"Cyclophosphamide" is an alkylating compound. This is an anticancer drug. Available in the form of a white or almost such crystalline powder. Further on this drug in more detail.
Cyclophosphamide - manufacturer
This medicine is made at the Russian enterprise Biochemistry OJSC. It is located in the city of Saransk on Vasenko St., 15A.
Cost
In any pharmacy you can buy powder number 1 "Cyclophosphamide." Its price fluctuates around 90-98 rubles.
Description of the dosage form
A solution is prepared from this powder. It is intended for intramuscular and intravenous administration.
Features of the composition
Each powder vial contains an active substance called cyclophosphamide. A certain is its quantity. Namely, it contains “Cyclophosphamide” 200 mg of the specified substance in one bottle. There are no excipients in this drug.
Description of the pharmacological action
Based on the instructions for use, Cyclophosphamide is an alkylating cytostatic drug. Its chemical composition is similar to substances such as nitrogen analogues of mustard gas. The pharmacological action of Cyclophosphamide is the formation of cross-type cross-linking between DNA and RNA strands. This drug also contributes to the inhibition of protein synthesis.
Cyclophosphamide - analogues
In this case, those funds are selected that match the ATX code of the fourth category. Quite peculiar is Cyclophosphamide. Analogues of this drug exist in considerable numbers. The most common are:
- "Endoxan."
- "Ifosfamide."
- Alkeran.
- "Holoxan"
- "Ribomustine."
- Leukeran.
The selection of each of these drugs is carried out by the doctor individually. In this case, the state of health and tolerance of the components are taken into account.
In what cases is applied?
Consider this item in more detail. Quite peculiar is the use of such a drug as Cyclophosphamide. Instructions for use in this regard will be an indispensable assistant. It indicates that this drug is indicated in the following cases:
- In the event of chronic and acute lymphocytic leukemia.
- In the presence of multiple myeloma.
- With the onset of symptoms of non-Hodgkin lymphoma.
- With the occurrence of fungal mycosis and retinoblastoma.
- In the presence of lymphogranulomatosis, as well as cancer of the ovaries and breast.
- With the manifestation of symptoms of neuroblastoma.
In addition to all this, this drug is used in combination with other anti-tumor drugs for treatment in the following cases:
- With germ cell tumors.
- With cancer of the bladder and lung.
- With sarcoma of soft tissue type.
- When there is cancer of the prostate and cervix.
- With Ewing's sarcoma.
- In the case of Wilms tumors.
- With reticulosarcoma.
Also, a drug such as Cyclophosphamide, which reviews are positive, is effective as an immunosuppressive drug in the manifestation of progressive autoimmune diseases. In this case, the occurrence of psoriatic and rheumatoid arthritis, autoimmune hemolytic anemia, collagenosis, nephrotic syndrome is implied. Also, said agent suppresses the transplant rejection reaction.
Contraindications
"Cyclophosphamide" has certain contraindications. It can not be used:
- During the period of breastfeeding and pregnancy.
- With severe impairment of bone marrow function.
- In case of hypersensitivity.
- With urinary retention.
- In the presence of active infections.
- During the manifestation of cystitis.
With caution, it is necessary to "Cyclophosphamide", analogues of which are indicated above, to appoint in certain cases. Namely, in the presence of the following ailments:
- Nephrourolithiasis.
- Severe diseases of the heart, liver and kidneys.
- Gout.
- Bone marrow tumor cell infiltration.
- Adrenalectomy.
- Inhibition of bone marrow functionality.
Description of side effects
Cyclophosphamide, whose synonyms (analogues) are indicated above, may contribute to the following side effects:
- Symptoms such as vomiting, nausea, anorexia, discomfort, stomatitis, abdominal pain, diarrhea, or constipation can occur in the digestive system. Isolated cases of jaundice and hemorrhagic colitis are also known.
- In the hematopoietic system, manifestations of neutropenia, anemia, thrombocytopenia, and leukopenia were observed. On the 7-14th day of admission, platelet and white blood cell counts may slightly decrease.
- On the skin there were manifestations of alopecia. Hair grows back after the drug is completed. In addition, a rash may appear on the skin during the treatment period. Pigmentation of the skin and changes in the nails may also be observed.
