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Cancer Treatment Information

Treatment Options > Chemotherapy > OncoLink Rx

Cyclophosphamide (Cytoxan®, Neosar®)

Hematology-Oncology Patient/Family Education Comittee
Hospital of the University of Pennsylvania
Last Modified: November 1, 2001

Cyclophosphamide (sye kloe fos' fa mide)
Other Names: Cytoxan®, Neosar®

How it is given:	Cyclophosphamide is injected into a vein. It can also be given by mouth in the form of a tablet. It can be given alone or with other drugs.
How it works:	Cyclophosphamide slows or stops the growth of cancer cells in your body.

Side Effects And Precautions

Let your doctor or nurse know if you have any allergies and what medications you are currently taking, both prescription and over the counter medications. This includes vitamins, herbs, nutritional supplements and any recreational drugs. Ask you doctor about drinking alcoholic beverages. Not everyone experiences side effects during chemotherapy and most side effects are temporary. The side effects you may experience:

Common Side Effects

Decrease in the number of white blood cells (neutropenia)
Puts you at risk of infection.
What to do: Call your doctor or nurse for a fever of 100.4 F or greater. Avoid people with the flu or colds. When working in your yard, wear protective clothing including long pants and gloves. Do not handle pet waste. Keep all cuts or scratches clean. Shower or bath daily and refer to Chemotherapy and You (NCI, 1997) for mouth care. Do not cut cuticles or ingrown nails. You may wear nail polish but not fake nails. Ask your doctor or nurse before scheduling dental appointments or procedures. Ask you doctor or nurse before you or a family member has any vaccinations.

Decrease in red blood cells (anemia)
Causes loss of energy.
What to do: Call your doctor or nurse if you feel more tired than usual or short of breath while doing normal activities.

Decrease in platelets (thrombocytopenia)
Puts you at risk for bruising and bleeding.
What to do: Call your doctor or nurse if you notice any unusual bruising or bleeding. Do not floss or use toothpicks. Use a soft-bristle toothbrush or cotton swab. Ask your doctor or nurse before scheduling dental appointments or procedures. Use an electric razor to avoid cuts. Do not use medication containing aspirin or ibuprofen without asking your doctor or nurse.

Nausea and Vomiting
What to do: Take your anti-nausea medications as prescribed. Try to drink 6-8 glasses of fluid a day. Avoid eating fatty foods, large meals, and acidic foods (e.g. tomatoes, lemons, oranges, grapefruits) and spicy or hot foods when you feel nauseated. Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Mouth ulcers (sores)
What to do: Call your doctor or nurse if your mouth, tongue or inside of your cheek becomes white, ulcerated or painful. Brush with a soft-bristle toothbrush or cotton swab twice a day. Avoid mouthwashes that contain alcohol. A baking soda and/or salt warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon salt in an eight ounce glass of warm water) is recommended 4 times daily. If your mouth becomes dry, eat moist foods, drink plenty of fluids (6-8 glasses) and suck on sugarless hard candy. Avoid drinking alcoholic beverages and citrus juices, smoking and chewing tobacco.

Decreased appetite
What to do: Try to eat five or six small meals or snacks throughout the day. If you are not eating enough, nutritional supplements may help. Ask your nurse for a copy of the Eating Hints booklet (NCI, 1995) and about nutritional counseling services.

Taste and smell changes
You may experience a metallic taste or dislike foods or beverages that you liked before receiving chemotherapy. These symptoms can last up to several months.
What to do: Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell. Flavor meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary. Bacon, ham and onion can add flavor to vegetables. Ask your nurse for the Eating Hints booklet (NCI, 1995) and about nutritional counseling services.

Weight gain
What to do: Ask your nurse for the Eating Hints booklet (NCI, 1995) and about nutritional counseling services.

Loss or thinning of scalp and body hair (alopecia)
Your hair may become thinned, brittle or may fall out. This may begin two weeks after treatment starts.
What to do: The use of scarves, wigs and hairpieces may help during this temporary condition.

Sexual and reproductive changes
The menstrual cycle and sperm production may become irregular or stop permanently. Women may experience menopausal effects including hot flashes and vaginal dryness. The desire for sex may decrease during treatment. Exposure of an unborn child to this medication could cause birth defects.
What to do: Discuss with your doctor or nurse how these changes will affect you. You may want to ask about sperm banking, egg harvesting, menopausal symptoms, sexual or relationship problems. Effective birth control is necessary during treatment. Contact your doctor or nurse if you think you may be pregnant. Do not breast feed while on this medication.

Bladder irritation
May irritate your bladder and cause blood in your urine and pain on urination.
What to do: Drink about 6 to 8 glasses of fluid/day and urinate every 2-3 hours for two days following each treatment. Let your doctor or nurse know if you have difficulty, pain, or bleeding during urination. When given in high doses, your doctor may give you a mediation to protect your bladder.

Nasal congestion
May occur while being infused and last for several days after each treatment.
What to do: Call your doctor or nurse if you experience sinus pain.

Uncommon Side Effects

Diarrhea
What to do: Call your doctor or nurse if you experience an increase in the number of stools, an increase in the volume of stool or if the stool becomes more liquid. Your doctor may recommend an over the counter or prescription antidiarrhea medication. Increase your fluid intake by drinking more liquids than usual (e.g. sports drinks, broth, gelatin, popsicles, soup). Eat bland foods such as bananas, rice, unsweetened applesauce, toast, cereal and potatoes. If the diarrhea continues or if you feel lightheaded contact your doctor or nurse again.

Fluid retention
May occur when given in high doses.
What to do: Call your doctor or nurse if you do not urinate for more than 12 hours, experience shortness of breath, or you have an unexpected weight gain. Also call them if your hands, feet or legs become swollen.

Nail changes
Darkening or ridging of the fingernails/toenails may occur.
What to do: Keep your fingernails and toenails clean and dry. Do not wear fake nails. You may use nail polish. Notify your doctor or nurse if there is loss of any nails.

Lung changes
May cause breathing problems at any time, but especially after repeated treatments or with very high doses.
What to do: Call your doctor or nurse if you have shortness of breath, cough or difficulty breathing.

Heart damage
When given in high doses, the muscles of the heart may be weakened.
What to do: It is important that you report immediately to your doctor or nurse any shortness of breath, cough, ankle swelling, chest pain, rapid or irregular heart beats. Your doctor may order tests to check your heart function.

Liver changes
May occur with repeated treatments or with high doses. Your doctor may order some blood tests to check your liver function.
What to do: Call your doctor or nurse immediately if you have abdominal pain, if you pass dark urine, or if your skin or the white of your eyes become jaundiced (yellow in color).

Vision
What to do: Call your doctor or nurse if you have blurred vision or difficulty seeing.

Allergic-type reaction
Rarely, rash, itching, redness, hives and/or difficulty breathing may occur.
What to do: If needed, medications are given to counteract these effects. If you experience any of these effects, notify your doctor or nurse.

Secondary malignancies
There is a risk of developing leukemia or a different type of cancer, which is associated with repeated treatments or with high doses.