Cyclophosphamide is a chemotherapy agent used to treat different types of cancer including lymphomas, leukemias, myeloma, lung cancer, and breast cancer.

HOW IS CYCLOPHOSPHAMIDE ADMINISTERED?

Cyclophosphamide is given in the chemotherapy day unit or during a hospital stay. A chemotherapy nurse will give it to you.

Before the day of treatment, a nurse will take a blood sample from you to see if you are fit for chemotherapy.

You will also be able to see a doctor or nurse before having chemotherapy. They will ask you how you have been feeling. If the results of your blood test are good on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will give you medication for nausea and, sometimes, steroids administered intravenously. Chemotherapy drugs may be given in the following ways:

• Through a thin tube (line) inserted into a vein in the arm or hand by a nurse
• Through a tube that goes below the skin of your chest to a nearby vein (central line)
• Through a thin tube that is placed in a vein of the arm and goes up through a vein toward the chest (PICC)

Your nurse will give you cisplatin as a drip (perfusion) through a cannula or a line for about half an hour. This kind of drip is usually given using a perfusion pump for the sake of timing.

Administering chemotherapy

Some people may have side effects while they are receiving chemotherapy.

ALLERGIC REACTION

On rare occasions, cyclophosphamide can cause an allergic reaction while it is being administered. The signs of a reaction may include the following: rash, itchiness, breathlessness; swelling in the face or lips; nausea; pain in the abdomen, back, or chest; or feeling unwell. Tell your nurse immediately if you have any of these symptoms.

PAIN ALONG THE VEIN

If you feel pain in your vein, let your nurse know immediately; they will check the puncture site and the rate of administration to relieve you of your pain.

CYCLOPHOSPHAMIDE PILLS

If you are taking cyclophosphamide in pill form, take them exactly as you have been told. This is important to ensure that it is working as well as possible. Swallow the pills whole with a glass of water, preferably with a glass of water. Take the pills in the morning.

If you vomit right after taking the pills, get in touch with your hospital. You may have to take another dose. If you forget to take a pill, do not take a double dose; rather, keep to your normal schedule and let your doctor or nurse know.

Other things to keep in mind about pills:

• Keep them in their original packaging.
• Keep them at room temperature and away from heat and direct sunlight.
• Keep them safe and out of the reach of children.
• Return the remaining pills to the hospital if the treatment is discontinued.

POSSIBLE SIDE EFFECTS OF CYCLOPHOSPHAMIDE

You may experience some of the side effects mentioned here, though it is rare for a patient to have all of them. If you receive other chemotherapy drugs, you may have other side effects that are not mentioned here. Always inform your doctor of the effects you experience.

Your doctor can prescribe medication to help control some of the side effects. It is very important to take the medication exactly as your doctor says for it to have the highest chance of working well. Your nurse will advise you on managing the side effects. After treatment, the side effects start to get better.

RISK OF INFECTION

Cyclophosphamide may lower the number of white blood cells in your blood. This will make you more susceptible to infection. Your nurse can tell you when you might have the lowest levels of these cells. When the number of white blood cells is low, this is called neutropenia.

Contact your hospital immediately if any of the following happens:

• your temperature goes above 38 ° C
• you suddenly feel unwell, even if your temperature is normal.
• You have symptoms of infection, which may include sore throat, coughing, or the need to urinate frequently.

The number of white blood cells normally increases gradually, returning to normal before your next chemotherapy session. You will have a blood test before your next chemotherapy. If your white blood cells are still low, your doctor may postpone the treatment for a short period of time.

BRUISING AND BLEEDING

Cyclophosphamide may lower the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any unexplained bleeding or bruising. This includes nosebleeds, bleeding gums, blood spots, or skin eruptions (rashes). Some people may require additional platelets.

ANEMIA

Cyclophosphamide may lower the number of red blood cells in your blood. Red blood cells transport oxygen throughout the body. If you have a low number of red blood cells, you may be tired and short of breath. Tell your doctor or nurse if you feel like this. If you are very anemic, it's possible you will require a blood transfusion.

BLADDER

Cyclophosphamide can irritate the bladder and cause discomfort when urinating. Drink lots of fluids – at least two liters in the 24 hours after chemotherapy. It is also important to empty your bladder regularly and try to urinate as soon as you feel the need.

If you are in treatment using high doses of cyclophosphamide, you will be given fluids through a drip. You may also be given a medication called mesna as a drip and/or tablet. This helps prevent bladder irritation.

Get in touch with your hospital immediately if you feel discomfort or burning when urinating or if you notice blood in your urine.

NAUSEA

This can happen on the first few days after chemotherapy. Your doctor will prescribe you antiemetic drugs to help prevent or control your nausea. It is easier to prevent nausea than it is to treat it once it has begun.

If you still have nausea or are vomiting, get in touch with the hospital as soon as possible. They can give you advice and change your medication to one that works better.

LOSS OF APPETITE

You may lose your appetite during the treatment. Try to eat in small quantities and have frequent meals. Don't worry if you don't eat much for a day or two. If your appetite doesn't get any better after a few days, tell your nurse or dietitian. They can give you nutritional supplements or good-tasting meal-replacement drinks.

SORENESS OF THE MOUTH

You may have a sore mouth or mouth ulcers, which could make you more prone to getting a mouth infection. Lightly brush your teeth and/or dentures in the morning and night and after meals. Use a soft-bristle toothbrush. Your nurse might ask you to rinse your mouth out regularly or use mouthwash. It is important that you follow all the instructions you are given and that you drink a lot of fluids.

