Alkylating agent / immunosuppressant

Cyclophosphamide

Brand names: Endoxana

Adult dose

Dose: Per protocol — Lupus nephritis: Euro-Lupus 500mg IV q2w ×6; Vasculitis: 15mg/kg IV q2–3w; Oncology: variable

Route: IV / Oral

Frequency: Per protocol

Clinical pearls

EULAR / BSR / KDIGO: induction therapy for severe ANCA-associated vasculitis, lupus nephritis
ESMO oncology indications
Mesna and IV hydration mandatory; consider fertility preservation pre-treatment

Contraindications

Severe myelosuppression
Active urinary tract infection
Severe hepatic / renal impairment
Pregnancy/breastfeeding
Hypersensitivity

Side effects

Myelosuppression
Haemorrhagic cystitis (mesna co-administration / hydration)
Bladder cancer
Infertility
Nausea/vomiting
Hyponatraemia (SIADH)
Cardiotoxicity (high-dose)
Secondary malignancy

Interactions

Live vaccines
Allopurinol (myelotoxicity)
Warfarin
CYP3A4 inducers/inhibitors
Other immunosuppressives

Monitoring

FBC
Urinalysis
Renal function
LFTs
Sodium
Cumulative dose
Bladder symptoms / cystoscopy if haematuria

Reference: BNF; EULAR; BSR vasculitis; KDIGO; ESMO; SmPC; https://bnf.nice.org.uk/drugs/cyclophosphamide/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways