cyclophosphamide monitoring

A lifetime of specialist care

Cyclophosphamidemonitoringand dosage record for

respiratory patients with interstitial lung disease

Cyclophosphamide monitoring.qxp:Patient Booklet 17/09/2014 12:46 Page 2

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Your details 3Important information 3Contact details for the healthcare team looking after you 4Cyclophosphamide 5Intravenous cyclophosphamide 5Oral cyclophosphamide 7What else do I need to know about cyclophosphamidetreatment? 10Can I take other medicines with cyclophosphamide? 10What do I do if I forget to take my medicine? 11Things you must tell medical staff 11Over-the-counter medicines 11Monitoring results 12What the terms mean 18

Contents

This leaflet gives you general information on cyclophosphamidemonitoring. It does not replace the need for personal advicefrom a healthcare professional. Please ask us if you have anyquestions.


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Cyclophosphamide monitoring

Name:

Address:

Date of birth:

Contact telephone number:

Your details

• This medicine has been prescribed for you alone. Do not giveit to anyone else, even if their symptoms are the same asyours.

• Take this medication only as prescribed by your doctor. Do not change anything without checking with your doctorfirst.

This booklet holds information about your immunosuppressiontreatment. Please keep this booklet with you all the time andshow it to any person treating you including your doctor,pharmacist and nurse.

Important information


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Indication for treatment:

Consultant name and contact no:

GP surgery address and telephone:

Community pharmacy address and telephone:

For further information on medicines, please contact thepharmacy medicines information patient helpline on 020 7351 8901, 10am-5pm, Monday to Friday.

For advice outside working hours, call the NHS 111 service freeof charge from any phone by dialling 111 or phone RoyalBrompton Hospital switchboard on 020 7352 8121 and ask forthe operator. You can ask the operator to connect you to theon-call respiratory doctors.

Contact details for the healthcare team lookingafter you:


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Cyclophosphamide is animmunosuppressant drug.Immunosuppressant drugs areused to suppress (dampendown) the body’s immunesystem in conditions where theimmune system is overactiveand reacts against your ownbody.

This drug can be used:

• To prevent organ rejectionin patients who have hadan organ transplant.

• In lung disease to reduceinflammation that may becontributing to yoursymptoms. (If you takeprednisolone, taking thesetreatments will usuallymean that your dose ofprednisolone can bereduced).

• In other conditions, such asrheumatoid arthritis.

Cyclophosphamide is givenintravenously or orally.

Cyclophosphamide (sye-kloe-FOSS-fa-mide)

Cyclophosphamide is given byintravenous infusion (into avein) to treat severeinflammation in the lung thatmay not have responded tosteroid treatment.

Your doctor will decide whatdose you need. The dose willdepend on your body weightand total body surface areaand is usually given monthlyfor a period of six months.

Occasionally, cyclophosphamideinfusion is given morefrequently. If it is thought youwould benefit from a more

frequent dose, your consultantwill discuss this with you.

Side effects

Intravenous cyclophosphamide

Allergic reaction – tellyour doctor immediatelyif you experience allergicsymptoms such asflushing, wheezing andswelling of the face,increased heart rate,decreased blood pressureand breathingdifficulties.


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This is not the full list ofpossible side effects. Pleaserefer to the patientinformation leaflet suppliedwith your medicine for acomplete list.

• Nausea, vomiting,headache and fatigue – tellyour doctor if any of thesesymptoms are severe or donot go away.

• Bladder irritation that maycause the appearance ofblood in your urine – if thishappens, tell your doctor ornurse immediately.

• Decreased production ofblood cells.

• Kidney or liver problemsresulting in reducedfunction.

• Hair loss or thinning is arare side effect and hairwill normally start to re-grow after, and sometimeseven during, treatment.

• Reduced sperm count –usually returns to normalwhen treatment is stopped.Please discuss this with yourdoctor before starting thetreatment as a referral to afertility specialist may berequired.

• Irregular menstrual periods

and loss of ovulation – maynot return to normal evenwhen treatment is stopped.Please discuss this with yourdoctor before starting thetreatment as a referral to afertility specialist may berequired.

Patients receivingcyclophosphamide may bemore likely to develop bladdercancer, leukaemia and otherforms of cancer.

Blood testsYour blood and urine will bechecked each month prior totreatment withcyclophosphamide to check forany unwanted effects on yourblood cell production, kidneyand liver function.

