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Conventional DMARD — Alkylating Agent

Cyclophosphamide (Rheumatology)

Brand names: Endoxana

In rheumatology, cyclophosphamide is an alkylating cytotoxic immunosuppressant reserved for severe or organ-threatening autoimmune disease such as systemic vasculitis and lupus nephritis.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Its active metabolites cross-link DNA, suppressing rapidly dividing lymphocytes and dampening pathogenic B- and T-cell responses driving severe autoimmunity.

Prescribing in practice

  • Causes haemorrhagic cystitis and a long-term bladder-cancer risk — ensure adequate hydration, and mesna is used with higher intravenous regimens to protect the bladder.
  • Profoundly immunosuppressive and myelosuppressive with infertility risk; offer infection prophylaxis, gonadal protection counselling and avoid live vaccines.
  • Prescribe under specialist supervision following the SPC and local protocols for the relevant rheumatological indication.

Monitoring

Monitor full blood count, renal and liver function, and urinalysis for haematuria throughout and after treatment.

Counselling the patient

  • Drink plenty of fluids and report blood in the urine promptly.
  • Seek urgent help for fever or signs of infection.
  • Discuss fertility preservation before starting.

Evidence & guidelines

Use in severe vasculitis and lupus nephritis is supported by landmark randomised trials and UK guidance.

Reference: CYCLOPS Trial (NEJM 2009); Euro-Lupus Nephritis Trial (Lancet 2002); EUVAS Guidelines; BSR/BHPR ANCA Vasculitis Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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