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Cytoxan Side Effects Center
Medical Editor: John P. Cunha, DO, FACOEP
Cytoxan (cyclophosphamide) is used to treat several types of cancer. Cytoxan is also used to treat certain cases of nephrotic syndrome (kidney disease) in children. It is a cancer (chemotherapeutic) medication. Common side effects include nausea or vomiting (may be severe), loss of appetite, stomach ache, diarrhea, or darkening of the skin/nails.
In treatment of cancer, the initial course of Cytoxan is usually of 40 to 50 mg/kg given intravenously (IV) in divided doses over a period of 2 to 5 days. Other intravenous regimens include 10 to 15 mg/kg given every 7 to 10 days or 3 to 5 mg/kg twice weekly. Oral Cytoxan dosing is usually in the range of 1 to 5 mg/kg/day for both initial and maintenance dosing. For non-malignant disease an oral dose of 2.5 to 3 mg/kg daily for a period of 60 to 90 days is recommended. Cytoxan may interact with phenobarbital, allopurinol, digoxin, warfarin, thiazide diuretics (water pills), other chemotherapy medicines, or "live" vaccines. Tell your doctor all medications you use. Cytoxan is not recommended for use during pregnancy. It may cause harm to a fetus. Women of childbearing age and men should use birth control during treatment and for some period afterwards. This drug passes into breast milk. Because of the potential risk to the infant, breast-feeding while using this drug is not recommended.
Our Cytoxan (cyclophosphamide) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What is Patient Information in Detail?
Easy-to-read and understand detailed drug information and pill images for the patient or caregiver from Cerner Multum.
Cytoxan in Detail - Patient Information: Side Effects
If you experience any of the following serious side effects, seek emergency medical attention or contact your doctor immediately:
- an allergic reaction (shortness of breath; closing of your throat; difficulty breathing; swelling of your lips, face, or tongue; or hives);
- blood in the urine;
- black or tarry stools;
- painful or difficult urination;
- signs of infection such as fever; chills, or sore throat;
- jaundice (yellowing of the skin or eyes);
- lower back or side pain;
- chest pain, difficulty breathing, or swelling;
- unusual bleeding or bruising; or
- changes in bone marrow function (detected by blood tests).
Other less serious side effects may be more likely to occur. Talk to your doctor if you experience
- nausea, vomiting, or decreased appetite;
- mouth sores;
- abdominal pain;
- temporary hair loss;
- temporary or permanent sterility;
- changes in skin color; or
- changes in nails.
In some cases, secondary cancers have been reported to occur during and following treatment with cyclophosphamide. Talk to your doctor about the risks and benefits of this medication.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.
Read the entire detailed patient monograph for Cytoxan (Cyclophosphamide) »
What is Patient Information Overview?
A concise overview of the drug for the patient or caregiver from First DataBank.
Cytoxan Overview - Patient Information: Side Effects
Temporary hair loss may occur. Hair growth should return after treatment has ended or may even return during treatment. However, new hair may have a different color or texture.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor immediately if any of these unlikely but serious side effects occur: pink/bloody urine, unusual decrease in the amount of urine, mouth sores, unusual tiredness or weakness, joint pain, easy bruising/bleeding, stopping of menstrual periods, existing wounds that are slow healing.
Tell your doctor immediately if any of these rare but very serious side effects occur: black/bloody stools, severe stomach/abdominal pain, yellowing eyes or skin, dark urine, mental/mood changes, muscle weakness/spasm, swelling of the ankles/feet, sudden or unusual weight gain.
This medication may rarely cause very serious effects on the heart, especially when used in high doses, or in combination with radiation treatment or certain other chemotherapy drugs (e.g., doxorubicin). Seek immediate medical attention if you develop: chest pain, jaw/left arm pain, trouble breathing, irregular heartbeat.
This medication can lower the body's ability to fight an infection. Notify your doctor promptly if you develop any signs of an infection such as fever, chills or persistent sore throat.
Cyclophosphamide may lessen the chance of having children in both men and women. Sterility is usually temporary with this medication, but can be permanent in some cases. Consult your doctor for more details.
Although cyclophosphamide is used to treat cancer, in some patients it may increase the risk of developing another form of cancer, sometimes months to years after treatment. Consult your doctor for more details. It is important to be closely monitored by your doctor during treatment. You should also see your doctor regularly after treatment is finished. Tell your doctor immediately if you develop: unusual growths or lumps, swollen glands, unexplained or sudden weight loss, night sweats, pain in the pelvis, painful or frequent urination.
A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Read the entire patient information overview for Cytoxan (Cyclophosphamide)»
What is Prescribing information?
The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.
Cytoxan FDA Prescribing Information: Side Effects
The following adverse reactions are discussed in more detail in other sections of the labeling.
