Cyclophosphamide (Cytoxan) Cyclophosphamide (brand name: Cytoxan) is a medication that lowers the body’s natural immunity. The immune system is thought to be involved in causing Nephrotic Syndrome. By lowering the immune system’s activity, this treatment may help patients suffering from Nephrotic Syndrome. However, it may take several weeks for cyclophosphamide to make a difference. Why is cyclophosphamide needed for Nephrotic Syndrome patients? If too many relapses are occurring, a doctor may prescribe cyclophosphamide. A doctor may recommend this treatment if Nephrotic Syndrome doesn’t get better with steroid treatment or if it keeps coming back. Usual dosage time is 8–12 weeks. It should help symptoms to improve and help people to go into or stay in remission. How is cyclophosphamide administered? Cyclophosphamide is available in tablet or liquid form. Cyclophosphamide is usually given once a day, usually in the morning to reduce the chance of developing bladder problems. The medication should be given at about the same time(s) every day so that this becomes part of a daily routine, which also helps patients to remember to take it. The doctor will determine the correct dose of cyclophosphamide. A simple urine and blood test will be performed to make sure the dose is correct. Tablets should be taken with a glass of water, milk, or juice. Tablets should not be chewed. If taking the liquid form, measure the correct amount using an oral syringe or medicine spoon. (You can get these from your pharmacist.) Do not use a kitchen teaspoon because you will not be able to measure out the correct amount. What are the possible side effects of cyclophosphamide? Some people may develop some common side effects while taking cyclophosphamide. Check with your doctor if any of these side effects will not go away or become bothersome: Upset stomach Vomiting Flushing (face turning red and warm) Stuffy nose, headache, pain across the cheekbones Darkening of the skin and fingernails Immediately consult a doctor if you notice any of these side effects: Unusual tiredness or weakness Uncontrolled diarrhea Sores on the lips, tongue, mouth, or throat Missing monthly menstrual periods The following side effects are not common, so they may be a sign of a serious problem. Call your doctor immediately or go to the emergency room if you experience these side effects: Fever or chills Cough or sore throat Unusual bleeding or bruising Burning feeling or pain when urinating Pain in the lower back or side Blood in the urine or in the stool Black, tarry stools Trouble breathing or shortness of breath Fast heartbeat Dizziness, confusion, or agitation Yellow eyes or skin After stopping cyclophosphamide, some side effects may still continue. Check with your doctor right away if there is blood in your urine, especially after stopping cyclophosphamide. What are precautionary measures to take while taking cyclophosphamide? Cyclophosphamide may lower the number of white blood cells in the blood, which increases the chances of infection. A blood test will be done every week to make sure that these white blood cells don’t decrease too much. The dose may need to be lowered or temporarily stopped if the white blood cells decrease too much. Your doctor will notify you if any change is required in the dose of the drug. Watch closely for signs of infection, such as a fever, chills, cough, and sore throat. Contact a doctor immediately if you notice any signs of infection. Cyclophosphamide can lower the number of platelets in the blood, which means bleeding may occur more easily. To prevent bleeding: Be careful when using a razor, scissors, or clippers to cut nails or hair. Do not engage in rough sports where there is a chance that bruising or injury may occur. Be careful when using a toothbrush, dental floss, or toothpick. Your doctor can show you other ways to clean the mouth and teeth. No immunizations (vaccines) should be given without the doctor’s approval. If blood levels of cyclophosphamide are too high, kidney function may decrease. This is why blood work is done frequently so that the dose of cyclophosphamide can be adjusted. Your doctor may want the bladder emptied every two hours and may also want the bladder emptied during the night. This helps prevent problems with the bladder and kidneys. Avoid grapefruit and grapefruit juice when taking cyclophosphamide. These increase the amount of cyclophosphamide in the blood, which may cause more side effects. Cyclophosphamide may cause birth defects. If you are pregnant or there is a possibility that you may become pregnant, tell your doctor right away. Check with your doctor before taking any other medicines (prescription, non-prescription, herbal, or natural products). Before having any operation or procedure, inform your doctor or dentist that you are taking cyclophosphamide. Hair loss may occur, but this is rare at the dosage levels used to treat Nephrotic Syndrome. If hair loss does occur, the hair will grow back when treatment with cyclophosphamide stops, but the color and texture may change when it does. *Note: The decision to prescribe a medication is the responsibility of your physician/primary care provider based on his/her evaluation of your condition. The above is meant for informational purposes only. Discuss this information and all information about drugs/medications with your physician before starting or stopping any medication.