Pregnancy and breastfeeding• Make sure you are not

pregnant before startingcyclophosphamide –cyclophosphamide cancause problems for yourunborn baby

• Cyclophosphamidetreatment will only bestarted following anegative pregnancy test

• Use adequate contraceptionbefore starting treatment,during treatment and for



three months after stoppingtreatment

• You must contact yourdoctor immediately if youbecome pregnant whilst ontreatment

• You must not breastfeedwhile you are takingcyclophosphamide

PrecautionsTo avoid bladder irritation, it isimportant that you drinkplenty of fluid while takingcyclophosphamide for the firstfew days following yourinfusion.

If you get a sore throat or anysigns of an infection, youshould tell your doctor as soonas possible.

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Oral cyclophosphamide

A very small number ofpatients will be givencyclophosphamide tablets ifthey cannot have the infusion.

Your doctor will decide onwhat dose you need. Your dosewill depend on your bodyweight. Oral cyclophosphamideis usually taken once a day andone hour before food or on anempty stomach.

If you take any othermedicines including any over-the-counter medicines, pleaselet your doctor know so thathe or she can check if they aresafe for you to take withcyclophosphamide.

You will start on a low dose ofcyclophosphamide for one

month to check if youexperience any side effects orproblems from this treatment.Your dose will then graduallyincrease to the maximum doseprescribed by your doctor.

Cyclophosphamide does notwork immediately and it maybe six to 12 weeks before younotice any benefit.


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Test dose mg Start date:

Increased dose mg Start date:



Your recommended dose:

Side effects

This is not the full list ofpossible side effects. Pleaserefer to the patientinformation leaflet suppliedwith your medicine for acomplete list.

• Nausea, vomiting, headache,

sore mouth – tell yourdoctor if any of thesesymptoms are severe or donot go away.

• Bladder irritation that maycause the appearance ofblood in your urine – if thishappens, tell your doctorimmediately.

• Decreased production ofblood cells.

• Kidney or liver problemsresulting in reducedfunction.

• Hair loss or thinning is arare side effect and hairwill normally start to re-grow after, and sometimeseven during, treatment.

• Reduced sperm count –usually returns to normalwhen treatment is stopped.

Tell your doctorimmediately if youexperience allergicsymptoms such asflushing, wheezing andswelling of the face,increased heart rate,decreased blood pressureand breathing difficulties.


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Please discuss this with yourdoctor before starting thetreatment as a referral to afertility specialist may berequired.

• Irregular menstrual periodsand loss of ovulation – maynot return to normal evenwhen treatment is stopped.Please discuss this with yourdoctor before starting thetreatment.

Patients receivingcyclophosphamide may bemore likely to develop bladdercancer, leukaemia and otherforms of cancer.

Blood testsYour GP should arrange foryou to have a blood test everyweek until your dose isstabilised, then every fourweeks from there on to checkfor any unwanted effects on

your blood cell production,kidney and liver function.

Pregnancy and breastfeeding• Cyclophosphamide can

cause problems for yourunborn baby

• Make sure you are notpregnant before startingtreatment

• Treatment will only startafter a negative pregnancytest

• Use adequatecontraception beforestarting treatment, duringtreatment and for 3 monthsafter stopping treatment

• You must contact yourdoctor immediately if youbecome pregnant while ontreatment

• Do not breastfeed whileyou are takingcyclophosphamide as smallamounts of the drug canpass into breast milk

PrecautionsTo avoid bladder irritation, it isimportant that you drinkplenty of fluid while takingcyclophosphamide. If you get asore throat or any signs of aninfection, you should tell yourdoctor as soon as possible.

It is important thatyou do not takecyclophosphamideunless you arehaving regularblood tests.


Because the tablets andinfusion work by suppressing(dampening down) the body’simmune system, you may havea decreased ability to fightinfection.

If you get any signs ofinfection (a sore throat, fever,etc.), experience jaundice(yellowing of the skin orwhites of the eyes) or any

unexplained bleeding orbruising you should tell yourdoctor as soon as possible.

If you have not hadchickenpox but come intocontact with someone who haschickenpox or shingles, or ifyou develop chickenpox orshingles, you should see yourdoctor immediately as youmay need special treatment.

What else do I need to know aboutcyclophosphamide treatment?

Always ask your doctor orpharmacist about any othermedicines before you start totake them. This includes over-the-counter medicines, herbaland alternative remedies. Allof these can interact withcyclophosphamide and affectyour treatment.

Keep a record of anysymptoms and discuss themwith your doctor. It isimportant for your doctor orpharmacist to know so theycan help you. The symptomsyou are trying to treat may bea sign of cyclophosphamide

not working safely for you.

While you are takingcyclophosphamide – and for atleast six months after you stoptreatment – do not have anylive vaccines, such as yellowfever, and discuss any othervaccinations with your doctorfirst. Immunosuppressantslower your body’s resistance.This may cause you to get aninfection from the vaccine andthe response to the vaccinemay be reduced. Pneumovaxand yearly flu vaccines are safeand recommended.

