in about 33% of patients on cyclophosphamide
therapy. Hair loss may be noted 3 weeks after therapy begins;
regrowth (often differs in texture and color) usually starts 5–6 weeks
after drug is withdrawn and may occur while on maintenance doses.

17. Patient & Family Education (cont’d…)
• Use adequate means of contraception during and for at least 4 months
after termination of drug treatment. Breast-feeding should be
discontinued before cyclophosphamide therapy is initiated.
• Amenorrhea may last up to 1 year after cessation of therapy in 10–
30% of women.
• Do not breast feed while taking this drug.

18. References
Medscape. Cyclophosphamide. Accessed from https://reference.medscape.com/drug/cytoxan-
cyclophosphamide-342214 16th December 2021.
Rob holland. Cyclophosphamide. Accessed from
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/C122.html 15th
December 2021.
Skidmore, L.S. (2015). Mosby’s drug guide for nursing students (11th ed.). ELSEVIER publication.
Smeltzer et al., (2012). Brunner and Suddharth’s Textbook of medical surgical nursing (12th ed.). Pp
354. Wolters Kluwer Publication.
Tripathi, K.D. (2019). Essential of medical pharmacology. Jaypee publication.