"The U.S. Food and Drug Administration today expanded the approved uses of Abraxane (paclitaxel protein-bound particles for injectable suspension, albumin-bound) to treat patients with late-stage (metastatic) pancreatic cancer.
Cytoxan (cyclophosphamide) is indicated for the treatment of:
- malignant lymphomas (Stages III and IV of the Ann Arbor staging system), Hodgkin's disease, lymphocytic lymphoma (nodular or diffuse), mixed-cell type lymphoma, histiocytic lymphoma, Burkitt's lymphoma
- multiple myeloma
- leukemias: chronic lymphocytic leukemia, chronic granulocytic leukemia (it is usually ineffective in acute blastic crisis), acute myelogenous and monocytic leukemia, acute lymphoblastic (stem-cell) leukemia (cyclophosphamide given during remission is effective in prolonging its duration)
- mycosis fungoides (advanced disease)
- neuroblastoma (disseminated disease)
- adenocarcinoma of the ovary
- carcinoma of the breast
Cyclophosphamide, although effective alone in susceptible malignancies, is more frequently used concurrently or sequentially with other antineoplastic drugs.
Minimal Change Nephrotic Syndrome in Pediatric Patients:
Cyclophosphamide is indicated for the treatment of biopsy proven minimal change nephrotic syndrome in pediatrics patients who failed to adequately respond to or are unable to tolerate adrenocorticosteroid therapy.
Limitations of Use
The safety and effectiveness for the treatment of nephrotic syndrome in adults or other renal disease has not been established.
DOSAGE AND ADMINISTRATION
During or immediately after the administration, adequate amounts of fluid should be ingested or infused to force diuresis in order to reduce the risk of urinary tract toxicity. Therefore, cyclophosphamide should be administered in the morning.
Dosing for Malignant Diseases
Adults and Pediatric Patients
When used as the only oncolytic drug therapy, the initial course of cyclophosphamide for patients with no hematologic deficiency usually consists of 40 mg per kg to 50 mg per kg given intravenously in divided doses over a period of 2 to 5 days. Other intravenous regimens include 10 mg per kg to 15 mg per kg given every 7 to 10 days or 3 mg per kg to 5 mg per kg twice weekly.
Oral cyclophosphamide dosing is usually in the range of 1 mg per kg per day to 5 mg per kg per day for both initial and maintenance dosing.
Many other regimens of intravenous and oral cyclophosphamide have been reported. Dosages must be adjusted in accord with evidence of antitumor activity and/or leukopenia. The total leukocyte count is a good, objective guide for regulating dosage.
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.
Dosing for Minimal Change Nephrotic Syndrome in Pediatric Patients
An oral dose of 2 mg per kg daily for 8 to 12 weeks (maximum cumulative dose 168 mg per kg) is recommended. Treatment beyond 90 days increases the probability of sterility in males [see Use in Specific Populations].
Preparation, Handling and Administration
Handle and dispose of cyclophosphamide in a manner consistent with other cytotoxic drugs.1 Caution should be exercised when handling and preparing Cyclophosphamide for Injection, USP (lyophilized powder), or bottles containing cyclophosphamide tablets. To minimize the risk of dermal exposure, always wear gloves when handling vials containing Cyclophosphamide for Injection, USP (lyophilized powder), or bottles containing cyclophosphamide tablets. The coating of the cyclophosphamide tablets prevents direct contact of persons handling the tablets with the active substance. However, to prevent inadvertent exposure to the active substance, the cyclophosphamide tablets should not be cut, chewed, or crushed. Personnel should avoid exposure to broken tablets. If contact with broken tablets occurs, wash hands immediately and thoroughly.
Cyclophosphamide for Injection, USP
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not use cyclophosphamide vials if there are signs of melting. Melted cyclophosphamide is a clear or yellowish viscous liquid usually found as a connected phase or in droplets in the affected vials.
For Direct Intravenous Injection
Reconstitute Cyclophosphamide with 0.9% Sodium Chloride Injection, USP only, using the volumes listed below in Table 1. Gently swirl the vial to dissolve the drug completely. Do not use Sterile Water for Injection, USP because it results in a hypotonic solution and should not be injected directly.
