Cyclophosphamide (Cytoxan®) (Endoxana®)

This is the ‘C’ in the CHOP chemotherapy regime

 

Possible side effects

 

Temporary reduction in the production of blood cells by the bone marrow.

This can result in anaemia, risk of bruising or bleeding and infection. This effect can begin seven days after the treatment has been given and the number of blood cells is usually at its lowest point at 10-14 days after the chemotherapy. Your blood count will then increase steadily and will have usually returned to normal within 21 days.

The extent to which the number of blood cells is reduced depends on the dose of chemotherapy you receive and which other chemotherapy drugs, if any, are given in combination. Your doctor can advise you how likely it is that your blood cells will be lowered by the chemotherapy. Your blood will be checked regularly to see how well your bone marrow is working.

 

Temperature

If your temperature goes above 38°C (100.5°F), or you have any unexplained bruising or bleeding, or you suddenly feel unwell, even if you have a normal temperature, contact your doctor or the hospital straight away.

 

Nausea (feeling sick) and vomiting.

There are now very effective anti-sickness drugs to prevent or greatly reduce nausea and vomiting. If you do feel sick it may begin a couple of hours after the treatment is given and last for up to 24 hours (or a few days if high dose treatment is given). If the sickness is not controlled, or continues, tell your doctor. They can prescribe other anti-sickness drugs, which may be more effective.

 

Loss of appetite.

A dietician or specialist nurse at your hospital can give advice.

 

Irritation of the bladder lining.

It is important to drink plenty of fluids to help prevent any irritation. If you notice any blood in your urine tell your doctor. With high dose cyclophosphamide, fluids are given into the vein, along with a drug called mesna, which can help to prevent bladder irritation.

 

Hair loss.

This usually starts 3-4 weeks after the first dose of cyclophosphamide, although it may occur earlier. Hair may be lost completely or may just thin. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and the hair will start to regrow once the treatment is finished.

 

 

Less Common Side Effects

 

Temporary Liver Changes

Your liver may be temporarily affected. Cyclophosphamide may cause changes in the way that your liver works, which return to normal when the treatment is finished. This is very unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver function.

 

Sore mouth and taste change. 

Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help reduce the risk of this happening. Tell your doctor if you do have any of these problems as they can prescribe special mouthwashes and medicine to prevent or clear any mouth infection.

You may notice that your food tastes different. Normal taste will come back after the treatment finishes.

 

Diarrhoea.

This can usually be easily controlled with medicine but tell your doctor if it is severe or persistent. It is important to drink plenty of fluids if you do have diarrhoea.

 

Changes in nails.

Your nails may become darker, or ridged. These changes grow out over a few months once the treatment has finished.

 

Skin changes.

Your skin may darken, due to excess production of pigment, but this is rare.

 

Changes to the lungs.

Cyclophosphamide may cause some changes to lung tissue. Tell your doctor if you notice any cough or breathlessness.

 

Second cancer.

With long-term use of this drug there is a very small risk of developing a second cancer after many years.

 

Changes in the way your heart works.

This is very uncommon with usual doses but may occasionally occur with high dose treatment. The muscle of the heart may be affected, usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given, and occasionally before each treatment.

 

Additional Side Effects

 

Some people have hot flushes, dizziness, a strange taste and a feeling of having a blocked nose when the drug is being given. If you have any of these symptoms tell the doctor or nurse. They can slow the drip down to reduce the feeling.

 

Fertility.

Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

 

Contraception.

It is not advisable to become pregnant or father a child while taking cyclophosphamide as it may harm the developing foetus. It is important to use effective contraception whilst taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

 

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