Cyclotox
Generic Name
Cyclophosphamide
Manufacturer
Acme Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| cyclotox 1 gm injection | ৳ 650.00 | N/A |
Description
Overview of the medicine
Cyclophosphamide is an alkylating agent used in the treatment of various neoplastic diseases, including lymphomas, leukemias, multiple myeloma, and breast cancer. It is also used as an immunosuppressant in certain autoimmune conditions and organ transplantation.
Uses & Indications
Dosage
Adults
Highly variable and individualized based on the specific cancer or autoimmune condition, concomitant therapies, and patient's general health, typically administered intravenously. Dosage ranges from 50 mg/m² to 1500 mg/m² at various intervals (daily, weekly, monthly).
Elderly
Reduced doses may be necessary in elderly patients due to age-related decline in renal or hepatic function and increased susceptibility to myelosuppression.
Renal_impairment
Dose adjustment is required for patients with severe renal impairment (CrCl <20 mL/min). Generally, a 25-50% dose reduction may be necessary.
How to Take
Primarily administered as an intravenous (IV) infusion, diluted in saline or dextrose solution. Can also be given orally (tablets) or intramuscularly (IM) in some cases.
Mechanism of Action
Cyclophosphamide is a prodrug that is activated in the liver to form active alkylating metabolites. These metabolites cross-link DNA strands, preventing cell replication and transcription, leading to cell death. It is cell-cycle nonspecific.
Pharmacokinetics
Onset
Onset of action varies based on the indication and dosage regimen, often days to weeks for therapeutic effect.
Excretion
Primarily excreted renally as unchanged drug and metabolites. Approximately 5-25% of the dose is excreted unchanged in urine.
Half life
Elimination half-life of cyclophosphamide is approximately 3 to 10 hours; active metabolites have a longer half-life.
Absorption
Rapidly and extensively absorbed after oral administration. IV administration ensures complete bioavailability.
Metabolism
Extensively metabolized in the liver by cytochrome P450 enzymes to active metabolites (e.g., phosphoramide mustard, acrolein) and inactive metabolites.
Side Effects
Contraindications
- Hypersensitivity to cyclophosphamide or its excipients
- Severe bone marrow depression
- Active acute infections
- Recent extensive radiation therapy
- Urinary outflow obstruction (especially with acrolein-induced cystitis)
Drug Interactions
Warfarin
May alter the anticoagulant effect of warfarin, requiring close monitoring of INR.
Allopurinol
May increase bone marrow depression and cyclophosphamide toxicity.
Live vaccines
Increased risk of severe infection; avoid administration during cyclophosphamide therapy.
Phenobarbital
Can induce hepatic enzymes, potentially increasing the formation of active cyclophosphamide metabolites and toxicity.
Anthracyclines (e.g., Doxorubicin)
Increased risk of cardiotoxicity.
Storage
Store intact vials at controlled room temperature (20-25°C) and protect from light. Reconstituted solution stability varies, often 24 hours at room temperature or several days refrigerated.
Overdose
Overdose can lead to severe myelosuppression, hemorrhagic cystitis, cardiotoxicity, and hepatotoxicity. Treatment is supportive, including intensive hydration, administration of mesna to prevent cystitis, and hematopoietic growth factors for myelosuppression.
Pregnancy & Lactation
Cyclophosphamide is classified as Pregnancy Category D. It can cause fetal harm when administered to a pregnant woman. Should not be used during pregnancy or lactation due to excretion into breast milk and potential for serious adverse reactions in nursing infants.
Side Effects
Contraindications
- Hypersensitivity to cyclophosphamide or its excipients
- Severe bone marrow depression
- Active acute infections
- Recent extensive radiation therapy
- Urinary outflow obstruction (especially with acrolein-induced cystitis)
Drug Interactions
Warfarin
May alter the anticoagulant effect of warfarin, requiring close monitoring of INR.
Allopurinol
May increase bone marrow depression and cyclophosphamide toxicity.
Live vaccines
Increased risk of severe infection; avoid administration during cyclophosphamide therapy.
Phenobarbital
Can induce hepatic enzymes, potentially increasing the formation of active cyclophosphamide metabolites and toxicity.
Anthracyclines (e.g., Doxorubicin)
Increased risk of cardiotoxicity.
Storage
Store intact vials at controlled room temperature (20-25°C) and protect from light. Reconstituted solution stability varies, often 24 hours at room temperature or several days refrigerated.
Overdose
Overdose can lead to severe myelosuppression, hemorrhagic cystitis, cardiotoxicity, and hepatotoxicity. Treatment is supportive, including intensive hydration, administration of mesna to prevent cystitis, and hematopoietic growth factors for myelosuppression.
Pregnancy & Lactation
Cyclophosphamide is classified as Pregnancy Category D. It can cause fetal harm when administered to a pregnant woman. Should not be used during pregnancy or lactation due to excretion into breast milk and potential for serious adverse reactions in nursing infants.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2 to 3 years from the date of manufacture when stored correctly.
Availability
Available in hospitals and specialized pharmacies
Approval Status
Approved by major regulatory bodies (e.g., FDA, DGDA)
Patent Status
Generic, patent expired
WHO Essential Medicine
YesClinical Trials
Cyclophosphamide has been extensively studied in numerous clinical trials for various cancers and autoimmune conditions. Ongoing research continues to evaluate its efficacy, safety, and optimal use in combination therapies.
Lab Monitoring
- Complete Blood Count (CBC) with differential (before each dose and regularly during therapy)
- Renal function tests (serum creatinine, BUN)
- Liver function tests (ALT, AST, bilirubin)
- Urinalysis (for hematuria, especially prior to each dose)
- Fluid balance monitoring
Doctor Notes
- Ensure adequate hydration and prophylaxis with mesna, especially with high doses, to prevent hemorrhagic cystitis.
- Monitor CBC with differential prior to each dose and adjust subsequent doses based on hematological response and toxicity.
- Assess renal and hepatic function before and during therapy.
- Counsel patients on fertility preservation options before initiating treatment.
- Consider the cumulative cardiotoxicity risk, particularly with concomitant anthracycline use.
Patient Guidelines
- Maintain adequate hydration by drinking plenty of fluids to prevent hemorrhagic cystitis.
- Report any signs of infection (fever, chills) or bleeding/bruising immediately.
- Avoid contact with people who are sick or have infections.
- Follow all instructions regarding dose and schedule carefully.
- Use effective contraception during and for a period after treatment.
Missed Dose Advice
As this medication is typically administered in a controlled clinical setting, a missed dose is unlikely. If a scheduled dose is missed, immediately inform your healthcare provider for guidance.
Driving Precautions
Cyclophosphamide may cause dizziness, fatigue, or visual disturbances. Patients should be advised to exercise caution when driving or operating machinery until they know how the medication affects them.
Lifestyle Advice
- Practice good hand hygiene and avoid crowded places to minimize infection risk.
- Maintain a balanced diet and ensure adequate rest.
- Avoid alcohol and tobacco products.
- Discuss any vaccinations with your doctor before receiving them.
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