It is available in an oral form but is usually given intravenously (through a small piece of tubing inserted into the patient's vein), either in a peripheral (arm) vein or a central line using a Hickman catheter
Hickman line
A Hickman line is a central venous catheter most often used for the administration of chemotherapy or other medications, as well as for the withdrawal of blood for analysis. Some types are used mainly for the purpose of apheresis or dialysis. Hickman lines may remain in place for extended periods a…
Vincristine
Vincristine is used to treat various types of cancer. It is a cancer chemotherapy drug that is usually used with other chemotherapy drugs to slow or stop cancer cell growth..
Full Answer
How do you give cyclophosphamide injection?
It is usually given through a vein by injection or infusion (intravenous, IV) or by mouth in tablet form, depending upon diagnosis. Cyclophosphamide is also approved to be given by a shot into a muscle (IM), into the abdominal lining (intraperitoneal, IP), or into the lining of the lung (intrapleural).
What type of drug is cyclophosphamide?
Drug Type: Cyclophosphamide is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "alkylating agent."
What are the limitations of cyclophosphamide for the treatment of hemorrhagic cystitis?
The limiting factor in cyclophosphamide dosage in the treatment of neoplasms and immune-inflammatory conditions is urinary tract toxicity. The severity of hemorrhagic cystitis may vary from light pinkish to exsanguinating hemorrhage.
Can I have a baby while taking cyclophosphamide?
For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking cyclophosphamide. Barrier methods of contraception, such as condoms, are recommended for up to one year after last dose of cyclophosphamide.
Does cyclophosphamide require central line?
How is the cyclophosphamide treatment given? The drug is given gradually, through a drip into a central line. This is a long, thin plastic tube which is placed into a large vein in your chest or a vein in your arm.
Can Cytoxan be given through peripheral IV?
It is available in an oral form but is usually given intravenously (through a small piece of tubing inserted into the patient's vein), either in a peripheral (arm) vein or a central line using a Hickman catheter, Broviac catheter, or a port-a-cath.
How do you administer cyclophosphamide IV?
If the solution is to be used for IV infusion, Cyclophosphamide (containing cyclophosphamide) is reconstituted by adding sterile water for injection or 0.9% sterile sodium chloride solution. Reconstituted Cyclophosphamide should be further diluted in 5% dextrose or 0.9% sodium chloride solution prior to infusion.
How do you administer Cytoxan?
It is usually given through a vein by injection or infusion (intravenous, IV) or by mouth in tablet form, depending upon diagnosis. Cyclophosphamide is also approved to be given by a shot into a muscle (IM), into the abdominal lining (intraperitoneal, IP), or into the lining of the lung (intrapleural).
Can you give chemotherapy through a peripheral IV?
Many cancer patients will receive chemotherapy infusions as a part of their cancer treatment. Sometimes, chemotherapy is delivered safely through a standard (or “peripheral”) IV line. Other times, infusions must be administered through a central line catheter, such as a PICC, CVC or port.
Which vein is the best location for a peripheral IV for chemotherapy?
Moreover, for chemotherapy infusion, insertion in a vein of the forearm is strongly recommended, avoiding hand, wrist and bend of the elbow veins.
Can you give cyclophosphamide IV push?
Slow IVP (doses ≤1 gram2): Cyclophosphamide should be prepared for parenteral use by adding 0.9% sterile sodium chloride solution if injected directly. IVPB or continuous intravenous infusion2: I.V. infusions may be administered over 1 to 24 hours.
How fast can you infuse cyclophosphamide?
infusions may be administered over 1 to 24 hours. Doses >500 mg to approximately 2 grams may be administered over 20- 30 minutes.
Can you touch cyclophosphamide?
Safe handling of cyclophosphamide You should be careful when handling this medicine and try to keep the drug from touching the skin. Taking precautions will ensure that both the patient and the caregiver are protected as well as possible.
What is the best way to administer chemotherapy?
Chemotherapy is most often given as an infusion into a vein (intravenously). The drugs can be given by inserting a tube with a needle into a vein in your arm or into a device in a vein in your chest.
