Cyclophosphamide infusion

Cyclophosphamide is an alkylating agent (a type of cytotoxic medicine) used in children to treat different conditions that involve the immune system, to stop organ transplant rejection and to treat some types of cancers. It works by lowering the body’s immune system response to stop the body from harming itself. Cyclophosphamide is used when other medicines (e.g. corticosteroids such as prednisolone or methylprednisolone) aren’t working for the condition or when the condition is particularly severe or these medicines are not strong enough to treat the condition on their own.

While using this medicine – Remember

• Talk with your doctor about the plan for cyclophosphamide infusions (how many and when) and how you will know the medicine is working. Before you leave the hospital, make sure you know when and where the next infusion will be.
• Your child will need to have a blood test 7-10 days after each cyclophosphamide infusion. This is to check their blood cell counts and ensure that their dose is correct. Your doctor will give you a pathology form to get this blood test done.
• Special precautions are required to handle this medicine and for all of your child’s body fluids (vomit, urine/wee, faeces, poo) for up to 7 days after they have received a dose. If you are a parent or carer who is pregnant or breastfeeding, and your child is being treated with cyclophosphamide, it is recommended you avoid directly handling your child’s body fluids for 7 days after they have received a dose.
• Watch at home for side effects and know which ones you need to do something about. If your child develops any signs of infection whilst on this medication, they will need urgent medical review.

Giving my child Cyclophosphamide

Cyclophosphamide infusion is only available in hospital. Your doctor will work out the amount (the dose) that is right for your child and an infusion will be prepared specifically for your child.

Cyclophosphamide is also available as tablets, but this leaflet is about using the infusion.

When and how should Cyclophosphamide be given?

Each child gets the dose of cyclophosphamide that is right for their condition. The doctor will decide how much cyclophosphamide to give how many infusions to give, and how far apart they will be. They will work this out using your child’s weight, age, height and how well their kidneys work. Cyclophosphamide infusion is sometimes given every 2 to 4 weeks for several months.

Cyclophosphamide infusion is always given in hospital administered through a cannula into a vein over a set time. The doctor will check it is safe for your child to be given cyclophosphamide. They will arrange for blood tests for your child to check this.

Your child will have a cannula inserted. The nursing staff will give:

• Hydration fluids. These are extra fluids to flush the kidneys and bladder to stop the cyclophosphamide irritating the bladder lining, causing it to bleed (haemorrhagic cystitis). The doctor decides how much fluid is needed. It may start one hour before the cyclophosphamide infusion, keep going during the infusion, and continue for another four hours after.
• Cyclophosphamide infusion. This will run for one hour.

Visiting the hospital and having the cyclophosphamide can take six to eight hours. Sometimes, the doctor has to make changes to the infusion time for your child. These changes will only be decided on the day.

Another medication called Mesna may also be used to protect the bladder from the side effects of cyclophosphamide (bleeding). Your doctor will decide whether your child needs Mesna.

Before you leave, make sure you know when the next infusion will be, and what blood tests are required. A blood test will be needed 7-10 days after each cyclophosphamide infusion, to check the blood cell counts and make sure their dose is correct. Your doctor will give you a pathology form to get this blood test done.

What to do if a dose is missed

Make sure you know when your child’s next infusion appointment is. Try to keep appointments for the infusion and contact the hospital if you think you can’t attend. It is important to give this medicine at the right interval.

What about using other medicines with Cyclophosphamide?

Tell your doctor or pharmacist about any other medicines or products your child takes before starting Cyclophosphamide. This includes prescription, over the counter medicines, vitamins, supplements, herbal or complementary medicines that you buy from a pharmacy, supermarket, health food shop or online.

Check with your doctor or pharmacist before starting new medicines or products in your child.

You can give your child:

• Paracetamol (to treat pain), unless your doctor has told you not to.

Check with your child’s doctor before giving:

• Non-steroidal anti-inflammatory medicines (also called NSAIDs or anti-inflammatories) or aspirin as they may need to be avoided. Examples include: ibuprofen (Nurofen®), diclofenac (Voltaren®) and naproxen (Naprogesic®).
• Any other medicine or new medicine, including prescription medicines, medicines bought over the counter, online or from health food stores (includes herbal and complementary medicines). These might affect how well cyclophosphamide works. Talk to your doctor or pharmacist

If your child is sexually active, it is important they use appropriate contraception while receiving cyclophosphamide and for a period of time after. Please ask your child’s doctor for more information.

Possible side effects – what other effects can occur?

Side effects you must do something about

Take your child to hospital or call 000 for an Ambulance if your child has:

• Signs of infection such as fever (above 38°C), chills, sore throat, cough or rash. Contact your doctor even if it has been a number of weeks since your child’s last infusion of cyclophosphamide
• Haemorrhagic cystitis or bleeding from the bladder. Signs include blood in urine, pain when passing urine and increased need to urinate. The hydration your child receives during hospital will reduce the risk
• Allergic reactions e.g. trouble breathing, wheezing, chest tightness, swelling of throat, lips, tongue or face, skin blistering or peeling, rash or redness, chest pain, altered heartbeat, seizures (fitting), dizziness – Call an Ambulance on 000
• Severe diarrhoea, lower stomach pain, mouth ulcers, yellowing of the skin or whites of the eyes
• Bleeding or bruising that is unusual or more than normally occurs
• Tiredness, dizziness and pale looking skin which may be due to cyclophosphamide’s effects on the body’s ability to make red blood cells

Other side effects you need to know about

Some side effects go away with time or after the dose has been changed. Speak to your doctor if you are worried about any of the following or if they continue.

