Cyclophosphamide administration routine in autoimmune rheumatic diseases: a review

Abstract

r e v b r a s r e u m a t o l. 2 0 1 7;5 7(6):596-604 w w w. r e u m a t o l o g i a. c o m. b r Antiemetics Chemotherapy Cystitis a b s t r a c t Cyclophosphamide is an alkylating agent widely used for the treatment of malignant neo-plasia and which can be used in the treatment of multiple rheumatic diseases. Medication administration errors may lead to its reduced efficacy or increased drug toxicity. Many errors occur in the administration of injectable drugs. The present study aimed at structuring a routine for cyclophosphamide use, as well as creating a document with pharmacotherapeu-tic guidelines for the patient. The routine is schematized in three phases: pre-chemotherapy, administration of cyclophosphamide, and post-chemotherapy, taking into account the drugs to be administered before and after cyclophosphamide in order to prevent adverse effects, including nausea and hemorrhagic cystitis. Adverse reactions can alter laboratory tests; thus, this routine included clinical management for changes in white blood cells, platelets, neutrophils, and sodium, including cyclophosphamide dose adjustment in the case of kidney disease. Cyclophosphamide is responsible for other rare-but serious-side effects, for instance, hepatotoxicity, severe hyponatremia and heart failure. Other adverse reactions include hair loss, amenorrhea and menopause. In this routine, we also entered guidelines to post-chemotherapy patients. The compatibility of injectable drugs with the vehicle used has been described, as well as stability and infusion times. The routine aimed at the rational use of cyclophosphamide, with prevention of adverse events and relapse episodes, factors that may burden the health care system. (K.A. Teles), pmedeirossouza@uol.com.br (P. Medeiros-Souza). http://dx.doi.org/10.1016/j.rbre.2016.09.008 2255-5021/© 2016 Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/). r e v b r a s r e u m a t o l. 2 0 1 7;5 7(6):596-604 597 Rotina de administração de ciclofosfamida em doenças autoimunes reumáticas: uma revisão Palavras-chave: Ciclofosfamida Antieméticos Quimioterapia Cistite r e s u m o A ciclofosfamida é um agente alquilante vastamente usado para o tratamento de neoplasias malignas e pode ser usado no tratamento de diversas doenças reumatológicas. O erro de administração de medicamentos pode levar à diminuição da eficácia ou ao aumento da toxicidade medicamentosa. Diversos erros ocorrem na administração de medicamentos injetáveis. O trabalho objetivou a estruturação de uma rotina do uso de ciclofosfamida, bem como a criação de um documento de orientaç ões farmacoterapêuticas para o paciente. A rotina foi esquematizada em três fases, a pré-quimioterapia, a administração da ciclofos-famida e a pós-quimioterapia, que levaram em consideração os medicamentos que devem ser administrados antes e depois da ciclofosfamida para prevenção aos efeitos adversos, incluindo náusea e cistite hemorrágica. As reaç ões adversas podem alterar os exames...

Combined Immunosuppressive Therapy Induces Remission in Patients With Severe Type B Insulin Resistance: A Prospective Cohort Study

“…Hemorrhagic cystitis, due to acrolein deposition in the bladder, is a well-known complication of therapy with cyclophosphamide, which occurs in ∼10–15% of patients requiring it for therapy of autoimmune diseases or myeloablative conditioning (42,43). In our cohort, this complication developed only in one patient, suggesting that likely due to hyperglycemia-induced hyperfiltration, type B insulin resistant patients might be protected from this complication.…”

“…In our cohort, this complication developed only in one patient, suggesting that likely due to hyperglycemia-induced hyperfiltration, type B insulin resistant patients might be protected from this complication. Therapy with cyclophosphamide has been also associated with an increased risk of secondary malignancies, such as bladder cancer, squamous cell carcinoma of the vagina, and squamous cell skin cancer, with conflicting reports on its association with adenocarcinoma of the lungs (37,43). We observed one case of lung cancer in our cohort; however, its association with exposure to cyclophosphamide is uncertain, as the patient was a heavy smoker with an exposure history of 60 pack-years.…”

“…Cyclophosphamide has been also associated with a decrease in gonadal function and teratogenicity (43). Our cohort of patients, consisting predominantly of women of reproductive age, is especially vulnerable to these adverse effects.…”

Interstitial pneumonia induced by cyclophosphamide: A case report and review of the literature

“…Drug-induced interstitial pneumonia is caused by the drug, affecting the bronchioles, alveolar cavities, small pulmonary vessels and leading to pulmonary interstitial fibrosis, which has been reported in recent years. The drugs include anti-tumor, antibiotics, cardiovascular drugs, anti-rheumatic drugs, targeted drugs, biological agents and so on [1] Cyclophosphamide (CP) is an alkylating agent widely used for the treatment of malignancies, renal diseases, multiple rheumatic diseases [2]systemic lupus erythematosus [3,4]. and interstitial lung disease [5,6].…”

Effect of Cyclophosphamide and Its Combination with Metformin on the Survival Rate in Mice

“…Due to this cytotoxic property, it is used extensively in a variety of carcinomas, either as monotherapy or in combination with other drugs [5]. CYP is also used at lower doses for some autoimmune diseases, such as systemic lupus erythematosus, severe rheumatoid arthritis, multiple sclerosis, glomerulonephritis, and post organ transplantation for prevention of organ rejection [6].…”