Medicine Information

Endoxan

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

Powder for solution for injection200 mgAntineoplastic agent, ImmunosuppressantATC: L01AA01

Generic Name

Cyclophosphamide

Manufacturer

Baxter

Country

Germany (original developer)

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Price Details

Current market pricing information

Variant	Unit Price	Strip Price
endoxan 200 mg injection	৳ 222.63	N/A

Description

Overview of the medicine

Endoxan 200 mg injection contains Cyclophosphamide, an alkylating agent used in chemotherapy for various cancers and as an immunosuppressant for autoimmune diseases.

Uses & Indications

Various types of cancer (e.g., Lymphoma, Leukemia, Multiple Myeloma, Breast Cancer, Ovarian Cancer, Neuroblastoma)

Severe progressive rheumatoid arthritis

Systemic lupus erythematosus (SLE)

Wegener's granulomatosis

Minimal change nephrotic syndrome in children

Dosage

Adults

Highly individualized based on indication, patient condition, and concomitant therapy. Oncology doses typically range from 500-1500 mg/m² intravenously every 2-4 weeks. For immunosuppression, lower doses (e.g., 500-1000 mg IV monthly) are used. Refer to specific treatment protocols.

Elderly

Dose adjustment may be necessary due to potential decreased renal/hepatic function and bone marrow reserve. Close monitoring is crucial.

Renal_impairment

Dose reduction required for significant renal impairment. e.g., CrCl <25 mL/min: reduce dose by 25-50%.

How to Take

Administered as an intravenous infusion after reconstitution with sterile water for injection, typically over 30 minutes to 2 hours. Ensure adequate hydration, often with co-administration of Mesna, to prevent hemorrhagic cystitis.

Mechanism of Action

Cyclophosphamide is a prodrug activated in the liver to form active metabolites (phosphoramide mustard and acrolein). These metabolites cross-link DNA strands, inhibiting DNA synthesis and cell proliferation, leading to cell death. It is cell-cycle non-specific and also possesses immunosuppressive properties.

Pharmacokinetics

Onset

Effects can be seen within hours to days depending on indication and dose.

Excretion

Primarily renal, with 5-25% excreted as unchanged drug and metabolites in urine. Some biliary excretion also occurs.

Half life

Parent drug: 3-12 hours; active metabolites have variable half-lives.

Absorption

Administered intravenously, hence 100% bioavailability. Absorbed from the gastrointestinal tract if given orally.

Metabolism

Extensively metabolized in the liver by cytochrome P450 enzymes (e.g., CYP2B6, CYP2C9, CYP3A4/5) to active and inactive metabolites.

Side Effects

Contraindications

Known hypersensitivity to cyclophosphamide or any excipients
Severe bone marrow depression
Acute infections
Urinary outflow obstruction
Existing hemorrhagic cystitis

Drug Interactions

Phenytoin

May reduce cyclophosphamide levels.

Allopurinol

Increased bone marrow toxicity.

Barbiturates

May increase cyclophosphamide metabolism, leading to increased toxicity.

Immunosuppressants

Enhanced immunosuppression and increased risk of infection.

Cardiotoxic agents (e.g., anthracyclines)

Increased risk of cardiotoxicity.

Storage

Store below 25°C (77°F). Protect from light. Do not freeze. Reconstituted solution stability varies by diluent and temperature; follow specific manufacturer guidelines.

Overdose

Symptoms include severe myelosuppression, severe nausea/vomiting, and hemorrhagic cystitis. Management is supportive, including colony-stimulating factors for myelosuppression and mesna for uroprotection. There is no specific antidote.

Pregnancy & Lactation

Pregnancy Category D (evidence of fetal risk). Use only if potential benefit justifies the potential risk to the fetus and safer alternatives are not available. Contraindicated during lactation as it is excreted in breast milk and can cause serious adverse effects in the infant.

Frequently Asked Questions

Common questions about this medicine

Pack Sizes

1 vial of 200 mg5 vials of 200 mg

Shelf Life

Typically 2-3 years for unopened vials when stored correctly. Reconstituted solution stability is limited and should be used promptly or as per manufacturer's guidelines.

Availability

Hospitals, specialized pharmacies

Approval Status

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

Patent Status

Generic available

WHO Essential Medicine

Yes

Clinical Trials

Numerous clinical trials have established cyclophosphamide's efficacy in various cancers and autoimmune conditions, often as part of multi-drug regimens. Ongoing research explores new indications, optimized dosing, and strategies to mitigate adverse effects.

Lab Monitoring

Complete Blood Count (CBC) with differential (before each dose and regularly during treatment)
Renal function tests (BUN, creatinine, electrolytes)
Liver function tests (ALT, AST, bilirubin, alkaline phosphatase)
Urinalysis (for hematuria, especially before each dose)
Cardiac function monitoring (ECG, echocardiogram) for patients with pre-existing heart conditions or high cumulative doses

Doctor Notes

Ensure co-administration of Mesna for high-dose cyclophosphamide regimens to prevent hemorrhagic cystitis.
Monitor CBC, renal, and hepatic function closely before, during, and after treatment.
Counsel patients on potential fertility issues and discuss preservation options if appropriate.
Administer in a healthcare facility equipped to manage cytotoxic drug-related emergencies and provide supportive care.
Regularly assess for signs of infection and secondary malignancies.

Patient Guidelines

Report any signs of infection (fever, chills, sore throat) immediately to your doctor.
Maintain adequate hydration by drinking plenty of fluids to prevent bladder irritation and damage.
Report any blood in urine, painful urination, or frequent urination.
Use effective contraception during and for a period (e.g., 1 year) after treatment, as cyclophosphamide can cause fetal harm and affect fertility.
Avoid crowded places and contact with sick individuals to reduce the risk of infection due to immunosuppression.

Missed Dose Advice

As this is an oncology/specialized drug, missed doses must be reported to the treating physician immediately. Do not self-administer or adjust dosage. The physician will decide the next course of action.

Driving Precautions

Cyclophosphamide may cause dizziness, fatigue, or visual disturbances. Patients should be cautious when driving or operating machinery until they know how the medicine affects them.

Lifestyle Advice

Maintain good personal hygiene, including frequent hand washing.
Eat a balanced, nutritious diet as tolerated, avoiding raw or undercooked foods.
Discuss vaccination schedule with your doctor, as live vaccines are generally contraindicated during treatment.
Report any unusual bleeding or bruising.