- In the cardiovascular system, with the introduction of increased dosages of this drug over a long period of time, a manifestation of cardiotoxicity may occur. This is important to remember. In addition, the occurrence of complex, and sometimes fatal, cases of heart failure were observed. This is due to the occurrence of hemorrhagic myocarditis.
- In the urinary system, the appearance of renal canal necrosis (up to a fatal outcome), hemorrhagic cystitis or urethritis, urinary bladder fibrosis is possible. In rare cases, when using high doses of this drug, nephropathy, hyperuricemia, and impaired renal function may occur. In this case, the presence of epithelial cells may be observed in the urine.
- In the respiratory system , interstitial pulmonary fibrosis may occur.
- In the reproductive system, there may be a violation of oogenesis and spermatogenesis, as well as sterility. The last symptom in some cases may be irreversible. In most women, with the use of this drug, amenorrhea develops. After treatment, the regularity of menstruation, as a rule, is restored. In men, taking this drug can lead to oligospermia or azoospermia, as well as to varying degrees of testicular atrophy.
- In this case, allergic reactions can also be observed. Namely, the manifestation of skin rash, itching, urticaria, anaphylactic reactions.
- Also, side effects may occur. That is, flushing of the facial skin, hyperemia, the development of malignant secondary tumors, excessive sweating, headaches.
Interaction Forms
When taking this drug, some elements that contribute to microsomal oxidation in the liver can carry out the induced microsomal metabolism of cyclophosphamide. This leads to certain factors. Namely, to the large formation of metabolites of an alikylating type. At the same time, the period during which the half-life of cyclophosphamide is carried out is reduced, and its activity also increases. Reception of cyclophosphamide, which markedly and permanently suppresses the activity of cholinesterase, provides an increase in the effect of suxamethonium. It also helps reduce or slow cocaine metabolism. As a result, the duration of its effect intensifies or increases and the risk of its toxic effects increases. This has a negative effect on the body as a whole. In addition, the simultaneous use with allopurinol can enhance the toxic effect on the bone marrow.
With the combined use of cyclophosphamide with allopurinol, colchicine, probenecid, sulfinpyrazone, there may be a need for dose adjustment of anti-gout type drugs in the treatment of gout and hyperuricemia. Also, an increased risk of nephropathy may be manifested, which is associated with an increased formation of uric acid when using cyclophosphamide.
The latter substance may cause an increase in anticoagulant activity. Since the synthesis of factors contributing to blood coagulation and impaired platelet formation is reduced in the liver. However, a decrease in the activity of anticoagulants through a mechanism of an unknown type may also occur.
Cyclophosphamide enhances the cardiotoxic effect of daunorubicin and doxorubicin. Other immunosuppressants (chlorambucil, azathioprine, cyclosporine, glucocorticosteroids, mercaptopurine, etc.) can increase the likelihood of secondary tumors and infections.
The simultaneous use of lovastatin in patients with cardiac transplantation may increase the risk of diseases such as acute skeletal muscle necrosis and acute renal failure.
If myelosuppressive drugs or radiation therapy are used in combination with this drug, then the manifestation of additive inhibition of bone marrow functions is possible.
The simultaneous use of cytarabine in large doses with a substance such as cyclophosphamide, at the preparatory stage for the bone marrow transplantation process, leads to a frequency increase in cardiomyopathy with the onset of death.
Main criteria
During the application, the following is taken into account:
- During treatment with this drug, a blood test should be performed regularly in order to assess the degree of myelosuppression. In this case, it is especially necessary to pay attention to the amount of platelet and neutrophil content.
- Also, a urinalysis should be performed regularly for the presence of red blood cells. Their appearance can contribute to the development of a disease such as hemorrhagic cystitis. If such signs are found, treatment with Cyclophosphamide, the price of which is indicated above, must be discontinued.
- With a decrease in platelet count (below 100,000 / μl) and / or white blood cells (<2500 / μl), this drug should be stopped.
- If infections occur during the treatment with the specified drug, the course of treatment should be discontinued or interrupted. Or in this case, the dosage should be reduced. During treatment with Cyclophosphamide, men and women need to use reliable methods of contraception.
- During therapy with this drug, you need to refrain from drinking alcohol.
- In the event that the first ten days after the operation, which was carried out under general anesthesia, did not expire, and the patient is prescribed Cyclophosphamide, the price of which is indicated above, the anesthetist should be informed about this.