What instructions should be given to a patient taking cyclophosphamide?
Drink plenty of fluids while being treated with cyclophosphamide, as this drug can irritate your kidneys and bladder. Cyclophosphamide has been associated with the development of certain types of cancers. Talk with your doctor about the potential risk of developing cancer.
What is the nursing consideration for cyclophosphamide?
Watch for signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician or nursing staff immediately.
Is Cytoxan a vesicant or irritant?
Chemotherapy vesicant & irritant properties and suggested management for extravasationDrugVesicant or IrritantCyclophosphamide (Cytoxan)Irritant or neutral, depending on referenceCytarabine (Ara-C)Irritant or neutral, depending on referenceCytarabine liposomal (DepoCyt)IrritantDacarbazine (DTIC)Irritant46 more rows•Sep 17, 2022
Can Gemzar be given peripherally?
The lyophilized formulation of gemcitabine should hence be used in peripheral intravenous infusion for the treatment of patients with cancer.
What is the preferred location for IV access for chemotherapy?
The subclavian vein is the preferred placement site to maximize patient comfort and minimize infection risk, but it has a higher risk of pneumothorax during placement. The internal jugular vein is less comfortable for the patient with a higher infection risk, but it is safer during placement.
What kind of IV is used for chemo?
Intravenous (IV) chemo Intravenous or IV chemo is put right into your bloodstream through a tiny, soft, plastic tube called a catheter. A needle is used to put the catheter into a vein in your forearm or hand; then the needle is taken out, leaving the catheter behind.
Why is chemotherapy given in cycles?
The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells.
How is cyclophosphamide given?
It is usually given through a vein by injection or infusion (intravenous, IV) or by mouth in tablet form, depending upon diagnosis. Cyclophosphamide is also approved to be given by a shot into a muscle (IM), into the abdominal lining (intraperitoneal, IP), or into the lining of the lung (intrapleural).
What is the trade name for Cyclophosphamide?
Cyclophosphamide. (sye-kloe-FAHS-fah-mide) Trade Names: Cytoxan®, Neosar®. Cyclophosphamide is the generic name for the trade name drug Cytoxan or Neosar. In some cases, health care professionals may use the trade name Cytoxan or Neosar when referring to the generic drug name cyclophosphamide. Drug Type: Cyclophosphamide is an anti-cancer ...
How long does it take for cyclophosphamide to cause nausea?
Nausea and vomiting: more common with larger doses, usually beginning 6-10 hours after therapy. Poor appetite. Discoloration of the skin or nails. The following are less common side effects (occurring in 10-29%) for patients receiving cyclophosphamide:
How long after taking Cyclophosphamide can you void?
It is important to void (empty your bladder) frequently especially in the first 24 hours after taking cyclophosphamide. Report any pain or burning on urination to your health care provider.
How long after cyclophosphamide can you get pregnant?
Barrier methods of contraception, such as condoms, are recommended for up to one year after last dose of cyclophosphamide.
What does nadir mean in chemo?
Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts. Hair loss: Temporary - usually begins 3-6 weeks after the start of therapy. Hair will grow back after treatment is completed although the color and/or texture may be different.
How often can you take cyclophosphamide?
Cyclophosphamide may be administered either intravenously (approximately once a month) or orally (once a day, typically in a smaller dose). To some degree, the side–effects of cyclophosphamide differ according to the way the drug is administered.
How often should I check my blood count after taking Cyclophosphamide?
This normally means checking blood counts every 2–4 weeks. When cyclophosphamide is given orally (i.e., every day, rather than once a month), blood counts should be checked about 7 days after starting treatment and then not less frequently than once every 3 weeks.
What causes a rash on one side of the face?
When it reactivates, Varicella zoster usually causes a painful rash in the distribution of a single nerve, such as over one side of the face or down one arm. The rash is characterized by groups of small vesicles (blisters) sitting on a base of reddened skin, and may be extremely painful.
What is the lowest point of cyclophosphamide?
