藥劑部參考美國 Johns Hopkins 大學研究團隊所建立的 NxP (Nephrotoxic Potential) 專家共識分級清單，本品具「顯著以上腎毒性風險」，被認定具中度至高度腎損傷潛勢，特別是同時合併其他腎毒性藥物、脫水、高齡或既有腎功能異常的患者族群，應更加注意。

【缺藥訊息】 公告日期：2023/10/24。 缺藥品項：化療 Endoxan 針 200mg/Vial。 缺藥原因：因廠商停止供應。 替代藥品：國內有同成份不同規格替代品。 配套措施：採購替代品，庫存量用罄關檔停用。 #高警訊藥品

Acute leukemia, lymphomas, Hodgkin's disease, endometrial carcinoma, breast cancer, sarcomas.

Antineoplastic Agent, Alkylating Agent
Cyclophosphamide is an alkylating agent that prevents cell division by cross-linking DNA strands and decreasing DNA synthesis. It is a cell cycle phase nonspecific agent. Cyclophosphamide also possesses potent immunosuppressive activity. Cyclophosphamide is a prodrug that must be metabolized to active metabolites in the liver.

Distribution:
1. Vd: 30 to 50 L (approximates total body water); crosses into CSF (not in high enough concentrations to treat meningeal leukemia)
2. Protein binding: ~20%; some metabolites are bound at >60%
Metabolism:
Hepatic to active metabolites acrolein, 4-aldophosphamide, 4-hydroperoxycyclophosphamide, and nor-nitrogen mustard
Half-life elimination:
IV: 3 to 12 hours; Children: 4 hours; Adults: 6 to 8 hours
Excretion:
Urine (10 to 20% as unchanged drug); feces (4%)

History of severe hypersensitivity to cyclophosphamide

1. Cyclophosphamide, if indicated, may be administered to pregnant women with breast cancer as part of some combination chemotherapy regimens
2. Chemotherapy should not be administered during the first trimester, after 35 weeks' gestation, or within 3 weeks of planned delivery

Cyclophosphamide is not recommended for use in breastfeeding mothers with autoimmune and systemic inflammatory diseases.

Leukopenia, thrombocytopenia, alopecia, cystitis, nausea, vomiting, pulmonary fibrosis, cardiotoxicity, skin rash

Maintenance treatment:
IV 3-6mg/kg/day (=120-240mg/m2 BSA)
Intermittent treatment:
10-15mg/kg (=400-600mg/m2 BSA) every 2-5 days
High-dose ontermittent treatment:
20-40mg/kg (=800-1600mg/m2 BSA; higher dose may be usde in bone marrow transplantation patients every 21-28 days

1. CrCl ≥30 mL/minute: No dosage adjustment necessary.
2. CrCl 10 to 29 mL/minute: Administer 75% or 100% of normal dose.
3. CrCl <10 mL/minute: Administer 50%, 75%, or 100% of normal dose.
4. Hemodialysis, intermittent: Moderately dialyzable; Administer 50% or 75% of the normal dose. On dialysis days, administer after hemodialysis, allowing at least 12 hours before the next hemodialysis session.
5. Peritoneal dialysis: Administer 75% of the normal dose. If possible, allow at least 12 hours before next peritoneal dialysis exchange.
6. CRRT: Administer 100% of the normal dose.

There are no dosage adjustments provided in the manufacturer's labeling.