cyclophosphamide.net

Lung Disease associated with Scleroderma Can Be Treated with Intravenous Cyclophosphamide Pulse Therapy

barry — Sun, 07 Mar 2010 18:44:06 +0000

In the past years renal crisis was the major cause of morbidity and lethal outcome in patients with scleroderma (SSc). Today, after the introduction into to medical practice of angiotensin-converting enzyme inhibitors used in the treatment of renovascular hypertension, pulmonary fibrosis and pulmonary hypertension have become the most common causes of death in SSc. As a result, the early diagnosis and treatment of pulmonary fibrosis is essential to decrease death rates and morbidity in SSc patients. The purpose of this study was to analyze the efficacy of intravenous cyclophoshamide pulse therapy in patients with SSc and the proof of active alveolitis assessed on a high resolution computed tomographic (HRCT) scan, and to compare the effectiveness of cyclophosphamide pulse therapy with oral therapy. Sixteen SSc patients were divided alternately into the two test groups. Eight patients have undergone monthly cyclophoshamide pulse therapy (750 mg/m2) for 12 months; the patients from the second group were given with oral cyclophosphamide (2-2.5 mg/kg/day) for the same period of time. All the patients involed in the study were given concurrently prednisone (10 mg/day). HRCT scans an d pulmonary function tests were done before the treatment and at 6 and 12 months. In the oral cyclophosphamide patient group, three patients with a grade I pattern experienced regression of disease extent. In the five remaining patients (one with grade II and four with grade III) the pattern and extent of disease stayed stable in the course of the research. The diffusing capacity for carbon monoxide increased dramatically between baseline and 12 months (p = 0.043). No statistical disparities were found in forced expiratory volume in 1 s, forced vital capacity and overall lung capacity during the study period. In the cyclophosphamide pulse therapy group, seven patients with a grade I pattern experienced disease regression at 6 months (p = 0.018) and 12 months (p = 0.012). One patient with grade III was stable during the research. In both groups the regression of the extent of disease evaluated on HRCT was due to the lessening in the ground glass appearance. The degree of the reticular appearance stayed stable throughout the research. Our findings imply that cyclophosphamide pulse therapy is effective in suppressing active alveolitis (ground glass appearance). Although this research is not enough to compare pulse therapy with oral therapy because of the pattern difference observed on HRCT between the two patient groups, oral therapy may be effective in suppressing active alveolitis too. Neither regimen improved pulmonary involvement when the reticular appearance predominated over the ground glass appearance on HRCT. The conclusion runs as follows: either pulse or oral cyclophosphamide therapy is beneficial for SSc patients and diminished the chance or lethal outcome.

What Should I Tell My Doctor?

barry — Mon, 08 Feb 2010 18:26:55 +0000

Before taking cyclophosphamide inform you doctor about any of the following conditions:

• planning to get pregnant, pregnant or breast-feeding
• taking any medicines, food supplements or using a special diet
• if you have allergies
• if you have had adrenalectomy (removal of adrenal gland)
• if you are undergoing or have undergone chemotherapy or radiation therapy
• if you have liver, kidney or bone marrow problems, suppressed immune system, infections, chickenpox, bone marrow suppression or other bone marrow problems, low levels of white blood cells
Cyclophosphamide should not be taken if you have any of the conditions listed below. If these conditions happen while you are taking cyclophosphamide, inform your health care provider immediately.
• you have severely suppressed bone marrow function
• you are in the first 3 months of pregnancy
• you are breast-feeding
• you are taking a tumor necrosis factor (TNF)-blocking medicine (eg, etanercept)
• you are allergic to cyclophosphamide or any of its components

Cyclophosphamide Interactions

barry — Mon, 07 Dec 2009 15:35:12 +0000

Cyclophosphamide can interact with other medications, as any other drug. Always inform your health care provider about all the drugs you are taking, as well as food supplements, diet or lifestyle peculiarities. It is recommended to compile the full list of medications in advance.
The list of medications interacting with cyclophosphamide may be incomplete, please consult with your doctor on cyclophosphamide interactions.
Certain anticonvulsants combined with cyclophosphamide may result in increased levels of cyclophosphamide in the blood and raise the risk of cyclophosphamide side effects . It you have to take these medicines together, cyclophosphamide dosage may have to be decreased. These anticonvulsants include:
o Phenobarbital (Luminal®)
o Phenytoin (Phenytek®, Dilantin®)
o Carbamazepine (Tegretol XR®, Epitol®, Equetro™, Tegretol®)
o Fosphenytoin (Cerebyx®)
o Pentobarbital (Nembutal®)
o Primidone (Mysoline®)
o Oxcarbazepine (Trileptal®)
Anthracycline chemotherapy medications taken together with cyclophosphamide may increase the risk of heart problems. If you have to take these medications together your heart should be carefully monitored. Anthracycline drugs include:
o Mitoxantrone (Novantrone®)
o Daunorubicin (Cerubidine®, DaunoXome®)
o Valrubicin (Valstar®)
o Doxorubicin (Adriamycin®, Doxil®)
o Epirubicin (Ellence®)
o Idarubicin (Idamycin®)
Live Vaccinations should be avoided because cyclophosphamide can suppress the activity of the immune system:
o Polio vaccine
o Chickenpox vaccine (varicella vaccine)
o Smallpox vaccine
o FluMist® (the nasal vaccine for influenza; the injected vaccine is not live)
o BCG vaccine (used in some countries for tuberculosis)
o Rotavirus vaccine
o Yellow fever vaccine
o MMR vaccine (measles, mumps, rubella vaccine)
Rifamycin Antibiotics (rifabutin (Mycobutin®), rifampin (Rifadin®), and rifapentine (Priftin®)) taken together with cyclophosphamide can raise the possibility of side effects by increasing the levels of cyclophosphamide in the blood. As a rule, taking rifamycin antibiotics requires to lower cyclophosphamide dosage.

Allopurinol (Zyloprim) intensifies the ability of cyclophosphamide to decrease production of blood cells from the bone marrow.
Coumarin (Coumadin): cyclophosphamide intensifies the effect of blood thinners
Quinolone antibiotics (Cipro): cyclophosphamide weakens the effect of quinolone antibiotics.
Doxorubicin (Adriamycin): cyclophosphamide increases the possibility of heart failure caused by Doxorubicin.