When cyclophosphamide is given intravenously, the white blood cell count tends to reach its low point (“nadir”) between 7 and 14 days after administration.
What is shingles pain?
In a small minority of cases, “shingles” results in pain that can last for months. This condition is called “post–herpetic neuralgia”. An example of the classic rash of “shingles”. Pneumocystis carinii pneumonia (“PCP”) — Pneumocystis carinii is a fungus that resides within the lungs of most people.
What is the name of the condition that causes pain when you swallow?
This condition, called “Candida esophagitis”, often results in pain on swallowing, and must be treated with potent anti–fungal medications such as fluconazole. “Shingles” — or Herpes zoster. “Shingles” results from reactivation of the virus that causes chickenpox (Varicella zoster).
Does cyclophosphamide cause infections?
Cyclophosphamide increases the risk of “opportunistic” infections, i.e. infections that a person’s intact immune system would normally be able to fight off. Thus, cyclophosphamide does not enhance a patient’s susceptibility to the common cold, it does heighten the risk of more serious infections, including tuberculosis, fungal infections, and serious viral infections. Several specific infections frequently associated with cyclophosphamide use (or the use of immunosuppressive drugs in general) are described below:
What temperature should cyclophosphamide be stored at?
Store vials at or below 25°C (77°F) [see USP Controlled Room Temperature]. During transport or storage of cyclophosphamide vials, temperature influences can lead to melting of the active ingredient, cyclophosphamide. Vials containing melted substance can be visually differentiated. Melted cyclophosphamide is a clear or yellowish viscous liquid usually found as a connected phase or in droplets in the affected vials. Do not use cyclophosphamide vials if there are signs of melting.
How long does cyclophosphamide stay in your system?
Cyclophosphamide is well absorbed after oral administration with a bioavailability greater than 75%. The unchanged drug has an elimination half-life of 3 to 12 hours. It is eliminated primarily in the form of metabolites, but from 5 to 25% of the dose is excreted in urine as unchanged drug. Several cytotoxic and noncytotoxic metabolites have been identified in urine and in plasma. Concentrations of metabolites reach a maximum in plasma 2 to 3 hours after an intravenous dose. Plasma protein binding of unchanged drug is low but some metabolites are bound to an extent greater than 60%. It has not been demonstrated that any single metabolite is responsible for either the therapeutic or toxic effects of cyclophosphamide. Although elevated levels of metabolites of cyclophosphamide have been observed in patients with renal failure, increased clinical toxicity in such patients has not been demonstrated.
How to prepare cyclophosphamide?
Cyclophosphamide should be prepared for parenteral use by adding 0.9% sterile sodium chloride solution if injected directly. Cyclophosphamide should be prepared for parenteral use by infusion by adding Sterile Water for Inject ion, USP.
How long does it take for cyclophosphamide to cause oligospermia?
In males, the incidence of oligospermia and azoospermia increases if the duration of cyclophosphamide treatment exceeds 60 days. Treatment beyond 90 days increases the probability of sterility. Adrenocorticosteroid therapy may be tapered and discontinued during the course of cyclophosphamide therapy.
When cyclophosphamide is included in combined cytotoxic regimens, it may be necessary to?
When cyclophosphamide is included in combined cytotoxic regimens, it may be necessary to reduce the dose of cyclophosphamide as well as that of the other drugs.
What is cyclophosphamide?
Melted cyclophosphamide is a clear or yellowish viscous liquid usually found as a connected phase or in droplets in the affected vials. Do not use cyclophosphamide vials if there are signs of melting. Procedures for proper handling and disposal of anticancer drugs should be considered.
How long does sodium lactate stay in the refrigerator?
Sodium Lactate Injection, USP (1/6 molar sodium lactate) Constituted cyclophosphamide is chemically and physically stable for 24 hours at room temperature or for six days in the refrigerator; it does not contain any antimicrobial preservative and thus care must be taken to assure the sterility of prepared solutions.
What is a VOD?
Veno-occlusive liver disease (VOD) including fatal outcome has been reported in patients receiving cyclophosphamide-containing regimens. A cytoreductive regimen in preparation for bone marrow transplantation that consists of cyclophosphamide in combination with whole-body irradiation, busulfan, or other agents has been identified as a major risk factor. VOD has also been reported to develop gradually in patients receiving long-term low-dose immunosuppressive doses of cyclophosphamide. Other risk factors predisposing to the development of VOD include preexisting disturbances of hepatic function, previous radiation therapy of the abdomen, and a low performance status.
What is cyclophosphamide used for?
Cyclophosphamide is indicated for the treatment of biopsy proven minimal change nephrotic syndrome in #N#pediatrics patients who failed to adequately respond to or are unable to tolerate adrenocorticosteroid #N#therapy. #N#
Why is neutropenia important?
The degree of neutropenia is particularly important because it correlates with a reduction in resistance to infections. Fever without documented infection has been reported in neutropenic patients.
Where is cyclophosphamide biotransformed?
Cyclophosphamide is biotransformed principally in the liver to active alkylating metabolites by a mixed function microsomal oxidase system. These metabolites interfere with the growth of susceptible rapidly proliferating malignant cells.
Does cyclophosphamide cause cancer?
Cyclophosphamide administered by different routes, including intravenous, subcutaneous or intraperitoneal injection, or in drinking water, caused tumors in both mice and rats. In addition to leukemia and lymphoma, benign and malignant tumors were found at various tissue sites, including urinary bladder, mammary gland, lung, liver, and injection site [see Warnings and Precautions (5.5)].
Does renal impairment increase plasma levels?
In patients with severe renal impairment, decreased renal excretion may result in increased plasma levels of cyclophosphamide and its metabolites. This may result in increased toxicity [see Clinical Pharmacology
Is cyclophosphamide safe for elderly?
There is insufficient data from clinical studies of cyclophosphamide available for patients 65 years of age and older to determine whether they respond differently than younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac functioning, and of concomitant disease or other drug therapy.
How does cyclophosphamide affect renal function?
The results demonstrated that the systemic exposure to cyclophosphamide increased as the renal function decreased. Mean dose-corrected AUC increased by 38% in the moderate renal group, (Creatinine clearance (CrCl of 25 to 50 mL/min), by 64% in the severe renal group (CrCl of 10 to 24 mL/min) and by 23% in the hemodialysis group (CrCl of < 10 mL/min) compared to the control group. The increase in exposure was significant in the severe group (p>0.05); thus, patients with severe renal impairment should be closely monitored for toxicity [see Use in Specific Populations ( 8.6 )].
What are the effects of cyclophosphamide on the skeleton?
Malformations of the skeleton, palate, limbs and eyes as well as miscarriage have been reported after exposure to cyclophosphamide in the first trimester. Fetal growth retardation and toxic effects manifesting in the newborn, including leukopenia, anemia, pancytopenia, severe bone marrow hypoplasia, and gastroenteritis have been reported after exposure to cyclophosphamide.
What is cyclophosphamide activated by?
Cyclophosphamide is a pro-drug that is activated by cytochrome P450s [see Clinical Pharmacology ( 12.3 )].
How much cyclophosphamide is in a vial?
Cyclophosphamide Injection is a 200 mg per mL sterile clear colorless ready to dilute solution in a multiple-dose vial available in the following presentations:
What is a VOD?
Veno-occlusive liver disease (VOD) including fatal outcome has been reported in patients receiving cyclophosphamide-containing regimens. A cytoreductive regimen in preparation for bone marrow transplantation that consists of cyclophosphamide in combination with whole-body irradiation, busulfan, or other agents has been identified as a major risk factor. VOD has also been reported to develop gradually in patients receiving long-term low-dose immunosuppressive doses of cyclophosphamide. Other risk factors predisposing to the development of VOD include preexisting disturbances of hepatic function, previous radiation therapy of the abdomen, and a low performance status.
Which organ is responsible for cyclophosphamide activation?