Table 1: Reconstitution for Direct Intravenous
|Strength||Volume of 0.9% Sodium Chloride||Cyclophosphamide Concentration|
|500 mg||25 mL||20 mg per mL|
|1 g||50 mL|
|2 g||100 mL|
For Intravenous Infusion
Reconstitution of Cyclophosphamide
Reconstitute Cyclophosphamide using 0.9% Sodium Chloride Injection, USP or Sterile Water for Injection, USP with the volume of diluent listed below in Table 2. Add the diluent to the vial and gently swirl to dissolve the drug completely.
Table 2: Reconstitution in
preparation for Intravenous Infusion
|Strength||Volume of Diluent||Cyclophosphamide Concentration|
|500 mg||25 mL||20 mg per mL|
|1 g||50 mL|
|2 g||100 mL|
Dilution of Reconstituted Cyclophosphamide
Further dilute the reconstituted Cyclophosphamide solution to a minimum concentration of 2 mg per mL with any of the following diluents:
- 5% Dextrose Injection, USP
- 5% Dextrose and 0.9% Sodium Chloride Injection, USP
- 0.45% Sodium Chloride Injection, USP
To reduce the likelihood of adverse reactions that appear to be administration rate-dependent (e.g., facial swelling, headache, nasal congestion, scalp burning), cyclophosphamide should be injected or infused very slowly. Duration of the infusion also should be appropriate for the volume and type of carrier fluid to be infused.
Storage of Reconstituted and Diluted Cyclophosphamide Solution
If not used immediately, for microbiological integrity, cyclophosphamide solutions should be stored as described in Table 3:
Table 3: Storage of Cyclophosphamide Solutions
|Reconstituted Solution (Without Further Dilution)|
|0.9% Sodium Chloride Injection, USP||up to 24 hrs||Up to 6 days|
|Sterile Water for Injection, USP||Do not store; use immediately|
|0.45% Sodium Chloride Injection, USP||up to 24 hrs||up to 6 days|
|5% Dextrose Injection, USP||up to 24 hrs||up to 36 hrs|
|5% Dextrose and 0.9% Sodium Chloride Injection, USP||up to 24 hrs||up to 36 hrs|
|1Storage time is the total time cyclophosphamide is in solution including the time it is reconstituted in 0.9% Sterile Sodium Chloride Injection, USP or Sterile Water for Injection, USP.|
Use of Reconstituted Solution for Oral Administration
Liquid preparations of cyclophosphamide for oral administration may be prepared by dissolving cyclophosphamide for injection in Aromatic Elixir, National Formulary (NF) Such preparations should be stored under refrigeration in glass containers and used within 14 days.
Dosage Forms And Strengths
Cyclophosphamide for Injection, USP (lyophilized powder) is a sterile white cake available in
- 500 mg
- 1 g
- 2 g
Cyclophosphamide Tablets, USP are white tablets with blue flecks available in
- 25 mg
- 50 mg
Storage And Handling
Cyclophosphamide for Injection, USP (lyophilized powder) is a sterile white cake containing cyclophosphamide and mannitol and is supplied in vials for single dose use.
Cyclophosphamide for Injection, USP
10019-988-01 500 mg vial, carton of 1
10019-989-01 1 g vial, carton of 1
10019-990-01 2 g vial, carton of 1
Store vials at or below 25°C (77°F). During transport or storage of cyclophosphamide vials, temperature influences can lead to melting of the active ingredient, cyclophosphamide [see DOSAGE AND ADMINISTRATION].
Cyclophosphamide Tablets, USP are white tablets with blue flecks containing 25 mg and 50 mg cyclophosphamide, respectively.
Cyclophosphamide Tablets, USP
10019-984-09 50 mg, bottles of 100
10019-982-09 25 mg, bottles of 100
Store tablets at or below 25°C (77°F). Tablets will withstand brief exposure to temperatures up to 30°C (86°F) but should be protected from temperatures above 30°C (86°F).
Cyclophosphamide is an antineoplastic product. Follow special handling and disposal procedures.1
1. OSHA Hazardous Drugs. OSHA. http://www.osha.gov/SLTC/hazardousdrugs/index.html.
Vials Manufactured by: Tablets Manufactured for: Baxter Healthcare Corporation Deerfield, IL 60015 USA. Revised: 05/2013
Last reviewed on RxList: 6/13/2013
This monograph has been modified to include the generic and brand name in many instances.
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