Can I take other medicines withcyclophosphamide?

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If you forget to take your medicine, you can take it as soon asyou remember but never take two doses at once. If you areunsure what to do, contact your doctor for advice.

What do I do if I forget to take my medicine?

If you need emergency treatment, the medical staff helping youwill need to know that you are on cyclophosphamide.

If you are pregnant, breastfeeding or allergic to any medicine,please inform your doctor before he or she prescribes any newmedicines.

If you take more tablets than you have been told, you mustcontact your doctor immediately.

Things you must tell medical staff

The information in this record will help a pharmacist determineif over-the-counter medicines are suitable for you.

Over-the-counter medicines


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Monitoring results

Please ask the person responsible for prescribing / monitoringyour treatment to record your test results below:

Date of blood test

Dose

HbMale 13.4-16.6g/dLFemale 11.5-15.1g/dL

MCV84-98fL

WBC5.1-11.4 10^9/L

Platelets147-397 10^9/L

Neutrophills2.0-7.5 10^9/L

Lymphocytes1.3-3.7 10^9/L

ALT0-40 IU/L

Alk phos38-126 U/L

CRP0-10 mg/L

Urea2.5-6.5 mmol/L

Creatinine60-120 umol/L

Total Billirubin3-24 umol/L

Next test date


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Monitoring results


Date of blood test

Dose


MCV84-98fL

WBC5.1-11.4 10^9/L




ALT0-40 IU/L

Alk phos38-126 U/L

CRP0-10 mg/L

Urea2.5-6.5 mmol/L



Next test date


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Monitoring results


Date of blood test

Dose


MCV84-98fL

WBC5.1-11.4 10^9/L




ALT0-40 IU/L

Alk phos38-126 U/L

CRP0-10 mg/L

Urea2.5-6.5 mmol/L



Next test date


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Monitoring results


Date of blood test

Dose


MCV84-98fL

WBC5.1-11.4 10^9/L




ALT0-40 IU/L

Alk phos38-126 U/L

CRP0-10 mg/L

Urea2.5-6.5 mmol/L



Next test date


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Monitoring results


Date of blood test

Dose


MCV84-98fL

WBC5.1-11.4 10^9/L




ALT0-40 IU/L

Alk phos38-126 U/L

CRP0-10 mg/L

Urea2.5-6.5 mmol/L



Next test date


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Monitoring results


Date of blood test

Dose


MCV84-98fL

WBC5.1-11.4 10^9/L




ALT0-40 IU/L

Alk phos38-126 U/L

CRP0-10 mg/L

Urea2.5-6.5 mmol/L



Next test date


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Hb: The oxygen-carrying component of red blood cells.

MCV: The average volume of a red blood cell.

WBC: White blood cells.

Platelets: An irregular, disc-shaped element in the blood thathelps in blood clotting.

Lymphocytes: A small white blood cell that plays a large role indefending the body against disease. They are responsible forimmune responses.

Neutrophils: A type of white blood cell filled with enzymes usedto kill and digest micro-organisms.

ALT: An enzyme normally present in the liver and heart cellsthat is released into the blood stream when the liver or heart isdamaged. Abnormally high ALT levels may indicate that theliver is not functioning normally.

ALK phos: An enzyme made in the liver that is usually releasedinto the blood during injury. Abnormally high levels mayindicate some liver damage.

CRP: A component of blood that rises in response toinflammation in the body. This rate increases with moreinflammation.

Urea and creatinine: Substances normally cleared from the bloodby the kidneys. Increased blood levels of urea and creatinineindicate that the kidneys may not be functioning normally.

What the terms mean

If you have concerns about any aspect of the service you havereceived in hospital and feel unable to talk to those peopleresponsible for your care, call PALS on:

• Royal Brompton Hospital 020 7349 7715

• Harefield Hospital 01895 826 572

or email [email protected]. This is a confidential service.


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Royal Brompton HospitalSydney StreetLondonSW3 6NPtel: 020 7352 8121textphone: (18001) 020 7352 8121

Harefield HospitalHill End RoadHarefieldMiddlesexUB9 6JHtel: 01895 823 737textphone: (18001) 01895 823 737

Website: www.rbht.nhs.uk

Brosu� rteki bilginin Tu� rkçe tercu� mesi için tedavi goru� yoroldugunuz bolu� me bas vurunuz. Bolu� m personeli tercu� meningerçeklesmesini en kisa zamanda ayarlacaktir.

© Royal Brompton & Harefield NHS Foundation Trust September 2014


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