Cyclophosphamide for rheumatoid arthritis

Examples

Generic Name	Brand Name
cyclophosphamide	Cytoxan, Neosar

How It Works

Cyclophosphamide is an immunosuppressive medication, which means that it decreases the effects of your body's immune system. By interrupting the immune process, cyclophosphamide reduces inflammation and slows joint damage caused by rheumatoid arthritis. Cyclophosphamide is a disease-modifying antirheumatic drug (DMARD), which means it controls the progression of the disease. DMARDs are also called slow-acting antirheumatic drugs (SAARDs).

Why It Is Used

Cyclophosphamide is used for severe rheumatoid arthritis that has not responded to other treatments.

Cyclophosphamide is often used as chemotherapy in treatments for certain cancers, including non-Hodgkin's lymphoma and breast cancer. It is also used to suppress the immune system before a bone marrow transplant or after an organ transplant.

How Well It Works

Cyclophosphamide has been found to be effective in reducing disease activity and joint inflammation in people with rheumatoid arthritis. Studies have shown that treatment with cyclophosphamide for 6 months significantly reduces disease activity and joint inflammation. However, because of its serious side effects, cyclophosphamide is most often reserved for use in people with severe rheumatoid arthritis that has not responded to other treatments.¹

Side Effects

Side effects of cyclophosphamide are common and can include:

• Nausea and vomiting.
• Allergic reactions.
• Hair loss (alopecia).
• Cessation of menstruation (amenorrhea) or early menopause.
• Decreased sperm count (azoospermia).
• Darkening of skin (hyperpigmentation).

Severe reactions can include:

• Decreased bone marrow function and serious blood problems.
• Bladder problems such as blood in the urine.

Because cyclophosphamide decreases the activity of your body's natural immune system, fever and chills are considered serious side effects that should be reported to your health professional immediately.

Cyclophosphamide increases the risk of infections such as herpes zoster (shingles). Prolonged use of cyclophosphamide is associated with an increased risk of some cancers, including bladder cancer.¹

If you take cyclophosphamide, you may have a slightly greater chance of getting cancer in your lifetime. This risk is small. But your doctor may check for cancer more often than if you did not take cyclophosphamide.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Cyclophosphamide should not be used by women who are pregnant or trying to become pregnant. If you are a woman of childbearing age and are going to take cyclophosphamide, use some form of reliable birth control.

If you are taking cyclophosphamide, it is very important to drink plenty of fluids (around 3 quarts) each day to avoid bladder irritations.

Your doctor will schedule you for regular blood counts during treatment with cyclophosphamide.

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Author:	Robin Parks, MS	Last Updated: August 23, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology
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