Shared Care Policy and Prescribing Information for General Practitioners
for oral Cyclophosphamide (Adults only, non-renal patients)
Publish public
Applies to: NHS Grampian
Coordinator
Medicines Information
pharmacist
Signature:
I Mweemba
Authorised for issue by
Medicines Guidelines
and Policies Group
Signature:
C Hind
Version 2
Document no:
NHSG/SCPa/Cyc/MGPG419
Effective date:
August 2010
Review Date: August 2012
Supersedes: Version 1
Please keep this document in the patients notes
PATIENT NAME
UNIT NUMBER
CHI NUMBER

HOSPITAL
WARD
TELEPHONE NO
CONSULTANT (print name)
ADDRESS
DATE OF BIRTH

Insert patient sticker here

THERAPEUTIC INDICATION FOR THIS PATIENT:
DATE
SIGNATURE
(to be completed by consultant)
DOSAGE/PREPARATION/ROUTE/FREQUENCY OF ADMINISTRATION: (to be completed by consultant)
SAFE PRACTICE IS THAT THE CLINICIAN WHO ORDERS THE TEST MUST ACT ON THE RESULT
CARE WHICH IS THE RESPONSIBILITY OF THE
HOSPITAL CONSULTANT
1. Baseline:
Full blood count (FBC); urinalysis; urea, creatinine
and electrolytes (U&E); liver function tests (LFTs).
2. Copy of results to be sent to GP.
3. Exclude pregnancy before starting therapy
Advise effective contraception essential during
treatment and for at least 3 months after
discontinuation in women or men.
4. Initiation of therapy and recommendations for
dose increments.
5. Decision on final dose required for patient.
6. Monitoring clinical response to treatment.
7. Advise patients to immediately report any signs
or symptoms of bone marrow suppression, e.g.
sore throat, fever, infection, inexplicable bruising or
bleeding, mouth ulcers or rash, haemorrhagic
cystitis.
CARE WHICH IS THE RESPONSIBILITY OF THE
GENERAL PRACTITIONER (GP)
1. Prescribing of medication under guidance of consultant.
2. The GP should check before prescribing medication that the
monitoring is up to date and that results are within the normal
range.
3. The GP should be aware that the drug can cause bone
marrow suppression.
 Patients should be asked about the presence of sore throat,
rash, abnormal bruising or bleeding, oral ulceration, or taste
disturbances at each visit.
When the patient has an intercurrent illness a FBC, U&E and
LFTs should be done and any abnormal results including
those noted above should be reported to the consultant.
4. The General Practitioner has primary responsibility for
monitoring therapy according to the schedule below:
 FBC, LFTs (incl. ALT and Alk Phos), U&E and urinalysis
weekly for the first month then fortnightly for the second and
third month.
 FBC, LFTs, U&E and urinalysis 4 weekly thereafter.
 Patients should be asked about the presence of sore throat,
rash, haemorrhagic cystitis, abnormal bruising or oral
ulceration at each visit.
When writing laboratory request forms always include
details of the patient’s medication
NOTE: in addition to absolute values for haematological indices a
rapid fall or a consistent downward trend in any value should
prompt caution and extra vigilance.
If something unexpected occurs contact consultant.
Notify the consultant if the drug is stopped.
UNCONTROLLED WHEN PRINTED Review Date August 2012 (sooner if recommendations change)
SCP and Prescribing Information for GPs for CYCLOPHOSPHAMIDE - Version 2, August 2010
NHSG/SCPa/Cyc/MGPG419
-1-
Shared Care Policy and Prescribing Information for General Practitioners
for oral Cyclophosphamide (Adults only, non-renal patients)
Abnormal Monitoring Results
9

WBC <4.0 x 10 /L

Neutrophils <2.0 x 109/L
Action To Be Taken
Withhold until discussed with consultant
9
Withhold until discussed with consultant

Platelets <150 x 10 /L
Withhold until discussed with consultant

>2-fold rise in ALT or Alk Phos
(from upper limit of reference range)
Withhold until discussed with consultant

MCV >105fl
Investigate and if B12 or folate low start appropriate
supplementation

Rash, oral ulceration, unexplained fever
Withhold until discussed with consultant

Abnormal bruising or sore throat
Withhold until FBC result available

Dipstick heamaturia
Advise increased fluid intake and discuss with consultant.
Monitor closely.

Macroscopic haematuria or
haematuria with dysuria
Withhold until discussed with consultant
For specific product information please consult the current summary of product characteristics
(http://emc.medicines.org.uk/) and the BNF (http://www.bnf.org/bnf/)
Other information
 Live vaccines should be avoided in patients taking cyclophosphamide.
 Single pneumococcal vaccination and annual influenza vaccine should be given.
 A high fluid intake should be encouraged to reduce the risk of haemorrhagic cystitis.
 Cyclophosphamide tablets should be swallowed whole, preferably on an empty stomach, if gastric
irritation is severe, they may be taken with meals.
 Oral tablets are only available in strengths of 50mg. These are sugar coated and cannot be divided.
 There are a number of drug interactions that must be considered. When a new drug is prescribed
please refer to Summary of Product Characteristics, BNF or contact Medicines Information.
Some important interactions to consider include the following:
 Interactions have been reported with allopurinol (increased bone marrow depression),
sulphonylureas (enhanced hypoglycaemia) and suxamethonium (prolonged apnoea).
Pregnancy
Discuss with consultant. Pregnancy should be avoided during and for three months after stopping therapy.
Advise to contact their physician immediately should pregnancy occur.
Breast-feeding
Discuss with Aberdeen Maternity Hospital. Discontinue breast-feeding during and for 36 hours after stopping
treatment.
Responsibilities of GPs undertaking monitoring
A GP agreeing to monitor cyclophosphamide should:
 Ensure that the relevant monitoring requirements are undertaken at the correct frequency.
 Ensure that the test results are checked for any abnormality as soon as the results are available.
 Ensure abnormal results are acted upon.
 Only continue to prescribe cyclophosphamide if it is being satisfactorily monitored.
 Contact the consultant in the event of a drug reaction or monitoring abnormality or anything you are
unhappy about.
 Be alert for any of the known adverse reactions.
** The patient should be encouraged to ensure blood tests are taken at the correct intervals. **
UNCONTROLLED WHEN PRINTED Review Date August 2012 (sooner if recommendations change)
SCP and Prescribing Information for GPs for CYCLOPHOSPHAMIDE - Version 2, August 2010
NHSG/SCPa/Cyc/MGPG419
-2-