Cyclophosphamide

Nausea, vomiting, abdominal pain, reversible thinning of the hair, and mouth sores are some of the more common side effects patients may experience. Suppression of the bone marrow leading to low blood counts is also frequently encountered and can be used to adjust future dosing of this medication. Many physicians actually desire to slightly reduce the white blood cell count to around 3-4 thousand to ensure that the drug is achieving its desired effect. Because cyclophosphamide irritates the bladder, it may uncommonly cause bleeding along the surface of the bladder, which in its most severe form is referred to as hemorrhagic cystitis. This complication actually occurs less frequently with intermittent intravenous dosing of cyclophosphamide. While there is also an increased risk of bladder cancer with prolonged use of cyclophosphamide, there also appears to be an increased risk of other cancers, the magnitude of which is undefined. Rarely, scarring in the lung has been reported with prolonged use of this medication.

Baseline blood count, urine test, kidney and liver function is recommended. Thereafter, a blood count every 2-4 weeks, and kidney and liver and kidney function periodically at the discretion of the provider is prudent. Urine tests should be performed every several months to look for small amounts of blood, and annual urine cytology (a test to screen for cancer cells) may be ordered at the discretion of the provider. Continued presence of abnormalities in the urine may prompt referral to a urologist.