• Nausea and vomiting. Your child will be given an anti-nausea medicine just before the cyclophosphamide infusion to help reduce nausea or vomiting. If your child has nausea or vomiting at home, contact your child’s doctor. They may be able to give you anti-nausea medication for use at home
• Facial flushing (redness) and nasal congestion (stuffy nose) may occur during the infusion
• Headache
• Hair loss (alopecia). Some people lose their hair during the infusions. This will grow back once the full course of treatment is finished. Sometimes the hair has a different colour or texture
• Monthly periods may temporarily stop (amenorrhea) in a small number of female patients (about 1 in 8). Periods usually start again when cyclophosphamide treatment is stopped, but it might take a few months
• Your child may be more likely to get infections, or cuts and sores might take longer to heal. This is because cyclophosphamide is affecting the immune system. Talk to your child’s doctor, nurse or pharmacist about what you can do to help protect your child from infections. Your child’s doctor may also prescribe medicines to prevent infections

Possible long term side effects

• There is a very small chance that cyclophosphamide will affect your child’s ability to have children later in life
• The use of cyclophosphamide can lead to a small increase in the chance of certain types of cancer occurring later in life
• Talk to your doctor about these effects. Often, the benefit of treating your child’s condition will outweigh the potential increased risk of these conditions. Ask questions if you are worried

There may be other side effects not listed above. If you notice anything unusual and are concerned, contact your doctor.

General advice – Safe handling of body fluids at home

Cyclophosphamide is a cytotoxic medicine, which means it can potentially damage cells within the body. It will be in your child’s vomit, wee (urine) and poo (bowel motions) for up to seven days after the infusion. It is important to minimise other members of the family being exposed to the medicine in these body fluids of your child.

In hospital, the staff coming in contact with the medicine or your child’s body fluids will wear full protective equipment.

While your child is being treated with cyclophosphamide the following equipment is recommended to have available at home and use for the 7 days after each infusion:

• Disposable household gloves are adequate to handle your child’s body fluids (cleaning up vomit, changing nappies, and changing soiled bed clothes)
• Protective gear such as plastic apron, goggles, mask and gloves may be available from the hospital. Talk to the nursing staff to arrange supply before you go home the first time.
• Flushable paper or paper towelling
• Household detergent
• Plastic bags

Using the toilet:

• It is safe for your child to use the toilet connected to normal sewerage or septic system during this time.
• Make sure you close the lid of the toilet prior to flushing and use a full flush volume. You can continue to clean your toilet as normal but should use protective equipment.
• Any other waste items such as nappies, pads, ostomy bags or gloves need to be placed into a plastic bag, tied and then placed into a second plastic bag and tied, before placing immediately into the outside general rubbish bin.

To clean your child’s wee (urine), poo (bowel motions) or vomit off a household surface:

1. Put on disposable gloves or protective gear depending on what you have available at home.
2. Wipe up the body fluid with either flushable paper (to be flushed down the toilet), or paper towelling/ disposable cloths (which are placed in a plastic bag after use).
3. Clean the area with disposable cloths, water and detergent, rinsing well (dispose of these cleaning cloths in the plastic bag).
4. Place all gloves, disposable cloths and other disposable protective equipment that you used into a plastic bag and tie it closed. Place this plastic bag into a second plastic bag and tie. Place this double bagged rubbish into your outside general rubbish bin.

For more information

This fact sheet is about using this medicine in children and young people. Some information may be different from the manufacturer’s Consumer Medicine Information (CMI). The manufacturer’s CMI is found at NPS MedicineWise. These should be read together. Talk to your doctor, nurse or pharmacist if you need more information.

Contact us

In an emergency, always contact 000 for immediate assistance

Pharmacy Department
Level 2, Queensland Children’s Hospital
501 Stanley Street, South Brisbane 4101
t: 07 3068 1901 (9am – 5pm Mon – Fri)
(9am – 12pm Sat – Sun/public holidays)

Endorsed by Queensland Children’s Hospital Medication Safety Committee and developed by Pharmacy Department CHQ with input from parents and carers.

Updated: January 2023.

Contact CHQMedicationSafety@health.qld.gov.au for sources used to create this Fact Sheet.

Disclaimer: We take great care to make sure the information in this Fact Sheet is correct, up-to-date and reflects current use in Australia. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something.

This Fact Sheet is to be used as an aid, rather than a substitute for a discussion with your doctor or pharmacist. Children’s Health Queensland Hospital and Health Service accepts no responsibility for any inaccuracies, omissions, reliance placed, or the success of any treatment regimens detailed in this Fact Sheet.