- After an adrenalectomy has been performed, the patient needs to carry out dosage adjustment of both glucocorticosteroids, which are used for the replacement therapy process, and such a drug as Cyclophosphamide.
Precautions
Acceptance of this drug is possible exclusively under the supervision of a doctor who has experience in chemotherapy. Strict adherence to the dosage regimen is also necessary. This should especially be done with combination therapy. Also, it is not necessary to double the next dose if the previous one was skipped. In the preparation of this drug for use in newborns, it is strictly not recommended to use diluents that contain benzyl alcohol. Since this can lead to the development of toxic lethal syndrome. Namely, the occurrence of metabolic acidosis, central nervous system depression, respiratory failure, renal failure, hypotension, seizures, intracranial hemorrhage.
During the entire treatment course, it is recommended to carry out a blood transfusion (once a week, 1 time 100-125 ml). This must be done in order to prevent diseases such as hyperuricemia and nephropathy, which is caused by the formation of an increased amount of uric acid. Such symptoms often appear at the beginning of the treatment period. Also, before carrying out therapy with the indicated drug and during 72 hours after its administration, it is recommended to carry out a certain fluid intake (about 3 liters per day), the use of allopurinol (in special cases) and drugs that alkalize urine. To prevent manifestations of hemorrhagic cystitis, it is often necessary to empty the bladder and take Uromiteksan. If there are initial signs of this disease, then the treatment course with the indicated drug should be discontinued until the symptoms that have arisen are completely eliminated.
To attenuate dyspeptic symptoms, cyclophosphamide can be taken in small doses during the first day. Full or partial alopecia, which can be observed during the treatment period, is reversible and after the end of the course, the function of normal hair growth is restored. However, their color and structure may be subject to change.
If you experience chills, fever, cough or hoarseness, pain in the lower back or side, painful or difficult urination, hemorrhage or bleeding, black stool, blood in the stool or urine, you should immediately consult a doctor.
The possibility of thrombocytopenia leads to the need for special caution when performing actions such as invasive procedures and dental interventions. In this case, you should regularly examine the skin and mucous membranes and places of intravenous administration. This is in order to detect signs of bleeding. It is also necessary to limit the frequency of venipuncture and abandon intramuscular injections. It is necessary to control the blood content in feces, vomit, urine. For these patients, it is extremely necessary to carry out the process of shaving, manicure, brushing, using toothpicks, etc. At the same time, falls and other damage should be strictly avoided. It is also forbidden to take acetylsalicylic acid and alcohol, which increase the risk of gastrointestinal bleeding. In this case, it is necessary to delay the vaccination schedule (after 3-12 months from the end of the last chemotherapy course). In this case, the exclusion of contact with infectious patients is desirable. During treatment, it is necessary to apply adequate contraceptive measures.
If this drug comes into contact with the mucous membrane or skin, it is necessary to thoroughly rinse this area with plain water or with soap, respectively.
When breastfeeding and pregnancy
In this regard, there are peculiar limitations that Cyclophosphamide has. The instruction indicates that the use of this drug during pregnancy is contraindicated. In this case, the category of exposure to the fetus is designated “D” by the FDA. During the treatment period, it is necessary to stop breastfeeding.
Overdose
In this case, there are certain nuances. The presence of a specific antidote in case of an overdose of this drug is unknown. This is a reliable fact. In case of an overdose, it is necessary to implement supportive measures, including the appropriate course of treatment for infectious diseases, as well as the occurrence of cardiotoxicity and / or myelosuppression.
Storage conditions
In this regard, a certain drug such as Cyclophosphamine requires certain conditions. The instruction for use states that it must be stored at a temperature of not more than 10 ° C in a place that is dry and protected from light. Moreover, children's access to it should be limited.
Shelf life
There is a certain period of time during which you can use a drug such as Cyclophosphamide. Instructions for use indicate that its shelf life is 3 years. In this case, you must adhere to a certain condition. It lies in the fact that the use of this drug after the expiration of the specified period is strictly prohibited.
Implementation
There is also a condition in this direction that Cyclophosphamide has. Instructions for use indicate that this drug is dispensed in pharmacies only by prescription.
Conclusion
This text has a lot of useful information. Namely, what Cyclophosphamide is, the instructions for use, the price of this drug. However, it should be borne in mind that before using this medication it is necessary to consult a qualified doctor.