The liver is the major site of cyclophosphamide activation. Approximately 75% of the administered dose of cyclophosphamide is activated by hepatic microsomal cytochrome P450s including CYP2A6, 2B6, 3A4, 3A5, 2C9, 2C18 and 2C19, with 2B6 displaying the highest 4-hydroxylase activity.
Why is neutropenia important?
The degree of neutropenia is particularly important because it correlates with a reduction in resistance to infections. Fever without documented infection has been reported in neutropenic patients.
What is the generic name for Cytoxan?
Cyclophosphamide is the generic name for the trade name drug Cytoxan or Neosar. In some cases, health care professionals may use the trade name Cytoxan or Neosar when referring to the generic drug name cyclophosphamide.
What does nadir mean in chemo?
Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.
How long after taking Cyclophosphamide can you void?
It is important to void (empty your bladder) frequently especially in the first 24 hours after taking cyclophosphamide. Report any pain or burning on urination to your health care provider.
How long after cyclophosphamide can you get pregnant?
Barrier methods of contraception, such as condoms, are recommended for up to one year after last dose of cyclophosphamide.
What happens if your blood count is low?
Low blood counts: Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding.
How to reduce nausea?
To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
Where is cyclophosphamide given?
Cyclophosphamide is also approved to be given by a shot into a muscle (IM), into the abdominal lining (intraperitoneal, IP), or into the lining of the lung (intrapleural).
Is Emla cream painful?
and thank goodness for emla cream. it very very painful if there's no emla cream.
Is port good for chemo?
The good thing about the port is that it's there for the long term. Even if the chemo can be given peripheral, she might need access for future needs. It would be nice to have the port for the long haul.
Do chemo patients have central ports?
Most of our patients receiving chemo do not have central lines/ports. If they have decent veins and are getting intermittent doses (vs continuous infusion over a period of days), we will use peripheral sites. The only exception is Vinorelbine. I've seen about the same number of problems with ports (infections, positions shifting, catheters floating up into the jugular!) as problems from using a peripheral vein. We have a well staffed clinic, though, (well, most of the time), and can monitor the patients closely. I have worked in other places where staffing was poor, infusion pumps were unavailable, and the chance for an IV site going bad would be much higher.
Is chemotherapy hard on veins?
I would be more concerned if the frequency of treatments were weekly. Chemo is hard on the veins, but it is not likely that her veins will be 'ruined' from the regimen she will be receiving.
Is it easier to get an IV stick or a port?
go for the port... it's so much easier on the patient. the more she has the chemo, the harder an IV stick she might become.
Infection
- Cyclophosphamide increases the risk of “opportunistic” infections, i.e. infections that a person’s intact immune system would normally be able to fight off. Thus, cyclophosphamide does not enhance a patient’s susceptibility to the common cold, it does heighten the risk of more serious infections, including tuberculosis, fungal infections, and serious viral infections. Several specific …
Bone Marrow Suppression
- The bone marrow is the organ of the body that makes red blood cells (which carry oxygen), white blood cells (which fight infection), and platelets (which help the blood clot). Nearly all patients treated with cyclophosphamide experience some suppression of the bone marrow’s ability to produce these vital blood elements. Thus, careful monitoring of blood counts is essential during …
Cancer
- Many of the side–effects of cyclophosphamide are most likely to occur while the patient is taking the medication. With those side–effects, the risk of their occurrence diminishes greatly after discontinuation of the drug. In contrast, the risk of cancer associated with cyclophoshamide use may continue for many years, even after patients stop the medication. The risk of cancer appear…
Bladder Problems
- In addition to cancer, cyclophosphamide may cause a variable amount of bleeding from the bladder, a complication known as “hemorrhagic cystitis”. This bleeding may range from a few red blood cells in the urine (invisible to the naked eye; only detectable by examining the urine under the microscope) to life–threatening hemorrhage from the bladder. If any bleeding from the blad…
Infertility
- Cyclophosphamide may cause infertility in both men and women who are treated with the medication. As with many of cyclophosphamide’s side–effects, the risk of infertility appears to be related to the length of time a patient receives the drug (and probably the cumulative dose, as well). A woman’s age may also affect her risk of infertility, with th...