Cytoxan: Potent Chemotherapy for Targeted Cancer Treatment
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Synonyms | |||
Cytoxan (cyclophosphamide) is a highly effective alkylating chemotherapeutic agent widely utilized in the management of various malignancies and autoimmune conditions. As a prodrug requiring hepatic activation, it exerts its cytotoxic effects by cross-linking DNA strands, ultimately inhibiting cancer cell proliferation. Its versatile application spans multiple treatment protocols, both as a monotherapy and in combination regimens, offering clinicians a reliable option for aggressive disease control. Proper administration under expert supervision ensures optimal therapeutic outcomes while mitigating associated risks.
Features
- Alkylating chemotherapeutic agent with prodrug activation
- Available in oral tablet and intravenous formulations
- Demonstrated efficacy across solid tumors and hematologic malignancies
- Compatible with various combination chemotherapy protocols
- Metabolized primarily by hepatic cytochrome P450 system
Benefits
- Induces tumor regression across diverse cancer types through DNA cross-linking
- Provides flexible administration routes supporting both inpatient and outpatient care
- Enhances treatment efficacy when combined with other antineoplastic agents
- Offers predictable pharmacokinetics enabling dose titration for individual patients
- Maintains activity against rapidly dividing malignant cells
- Supports immunosuppressive protocols for autoimmune conditions
Common use
Cytoxan is extensively employed in the management of Hodgkin lymphoma, non-Hodgkin lymphoma, multiple myeloma, and various solid tumors including breast, ovarian, and lung carcinomas. It serves as a cornerstone in many combination chemotherapy regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) for lymphoma treatment. Beyond oncology, it demonstrates efficacy in severe autoimmune disorders including systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis when conventional therapies prove inadequate. The medication may also be utilized in preparation for hematopoietic stem cell transplantation due to its immunosuppressive properties.
Dosage and direction
Dosage varies significantly based on indication, treatment protocol, and patient-specific factors. For intravenous administration in cancer therapy, typical doses range from 500-1500 mg/m² every 2-4 weeks, often administered with vigorous hydration to prevent hemorrhagic cystitis. Oral dosing generally ranges from 1-5 mg/kg daily for continuous therapy. Administration should always follow established protocols with appropriate premedication and supportive care. Intravenous formulations require reconstitution with sterile water and administration over 30-60 minutes. Dose adjustments are necessary for renal impairment (CrCl < 25 mL/min typically requires 75% of dose) and hepatic dysfunction. Treatment duration depends on response and tolerance, often continuing for multiple cycles in cancer therapy.
Precautions
Routine monitoring of complete blood counts is essential due to myelosuppression risks, with nadir typically occurring 7-14 days post-administration. Vigorous hydration (minimum 2 liters daily) must be maintained during treatment to prevent hemorrhagic cystitis. Patients should be advised regarding reproductive risks and options for fertility preservation before initiation. Regular assessment of renal and hepatic function is necessary throughout treatment. Secondary malignancy risk requires discussion before long-term therapy. Live vaccinations should be avoided during treatment and until immune recovery occurs.
Contraindications
Absolute contraindications include severe bone marrow suppression (unless part of planned myeloblative therapy), demonstrated hypersensitivity to cyclophosphamide or other alkylating agents, and active urinary tract infection with inadequate bladder emptying capacity. Relative contraindications encompass severe renal impairment (CrCl < 10 mL/min without dialysis), compromised hepatic function (Child-Pugh class C), and existing hemorrhagic cystitis. Pregnancy represents a strong contraindication due to teratogenic effects, requiring effective contraception during and after treatment.
Possible side effect
Myelosuppression manifesting as leukopenia, thrombocytopenia, and anemia represents the most common dose-limiting toxicity. Nausea and vomiting typically occur within 24 hours of administration but are generally manageable with antiemetics. Hemorrhagic cystitis resulting from acrolein accumulation requires prompt management with mesna and hydration. Alopecia affects most patients but is usually reversible after treatment cessation. Gastrointestinal disturbances including anorexia, diarrhea, and mucositis may occur. Cardiotoxicity presents as hemorrhagic myocarditis or heart failure in rare cases. Pulmonary toxicity including pneumonitis and fibrosis requires monitoring. Secondary malignancies, particularly bladder cancer and leukemia, may develop years after treatment.
Drug interaction
Allopurinol may increase cyclophosphamide toxicity by delaying elimination. Concurrent administration with cardiotoxic agents (e.g., anthracyclines) elevates cardiovascular risk. CYP450 inducers (phenobarbital, rifampin) may enhance activation to cytotoxic metabolites. Succinylcholine should be avoided due to prolonged apnea risk from pseudocholinesterase inhibition. Live vaccines are contraindicated during treatment. Warfarin effect may be potentiated through unknown mechanisms.
Missed dose
For scheduled intravenous administration, contact oncology team immediately to reschedule within 24-48 hours if possible. Oral doses should be taken as soon as remembered unless approaching next scheduled dose, in which case the missed dose should be skipped. Never double subsequent doses to compensate for missed administration. Consistent timing maintains therapeutic drug levels, particularly important for oral regimens.
Overdose
Manifests as severe myelosuppression, hemorrhagic cystitis, and cardiotoxicity. Management requires immediate hospitalization with supportive care including transfusions, antimicrobial prophylaxis, and mesna administration. Hemodialysis may provide limited benefit due to extensive protein binding. Treatment is primarily supportive with monitoring for infection, bleeding, and organ toxicity for several weeks.
Storage
Store tablets at controlled room temperature (20-25°C/68-77°F) in original container protected from moisture. Reconstituted intravenous solution remains stable for 24 hours at room temperature or 6 days refrigerated. Never freeze medication. Keep all formulations out of reach of children and pets. Properly dispose of unused medication through take-back programs.
Disclaimer
This information provides educational content regarding Cytoxan but does not replace professional medical advice. Treatment decisions must be made by qualified healthcare providers considering individual patient circumstances. Always follow prescribed protocols and report adverse effects promptly. Dosage and administration may vary based on specific clinical situations.
Reviews
Clinical studies demonstrate response rates of 60-90% in lymphomas when used in combination regimens. Oncologists consistently rate Cytoxan as a fundamental chemotherapeutic agent with predictable efficacy and manageable toxicity profile. Patients report satisfaction with treatment efficacy though note side effects require active management. Long-term follow-up studies confirm sustained remission in responsive malignancies while acknowledging monitoring requirements for late effects.