Originator: Rainer Klocke Consultant in RheumatologyDate: September 2011

Version: 1Date for Review: September 2014

DGOH Ref No: DGOH/PIL/00376

CyclophosphamideRheumatologyPatient Information Leaflet

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What is Cyclophosphamide?

Cyclophosphamide is used in the treatment of various types ofrheumatic disease including rheumatoid arthritis, systemic lupuserythamatosis (SLE) and vasculitis.

Cyclophosphamide is a very powerful drug. It acts by reducing theactivity of the immune system.

How is Cyclophosphamide given?

Cyclophosphamide is given as an intravenous infusion (drip). Thedose will depend upon your body weight. You will usually receive acourse of 6 infusions. The first infusion may be given as aninpatient on the Rheumatology Unit, and the following infusions willbe given as a day case. The frequency of infusions is usually every2-3 weeks.

You will also be given a tablet called Mesna, which is given in threedoses- the first dose is given two hours before the infusioncommences; the second dose is given six hours after the infusionhas commenced. Mesna helps to prevent you developing cystitis(irritation of the bladder), which is one of the possible side effects ofthe infusion.

How is Cyclophosphamide given?

Cyclophosphamide does not work immediately. It may take 6weeks or more before you start to notice an effect.

As you can see, Cyclophosphamide is not free of possible sideeffects. If you are at all uncertain about receiving this treatmentplease discuss this with the medical staff.

Remember, whilst you are on this medication, it is yourresponsibility to ensure that you have regular blood tests and it isimportant that you do not miss any of these tests. If your hospitalappointment is rescheduled, contact the Rheumatology Helpline ifyou need more blood forms.

If you have any problems or questions, contact the RheumatologyHelpline on 01384 244789 or contact your pharmacist. Please keepthis information in a safe place.

Patient and Professional Organisations with Useful Links

Arthritis Care Tel: 0808 800 4050http;//www.arthritiscare.org.uk

NHS Direct Tel: 0845 4647http://www.nhsdirect.org.uk

Dudley Group of Hospitals NHS Trust, Tel: 01384 456111(switchboard)The Rheumatology Department, Tel: 01384 244789 (Helpline)http://www.dgoh.nhs.uk/http://www.dgoh.nhs.uk/public/servportals/rheumatology/public/servportals/rheumatology/default.asp

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Do I need special tests while havingCyclophosphamide?

You will need to have a blood test a few days before each infusionand 10 days after the infusion. This is because Cyclophosphamidecan affect the immune system and certain blood cells, and theblood test will check for this. Before each infusion your urine willalso be checked.

It is your responsibility to have your blood tests. In order for us toreceive the results from your blood tests, you will have to have theblood test at any of the following centres:

Russell's Hall Hospital: Monday to Friday 08.30am to 7.30pm orSaturday 09.30am to 11.30am. No appointments required.

Corbett Hospital: Monday to Friday 08.30am to 4.30pm. Noappointments required.

Netherton Health Centre: Appointment required, ring 01384366500.

Cross Street Health Centre: Appointment required, ring 01384459500.

Lady's Walk Clinic: Appointment required, ring 01902 575103.

You should not breast-feed if you are having Cyclophosphamide.

Cyclophosphamide can affect fertility in men and women, and veryoccasionally the effect may be permanent. The risk of infertilityvaries from person to person. You doctor will discuss infertility riskswith you in more detail.

Can I have vaccination injections whilehaving Cyclophosphamide?

You should avoid 'live' vaccines. These include rubella (Germanmeasles) and some polio vaccines. You are advised to have yourannual flu vaccination and pneumonia vaccination. Always let yourdoctor know that you are having Cyclophosphamide before havinga vaccination.

Can I drink alcohol while havingCyclophosphamide?

You can drink alcohol within reason but we recommend that youstay within the government guidelines.

Can I drive after having aCyclophosphamide infusion?

It is advised that you do not drive immediately after having aCyclophosphamide infusion.

Will I have any side effects?

Some people have very few side effects, while others mayexperience more.

One of the most common side effects is nausea (feeling sick). Itmay start a few hours after the treatment is given and last for up to24 hours. Your doctor can prescribe an anti-sickness drug toprevent or reduce nausea.

One important, but very uncommon side effect is inflammation andbleeding of the bladder wall. If you notice blood in your urine youmust inform your doctor immediately. To reduce this happening it isimportant that you drink plenty of fluids (at least 8 - 10 glasses ofwater). You will be given mesna to try and reduce the risk of thishappening.

Cyclophosphamide can affect certain blood cells in your blood,which make it more likely for you to develop infections. If youdevelop an infection, have a high temperature or have unexplainedbruising or bleeding, you must inform your doctor immediately.

Your mouth may become sore and you may develop mouth ulcersduring your treatment with Cyclophosphamide. Drinking plenty offluids and cleaning your teeth regularly with a soft toothbrush canprevent this from happening. If you do have them, tell your nurse ordoctor who can given you a special mouthwash to help to preventor clear any mouth infections.

Other possible side effects include hair loss, irregular menstrualperiods and loss of appetite. If you develop any of these symptomsafter starting Cyclophosphamide, you should inform yourrheumatology nurse or doctor as soon as possible.

If you have not had chickenpox but come into contact withsomeone who has had chickenpox or shingles, or if you developchickenpox or shingles, you need to inform your doctorimmediately. Chickenpox and shingles can be severe in people onCyclophosphamide because of your lowered immune system.

Can I take other medicine withCyclophosphamide?

Cyclophosphamide is not a painkiller so you should continue takingyour usual painkillers if you need them.

Some medicines may interact with Cyclophosphamide. Do not buy'over the counter' preparations without discussing this first with yourdoctor, rheumatology nurse or pharmacist.

Does Cyclophosphamide affect fertility andpregnancy?

You need to inform the doctor if you think you may be pregnant.You should not have Cyclophosphamide if you are pregnant or ifyou are planning a pregnancy.

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