Cyclophosphamide
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Given as a drip into a vein (or sometimes tablets) for severe, organ-threatening disease. You will be given plenty of fluid and sometimes a bladder-protecting medicine, because it can irritate the bladder. It can affect fertility, so ask about preserving eggs or sperm before starting.
- IV pulse (vasculitis, severe lupus): A drip every 2 to 4 weeks for a set number of doses.
- Oral: Daily tablets for a limited period.
Tests while you take it
You will have regular blood tests and urine checks. Drink plenty of fluid and empty your bladder often on treatment days. Report blood in the urine or signs of infection.
What to know
How it is used in lupus
Because it is powerful, cyclophosphamide is saved for severe lupus, including serious kidney lupus and lupus that threatens an organ. For kidney lupus a lower-dose course is often preferred to reduce side effects.
Common side effects
The more common effects are nausea, lowered blood counts, a higher chance of infections, hair thinning, and bladder irritation. It can also reduce fertility, which your team will discuss and try to protect against.
Tests and monitoring
You will have blood counts and a kidney test weekly for the first 4 weeks, then monthly. If you could become pregnant, you will have a pregnancy test before every dose. Your urine is checked with infusions and then every 6 months after the course, and if the total dose over time is high, your team checks the urine for bladder cancer.
Important cautions
Cyclophosphamide can harm a pregnancy and can affect fertility, so it is generally avoided in pregnancy and stopped before trying to conceive. Your team can offer fertility-protecting steps, such as a hormone medicine for women or storing sperm for men. Your reviewed pregnancy guidance is on the separate pregnancy page.
What to watch for
- Signs of infection with a fever while on treatment. Contact your team promptly.
- Blood in the urine, burning when passing urine, or trouble passing urine.
- Unusual bruising or bleeding, or feeling very tired or breathless.