- Hypersensitivity [see CONTRAINDICATIONS]
- Myelosuppression, Immunosuppression, Bone Marrow Failure, and Infections [see WARNINGS AND PRECAUTIONS]
- Urinary Tract and Renal Toxicity [see WARNINGS AND PRECAUTIONS]
- Cardiotoxicity [see WARNINGS AND PRECAUTIONS]
- Pulmonary Toxicity [see WARNINGS AND PRECAUTIONS]
- Secondary Malignancies [see WARNINGS AND PRECAUTIONS]
- Veno-occlusive Liver Disease [see WARNINGS AND PRECAUTIONS]
- Embryo-Fetal Toxicity [see WARNINGS AND PRECAUTIONS]
- Reproductive System Toxicity [see WARNINGS AND PRECAUTIONS and Use In Specific Populations]
- Impaired Wound Healing [see WARNINGS AND PRECAUTIONS]
- Hyponatremia [see WARNINGS AND PRECAUTIONS]
Common Adverse Reactions
Neutropenia occurs in patients treated with Cytoxan (cyclophosphamide). 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.
Nausea and vomiting occur with cyclophosphamide therapy. Anorexia and, less frequently, abdominal discomfort or pain and diarrhea may occur. There are isolated reports of hemorrhagic colitis, oral mucosal ulceration and jaundice occurring during therapy.
Skin and its structures
The following adverse reactions have been identified from clinical trials or post-marketing surveillance. Because they are reported from a population from unknown size, precise estimates of frequency cannot be made.
Cardiac: cardiac arrest, ventricular fibrillation, ventricular tachycardia, cardiogenic shock, pericardial effusion (progressing to cardiac tamponade), myocardial hemorrhage, myocardial infarction, cardiac failure (including fatal outcomes), cardiomyopathy, myocarditis, pericarditis, carditis, atrial fibrillation, supraventricular arrhythmia, ventricular arrhythmia, bradycardia, tachycardia, palpitations, QT prolongation.
Ear and Labyrinth: deafness, hearing impaired, tinnitus.
Endocrine: water intoxication.
General Disorders and Administrative Site Conditions: multiorgan failure, general physical deterioration, influenza-like illness, injection/infusion site reactions (thrombosis, necrosis, phlebitis, inflammation, pain, swelling, erythema), pyrexia, edema, chest pain, mucosal inflammation, asthenia, pain, chills, fatigue, malaise, headache.
Hepatic: veno-occlusive liver disease, cholestatic hepatitis, cytolytic hepatitis, hepatitis, cholestasis; hepatotoxicity with hepatic failure, hepatic encephalopathy, ascites, hepatomegaly, blood bilirubin increased, hepatic function abnormal, hepatic enzymes increased.
Immune: immunosuppression, anaphylactic shock and hypersensitivity reaction.
Infections: The following manifestations have been associated with myelosuppression and immunosuppression caused by cyclophosphamide: increased risk for and severity of pneumonias (including fatal outcomes), other bacterial, fungal, viral, protozoal and, parasitic infections; reactivation of latent infections, (including viral hepatitis, tuberculosis), Pneumocystis jiroveci, herpes zoster, Strongyloides, sepsis and septic shock.
Metabolism and Nutrition: hyponatremia, fluid retention, blood glucose increased, blood glucose decreased.
Nervous System: encephalopathy, convulsion, dizziness, neurotoxicity has been reported and manifested as reversible posterior leukoencephalopathy syndrome, myelopathy, peripheral neuropathy, polyneuropathy, neuralgia, dysesthesia, hypoesthesia, paresthesia, tremor, dysgeusia, hypogeusia, parosmia.
Pregnancy: premature labor.
Psychiatric: confusional state.
Renal and Urinary: renal failure, renal tubular disorder, renal impairment, nephropathy toxic, hemorrhagic cystitis, bladder necrosis, cystitis ulcerative, bladder contracture, hematuria, nephrogenic diabetes insipidus, atypical urinary bladder epithelial cells.
Respiratory: pulmonary veno-occlusive disease, acute respiratory distress syndrome, interstitial lung disease as manifested by respiratory failure (including fatal outcomes), obliterative bronchiolitis, organizing pneumonia, alveolitis allergic, pneumonitis, pulmonary hemorrhage; respiratory distress, pulmonary hypertension, pulmonary edema, pleural effusion, bronchospasm, dyspnea, hypoxia, cough, nasal congestion, nasal discomfort, oropharyngeal pain, rhinorrhea.
Skin and Subcutaneous Tissue: toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, palmar-plantar erythrodysesthesia syndrome, radiation recall dermatitis, toxic skin eruption, urticaria, dermatitis, blister, pruritus, erythema, nail disorder, facial swelling, hyperhidrosis.
Read the entire FDA prescribing information for Cytoxan (Cyclophosphamide) »
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