Tell your nurse or doctor if you have any mouth problems. They can prescribe you drugs to prevent or treat infections of the mouth and to treat any kind of pain.

DIARRHEA

Your doctor can prescribe medicines to control diarrhea. Let them know if your diarrhea is severe or if it doesn't get better. Make sure you drink at least two liters of fluids each day if you have diarrhea.

TIREDNESS

Feeling very tired is a common side effect. Fatigue is often worst toward the end of treatment and for a few months after the treatment has finished. Try to pace yourself and rest as much as you need to. Help balance this with a bit of light exercise, such as short walks. If you feel drowsy, don't drive or operate heavy machinery.

HAIR LOSS

Usually, people lose all of their hair. Also, the eyelashes, eyebrows, and other parts of the body may lose their hair. This normally starts after your first or second cycle of chemotherapy. It is almost always temporary, and the hair will continue to grow after you finish your chemotherapy. Until the time when you hair grows back, it is important to cover your head so as to protect the scalp while it is exposed to the sun's rays. Your nurse can give you advice on how to cope with losing your hair.

SKIN CHANGES

Chemotherapy can affect your skin. Cyclophosphamide can produce a rash, which may cause itchiness. If your skin is dry, try to use a fragrance-free moisturizing cream every day. Always tell your doctor about any change to your skin. These changes can be temporary, improving once the treatment is over.

TINGLING IN THE HANDS OR FEET

These symptoms are caused by the effect of cyclophosphamide on the nerves. It is called peripheral neuropathy. It may also be hard for you to press buttons and it can make other tasks more uncomfortable. You may also feel a certain degree of pain at your nerve endings.

Tell your doctor if you have these symptoms. It is sometimes necessary to lower the drug dose. The symptoms normally get better slowly once the treatment is over, though in some people they never go away. Talk to your doctor if you are worried about this.

CHANGES IN YOUR NAILS

Your nails may become fragile and break easily. They could darken or become discolored. These changes go away when the treatment is completed. During your treatment, try to protect your nails by wearing gloves to wash dishes. If you experience pain, reddening, or swelling around the nails, tell your doctor or nurse.

EYE PROBLEMS

You may feel pain or dryness in your eyes. Your doctor can prescribe eye drops to help this. If your eyes become red and inflamed (conjunctivitis), tell your doctor, as you may need antibiotic drops. Cyclophosphamide can also cause blurry vision and/or soreness of the eyes. Always tell your doctor or nurse if you have soreness in the eyes or notice any changes in your vision.

HEADACHES

If this happens, tell your doctor or nurse. They can give you painkillers for this.

CHANGES IN THE KIDNEYS AND LIVER

The treatment can affect the way the kidneys and liver function. These changes are normally mild and return to normal after the treatment. You will have blood tests done before the chemotherapy to check the state of your kidneys and liver.

LESS COMMON SIDE EFFECTS OF CARBOPLATIN

CHANGES IN THE HEART

Cyclophosphamide can affect the way the heart works, though normally this only happens when it is administered in high doses. This tends to be temporary. You may have tests done before, during, and after your treatment to see how your heart is working.

If you have pain or pressure in your chest, feel out of breath, or notice that your heart is beating faster at any time during or after treatment, let your doctor know immediately. These symptoms could be caused by other conditions, but it important to have them looked at by a doctor.

EFFECTS ON THE LUNGS

Cyclophosphamide can cause changes in the lungs. This is more common if you are treated with high doses of chemotherapy.

Always let your doctor know if you have wheezing, coughing, fever, or if you are out of breath. If necessary, tests can be done to check your lungs.

SECOND CANCER

Cyclophosphamide can increase the risk of developing a second cancer such as leukemia years down the road. Overall, however, the benefits of the treatment far outweigh this risk. Your doctor can talk to you about this.

MORE INFORMATION ABOUT CYCLOPHOSPHAMIDE

BLOOD CLOT RISK

Cancer and chemotherapy increase the chances of a blood (thrombosis). The symptoms include pain, reddening or swelling in a leg, difficulty breathing, and pain in the chest. Get in touch with your doctor immediately if you have any of these symptoms.

OTHER DRUGS

Some medicines can interact with chemotherapy or be harmful if they are taken alongside chemotherapy. This includes medications that can be purchased in a store or pharmacy. Tell your doctor the medicines you are taking, including over-the-counter medications, complementary therapies, and herbal medicines.

FERTILITY

Cisplatin can affect your fertility. If this worries you, you can talk to your doctor before beginning treatment.

CONTRACEPTION

Your doctor will advise you not to become pregnant during the treatment. This is because the drugs can harm developing babies. It is important to use contraception during chemotherapy and for a few months after the treatment ends.

SEX

If you have sex within the first few days after chemotherapy, it is necessary to use a condom. This is to protect your partner in case there is chemotherapy in semen or vaginal fluid.

BREASTFEEDING

Women are recommended not to breastfeed during treatment and for a few months after chemotherapy has concluded. This is in case the chemotherapy enters their breast milk.

MEDICAL AND DENTAL TREATMENT

If you have to go to the hospital for whatever reason other than cancer, always tell the doctors and nurses that you are having chemotherapy.

Talk to your cancer doctor or nurse if you think you need dental treatment. Always let your dentist know that you are having chemotherapy.

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