Medicine Information

Cyclomide

Name: Cyclomide
Brand: Cyclomide
Rating: 4.5 (117 reviews)

Injection200 mgAntineoplastic agent, Alkylating agentATC: L01AA01

Generic Name

Cyclophosphamide

Manufacturer

Generic Pharmaceuticals Ltd.

Country

Bangladesh

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Price Details

Current market pricing information

Variant	Unit Price	Strip Price
cyclomide 200 mg injection	৳ 150.00	N/A

Description

Overview of the medicine

Cyclophosphamide is an alkylating agent used in the treatment of various cancers and autoimmune diseases. It is a prodrug that is metabolically activated to form cytotoxic compounds.

Uses & Indications

Malignant lymphomas (Hodgkin's and non-Hodgkin's lymphoma)

Leukemias (e.g., acute and chronic lymphocytic leukemia)

Multiple Myeloma

Breast Cancer

Ovarian Cancer

Neuroblastoma

Retinoblastoma

Sarcomas (e.g., Ewing's sarcoma)

Mycosis fungoides

Autoimmune disorders (e.g., severe rheumatoid arthritis, lupus nephritis, granulomatosis with polyangiitis, multiple sclerosis)

Dosage

Adults

Highly variable based on indication, regimen, and patient factors (e.g., 500-1500 mg/m² IV every 2-4 weeks for cancer; 0.5-1 g/m² IV monthly for autoimmune diseases). Typically administered in cycles.

Elderly

Dosage adjustment may be needed based on renal, hepatic function, and general health status. Start with lower doses and titrate carefully.

Renal_impairment

Dosage reduction is required in patients with severe renal impairment (CrCl < 25 mL/min). Consult specific guidelines for exact adjustments.

How to Take

Administered intravenously by a trained healthcare professional. The powder is reconstituted with sterile water for injection, then diluted in a suitable intravenous fluid (e.g., normal saline or D5W) and infused slowly over 30 minutes to several hours, depending on the dose.

Mechanism of Action

Cyclophosphamide is a prodrug activated by cytochrome P450 enzymes in the liver to form phosphoramide mustard and acrolein. Phosphoramide mustard is an alkylating agent that cross-links DNA strands, leading to cell death and immunosuppression.

Pharmacokinetics

Onset

Cytotoxic effects typically manifest within hours of administration.

Excretion

Mainly renal, with 50-70% excreted as metabolites and 10-20% as unchanged drug within 24-48 hours.

Half life

Parent drug: 3-12 hours; active metabolites have a longer duration of action.

Absorption

Administered intravenously, resulting in 100% bioavailability.

Metabolism

Primarily hepatic activation by cytochrome P450 enzymes (e.g., CYP2B6, CYP2C19, CYP3A4/5) to active metabolites (phosphoramide mustard) and inactive metabolites.

Side Effects

Contraindications

Known hypersensitivity to cyclophosphamide or any excipients
Severe bone marrow depression (especially in patients with recent radiotherapy or chemotherapy)
Acute infections
Severe bladder outlet obstruction
Pregnancy and lactation

Drug Interactions

Warfarin

Cyclophosphamide may alter the anticoagulant effect of warfarin; monitor INR closely.

Allopurinol

May increase cyclophosphamide myelotoxicity.

Live vaccines

Avoid due to immunosuppression.

Succinylcholine

Prolonged neuromuscular blockade due to inhibition of pseudocholinesterase.

Doxorubicin, Anthracyclines

Increased risk of cardiotoxicity.

CYP2B6 inhibitors (e.g., bupropion, thiotepa)

May reduce cyclophosphamide activation and efficacy.

CYP2B6 inducers (e.g., phenobarbital, rifampin)

May increase cyclophosphamide activation, potentially leading to increased toxicity.

Storage

Store unopened vials at controlled room temperature (20°C to 25°C, excursions permitted to 15°C to 30°C). Protect from light. Reconstituted solution should be used within 24 hours if stored at 2°C to 8°C (refrigerated).

Overdose

Symptoms of overdose include severe myelosuppression, cardiotoxicity, nausea, vomiting, alopecia, and mucositis. Management is supportive, including transfusions, hematopoietic growth factors, mesna (for uroprotection), and symptomatic treatment for other toxicities. Hemodialysis is not effective for removing active metabolites.

Pregnancy & Lactation

Pregnancy Category D: Cyclophosphamide is teratogenic and can cause severe fetal harm or death. It should not be used in pregnant women unless the potential benefit outweighs the fetal risk. Lactation: Excreted into breast milk and can cause serious adverse effects in the infant. Breastfeeding is contraindicated during treatment.

Frequently Asked Questions

Common questions about this medicine

Pack Sizes

1 vial of 200 mg powder for injection

Shelf Life

Typically 2-3 years for unopened vials when stored as directed. Reconstituted solutions have a limited shelf life (e.g., 24 hours refrigerated).

Availability

Hospitals, oncology clinics, specialized pharmacies

Approval Status

Approved by major regulatory bodies globally (e.g., FDA, EMA, DGDA)

Patent Status

Generic available

WHO Essential Medicine

Yes

Clinical Trials

Cyclophosphamide has been extensively studied in numerous clinical trials for its efficacy in various oncological indications (e.g., breast cancer, lymphomas, leukemias) and autoimmune conditions. Ongoing research includes studies on novel combinations, targeted delivery systems, and pharmacogenomic influences on response and toxicity.

Lab Monitoring

Complete Blood Count (CBC) with differential (before each dose and regularly throughout treatment)
Urinalysis (for hematuria, to monitor for hemorrhagic cystitis)
Liver function tests (ALT, AST, bilirubin)
Renal function tests (Creatinine, BUN, Creatinine Clearance)
Electrolytes (especially sodium, for SIADH risk)
Cardiac function tests (e.g., ECHO, ECG) if cardiotoxicity is a concern

Doctor Notes

Ensure robust antiemetic prophylaxis for all patients.
Monitor CBC, renal, and hepatic function closely before and during each cycle.
Administer adequate hydration and consider Mesna for uroprotection, especially with higher doses or certain regimens.
Counsel patients regarding potential for infertility and discuss fertility preservation options.
Be vigilant for signs of infection, cardiotoxicity, and pulmonary toxicity.

Patient Guidelines

Report any signs of infection (fever, chills, sore throat) immediately due to myelosuppression.
Maintain excellent hydration by drinking plenty of fluids (as advised by your doctor) to prevent bladder irritation (hemorrhagic cystitis).
Report any unusual bleeding, bruising, or blood in urine.
Discuss potential for hair loss and available coping strategies (wigs, scarves) before treatment.
Attend all scheduled appointments for blood tests and treatment administration.
Avoid contact with sick individuals to minimize infection risk.

Missed Dose Advice

As a hospital-administered chemotherapy drug, missed doses are managed by the healthcare team according to the specific treatment protocol and schedule. Contact your healthcare provider immediately if a scheduled dose is missed.

Driving Precautions

Cyclophosphamide may cause fatigue, dizziness, or visual disturbances. Patients should be advised to exercise caution when driving or operating machinery, especially after administration, until they know how the drug affects them.

Lifestyle Advice

Maintain good personal hygiene, especially hand washing, to reduce infection risk.
Avoid raw or undercooked foods and ensure all food is properly prepared.
Discuss fertility preservation options with your doctor before starting treatment, as cyclophosphamide can cause infertility.
Avoid alcohol consumption during treatment as it may exacerbate side effects and interfere with liver metabolism.

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