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Guidelines for the safe use of daily cyclophosphamide

Guidelines for the safe use of daily cyclophosphamide
Limit duration of CYC use (ideally 6 to 12 months or less, for remission induction)
Administer medication in morning
Instruct the patient to drink eight 8-oz glasses of water daily
Adjust dose to maintain the total white blood cell count >3500 mm3
Decrease the dose in the setting of renal dysfunction
Check complete blood counts (with differential) and serum creatinine levels every two weeks (more frequently for those with borderline counts)
Monthly urinalyses
Use prophylaxis for Pneumocystis jiroveci (carinii) pneumonia infection
Long-term surveillance for CYC-induced bladder injury
CYC: cyclophosphamide.
Reproduced with permission from: Rheumatic Disease Clinics of North America 2001. 27(4):863. Copyright © 2001 Elsevier Science.
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