What does it do?

Cyclophosphamide is an immunosuppressant medicine used to treat inflammatory conditions such as rheumatoid arthritis and systemic lupus erythematosus (lupus/SLE). It is sometimes used for other conditions.

Before you start

• Tell your doctor if you have kidney, liver, bladder, blood or heart problems, or diabetes.
• Tell your doctor if you are pregnant or breastfeeding. If you or your partner are planning to become pregnant, or find you are pregnant, discuss this with your doctor. Both men and women should use reliable contraception while taking cyclophosphamide, and for 3 months after stopping.
• Cyclophosphamide can affect fertility in both men and women – discuss with your doctor.
• Cyclophosphamide weakens your immune system, making it harder for your body to fight infections. You may need tests before you start to make sure you don't have any infections like tuberculosis (TB), HIV, or hepatitis B and C.
• Ask your doctor what vaccines you might need before you start and while you are taking cyclophosphamide. You should not have a live vaccine while taking cyclophosphamide.

How should you take it?

Take cyclophosphamide regularly as directed, usually in the morning. Take with food and a glass of water. Swallow the tablets whole – do not break, crush or chew.

What if you forget a dose?

Take the missed dose as soon as possible. If it is close to the time for your next dose, skip the missed dose and carry on as normal. Do not take two doses at the same time.

Can you take other medicines?

Tell your pharmacist or doctor about all medicines or treatments that you may be taking, including vitamins, herbal products (e.g. St John's wort, echinacea) or recreational drugs.

What side effects might you notice?

Side Effects	Recommended action
Symptoms of allergy including: skin rash, itching, swelling, trouble breathing Reduced number of blood cells that fight infections or help your blood to clot - symptoms include: fever, chills, sore throat or generally feeling unwell, or easy or unusual bruising or bleeding Symptoms of liver problems including: yellow skin or eyes, itching, dark urine, pale bowel motions, abdominal pain Swollen feet or legs, fast or irregular heartbeat Short of breath, persistent dry cough	Tell your doctor immediately
Bloody or cloudy pee, pain when peeing	Tell your doctor
Hair loss or thinning, darkening of skin or fingernails Changes in periods Nausea, vomiting, loss of appetite, diarrhoea	Tell your doctor if troublesome

If you notice any other effects, discuss them with your doctor or pharmacist.

Other information:

• Cyclophosphamide can sometimes cause bladder damage. Drinking plenty of fluids may help prevent this – discuss with your doctor.
• You will need regular blood and urine tests while taking cyclophosphamide to monitor its effects on your kidneys, bladder and blood.
• Protect yourself from too much sunlight while taking immunosuppressant medicines (they may increase your risk of skin cancer). Always cover up and apply a thick layer of broad spectrum sunscreen (at least SPF30) when outside. Do not use sunbeds.
• Women using cyclophosphamide for a long time may need cervical screening more often. Discuss with your doctor.
• It is important to tell anyone who gives you medical or dental treatment that you are taking cyclophosphamide.
• You may not notice the effects of cyclophosphamide straight away – it can take several weeks before you start to feel better.